HomeMy WebLinkAbout20212198.tiffRESOLUTION
RE: APPROVE AMENDMENT #1 TO INTERGOVERNMENTAL AGREEMENT FOR
2021-2022 COUNTY INCENTIVES PROGRAM 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 Amendment #1 to the Intergovernmental
Agreement for the 2021-2022 County Incentives Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Department of Human Services, and the Colorado Department of Health Care Policy and
Financing, commencing upon full execution of signatures, and ending June 30, 2022, with further
terms and conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, a
copy of which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that Amendment #1 to the Intergovernmental Agreement for the 2021-2022
County Incentives Program between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Department of Human Services,
and the Colorado Department of Health Care Policy and Financing, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign and submit said amendment electronically.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 21st day of July, A.D., 2021.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:`'j,O ,,l(L;
Weld County Clerk to the Board
Deputy Clerk to t
ount Attorney
Date of signature: o7/2g/?-(
cc: HSCo
0'/02/21
2021-2198
HR0093
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PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: July 13, 2021
TO: Board of County Commissioners — Pass -Around
FR: Jamie Ulrich, Director, Human Services
RE: State of Colorado Amendment for Fiscal Year
2021-22 County Incentives
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 State of Colorado Amendment for Fiscal
Year 2021-22 County Incentives. Last year, the Department entered into an Intergovernmental
Agreement with the State of Colorado for the County Incentives Program with the Colorado
Department of Health Care Policy and Financing (HCPF), known as Tyler ID 2020-2389. The
State has issued an amendment for Fiscal Year 2021-22 extending the term date through June 30,
2022. Again, Weld County may earn incentives totaling up to $275,695.31, if benchmarks are
met.
This Amendment has been reviewed and approved by Legal (Gabe Kalousek).
I do not recommend a Work Session. I recommend approval of this Amendment and authorize
the Chair to sign through DocuSign.
Approve
Recommendation
Perry L. Buck
Mike Freeman
Scott K. James, Pro -Tern
Steve Moreno, Chair
Lori Saine
Schedule
Work Session
Other/Comments:
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Pass -Around Memorandum; July 13, 2021 — ID 5032 Page 1
2021-2198
7Au
DocuSign Envelope ID: AAE0796F-64B6-4556-86FD-A171 D4D94073
CONTRACT AMENDMENT #1
SIGNATURE AND COVER PAGE
State Agency
Department of Health Care Policy and Financing
Original Contract Number
2021 CMIP063
Contractor
Weld County
Amendment Contract Number
2021CMIP063A1
Current Contract Maximum Amount:
Initial Term
State Fiscal Year 2021 $275,695.31
Extension Terms
State Fiscal Year 2022 $275,695.31
Total for All State Fiscal Years $551,390.62
Contract Performance Beginning Date
July 1, 2021
Current Contract Expiration Date
June 30, 2022
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
Steve Moreno, Commissioner
Weld County
r—DocuSigned by:
S{Luul, Ak4r o
\—E74B8OB083D44A1...
Date:
7/21/2021
By:
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
Kim Bimestefer, Executive Director
(1DoeuSIbfl d by:
4.1 ✓1µ1g
g°"e4'GF&NSAIP
7/25/2021
Date:
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.
By:
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
CDocuSlvn.C by:
G T44...4.F
BBE0F4C030DC45C.,
7/26/2021
Amendment Effective Date:
Amendment Contract Number: 2021CMIP063AI Page 1 of 3
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1. PARTIES
This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover Page
for this Amendment (the "Contract") is entered into by and between the Contractor and the State.
2. TERMINOLOGY
Except as specifically modified by this Amendment, all terms used in this Amendment that are
defined in the Contract shall be construed and interpreted in accordance with the Contract.
3. AMENDMENT EFFECTIVE DATE AND TERM
A. Amendment Effective Date
This Amendment shall not be valid or enforceable until the Amendment Effective Date
shown on the Signature and Cover Page for this Amendment. The State shall not be bound
by any provision of this Amendment before that Amendment Effective Date, and shall have
no obligation to pay Contractor for any Work performed or expense incurred under this
Amendment either before or after of the Amendment term shown in §3.B of this Amendment.
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 July 1, 2021 and shall terminate on the termination of
the Contract June 30, 2022.
4. PURPOSE
The purpose of this Amendment is to create performance -based benchmarks and deliverables for
county departments of human/social services to achieve certain performance standards related to
County Administration, Medical Assistance Eligibility and cooperation with other Medical
Assistance -related entities. This Amendment includes new Performance Incentives.
5. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is
hereby deleted and replaced with the Current Contract Expiration Date shown on the
Signature and Cover Page for this Amendment.
B. The Contract Maximum Amount table on the Contract's Signature and Cover Page is hereby
deleted and replaced with the Current Contract Maximum Amount table shown on the
Signature and Cover Page for this Amendment.
C. This amendment is modifying the previous scope of work, deleting the previous statement of
work, and replacing it with Exhibit Al as shown below.
D. This amendment is adding Exhibit D: Review Sample Size Exemption Process Flow.
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
Amendment Contract Number: 2021CMIP063A1 Page 2 of 3
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Contract, in the event of any conflict, inconsistency, variance, or contradiction between the
provisions of this Amendment and any of the provisions of the Contract or any prior modification
to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and
control. The provisions of this Amendment shall only supersede, govern, and control over the
Special Provisions contained in the Contract to the extent that this Amendment specifically
modifies those Special Provisions.
Amendment Contract Number: 2021CMIP063A1 Page 3 of 3
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EXHIBIT Al, STATEMENT OF WORK
1. TERMINOLOGY
1.1.1.
The following list is provided to assist the reader in understanding acronyms, abbreviations and
terminology used throughout this document.
Applicant — An individual for whom the Contractor is performing a Determination.
1.1.2. Benchmark - degrees of performance between undesired current performance and target
performance (example: current timeliness 90%, benchmark for next month= 93% until we
reach 95%)
1.1.3. Child Health Plan Plus (CHP+) — public low-cost health insurance for certain children and
pregnant women.
1.1.4. Compliance - these measures are tied to contracts or to ensure Colorado does not fall below
expected standards.
1.1.5. COGNOS/Decision Support System 01 (DSS01) — the Department's data reporting systems
that use information from the Colorado Benefits Management System (CBMS).
1.1.6. Colorado Benefits Management System (CBMS) — the State's eligibility determination
system.
1.1.7. Colorado Information Security Policies (CISP) - Colorado Information Security Policies
promulgated by the Chief Information Security Officer in the Governor's Office of
Information Technology pursuant to §§24-37.5-401, et seq., C.R.S.
1.1.8. Colorado interChange (interChange) — the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data related
to those payments.
1.1.9. Correction Action Plan (CAP) - A formal plan implemented with technical assistance to
address non-compliance and/or performance.
1.1.10. County Administration website — the Department's public -facing website where contract
documentation is kept for the County Incentives Program
(http://www.colorado.gov/hcpf/county-admin).
1.1.11. County Financial Management System (CFMS) — the accounting system utilized by the
Contractor to record expenditures against county administration funding for Colorado's
Medical Assistance Program. The system is also used to issue Performance Incentive
Payments to eligible Contractors.
1.1.12. County Incentives Program — program that provides specific funding to county departments
of human/social services for meeting Medicaid -related Performance Incentive Standards in
their counties. Also referenced as Performance Incentive Standard Program throughout this
Agreement.
1.1.13. Determination — The act of using CBMS to determine if an Applicant is eligible for the
Colorado Medical Assistance Program based on information submitted on a new application,
a redetermination or a change in member circumstance.
Exhibit Al Page 1 of 15
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1.1.14. Disenroll or Disenrollment — The act of processing a change in circumstance that affects a
member's eligibility and makes them ineligible for coverage within Health First Colorado or
Child Health Plan Plus.
1.1.15. Governor's Office of Information Technology (OIT) — The office created by and described
in §§24-37.5.101, et seq. C.R.S. OIT is the Information Technology Service Provider for
Consolidated State Agencies.
1.1.16. HCPF Memo Series - The Department's policy, operational and informational
communications that are utilized to provide contract clarifications, provide data and
operational guidance and share information pertaining to the County Incentives Program.
1.1.17. Health First Colorado — the member -facing name for Colorado's Medical Assistance
Program, which includes all programs that use the Modified Adjusted Gross Income (MAGI)
methodology.
1.1.18. Home and Community -Based Services (HCBS) - HCBS waiver programs provide additional
benefits and services to eligible populations in addition to the standard benefit package
offered to all members.
1.1.19. Improvement Action Plan (IAP) - An informal plan implemented with technical assistance to
address non-compliance and/or performance that may lead to noncompliance.
1.1.20. Information Technology Service Provider (ITSP) - A Service Provider that provides
information technology services to the Contractor. The ITSP may be an internal department,
a third -party vendor or OIT.
1.1.21. Long Term Care (LTC) - Long -Term Care is a Medical Assistance program that provides
nursing -home care, home -health care, personal or adult day care for individuals aged at least
65 years or with a chronic or disabling condition.
1.1.22. Management Decision Letter (MDL) -A formal notification issued by the Department,
through a letter that details areas and findings of noncompliance by the Contractor. An MDL
can be issued for not meeting performance targets on the MAP Dashboard.
1.1.23. Member — An individual who is eligible for the Colorado Medical Assistance Program. Also
known as a client.
1.1.24. Medicaid Assistance Performance (MAP) Dashboards - a graphic representation of essential
information regarding performance measures, targets and benchmarks and the county's actual
performance. The MAP Dashboards highlights each county's performance and quality.
1.1.25. Performance Measure - A quantification that provides objective evidence of the degree to
which a performance result (goal) is occurring over time.
1.1.26. Program for the All -Inclusive Care for the Elderly (PACE) — Program provides
comprehensive medical and social support services to certain frail individuals 55 years of age
and over. The goal of PACE is to keep individuals in their homes and communities through
comprehensive care coordination.
1.1.27. PuMP - Performance Measurement Process developed by Stacey Barr.
1.1.28. Reporting Period — The period of time for each performance standard used to measure
whether the Contractor met that standard.
Exhibit Al Page 2 of 15
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1.128.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1282. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and end on
June 30 of that SFY.
1.1.29. Redetermination — A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.30. State Fiscal Year (SFY) — The period beginning July 1 of each calendar year and ending on
June 30 of the following calendar year. Also referred to as fiscal year in this Exhibit.
1.1.31. Status Report — a communication to the Contractor that details which Performance Incentive
Standards were met for each Reporting Period.
1.1.32. Timely Determination — Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.33. Timely Disenrollment — Processing a change in a member's circumstance and making a
determination within fifteen (15) calendar days.
1.1.34. Timely Redetermination — Any Redetermination that is completed by the last day of the
month prior to the month in which the member's new annual enrollment period begins.
1.1.35. Target - Degree of performance we are aiming to achieve (i.e. 95% Timeliness)
1.1.36. Untimely Determination — Any Determination that is not completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.37. Untimely Redetermination — Any Redetermination that is not completed by the last day of
the month prior to the month in which the member's new annual enrollment period begins.
This is based on the CBMS RRR Due Date.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility -related work within the Contractor's
county, required under C.R.S. §25.5-1-101 et seq. The Department and the Contractor share the
costs of this work performed by the Contractor as defined in those statutes and this Contract shall
not impact the allocated amount of that cost sharing.
3. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
3.1.1. To determine whether the Contractor met any or all the Performance Incentives Standards
when completing determinations and redeterminations within the Contractor's county, the
Department will utilize the COGNOS/DSS01 systems to pull data tracking and reports that
track the Contractor's compliance with certain Performance Incentive Standards. This data
will be visualized on each county's MAP Dashboards.
3.1.2. To determine whether the Contractor met any or all the Performance Incentives Standards
when working with Medicaid populations within the Contractor's county, the Department
may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive and the Department will, at its discretion, utilize
additional data and reports from the COGNOS/DSS01, interChange, and/or other systems to
determine whether the Contractor met any or all the Performance Incentives Standards.
Exhibit Al Page 3 of 15
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3.1.4. The date the data or reports will be pulled from the COGNOS/DSS01, interChange, and/or
other systems published on the MAP Dashboard will be defined in each applicable
Performance Incentive Standard and/or the PuMP template for those performance measures.
3.1.5. The Contractor should utilize policy, operational and informational guidance provided in this
Exhibit and through the HCPF Memo Series for each Performance Incentives Standard to
assist with implementing the Performance Incentives Standard and pulling applicable data
and reports to determine the Contractor's compliance with any or all the Performance
Incentives Standards.
3.2. Communications Utilized to Determine Compliance
3.2.1. To fulfill the requirements in Exhibit Al Statement of Work and earn a Performance
Incentive Payment, the Contractor shall utilize and comply with guidance issued through the
HCPF Memo Series.
3.2.2. The Contractor will utilize the HCPF Memo Series to find any forms, templates, program
contacts or additional information needed to operationalize the Performance Incentives
Standard Program referenced throughout this Agreement.
3.2.3. If additional guidance or contract clarification is needed, the Department may release
additional guidance to the Contractor through the HCPF Memo Series.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor may earn Performance Incentive Payments to reimburse it for a portion of its cost
sharing as described in Section 2.
4.2. Accuracy Performance Incentive Standard
4.2.1. The Contractor may earn the Accuracy Performance Incentive Payment by meeting the
Accuracy targets at the end of the Second Reporting Period. To earn the Accuracy
Performance Incentive Payment, the Contractor must meet both targets as specified in section
4.2.1.1, which includes (1) Target for Inaccurate Eligibility Determination Rate and (2)
Target for Errors that do not Impact Eligibility.
42.1.1. Accuracy Targets
4.2.1.1.1. The Inaccurate Eligibility Determination Rate target is used to determine how many
individuals in the sample had an incorrect determination.
4.2.1.1.1.1. The Inaccurate Eligibility Determination Rate is calculated as the number of
individuals that were incorrectly approved, denied, or terminated divided by the
total number of individuals in the sample (%), monthly (includes applications,
redeterminations, and case changes).
4.2.1.1.2. The Errors that do not Impact Eligibility target is used to determine how many
individuals in the sample had a correct determination with errors that did not impact
eligibility.
4.2.1.12.1. The Errors that do not Impact Eligibility is calculated as the number of individuals
with error(s) that did not impact eligibility divided by number of individuals in
the sample, monthly (includes applications, redeterminations, and case changes).
Exhibit Al Page 4 of 15
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4.2.1.2. HCPF Quality Assurance Process and Accuracy Dashboard
42121. The Contractor shall comply with HCPF Operational Memo (OM) 21-030, which
specifies the Contractor's role in the state quality assurance (QA) case review process.
4.2.1.2.1.1. The QA case reviews occur monthly.
4.2.1.2.1.2. The QA case review process is to monitor the accuracy and quality of eligibility
determinations for Medical Assistance made by the Contractor.
4.2.1.2.1.3. The Contractor must respond to documentation requests and error findings within
ten (10) business days of the request to ensure QA case reviews are completed
timely.
4.2.1.2.1.4. The Contractor must respond to the Department's QA case review error findings
by using the two options, 1) Agree/Concur or 2) Disagree/Rebut within ten (10)
business days.
4.2.1.2.1.5. If additional or revised guidance on the state quality assurance case review process
is issued, then the Contractor shall comply with the most current, recent
information issued through the HCPF Memo Series.
4.2.1.2.2 The Department shall utilize the Medical Assistance Performance (MAP) Accuracy
Dashboard to publish the results of the quality assurance case review findings on a
monthly basis and sends the results to the County Directors and County
Commissioners.
4.2.1.3. Setting Accuracy Targets and Benchmarks
4213.1. The Department shall use the May 2021 data, which will be published on the June
2021 MAP Accuracy Dashboard, to set the Second Reporting Period targets and
quarterly benchmarks. The Department shall communicate the targets and
benchmarks the Contractor is required to meet at the conclusion of the Second
Reporting Period through HCPF Memo Series.
4.2.1.4. Determining Compliance with the Accuracy Performance Incentives Standards
4.2.1.4.1 The MAP Accuracy Dashboard will be available monthly to the Contractor to
determine the Contractor's performance over the fiscal year. To determine
compliance with the Accuracy Performance Incentive, the Department will utilize the
June 2022 Accuracy data, available in the July 2022 MAP Accuracy Dashboard, to
determine whether the Contractor met or exceeded the specified Accuracy target.
4.2.1.4.2 The Department will take the Contractor's final actual performance on the MAP
Accuracy Dashboard in comparison to the Contractor's Accuracy targets at the end
of the fiscal year to determine if the Contractor's actual performance has met and/or
exceeded the Accuracy targets to earn an Accuracy Performance Incentive Payment.
The percentage calculation has zero (0) decimal places and will not be rounded.
4.2.1.5 Review Sample Size Exemptions
4.2.1.5.1 If the Contractor has a review sample size, as defined in section 4.2.1.5.2, performed
by HCPF QA, the Contractor may be eligible for the Review Sample Size Exemption.
4.2.1.5.2 Definition of Review Sample Size
Exhibit Al Page 5 of 15
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4.2.1.5.2.1
4.2.1.5.3
4.2.1.5.3.1
4.2.1.5.3.1.1
4.2.1.5.3.1.2
4.2.1.5.3.2
421532.1
4.2.1.5.4
4.2.1.5.4.1
4.2.1.5.4.2
4.2.1.5.4.2.1
4.2.1.5.4.3
4.2.1.5.4.3.1
4.2.1.5.4.3.1.1
4.2.1.5.4.3.2
The Contractor with twenty (20) or fewer quality assurance case reviews per fiscal
year would qualify for a Review Sample Size Exemption. The Contractor with a
review sample size that do not meet one or both of the Accuracy Incentive targets
as defined in section 4.2.1.1 may be eligible for the Review Sample Size
Exemption:
i. Inaccurate Eligibility Rate and/or,
ii. Errors that do not impact Eligibility.
Determining Targets percentage (%) for Potential Review Sample Size Exemptions
The Department shall have two tier target percentages for the Accuracy Targets:
Tier 1 target percentage (%): The Contractor with twenty (20) or more quality
assurance case reviews.
Tier 2 target percentage (%): The Contractor with fewer than twenty (20)
quality assurance case reviews.
The Department shall set the two tier targets percentage based on the June 2021
data for the Accuracy Incentive.
The finalized targets percentage will be communicated through the HCPF
Memo Series.
Review Sample Size Exemption Process
The Department shall follow Exhibit D for the Review Sample Size Exemption
Process.
Definition of Similar Error(s)
The MAP Accuracy Dashboard identifies the accuracy rates for each
Contractor; HCPF QA provides those errors caused by the Contractor that
impact accuracy rates. This allows the Contractor to address the root cause of
errors to prevent similar errors going forward. If errors are not addressed by
the Contractor and they repeat in future months, the errors will be considered
similar errors.
If the Contractor meets only one target with less than twenty (20) reviews, the
Review Sample Size Exemption Process will be applied only to the one target not
met by the Contractor.
If the QA case review size is less than three (3), the three (3) errors are not
similar errors at the end of fiscal year, an automatic exemption is applied,
If the three (3) errors are similar errors at the end of fiscal year, no
automatic exemption is applied.
If the QA case review size is greater than three (3) over the course of the fiscal
year with no similar errors, exemption process is applied, and the initial target
percentage shall be reviewed per section 4.2.1.5.3, and the Department may
review additional documentation per the Department's discretion to
recalculate the percentage, if needed.
Exhibit Al Page 6 of 15
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4.2.1.5.4.4
4.2.1.5.4.4.1
4.2.1.5.4.4.1.1
4.2.1.5.4.4.2
4.2.1.5.5
4.2.1.5.5.1
The Contractor that does not meet both targets with less than twenty (20) reviews,
exemption will be applied to both targets.
If the QA case review size is less than three (3) over the course of the fiscal
year, the three (3) errors are not similar errors at the end of fiscal year, an
automatic exemption is applied,
If the three (3) errors are similar errors at the end of fiscal year, no
automatic exemption is applied.
If the QA case review size is greater than three (3) over the course of the fiscal
year with no similar errors, exemption process is applied, and the initial target
percentage shall be reviewed per section 4.2.1.5.3, and the Department may
review additional documentation per the Department's discretion to
recalculate the percentage, if needed.
Notification of Review Sample Size Exemption
If the Contractor does not meet the Accuracy Incentive Targets per section
4.2.1.5.3, they will be notified through the Status Report of the Second Reporting
Period.
4.2.1.5.5.2 The Contractor that does not meet the Accuracy Incentive Targets but qualifies
for the exemption process per section 4.2.1.5.4, the Contractor will be notified
through the Status Report.
4215521 If the Contractor qualifies for the Review Sample Size Exemption Process, the
Department shall review previously submitted documentation from the
Contractor based on their MAP Accuracy Dashboard and may request
additional documentation as needed.
4215522 The Contractor shall submit any additional documentation requested for the
exemption process to hcpf countyrelations@state.co.us within ten (10)
business days from the day of notification.
4.2.1.5.6 Review Sample Size Exemption Process and Accuracy Performance Incentive
Payment
4.2.1.5.6.1 The Contractor shall earn an Accuracy Performance Incentive Payment if both
Accuracy Targets defined at sections 4.2.1.1.1 and 4.2.1.1.2 are met after eligible
exemption(s) are applied.
4.2.2 BENCHMARKS: Individualized, Contractor -specific accuracy targets for Inaccurate
Eligibility Determinations and Errors that do not impact Eligibility.
4.3 Performance Compliance Performance Incentive Standard
43.1 The Contractor shall comply monthly with the Director -level MAP Dashboard measures. The
performance measures include timeliness of applications/redeterminations, timeliness of long
term services and supports (LTSS) applications/redeterminations, timeliness of case changes,
etc.
4.3.1.1 The specific Director -level measures to be included in the Performance Compliance
Performance Incentives Standard shall be communicated through HCPF Memo Series.
Exhibit Al Page 7 of 15
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4.3.12 The Department reserves the right to remove and/or add additional measures as it is
appropriate.
4.3.1.3 If adding or revising MAP Dashboard measures, the Department shall apply the PuMP
process and the Contractor shall have an opportunity to provide feedback.
4.3.2 Department Monitoring of MAP Dashboards
4.3.2.1 The Department updates the MAP Dashboards monthly, which are accessible to the
Contractor through the Department's MAP Dashboard SharePoint Page; copies of these
Dashboards are also emailed to Contractor leadership monthly.
4.3.3 Contractor Monitoring of MAP Dashboards
4.3.3.1 The Contractor must monitor the monthly published MAP Dashboards to ensure targets
are met.
4.3.32 The Contractor shall designate MAP Dashboard performance owners to access the MAP
Dashboards and follow the Standard Operating Procedure (SOP) that is available on the
Department SharePoint Page to ensure targets are met and to take action.
4.3.3.3 The Contractor shall review and investigate the root causes for not achieving the target(s).
4.3.3.4 Contractors shall respond with the outcome of the investigation for not meeting the target
based on the established MAP Dashboard process.
4.3.3.5 The Contractor shall follow guidance regarding the MAP Dashboard process as issued
through the MAP Dashboard SOP, trainings and HCPF Memo Series.
4.3.4 Determining Compliance with Performance Compliance Performance Incentives Standard
43.4.1 The Contractor will be deemed out of compliance for specific Director -level measures
when the Contractor has not met the target(s) after a short- or long -run ofperformance.
434.1.1 The Contractor shall refer the MAP Dashboard SOP and HCPF Memo Series for
guidance on what constitutes a short- or long -run of performance.
43.4.12 A Management Decision Letter (MDL), requiring the Contractor to create an
Improvement Action Plan (IAP) or Corrective Action Plan (CAP), will be issued to
the Contractor to address the short- or long -run of performance.
4.3.4.1.2.1 The Contractor shall refer to HCPF OM 21-004 for guidance on MDLs, IAPs and
CAPs.
4.3.4.1.2.1.1
4.3.4.1.2.1.1.1
4.3.4.1.2.2
If additional guidance or clarification on MDLs, IAPs and CAPs is issued by
the Department, the Contractor shall comply with the most recently released
information.
The issuance of the MDL on a specific Director -level measure signifies
that measure as being out -of -compliance. Performance measures with an
active MDL shall be ineligible for a Performance Compliance
Performance Incentive Payment.
The Contractor may earn the Performance Compliance Performance Incentive
Payment by ensuring that a certain number of Director -level measures maintain
compliance with the performance targets and are not issued an MDL.
Exhibit Al Page 8 of 15
LJULUOly II CI I VCIOLIC I V. tV1U I UCIF-IX.I.IZILI-I-FULICI-001-LI-/-1 I I I L/4UJ4U I J
4.3.4.1.2.2.1 The specific number of Director -level measures that the Contractor must
maintain compliance with shall be communicated through the HCPF Memo
Series.
4.3.5 BENCHMARKs: Tie Contractor shall maintain compliance with a certain amount of
Director -level measures out of the total number of Director -level measures reported on the
MAP Dashboard.
4.4 Cyber Security Performance Incentive Standard
4.4.1 The Contractor may earn one Cyber Security Performance Incentive Payment for both
Reporting Periods in which the Contractor submits the required deliverable(s) relating to
remediation of certain high -risk non -compliant cyber security standards based on Colorado
Information Security Policies (CISP) and federal Health and Human Services Security Risk
Assessment. The Department will provide additional guidance through the HCPF Memo
Series, which can also be found on the County Administration website.
4.4.2 Fiscal Year Deliverable
4.42.1 No later than the semi-annual reporting due date for the Second Reporting Period, the
Contractor shall use a written Remediation Deliverable to address certain areas of
actionable high -risk non-compliance to be identified by the Department based on the
Contractor's FY 2020-21 Risk Assessment and Remediation Plan Deliverable.
4421.1 If the Contractor has not completed the FY 2020-21 Risk Assessment and
Remediation Plan Deliverable, this Deliverable must be completed and submitted to
the Department in order to be eligible to earn FY 2021-22 Cyber Security Incentive
funds. Full compliance with each and every CISP does not need to be met by the semi-
annual due date for the Second Reporting Period; rather, the Contractor, shall work
with the Stale to remediate identified actionable high -risk non -compliant Cyber
Security standards.
4.4.3 DELIVERABLE: Completed Remediation Deliverable submitted no later than the semi-
annual due date for the Second Reporting Period.
4.5 Continuous Coverage Performance Incentive Standard
4.5.1 The Contractor may earn a Continuous Coverage Performance Incentive Payment for the
fiscal year in which the Contractor meets its specified benchmarks relating to the percentage
of Medical Assistance members who have an eligibility review within one hundred eighty
(180) calendar days of the end of the COVID-19 public health emergency as described in
section 4.5.
4.5.1.1 Notification of end of continuous coverage and COVID-19 public health emergency
45.1.1.1 Upon notification from the federal government that the continuous coverage
requirement for Medical Assistance members has ended, the Contractor will be
notified through the HCPF Memo Series. The communication will include the starting
date of the one hundred eighty (180) calendar days period to review eligibility for those
members impacted by the continuous coverage requirement.
4.5.1.2 Percentages of Medical Assistance members with a required review of eligibility
Exhibit Al Page 9 of 15
UUUUOIVI I CIIVCIUFJC IU. MV-CUJ UUf -U4OU-4:JJU-oor U -1 I / I U4U.74UI J
45.121 The Contractor shall review eligibility within one hundred eighty (180) calendar days
for at least ninety percent (90.00%) of Health First Colorado and CHP+ members that
require a review due to the end of the COVID-19 public health emergency.
45.122 The Contractor shall review eligibility within one hundred eighty (180) calendar days
for at least ninety percent (90.00%) of Long Term Services and Supports members
that require a review due to the end of the COVID-19 public health emergency.
4.5.1.3 Members who require a review of eligibility
45.1.3.1 The Department will work with the CBMS Contractor to review eligibility for those
members who have the necessary information at the end of the COVID-19 public
health emergency. For those members who do not have the necessary information to
review eligibility, the Contractor will be responsible for ensuring the timely
completion of eligibility review within one hundred eighty (180) calendar days of the
end of COVID-19 public health emergency.
4.5.1.3.1.1 The Department has the discretion to amend section 4.5 if the PHE guidance
changes upon federal government direction.
4.5.1.4 Determining Compliance with the Continuous Coverage benchmarks
45.14.1 The Department will total the number of Health First Colorado and CHP+ members
that the Contractor completed a review of eligibility within one hundred eighty(180)
calendar days of the end of the COVID-19 public health emergency and divide that
by the total number of all Health First Colorado and CHP+ members that required a
review of eligibility due to COVID-19 public health emergency in the Contractor's
county.
45.142 The Department will total the number of LTSS members that the Contractor
completed a review of eligibility within one hundred eighty (180) calendar days of
the end of the COVID-19 public health emergency and divide that by the total number
of all LTSS members that required a review of eligibility due to COVID-19 public
health emergency in the Contractor's county.
45.143 To earn the Continuous Coverage Performance Incentive Payment, the Contractor
shall meet both the benchmarks described in section 4.5.1.4.
45.144 The Department will utilize a data pull from CBMS to determine compliance with the
benchmarks of the Continuous Coverage Performance Incentive Standard.
4.5.2 BENCHMARKS: Review benchmarks for ninety percent (90.00%) of Health First Colorado,
CHP+ and LTSS members who require a review of eligibility due to the end of the COVID-
19 public health emergency as described in section 4.5.
5 SEMI-ANNUAL REPORTING
5.1 The Contractor shall submit documentation to the Department to verify the Contractor's
compliance with each Performance Incentive Standard and will submit such documentation on a
semi-annual basis as required. The Contractor must submit documentation to
hcpf countyrelations@state.co.us, unless otherwise specified through the HCPF Memo Series.
5.1.1 For the Second Reporting Period, the Contractor shall submit the following documentation:
Exhibit Al Page 10 of 15
UULUOIIyI I GI I Ve,ULle IL/. PUYGU I UOr-oM-+.,.K,-oorI-r% I I I UYUIYUIJ
5.1.1.1 Any Accuracy Performance Incentive Standard Review Sample Size Exemption Process
documentation for the fiscal year if the Contractor failed to meet specified target(s). The
Contractor shall only submit documentation upon the Department's request.
5.1.1.2 Any Cybcr Security Performance Incentive Standard Remediation Plans or other
documents listed as deliverables under this agreement or specified through the HCPF
Memo Series.
5.1.2 DUE DATE: July 5, 2022
6 EXEMPTIONS
6.1 Exemptions for the Accuracy Performance Incentive Standard
6.1.1 The Contractor shall be responsible submitting any additional documentation requested for
the exemption process.
6.1.2 The Department may approve or reject any request for the Accuracy Targets exemption and
may limit the total number of exempted for the Accuracy Performance Incentive Standard.
6.1.2.1 The Department will deny exemption requests that do not meet the Accuracy Targets and
Benchmarks per section 4.2.1.3 and timeliness definition set forth in 10 C.C.R. 2505-
8.100.3.D (d) and section 1.1 due to the fault of the Contractor and/or any exemption
requests based on the following:
6.1.2.1.1 Failure of the Contractor to use the MAP Accuracy Dashboard for the purposes of
fulfilling Exhibit Al, Statement of Work.
6.1.2.2 The reasons for denial of an exemption as stated in section 6 are not all-inclusive and the
Department reserves the right to deny any exemption for reasons not stated in section 6.
6.1.2.2.1 Prior to denying an exemption for reasons beyond those stated in section 6, the
Department may, at its discretion, request further information from the Contractor to
determine whether the request for exemption meets the exemption standards as stated
in section 6, Exemptions.
6.1.2.3 The Department may approve or reject any request for exemption due to unusual
circumstances and may limit the total number of exemption requests.
6.2 Exemptions for Performance Incentive Standards other than the Accuracy Performance Incentive
Standard.
62.1 Exemptions will not be considered for any Performance Incentive Standard listed under
section 6.2.1.
6.2.1.1 Performance Compliance Performance Incentive Standard
6.2.1.2 Cyber Security Performance Incentive Standard
6.2.1.3 Continuous Coverage Performance Incentive Standard
622 The Contractor's performance and compliance with the Performance Incentive Standards
listed under section 6.2.1 will be deemed final, as determined by the Department, and
Performance Incentive Payments made without the opportunity to submit an exemption.
7 NOTIFICATIONS
7.1 After each Reporting Period, the Contractor will be provided a Status Report that details which
Performance Incentive Standards were met.
Exhibit Al Page 11 of 15
IJUI.UJlyIl CI I VCIU'.JC ILJ. MMCU 1.JUr-U•4OU-Y:l:JU-OUrIJ-MI J I V4 LJJYU/J
7.1.1 The Contractor's Reporting Period Status Report will only detail which Performance
Incentive Standards were met for the Reporting Period in question. Funding amounts will not
be provided until the conclusion of the fiscal year.
7.1.2 If the Contractor has more than one Reporting Period in the fiscal year to meet any
Performance Incentive Standards, the Reporting Period Status Report will not include the
Contractor's performance in those Performance Incentive Standards.
7.2 After the conclusion of the fiscal year, the Department will provide the Contractor a final Status
Report that details which Performance Incentive Standards were not met and met and how much
Performance Incentive Payments were earned by the Contractor.
7.2.1 The final Status Report cannot be disputed; if the Contractor disagreed with the Department's
determination of compliance with any Performance Incentive Standard, the Contractor must
have disputed that result based on the Reporting Period Status Report.
7.3 Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor's
compliance with the Performance Incentives Standards.
7.4 Status Reports far each Reporting Period will be sent within ten (10) calendar days after the
Semi -Annual Reporting due date for each Reporting Period as found in Section 5, Semi -Annual
Reporting. The date on which the Status Report for each Reporting Period is sent to the
Contractor will be considered the Status Report Date.
7.4.1 If unusual circumstances have delayed the Contractor's Reporting Period or final Status
Reports, the Department will inform the Contractor of the delay and an anticipated date of
resolution.
7.5 The final Status Report will be sent upon the Department's determination of final Performance
Incentive Payment amounts.
7.6 The Contractor will have the opportunity to dispute the Status Report results as defined in section
8, Dispute Resolution.
8 DISPUTE RESOLUTION
8.1 Opportunity and Timeframe for Dispute Resolution
8.1.1 In the event the Contractor disagrees with the findings of the official notification as found in
section 7, Notifications, the Contractor will have the opportunity to dispute the Reporting
Period Status Report for the Reporting Period in question.
8.1.2 The final Status Report cannot be disputed per section 7.2.
8.1.2.1 The Contractor will have ten (10) calendar days from the Status Report Date to review
each Reporting Period Status Report and dispute the results.
8.1.2.2 If the Contractor fails to dispute the Reporting Period Status Report within ten (10)
calendar days from the Status Report Date, the Status Report results will be deemed final.
No further disputes will be allowed, and compensation will be made per section 9 based
on the results of the non -disputed Status Report.
8.2 Allowable Disputes
82.1 The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
Exhibit Al Page 12 of 15
IJU A.1O1y II CI IVCIV'.1C IV. /V\CV/UCH- -0'YO0-'i J:JO-oor LYl1 I / IU.+ LJ '+IJ/J
8.2.1.1 The Contractor submitted documentation that was required for a Performance Incentive
Standard, so long as the Contractor has proof that the required documentation was
submitted on or before the contractually -required due date.
8.2.1.2 The Contractor requests a re -review of the Contractor's submitted documentation that
was used to determine compliance with any Performance Incentive Standard.
8.2.1.3 The Contractor has available data, such as systems reports or other tracking
methodologies, that conflicts with the Department's available data that will utilized to
determine compliance with a Performance Incentive Standard.
82.1.3.1 The Contractor will be responsible for providing all necessary and relevant data
available to the Department in order to determine if the Contractor's data actually
conflicts with the Department's data.
82.1.32 The Department will make the final determination when a conflict of data occurs and
will make Performance Incentive Standard Payments based on its final determination.
822 The Department reserves the right to add additional allowable dispute reasons throughout the
fiscal year based on additional information made available from the Department and/or
Contractor. These additional allowable dispute reasons will be considered on a case -by -case
basis, and the Department's determination of additional allowable dispute reasons are final
and not subject to the Dispute Resolution process as outlined in section 8.
8.3 Nonallowable Disputes
8.3.1 The Contractor will not be allowed to dispute the results of the Status Report based on the
following reasons:
8.3.1.1 The Contractor failed to meet contractually -specified requirements relating to the content
of submission of deliverables and the timely submission of deliverables.
8.3.1.2 The Contractor failed to meet contractually -specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3 The Contractor's failure to review and utilize County Incentives Program documentation,
including policy, informational, and operational guidance issued through the HCPF
Memo Series, that resulted in the Contractor failing to meet performance benchmarks and
deliverables relating to any Performance Incentive Standard.
8.3.1.4 The Department's final determination of the Contractor's exemption request(s) for the
Accuracy Performance Incentive Standard.
8.3.2 The Department reserves the right to deny a Contractor's dispute based on any reason not
included under section 8.3.1. The Department's determination is final and is not subject to
dispute or appeal.
9 COMPENSATION
9.1 Compensation
9.1.1 Performance Incentive Payment
9.1.1.1 The Department shall pay the Contractor, after the end of the fiscal year in which the
work was performed, a Performance Incentive Payment for each Performance Incentive
Standard it meets during the applicable Reporting Period as follows:
Exhibit Al Page 13 of 15
LJUL:UJIIylI CIIVCIUpC IL). %MGU I.7Ur-o+DQ-Y:Jou-oo U -MI t I IJ'FLJUMAJIJ
9.1.1.1.1 The Department shall pay the Contractor an Accuracy Performance Incentive
Payment, if applicable, as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.2 The Department shall pay the Contractor a Performance Compliance Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.3 The Department shall pay the Contractor a Cyber Security Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor meets
the requirements for that Performance Incentive Standard.
9.1.1.1.4 The Department shall pay the Contractor a Continuous Coverage Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.2 Remaining Funds Incentive Pool Payment
9.1.2.1 The Department will create a Remaining Funds Incentive Pool each SFY.
9.12.1.1 The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.1.1 The total amount of all base Performance Incentive Payments allocated to any
Contractor that selected to not participate in the Performance Incentive Standards
Program for that SFY.
9.1.2.1.1.2 Each of the Performance Incentive Payments the Accuracy Performance Incentive
Standard, Performance Compliance Performance Incentive Standard, the Cyber
Security Performance Incentive Standard and the Continuous Coverage
Performance Incentive Standard that were not earned by the Contractor during a
Reporting Period in that SFY.
9.121.121 The Contractor shall be eligible for Remaining Funds Incentive Pool
payments.
9.1.2.1.2 If the Remaining Funds Incentive Pool is zero dollars ($0.00) for any SFY, the
Contractor shall not receive a Remaining Funds Incentive Pool Payment for that SFY.
9.1.2.2 The Remaining Funds Incentive Pool will be paid as follows:
9.122.1 The Contractor shall be eligible for payment from the Remaining Funds Incentive
Pool based on the dollar amount of Incentives met during that SFY.
9.1222 Based on the proportion of total Incentive funds that the Contractor is eligible to be
paid in each SFY, the Contractor shall receive the same proportion of funds from the
Remaining Funds Incentive Pool.
9.12.2.3 The Contractor's payment of funds from the Remaining Funds Incentive Pool shall
never exceed the county's share of Medicaid expenditure, as specified in Section 2,
County Determinations.
9.2 Payment Procedures
921 The Contractor shall receive Performance Incentive Payments for each Reporting Period
within ninety days (90) days following the end of the fiscal year in which the Performance
Incentive Standards were met. This allocation will reflect the maximum the Contractor can
earn for each Performance Incentive Standard per Reporting Period.
Exhibit Al Page 14 of 15
IJUI.UJlyll CI IVCIUI/C ILl. fV‘ii/'Ur-UY00-.-JUU-OUrLJY"% I I IUYL/.7YUIJ
9.2.1.1 If the Contractor's county administration line item is over -expended during the county
administration closeout process, Settlement Accounting and the Department may utilize
the Contractor's earned Performance Incentive Payments during the closeout process.
922 Actual Performance Incentive Payment maximums are dependent on the Contractor's share
of Medicaid county administration expenditure. In no event shall the Contractor be paid more
than the Contractor's county share of Medicaid county administration expenditure in any
Reporting Period or fiscal year.
923 The Department may add any unearned funds from the First Reporting Period into the Second
Reporting Period allocation for any SFY.
924 The Contractor shall be paid the Performance Incentive Payments through the County
Financial Management System (CFMS).
925 The Department may use any unearned Second Reporting Period Performance Incentive
Payments during the county administration close out process.
9.2.5.1 The Incentive Payment earned is unrestricted, and the Contractor may utilize the fund per
the Contractors discretion.
Exhibit Al Page 15 of 15
✓UUUJIyII CI IVCIUF.JC 1✓. PV\U/ JOr-OYOO-V:J:JO-OOr ✓Y% I / I✓4✓DVU/J
EXHIBIT B, RATES
SFY 2021-22 Incentives Payment Table
Incentive Payment Name
% of Funding
Payment Amount
Accuracy Performance
Incentive Payment
35%
$96,493.36
Performance Compliance
Performance Incentive
Payment
25%
$68,923.83
Continuous Coverage
Performance Incentive
Payment
20%
$55,139.06
Cyber Security Performance
Incentive Payment
20%
$55,139.06
Exhibit B Page 1 of 1
vuuuOlyll Guiv iupe Iv. PV\CUt r-O'f QW:TJ0-oorv-MI I I UYLJV•tUIJ
Exhibit C, Sample Option Letter
State Agency
Insert Department's or IHE's Full Legal Name
Option Letter Number
Insert the Option Number (e.g. "1" for the first option)
Contractor
Insert Contractor's Full Legal Name
Original Contract Number
Insert CMS number or Other Contract Number of the Original Contract
Current Contract Maximum Amount
Initial Term
State Fiscal Year 20xx $0.00
Extension Terms
State Fiscal Year 20xx $0.00
State Fiscal Year 20xx $0.00
State Fiscal Year 20xx $0.00
State Fiscal Year 20xx $0.00
Total for All State Fiscal Years $0.00
Option Contract Number
Insert CMS number or Other Contract Number of this Option
Contract Performance Beginning Date
Month Day, Year
Current Contract Expiration Date
Month Day, Year
1.
OPTIONS:
A.
B.
C.
D.
E.
Option to extend for an Extension Term
Option to change the quantity of Goods under the Contract
Option to change the quantity of Services under the Contract
Option to modify Contract rates
Option to initiate next phase of the Contract
2. REQUIRED PROVISIONS:
A. For use with Option 1(A): In accordance with Section(s) Number of the Original Contract referenced above,
the State hereby exercises its option for an additional term, beginning Insert start date and ending on the current
contract expiration date shown above, at the rates stated in the Original Contract, as amended.
B. For use with Options 1(B and C): In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option to Increase/Decrease the quantity of the Goods/Services or both at
the rates stated in the Original Contract, as amended.
C. For use with Option 1(D): In accordance with Section(s) Number of the Original Contract referenced above,
the State hereby exercises its option to modify the Contract rates specified in Exhibit/Section Number/Letter.
The Contract rates attached to this Option Letter replace the rates in the Original Contract as of the Option
Effective Date of this Option Letter.
D. For use with Option 1(E): In accordance with Section(s) Number of the Original Contract referenced above,
the State hereby exercises its option to initiate Phase indicate which Phase: 2, 3, 4, etc, which shall begin on
Insert start date and end on Insert ending date at the cost/price specified in Section Number.
E. For use with all Options that modify the Contract Maximum Amount: The Contract Maximum Amount
table on the Contract's Signature and Cover Page is hereby deleted and replaced with the Current Contract
Maximum Amount table shown above.
3. OPTION EFFECTIVE DATE:
A. The effective date of this Option Letter is upon approval of the State Controller or , whichever is later.
STATE OF COLORADO
Jared S. Polis, Governor
INSERT -Name of Agency or IHE
INSERT -Name & Title of Head of Agency or IHE
By: Name & Title of Person Signing for Agency or IHE
Date:
In accordance with §24-30-202, C.R.S., 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:
Name of Agency or IHE Delegate -Please delete if contract
will be routed to OSC for approval
Option Effective Date:
Exhibit C
Page 1 of 1
vuVuolyrr cr rvclUpe Iv. r-/AuI.`J or-orfoo-Y:J:lo-ourv-MI / I vr#v.74UI
Exhibit D: Review Sample Size Exemption Process Flow
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20 tevinws not
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tweet by X percent t.roArrit,at &font)
3. t bolt. :swats ato mot after crampoon apt*trlpayment
Issued, a 0oth not metpiynrent not *Sued
Greny,(rtnl itev.Pv Pt0005s
L Cwrues Leh unmet inlets onuo MAP A(.cuticy
tlashPortra. Oelf fdlswd a Inat[Mehra 'Ongttal Of
penarance clump MB local yaaf totes (to MAP
Castrtea•3 proms to and.,ze an0 deternvrre toot cause
any report on MAP Accuracy Da 'Dxe0 (cwtiwn
prov(rs).
2. la uro purposes Of etempeert Ito Depwtmprrtsell
renew Ito GW n(; 's submrSa.on [tan (ho shaft- of 10,14 trip
of pertctmacC.?
3, O aadtrond xt1drmaten CS fOedeo 8r to purposes of
erem e.),r. the Dip rtmerrt may rotors up wan ttn county.
4. After renew of (to to ' 0anty prordert aYbht nen
rltorn aeon (root cause artatyrsyt. Oro eren 0Oc41S w11 De
apCrevel0r denied.
owner,' *sue," 0 w3F(IS)afe Mt &1!t owmp.on(s) are.
is appaw. I woetts) not met after grenrpoon, oaytnent
not issued
Exhibit D Page 1 of 1
a
New Contract Request
Entity Name*
COLORADO DEPT OF HEALTH CARE
POLICY & FINANCING
Entity ID*
@00007174
Contract Marne*
HEALTH CARE POLICY & FINANCING (CONTRACT
AMENDMENT)
Contract Status
CTB REVIEW
New Entity?
Contract ID
5032
Contract Lead*
APEGG
Contract Lead Email
apegg@weldgov.com:cobbx
xlk@weldgov.com
Parent Contract ID
Requires Board Approval
YES
Department Project #
Contract Description*
AMENDMENT FOR SFY 2022 COUNTY INCENTICES. ORIGINAL CONTRACT NOTED AS TYLER ID: 2020-2389.
Contract Description 2
PA IS BEING ROUTED THROUGH THS NORMAL PROCESS. ETA TO CTB: 7/15/21
Contract Type 4.
AMENDMENT
Amount*
$0.00
Renewable*
NO
Automatic Renewal
Department
HUMAN SERVICES
Email
CM -
H umanServices@weldgov.co
rn
De rrient Head Email
CM-HurnanServices-
DeptHead veldgov.com
County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COU NTYA I I ORN EY7AVELDG
OV.COM
a renewal enter previous Contract ID
If this is part of a MSA enter MSA Contract ID
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in
OnBase
Contract Dates
Requested BOCC Agenda
Date*
07:21/2021
Due Date
07;17/2021
Will a work session with BOCC be required?*
NO
Does Contract require Purchasing Dept. to be included?
Effective Date
Review Date
05/02 2022
Renewal Date
Termination Notice Period
Contact Information
Contact Info
Contact Name
Purchasing
Committed Delivery Date
Expiration Date*
06:30/2022
Contact Type Contact Email Contact Phone 1 Contact Phone 2
Purchasing Approver Purchasing Approved Date
Approval Process
Department Head
JAMIE ULRICH
DH Approved Date
0714/2021
Final Approval
ROCC Approved
ROCC Signed Date
ROCC Agenda Date
07x'2112021
Originator
APEGG
Finance Approver
BARB CONNOLLY
Legal Counsel
GABE KALOUSEK
Finance Approved Date Legal Counsel Approved Date
07,'15:2021 07,15/2021
Tyler Ref it
AG 072121
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