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Home My WebLink About20211836.tiffCheryl Hoffman From: Sent: To: Cc: Subject: Attachments: Good morning, COMMUNICATION ITEM: Lesley Cobb Thursday, June 8, 2023 9:01 AM CTB HS -Contract Management COMMUNICAITON/FAST TRACK ITEM: Single Entry Point (SEP) Option Letter #7 - CMS #7070 FY23-24 Weld Option Letter 7.pdf Attached please find Option Letter #7 to the 2021 Area Agency on Aging Single Entry Point (SEP) contract #21-160398 (Tyler ID#2020-1636). This option letter is extending the current contract until June 2024 as well as modifying the rates table. This Option Letter will be a Fast Track Item in CMS for tracking purposes only. This will be CMS #7070. 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 W(970) 400-6512 A (970) 353-5212 cobbxxlk@weld.gov Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. Co IMMv/1'. cai-:o nS °6/21123 CC •. HSD, d1CTCcP/cD) 06 / ict /23 2021-1T36 HRoo93 DocuSign Envelope la 309442A6-1B9B-45A2-8F2C-0765445B5646 OPTION LETTER #7 State Agency Department of Health Care Policy and Financing Option Letter Number 7 Contractor Weld County Department of Human Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL7 Contract Performance Beginning Date July 1, 2020 Current Contract Expiration Date June 30, 2024 1. OPTIONS: A. Option to extend for an Extension Term B. Option to modify Contract rates 42. REQUIRED PROVISIONS: A. In accordance with Section(s) 2.C. of the Original Contract referenced above, the State hereby exercises its option for an additional term, beginning July 1, 2023 and ending on the current contract expiration date shown above, at the rates stated in the Original Contract, as amended. B. In accordance with Section(s) 8.1.2 of Exhibit B-2, Statement of Work, of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in Section 8.1.1. The Contract rates attached to this Option Letter replace the rates for the deliverables identified in the table below, in the Original Contract as of the Option Effective Date of this Option Letter. No other rates in this contract will be changed. 43. OPTION EFFECTIVE DATE: A. The Effective Date of this Option Letter is upon approval of the State Controller or 07/01/2023, whichever is later. STATE OF COLORADO Jared S. Polis, Governor Department of Health Care Policy and Financing Kim Bimestefer, Executive Director DoeuSigned by: By: GRA tSmt-stei'tx A.,oa�,e,Fa�aa Date: 5/3/2023 I 15:03 PDT In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: DocuSigned by: St/821 C,38FALALA... Option Effective Date: 5/3/2023 I 15:14 PDT DocuSign Envelope ID: 309442A6-1696-45A2-8F2C-076544565646 ADMINISTRATIVE FUNCTION RATE TABLE DESCRIPTION RATE FREQUENCY Operations Guide $ 7,750.55 One Time Payment per Initial Operations Guide Update and Summary $ 1,394.16 Each Annual Update Complaint Trend Analysis $ 3,781.41 Per Quarterly Deliverable Continuous Quality Improvement Plan $ 496.78 Per Plan Critical Incident Reporting $ 1.58 Per Month Per Enrollment Critical Incident Follow -Up Completion Performance Standard $ 2,405.78 Per Quarter Case Management Training $ 636.03 Per Bi-Annual Deliverable Committee Updates $ 1,050.72 Per Bi-Annual Deliverable Appeals — Creation of Packet $ 521.18 Per Appeal Packet Appeals — Attendance at Hearing $ 481.34 Per Appeal Hearing Attended Initial Level of Care Screening and Assessment $ 278.06 Payment per Assessment Continued Stay Review — Level of Care Screening and Assessment $ 193.28 Payment per Assessment Monitoring $ 102.69 Payment per Monitoring Visit (Up to 2 Visits per Year) On -Going Case Management Tier One (1-700) $ 94.16 Monthly, Payment per Member per Activity On -Going Case Management Tier Two (701-2750) $ 89.59 Monthly, Payment per Member per Activity On -Going Case Management '1'rer 'three (2 i'1+) $ 77.09 Monthly, Payment per Member per Activity Rural Travel Add -On (Initial, CSR, In -Person Monitoring) for Rural and Frontier Counties $ 36.73 Payment per Activity Initial Level of Care Screen $ 206.15 Per Screen Annual Reassessment — Level of Care Screen $ 191.79 Per Screen Initial Needs Assessment — Required Questions Only $ 260.28 Per Assessment Annual Reassessment Needs Assessment — Required Questions Only $ 244.31 Per Assessment Initial Needs Assessment — Voluntary Questions Included $ 325.36 Per Assessment Annual Reassessment Needs Assessment — Voluntary Questions Included $ 310.93 Per Assessment Completed Training on Colorado Single Assessment and Person -Centered Support Plan Instniments Training on the Care and Case Management Information Technology System (CCM), Assessment, and Support Plan Instruments Upon Training Completion Calculated Allocation Completed Case Management Training on the Care and Case Management (CCM) Information Technology system Upon Training Completion Calculated Allocation Chloe White From: Sent: To: Cc: Subject: Attachments: Good morning, COMMUNICATION ITEM: Lesley Cobb Tuesday, June 28, 2022 8:22 AM CTB HS -Contract Management; Kelly Morrison COMMUNICAITON/FAST TRACK ITEM: Single Entry Point (SEP) Option Letter #6 - CMS# 6084 FY22-23 Weld Option Letter 6 Executed.pdf Attached please find Option Letter #6 to the 2021 Area Agency on Aging Single Entry Point (SEP) contract #21-160398 (Tyler ID#2020-1636). This option letter is extending the current contract until June 2023 as well as modifying the rates table. This Option Letter will be a Fast Track Item in CMS for tracking purposes only. This will be CMS #6084. 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 W(970) 400-6512 8 (970) 353-5212 ® cobbxxlk@weldgov.com Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. CoP m.On , co.+;on S 7/Il/22 2021-1336 I-IRoog3 DocuSign Envelope ID: C8882665-D605-47ED-8768-4D6B306389D4 OPTION LETTER #6 State Agency Department of Health Care Policy and Financing Option Letter Number 6 Contractor Weld County Department of Human Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL6 Contract Performance Beginning Date July 1, 2020 Current Contract Expiration Date June 30, 2023 1. OPTIONS: A. Option to extend for an Extension Term B. Option to modify Contract rates 2. REQUIRED PROVISIONS: A. In accordance with Section(s) 2.C. of the Original Contract referenced above, the State hereby exercises its option for an additional term, beginning July 1, 2022 and ending on the current contract expiration date shown above, at the rates stated in the Original Contract, as amended. B. In accordance with Section(s) 8.1.2 of Exhibit B-2, Statement of Work, of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in Section 8.1.1. The Contract rates attached to this Option Letter replace the rates for the deliverables identified in the table below, in the Original Contract as of the Option Effective Date of this Option Letter. No other rates in this contract will be changed. 3. OPTION EFFECTIVE DATE: A. The Effective Date of this Option Letter is upon approval of the State Controller or 07/01/2022, whichever is later. STATE OF COLORADO Jared S. Polis, Governor Department of Health Care Policy and Financing Kim Bimestefer, Executive Director ,-DocuSigned by: {We foeet.5 �0B6A84797EA8493... By: Date: 5/20/2022 In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD ^DocuSigned by: By: \-5E7821C38FAC42A... 5/23/2022 Option Effective Date: Page 1 of 2 DocuSign Envelope ID: C8882665-D605-47ED-87B8-4D6B30B389D4 ADMINISTRATIVE FUNCTIONS RATE TABLE Description Rate Frequency Operations Guide $7,683.58 Annually — Year 1 of the Contract Operations Guide Update $1,382.11 Annually - Years 2, 3, 4, and 5 of the Contract Committee Updates $1,041.64 Semi -Annually Complaint Trend Analysis $3,748.73 Quarterly Case Management Training $630.53 Semi -Annually Creation Of Packet - Appeals $516.68 Per Packet Attendance At Hearing - Appeals $477.18 Per Hearing Critical Incident Reporting $1.56 Monthly, Per Member Enrolled Critical Incident Follow -Up Performance Standard $2,384.99 Quarterly Initial Level Of Care Screening And Assessment $275.66 Per Screening and Assessment CSR Level Of Care Screening And Assessment $191.61 Per Screening and Assessment Pilot - Initial Level Of Care Screen $204.37 Per Screen Pilot - CSR Level Of Care Screen $190.13 Per Screen Pilot - Initial Basic Needs Assessment $258.03 Per Assessment Pilot - CSR Basic Needs Assessment $242.19 Per Assessment Pilot - Initial Comprehensive Needs Assessment $322.54 Per Assessment Pilot - CSR Comprehensive Needs Assessment $308.24 Per Assessment Rural Travel Add -On $36.41 Per Initial or CSR, Monitoring Ongoing Case Management - Tier 1 $93.35 Monthly, Per Activity per Member Enrolled Ongoing Case Management - Tier 2 $88.82 Monthly, Per Activity per Member Enrolled Ongoing Case Management - Tier 3 $76.42 Monthly, Per Activity per Member Enrolled Monitoring $101.80 Per Contact Soft Launch Training On The CCM, Assessment And Support Plan Instruments Calculated Allocation Upon Training Completion Training On The CCM, Assessment And Support Plan Instruments Calculated Allocation Upon Training Completion Continuous Quality Improvement Plan $492.49 Per Plan Page 2 of 2 Mariah Higgins From: Sent: To: Cc: Subject: Attachments: Follow Up Flag: Flag Status: Good morning, COMMUNICATION ITEM Lesley Cobb Tuesday, March 29, 2022 9:46 AM CTB HS -Contract Management COMMUNICATION ITEM: SEP Contract Option Letter #5 Option Letter 5 effective 4.1.22.pdf Follow up Flagged Attached please find Option Letter #5 that the State had issued related to the Single Entry Point (SEP) Contract #21- 160398 executed in 2020 (Tyler ID #2020-1636). For your reference, Option Letters 1-4 have been referenced under Tyler ID#21-1836. Please let me know if you have any questions. 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 W(970) 400-6512 A (970) 353-5212 ® cobbxxlk@weldgov.com Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited. CotKMun ; Go.-l-;onS Ll /i3 /2.2 1 202i- in6 DocuSign Envelope ID: FDBDFA25-BC66-440B-8B8C-01583A40A186 OPTION LETTER #5 State Agency Department of Health Care Policy and Financing Option Letter Number 5 Contractor Weld County Department of Human Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL5 Contract Performance Beginning Date July 1, 2020 Current Contract Expiration Date June 30, 2022 1. OPTIONS: A. Option to modify Contract rates 2. REQUIRED PROVISIONS: In accordance with Section(s) 8.1.2 of Exhibit B-2, Statement of Work, of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in Section 8.1.1. The Contract rates attached to this Option Letter replace the rates for the deliverables identified in the table below, in the Original Contract as of the Option Effective Date of this Option Letter. No other rates in this contract will be changed. 3. OPTION EFFECTIVE DATE: A. The Effective Date of this Option Letter is upon approval of the State Controller or 4/1/2022, whichever is later. By: STATE OF COLORADO Jared S. Polis, Governor Department of Health Care Policy and Financing Kim Bimestefer, Executive Director Date: U«usipn.e by: ,`w nnnaaanlcannaa 3/16/2022 In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: DocuSigned by: aaMan W0214W 3/17/2022 Option Effective Date: Page 1 of 3 DocuSign Envelope ID: FDBDFA25-BC66-440B-8B8C-01583A40A186 ADMINISTRATIVE FUNCTIONS RATE TABLE Description Rate Frequency Operations Guide $7,532.92 Annually — Year 1 of the Contract Operations Guide Update $1,355.01 Annually — Years 2, 3, 4, and 5 of the Contract Committee Updates $1,021.21 Semi -Annually Complaint Trend Analysis $3,675.22 Quarterly Case Management Training $618.16 Semi -Annually Creation Of Packet - Appeals $506.55 Per Packet Attendance At Hearing - Appeals $287.59 Per Hearing Critical Incident Reporting $1.53 Monthly, Per Member Enrolled Critical Incident Follow -Up Performance Standard $2,338.23 Quarterly Initial Level Of Care Screening And Assessment $270.25 Per Screening and Assessment CSR Level Of Care Screening And Assessment $187.85 Per Screening and Assessment Pilot - Initial Level Of Care Screen $200.36 Per Screen Pilot - CSR Level Of Care Screen $186.40 Per Screen Pilot - Initial Basic Needs Assessment $252.97 Per Assessment Pilot - CSR Basic Needs Assessment $237.44 Per Assessment Pilot - Initial Comprehensive Needs Assessment $316.21 Per Assessment Pilot - CSR Comprehensive Needs Assessment $302.19 Per Assessment Rural Travel Add -On $35.70 Per Initial or CSR, Monitoring Ongoing Case Management - Tier 1 $91.52 Monthly, Per Member Enrolled Ongoing Case Management - Tier 2 $87.08 Monthly, Per Member Enrolled Ongoing Case Management - Tier 3 $74.92 Monthly, Per Member Enrolled Monitoring $85.21 Per Contact Soft Launch Training On The CCM, Assessment And Support Plan Instruments Calculated Allocation Upon Training Completion Training On The CCM, Assessment And Support Plan Instruments Calculated Allocation Upon Training Completion Continuous Quality Improvement Plan $482.84 Per Plan Page 2 of 3 DocuSign Envelope ID: 56A534AE-AF38-4A03-BB78-F4DCE110C45F OPTION LETTER #1 State Agency Department of Health Care Policy and Financing Option Letter Number 1 Contractor Weld County Area Agency on Aging Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL1 Contract Performance Beginning Date The later of the Effective Date or July 1, 2020 Current Contract Expiration Date June 30, 2021 1. OPTIONS: A. Option to modify Contract rates 2. REQUIRED PROVISIONS: A. In accordance with Section(s) 7.1.2 of Exhibit B of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in 7.1.1. The Contract rates attached to this Option Letter replace the rates in the Original Contract as of the Option Effective Date of this Option Letter. 3. OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or 7/1/2020, whichever is later. STATE OF COLORADO Jared S. Polis, Governor Department of Health Care Policy and Financing Kim Bimestefer, Exe uttive Director DocuSigned by: By: 0B6A84797EA8493... 7/20/2020 Date: In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Option Effective Date: DocuSigned by: #xts 740.4.e4 RRF0F4Cet 0n(.45C 7/20/2020 Page 1 of 2 CoMMun Cvv+;4 S oS/©a la.I 2021 - 1n6 t-IRooQi 3 DocuSign Envelope ID: 56A534AE-AF38-4A03-BB78-F4DCE110C45F SEP ADMINISTRATIVE RATE TABLE DELIVERABLE DESCRIPTION Operations Guide Operations Guide Update and Summary Complaint Trend Analysis Critical Incident - MANE Critical Incident - Other Critical Incident Trend Analysis Training Deliverable Committee Updates Appeals — Creation of Packet Appeals — Attendance at Hearing Initial Functional Eligibility Continued Stay Review — Functional Eligibility In Person Monitoring On -Going Case Management PMPM Tier One (1-700) On -Going Case Management PMPM Tier Two (701-2750) On -Going Case Management PMPM Tier Three (2751+) Rural Travel Add -On (Initial, CSR, Monitoring) for Rural and Frontier Counties PAYMENT FREQUENCY One Time Payment per Initial Guide Each Annual Update Per Quarterly Deliverable Each Critical Incident Each Critical Incident Per Quarterly Deliverable Per Bi-Annual Deliverable Per Bi-Annual Deliverable Per Appeal Packet Per Appeal Hearing Attended Payment per Assessment Payment per Assessment Payment per In -Person Monitoring Visit (Up to 2 Visits per Year) Payment per Member per Month Payment per Member per Month Payment per Member per Month Payment per Activity Page 2 of 2 RATE $7,197.33 $1,294.64 $3,511.49 $102.18 $32.13 $1,292.71 $590.62 $975.72 $483.98 $274.78 $258.21 $179.48 $81.41 $82.64 $78.63 $67.65 $34.11 DocuSign Envelope ID: A33EE18D-003A-434F-B713-B047851410C8 OPTION LETTER #2 State Agency Department of Health Care Policy and Financing Option Letter Number 2 Contractor Weld County DepartmentofHuman Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-1603980L2 Contract Performance Beginning Date The Effective Date Current Contract Expiration Date June 30, 2021 1. OPTIONS: A. Option to modify Contract rates 2. REQUIRED PROVISIONS: In accordance with Section(s) 7.1.2 ofExhibit B ofthe Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in 7.1.1. In accordance with Section(s) 1.1 ofExhibit B ofthe Original Contract referenced above, specifically 1.1.1.2., the Contractor shall also adhere to all Department written communications including Operational Memo #OM 21-031, attached hereto for reference, in order to receive payment for Homebound Eligible Member Vaccine Outreach. The Contract rates attached to this Option Letter are added to rates in the Original Contract as ofthe Option Effective Date ofthis Option Letter. 3. OPTION EFFECTIVE DATE: A. The effective date ofthis Option Letter is upon approval ofthe State Controller. STATE OF COLORADO Jared S. Polis, Governor Department ofHealth Care Policy and Financing Kim Bimestefer, Executive Director Doeu5i9nM by: By: OB6A84797E48493.._ 3/19/2021 Date: In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD w Do8gn4e by: By: 0A7049A40221490.. Option Effective Date: 3/19/2021 Page 1 of 2 CoMMun',coa-F;onS 0 'lag f ) 2021-1836 SIR oo c‘3 DocuSign Envelope ID: A33EE18D-003A-434F-8713-B047851410C8 SEP ADMINISTRATIVE RATE TABLE DELIVERABLE DESCRIPTION Homebound Member Vaccine Outreach PAYMENT FREQUENCY RATE One Time Payment Per Member $46.77 Outreached Page 2 of 2 DocuSign Envelope ID: A33EE18D-003A-434F-B713-B04785141008 AO COLORADO Department of Health Care Policy & Financing OPERATIONAL MEMO TITLE: CASE MANAGEMENT AGENCY AND REGIONAL ACCOUNTABLE ENTITY COVID-19 VACCINATION OUTREACH FOR ELIGIBLE HOMEBOUND HEALTH FIRST COLORADO MEMBERS SUPERSEDES NUMBER: NA EFFECTIVE DATE: MARCH 17, 2021 DIVISION AND OFFICE: CASE MANAGEMENT QUALITY PERFORMANCE, OFFICE OF COMMUNITY LIVING, HEALTH PROGRAMS OFFICE PROGRAM AREA: CASE MANAGEMENT AGENCIES (CMA), SINGLE ENTRY POINT (SEP), COMMUNITY CENTERED BOARD (CCB), REGIONAL ACCOUNTABLE ENTITY (RAE). MANAGED CARE ORGANIZATION, MCO KEY WORDS: CASE MANAGEMENT, CHILDREN'S HOME AND COMMUNITY BASED SERVICES, HOME AND COMMUNITY BASED SERVICES, CHCBS CASE MANAGEMENT AGENCY, REGIONAL ACCOUNTABLE ENTITY, SINGLE ENTRY POINT, COMMUNITY CENTERED BOARD, COVID-19, CMA, RAE, SEP, CCB, MCO, HCBS, CHCBS, MANAGED CARE ORGANIZATION, HOMEBOUND, TARGETED CASE MANAGEMENT, TCM OPERATIONAL MEMO NUMBER: OM 21-031 ISSUE DATE: MARCH 17, 2021 APPROVED BY: BONNIE SILVA HCPF Memo Series can be accessed online: htivs://www.colorado.gov/hcpfimemo-series Purpose and Audience: The purpose of this Operational Memo is to inform Community Centered Boards (CCB), Single Entry Points (SEP), Children's Home and Community Based Services (CHCBS) Case Management Agencies, Managed Care Organizations (MCOs) and Regional Accountable Entities (RAEs) of vaccination outreach needed to provide members with DocuSign Envelope ID: A33EE18D-003A-434F-B713-B047851410C8 HCPF OM 21-031 Page 2 of 5 information and resources on how to obtain the COVID-19 vaccine and to identify members 16 and older for whom in -home vaccine administration will be required. Information: Colorado is a national leader in vaccine distribution and is dedicated to supporting all Coloradans in obtaining a COVID-19 vaccination. To facilitate and coordinate vaccination efforts among Health First Colorado members, the Department of Health Care Policy and Financing (the Department) has identified Health First Colorado's statewide care and case management infrastructure as a key component in helping members obtain a COVID-19 vaccination. The Colorado Department of Public Health & Environment (CDPHE) created a phased plan for when Coloradans will be eligible for the vaccine. It is based on people's risk of serious complications and death from the virus. The Department is requesting that CCBs, SEPs, MCOs, RAEs, and CHCBS case management agencies reach out and coordinate vaccination efforts for members who may be homebound, with an initial focus on members eligible for the vaccine in phases lb.1 and lb.2: specifically, those 65 years and older who may be homebound. After those groups are contacted, agencies are expected to continue performing outreach to homebound members in phase lb.3 followed by members in additional phases who are aged 16+. Please note that "homebound" means the member is not able to leave their home and therefore cannot obtain a vaccination outside of their home. It does not include members who would prefer to receive a vaccination in their home or members who need transportation to obtain a vaccination. Outreach Requirements for SEP, CCB, and CHCBS Case Management Agencies Each SEP, CCB, and CHCBS case management agency will be provided with a list by the Department of members who have been identified as someone who may be unable to leave their home to receive a COVID-19 vaccine. The Department has received vaccination administration data and removed members who have already received the vaccine from the outreach list. As members are receiving vaccinations daily, there may be members who have received a vaccination who are on the outreach list. Based on eligibility phasing, each agency will outreach to each individual on their list. The SEP, CCB, and CHCBS case management agencies will receive their outreach lists on Excel spreadsheets through each agency's secured SharePoint site in the case management folder. DocuSign Envelope ID: A33EE18D-003A-434F-B713-B047851410C8 HCPF IM YR-000 Page 3 of 5 When contacting the member and/or the member's legal representative, the case manager shall ask and document the responses to the following questions: 1. "Have you received a COVID-19 vaccine or are scheduled to receive one?" 2. "Would you like to receive a vaccination?" 3. "Do you need assistance to obtain a vaccination?" a. If the member needs assistance the case manager will assist with transportation coordination and scheduling vaccination appointment. Resources: Where can I get vaccinated; Non -Emergent Medical Transportation 4. "Are you homebound/unable to leave your home to obtain a vaccine?" a. If the member is homebound, please inform the member that they will be contacted for additional vaccine support. The member responses are to be documented using the Google form provided by the Department, including if the member has declined all support in obtaining the vaccine. Case managers must complete the Google form for all members the case manager has spoken with to obtain the information outlined above. The Department will utilize this information to provide additional vaccination support to members who are homebound. The link to the Google form will be provided with each agency's spreadsheet of members to be contacted. Failure to complete the Google form can result in loss of payment to the agency completing this outreach. Outreach timelines for members: Phase 1b.1 through lb.4 is to be completed by April 2*, 2021 *Given the urgency of this outreach for this vulnerable population, the Department expects the majority of this outreach to be completed by April 2, 2021, however CMAs and RAEs will have up to April 9, 2021, as needed to complete all outreach for these phases. Phase 2 and continued outreach is to be completed as soon as possible but no later than April 23, 2021 Coordination The RAEs and MCOs are responsible for both conducting targeted outreach and for ensuring oversight of all outreach efforts for their region. RAEs and MCOs will be required to conduct outreach to members on a list provided by the Department for members who are not served by a CCB, SEP, or CHCBS case management agency who may be homebound or need service coordination to access the vaccine. In addition, DocuSign Envelope ID: A33EE18D-003A-434F-8713-B047851410C8 HCPF OM 21-031 Page 4 of 5 RAEs and MCOs will monitor outreach efforts by all case management agencies to members who are potentially homebound to ensure outreach has occurred within the Department's prescribed timeline. RAEs can use this information to inform their overall RAE and MCO Vaccine Response Plan. SEPs, CCBs, and CHCBS case management agencies shall provide weekly status updates on this outreach to the RAE(s) and/or MCO(s) in their region. The RAE is responsible for ensuring all outreach is completed in their region and for using the insight garnered from the outreach to inform strategies to ensure adequate vaccine access within their region. Compensation The Department will provide the SEP, CCB and CHCBS agencies with a list of members on whom to perform outreach and issue a one-time payment of $46.77 per member for the outreach completed. This rate encompasses all contact the case manager will make with the member, including multiple contacts as needed. In order for payment to be issued, the case manager must complete the contact with the member/member legal representative and complete the required questions into the Google form provided by the Department. Regional Accountable Entities RAEs will receive compensation for outreach and support of potentially homebound members assigned to them through incentive programs and any additional funds made available in response to the public health emergency. Community Centered Boards and CHCBS Case Management Agencies The CCBs and CHCBS Case Management Agencies will be reimbursed $46.77 per member contacted using the data provided by the case manager through the Google form. The CCBs and CHCBS Case Management Agencies will receive payment by check or EFT dependent on the payment information on file with the Department. The Department will contact agencies directly if payment information on file needs to be updated. Reimbursement for this work will not be provided through the Colorado interChange Medicaid Management Information System (MMIS). Therefore, providers may not bill Case Management for this work. Single Entry Points DocuSign Envelope ID: A33EE18D-003A-434F-B713-B047851410C8 HCPF IM YR-000 Page 5 of 5 The SEPs will be reimbursed through the SEP Contract using the data provided by the case manager through the Google form. The Department will execute an Option Letter to amend the existing rates table and add the outreach rate of $46.77 per member outreached. Please note that the Department is prohibited by Fiscal Rule and cannot reimburse agencies for any vaccination outreach activities that occur prior to the Option Letter being executed. The Department will notify each agency via email once the Option Letter is executed and will upload them to each agencies SharePoint site. For more information about COVID-19 vaccines, where to get them, safety information and more, visit the Centers for Disease Control website and CDPHE website, or call 1- 877-COVAXCO. Attachment(s): None Department Contacts: Rhyann.Lubitz@state.co.us Matthew.Sundeen@state.co.us DocuSign Envelope ID: 30B7C8B9-EA78-4119-A712-5D475E4180ED OPTION LETTER #3 State Agency Department of Health Care Policy and Financing Option Letter Number 3 Contractor Weld County Department of Human Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL3 Contract Performance Beginning Date The later of the Effective Date or April 1, 2021 Current Contract Expiration Date June 30, 2021 1. OPTIONS: A. Option to modify Contract rates 2. REQUIRED PROVISIONS: In accordance with Section(s) 7.1.2 of Exhibit B of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in 7.1.1. The Contract rates attached to this Option Letter replace the rates for the deliverables identified in the table below, in the Original Contract as of the Option Effective Date of this Option Letter. No other rates in this contract will be changed. 3. OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller or 4/1/2021, whichever is later. STATE OF COLORADO Jared S. Polls, Governor Department of Health Care Policy and Financing Kim Bimestefer, Executive Director 0000siynee by: By: naa 3/25/2021 Date: In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert bLLos, CPA, MBA, JD By: 3/25/2021 Option Effective Date: Page 1 of 2 Co K IA a.02.1 - l X36 HRooat3 DocuSign Envelope ID: 30B7C8B9-EA78-4119-A712-5D475E4180ED SEP ADMINISTRATIVE RATE TABLE DELIVERABLE DESCRIPTION PAYMENT FREQUENCY RATE On -Going Case Management PMPM Payment per Member per Month $87.44 Tier One (1-700) On -Going Case Management PMPM Payment per Member per Month $83.20 Tier Two (701-2750) On -Going Case Management PMPM Payment per Member per Month $71.58 Tier Three (2751+) Page 2 of 2 DocuSign Envelope ID: B2F37A31-094B-4ED4-93E3-A2602A6C9C01 OPTION LETTER #4 State Agency Department of Health Care Policy and Financing Option Letter Number 4 Contractor Weld County Department of Human Services Original Contract Number 21-160398 Current Contract Maximum Amount No Maximum for any SFY Option Contract Number 21-160398OL4 Contract Performance Beginning Date The Effective Date Current Contract Expiration Date June 30, 2021 1. OPTIONS: A. Option to modify Contract rates 2. REQUIRED PROVISIONS: In accordance with Section(s) 7.1.2 of Exhibit B of the Original Contract referenced above, the State hereby exercises its option to modify the Contract rates specified in 7.1.1. In accordance with Section(s) 1.1 of Exhibit B of the Original Contract referenced above, specifically 1.1.1.2., the Contractor will receive a Case Management COVID-19 Workload Impact payment for the increased workload which required action throughout the COVID-19 pandemic. The Contract rates attached to this Option Letter are added to rates in the Original Contract as of the Option Effective Date of this Option Letter. 3. OPTION EFFECTIVE DATE: A. The effective date of this Option Letter is upon approval of the State Controller. By: STATE OF COLORADO Jared S. Polis, Governor Department of Health Care Policy and Financing Kim Bimestefer, Executive Director Date: ooeushnee by: 0B6A84707CA8O6... 6/14/2021 In accordance with C.R.S. §24-30-202, this Option is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: ooeusioned by: 6A7649A49221490... Option Effective Date: 6/14/2021 C2rnrnQri cc+ o rs 07/l2/2.I Page 1 of 2 2021-1836 I-IR0© 13 DocuSign Envelope ID: B2F37A31-094B-4ED4-93E3-A2602A6C9C01 SEP ADMINISTRATIVE RATE TABLE DELIVERABLE DESCRIPTION Case Mangement COVID-19 Workload Impact — Adult Waivers Case Management COVID-19 Workload Impact — Children with Life Limiting Illness Waiver PAYMENT FREQUENCY One Time Payment Per Member One Time Payment Per Member Page 2 of 2 RATE $78.00 $64.47 Hello