HomeMy WebLinkAbout20192360.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #4 FOR HEALTHY COMMUNITIES PROGRAM
AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with Contract Amendment #4 for the Healthy
Communities Program between the County of Weld, State of Colorado, by and through the Board
of County Commissioners of Weld County, on behalf of the Weld County Department of Public
Health and Environment, and the Colorado Department of Health Care Policy and Financing,
commencing July 1, 2019, and ending June 30, 2020, 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 Contract Amendment #4 for the Healthy Communities Program between
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the Weld County Department of Public Health and Environment, and
the Colorado Department of Health Care Policy and Financing, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 24th day of June, A.D., 2019.
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Weld County Clerk to the Board
BY GV
eputy Clerk to the Board
VED AS T! = RM
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLO ADO
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Barbara Kirkmeyer, C
air -""Ye-j‘-d
Mike Freeman, Pro-Tem
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Steve Moreno
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2019-2360
HL0051
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Memorandum
TO: Barbara Kirkmeyer, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: June 11, 2019
SUBJECT: FY19-20 Healthy Communities Contract
Amendment #4 with Health Care Policy &
Financing
For the Board's approval is a continuation contract between the Colorado Department of Health
Care Policy and Financing and the Board of County Commissioners of Weld County. This
contract amendment allows the Weld County Department of Public Health and Environment to
continue providing Healthy Communities services in Weld County.
Funding for this contract will be used to provide Early and Periodic Screening, Diagnosis &
Treatment (EPSTD) services including health care case management, outreach and support
services for children and pregnant women who are enrolled in Health First Colorado, Colorado's
Medicaid program, and Child Health Plan (Plus) (CHP+). Emphasis is on educating families about
age appropriate well child services and helping them utilize these services available in the
community. In addition, this program provides outreach to non -enrolled individuals and
community based organizations to bring awareness of the Healthy Communities program.
The term of the contract is from July 1, 2019, through June 30, 2020. Funding for this renewal
period will not exceed $142,382. No new FTE will be required to perform the work as outlined in
the contract.
Assistant County Attorney, Karin McDougal, has reviewed this contract and determined that the
terms are acceptable.
Furthermore, this amendment was approved for placement on the Board's agenda via pass -around
dated June 5, 2019.
I recommend approval of this Healthy Communities renewal contract with Colorado Health Care
Policy & Financing.
2019-2360
4O[
Contract Number 20160000000000000029A4
CONTRACT AMENDMENT NO. 4
Original Contract Number 20160000000000000029
1. PARTIES
This Amendment to the above -referenced Original Contract (hereinafter called the "Contract") is
entered into by and between Board of County Commissioners of Weld County, (hereinafter
called "Contractor"), and the STATE OF COLORADO, acting by and through the Department of
Health Care Policy and Financing, 1570 Grant Street, Denver, Colorado 80203 (hereinafter called
"Department" or "State.")
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date.") The Department
shall not be liable to pay or reimburse Contractor for any performance hereunder, including, but
not limited to, costs or expenses incurred, or be bound by any provision hereof prior to the
Effective Date.
3. FACTUAL RECITALS
The Parties entered into the Contract to provide Early and Periodic Screening, Diagnosis and
Treatment (EPSDT) services for Weld County. The purpose of this Amendment is to extend the
Contract through State Fiscal Year 2019-20, to increase the maximum amount payable, and to
replace Exhibit A, Statement of Work.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein, and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
This Amendment is incorporated by reference into the Contract, and the Contract and all prior
amendments thereto, if any, remain in full force and effect except as specifically modified herein.
6. MODIFICATIONS
The Contract and all prior amendments thereto, if any, are modified as follows:
A. Section 5, Term, Subsection A, Initial Term, is hereby deleted in its entirety and replaced
as follows:
Page 1 of 3
Initial Term
The parties' respective performances under this Contract shall commence on the later of
July 1, 2019, or the effective date. This Contract shall expire June 30, 2020, unless sooner
terminated or further extended as specified elsewhere herein.
B. Section 7, Payments to Contractors, Subsection G, Maximum Amount, is hereby deleted
in its entirety and replaced as follows:
G. Maximum Amount
The maximum amount payable under this Contract to Contractor by the
Department is shown in the following table, as determined by the
Department from available funds. Payments to Contractor are limited to the
unpaid obligated balance of the Contract. The maximum amount payable
by the Department to Contractor is:
State Fiscal Year 2015-2016
$135,000.00
State Fiscal Year 2016-2017
$137,000.00
State Fiscal Year 2017-2018
$137,000.00
State Fiscal Year 2018-2019
$142,382.00
State Fiscal Year 2019-2020
$142,382.00
Total for All State Fiscal Years
$693,764.00
C. Exhibit A3, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A4, Statement of Work, attached hereto and incorporated by reference into the Contract.
All references within the Contract to Exhibit A, Exhibit Al, Exhibit A2, and/or Exhibit
A3 shall be deemed to reference to Exhibit A4.
D. Exhibit D, Healthy Communities Contract Deliverable Schedule - SFY2020 is hereby
added in its entirety.
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
Except for the Special Provisions and the HIPAA Business Associates Addendum, in the eventof
any conflict, inconsistency, variance, or contradiction between the provisions of this Amendment
and any of the provisions of the Contract, the provisions of this Amendment shall in all respects
supersede, govern, and control. The most recent version of the Special Provisions incorporated
into the Contract or any amendment shall always control other provisions in the Contract or any
amendments.
9. AVAILABLE FUNDS
Page 2 of 3
Financial obligations of the state payable after the current fiscal year are contingent upon funds
for that purpose being appropriated, budgeted, or otherwise made available to the Department by
the federal government, state government and/or grantor.
Page 3 of 3
Contract Number 20160000000000000029A4
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Persons signing for Contractor hereby swear and affirm that they are authorized to act on
Contractor's behalfand acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
Board of County Commissioners
of Weld County
aiD tit ,t,.e..- By:
Signature of Authorize Officer
Date: JUN 2 4 2019
Date:
Barbara Kirkmeyer
STATE OF COLORADO:
Jare S., .' of Go ernor
Kim Bimestefer
Executive Director
Department of Health Care Policy and
Financing
- S--.4
LEGAL REVIEW:
Printed Name of Authorized Officer Phil Weiser, Attorney General
Chair
By:
Printed Title of Authorized Officer Date:
ALL CONTRACTS REOUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not
valid until signed and dated below by the State Controller or delegate. Contractor is not authorized
to begin performance until such time. If Contractor begins performing prior thereto, the State of
Colorado is not obligated to pay Contractor for such performance or for any goods and/or services
provided hereunder.
By:
Date:
STATE CONTROLLER:
Rob e - + • CPA, MBA, JD
Department alth Care alley and Financing
Page 4 of 3
o20,9.-,2,3666)
Contract Number 20160000000000000029A4
EXHIBIT A-4, STATEMENT OF WORK
SECTION 1.0 PROGRAM PURPOSE
In partnership between the Department and Healthy Communities vendors, our shared
objective is to ensure that children and pregnant women enrolled in Health First Colorado,
Colorado's Medicaid Program, and Child Health Plan Plus (CHP+) receive the best
possible start with respect to utilizing the health care services and supports available to
them.
Toward that end, the Contractor:
Provides outreach to non -enrolled individuals and community -based organizations
to bring awareness of Health First Colorado, CHP+ and the Healthy Communities
program.
1.1.1.2. Provides outreach and administrative case management to members newly enrolled
into Health First Colorado and CHP+.
1.1.1.3. Directs members to primary and specialty medical providers as needed.
1.1.1.4. Directs members to community -based organizations and agencies for non -medical
services.
1.1.1.5. Coordinates with community -based organizations, the Department and other
Department contractors to assist them in improving overall health outcomes as
determined by the Department.
1.1.1.5.1. Specifically, the Contractor's work helps the Department attain its goal to
increase well -child and oral health (EPSDT Rates) to eighty percent (80%); to
increase child lead screening to one hundred percent (100%) for children at ages
recommended by the Advisory Committee on Childhood Lead Poisoning
Prevention (ACCLPP) and to improve education and outcomes around
maternity support and the benefits and advantages of prenatal care for
pregnant women.
SECTION 2.0 ACRONYMS, ABBREVIATIONS, DEFINITIONS AND OTHER
TERMINOLOGY
2.1. Acronyms, abbreviations and other terminology are defined at their first occurrence in this
Statement of Work. The following list is provided to assist the reader in understanding
acronyms, abbreviations and terminology used throughout this document.
22. Acceptance Status — Indication to the Contractor of whether a deliverable has been
Accepted (as received), Accepted with Changes, or Not Accepted. Deliverables deemed
Accepted with Changes or Not Accepted will be accompanied by the actions to be taken
to bring the deliverable to an Accepted status as well as a deadline for its completion.
Unless otherwise stated, the Department shall provide contractor with notice of a
deliverable's acceptance status within 30 days.
2.3. Administrative Case Management — assisting members and their family representatives to
navigate Colorado's public health care system to address concerns regarding eligibility
and enrollment in their respective Medical Assistance Program including application
assistance as necessary.
2.4. Business Day - Any day in which the Department is open and conducting business, but
shall not include Saturday, Sunday or Legal Holidays as listed in §24-11-101(1), C.R.S.
25. Business Interruption - Any event that disrupts the Contractor's ability to complete the
Work for a period of time, and may include, but is not limited to a Disaster, power outage,
strike, loss of necessary personnel or computer virus.
2.6. Child Health Plan Plus (CHP+) — CHP+ is Colorado's Children's Health Insurance
Program (CHIP). A Title XXI program, it is a low-cost health insurance program for
uninsured Colorado children under age 19 and prenatal women whose families earn too
much to qualify for Health First Colorado but cannot afford private insurance.
2.7. Closeout Period - The period beginning on the earlier of ninety (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.
2.8. Community Resources - Any private, nonprofit or governmental organization, entity,
individual or program that may help meet the non -medical needs of a member or their
family — especially those needs that may present a barrier to the member accessing
medical care and fully utilizing the benefits available to them through the Medical
Assistance Program.
2.9. Disaster - An event that makes it impossible for the Contractor to perform the Work out
of its regular facility, and may include, but is not limited to, natural disasters, fire or
terrorist attacks.
2.10. Eligible But Not Enrolled (EBNE) — Pregnant women and children who may be eligible
for Health First Colorado or Child Health Plan Plus, but who may not be enrolled in the
program.
2.11. EBNE Outreach — To actively generate awareness and provide education to women and
children currently not enrolled in the Healthy Communities but who may be eligible.
Such outreach may include direct communication with EBNE populations, individually
or as groups, as well as indirectly via other organizations who may work directly with
this population.
2.12. Early and Periodic Screening, Diagnostic and Treatment (EPSDT) Rates - Well -child
visits as counted on the Centers for Medicare and Medicaid Services Early and Periodic
Screening, Diagnostic and Treatment (CMS EPSDT) 416 report.
2.13. Health First Colorado, Colorado's Medicaid Program — The name for Colorado's
Medicaid program.
2.14. Healthy Communities Member Relationship Management System — A Salesforce-based
database managed by the Department.
2.15. Inform — A noun describing the act of providing information to Health First Colorado and
Colorado Child Health Plan Plus members by the Contractor. The Healthy Communities
Program utilizes several Informs including, but not limited to, Health First Colorado New
Member (Child) Inform, Colorado Child Health Plan Plus New Member (Child) Inform,
Health First Colorado New Member (Pregnant) Inform, Colorado Child Health Plan Plus
New Member (Pregnant) Inform.
2.16. Member - Any individual who is eligible for EPSDT through Health First Colorado, a
pregnant woman enrolled in Health First Colorado or any person enrolled in the CHP+
program. When referring to a member who is a minor, member may include the
member's parent, guardian or other family or personal representative. Member has the
same meaning as and replaces the term Client.
2.17. Member Onboarding — Outreach, navigation and education services to Members or their
family representative.
2.18. Newly Enrolled Member List — The list of members who have recently become eligible
for a Colorado Medical Assistance Program. The list is provided by the Department to
the Contractor via the Healthy Communities Member Relationship Management System.
2.19. Operational Start Date - The later of July 1, 2019, or when the Department authorizes the
Contractor to begin fulfilling its obligations under the Contract.
220. Personally Identifiable Information (PII) — Personally identifiable information including,
without limitation, any information maintained by the State about an individual that can
be used to distinguish or trace an individual's identity, such as name, Social Security
Number, date and place of birth, mother's maiden name, or biometric records; and any
other information that is linked or linkable to an individual, such as medical, educational,
financial, and employment information. PII includes, but is not limited to, all information
defined as personally identifiable information in §24-72-501, C.R.S.
221. Protected Health Information (PHI) - 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.
222. Provider — Any health care professional or entity that has been accepted as a providerin
the Colorado Medicaid program, Colorado's CHP+ program, or the Colorado Indigent
Care Program, as determined by the Department.
223. Referral - To offer to a Member or his/her representative the contact information for an
individual or a list of community partners or Providers to help meet the Member's
individual needs.
224. Regional Accountable Entity (RAE) — Under Phase II of the Accountable Care
Collaborative (ACC), the single regional entity responsible for administering the ACC
program in a designated region. Work — The tasks and activities the Contractor is
required to perform to fulfill its obligations under the Contract, including the
performance of any services and delivery of any goods.
SECTION 3.0 CONTRACTOR'S GENERAL REQUIREMENTS
3.1. The Department will contract with only one (1) organization, the 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.
3.2. The Contractor may be privy to internal policy discussions, contractual issues, price
negotiations, confidential medical information, Department financial information, and
advance knowledge of legislation. In addition to all other confidentiality requirements of
the Contract, the Contractor shall also consider and treat any such information as
confidential and shall only disclose it in accordance with the terms of the Contract.
3.3. The Contractor shall work cooperatively with key Department staff and, if applicable, the
staff of other Department contractors or other State agencies 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 the Contractor and
any other Department contractor, the Department will resolve the conflict and the
Contractor shall abide by the resolution provided by the Department.
3.4. The Contractor shall inform the Department, upon request, on current trends and provide
information on new technologies in use that may impact the Contractor's responsibilities
under this Contract.
3.5. Deliverables
35.1. All deliverables shall meet Department -approved format and content requirements. The
Department will specify the number of copies and media for each deliverable.
3.52. Each deliverable will follow the deliverable submission process as follows:
3.5.2.1. The Contractor shall submit each deliverable to the Department for review and
approval using Department -created forms or templates when available.
3.5.2.2. The Department will review the deliverable and may direct the Contractor to make
changes to the deliverable. The Contractor shall make all changes within ten (10)
Business Days following the Department's direction to make the change unless the
Department provides a longer period in writing. The Department may not use this
section to make substantial substantive changes to the Work.
3522.1. Changes the Department may 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 that
was left out of the deliverable.
3.523. The Department may also direct the Contractor to provide clarification or provide a
walkthrough of each deliverable to assist the Department in its review. The Contractor
shall provide the clarification or walkthrough as directed by the Department.
352.4. Once the Department has received an acceptable version of the deliverable, including
all changes directed by the Department, the Department will notify the Contractor of
its acceptance of the deliverable in writing. A deliverable shall not be deemed
accepted prior to the Department's notice to the Contractor of its acceptance of that
deliverable.
353. The Contractor shall employ an internal quality control process to ensure that all
deliverables, documents and calculations are complete, accurate, easy to understand and
of high quality. The Contractor shall provide deliverables that, at a minimum, are
responsive to the specific requirements for that deliverable, organized into a logical
order, contain no spelling or grammatical errors, are formatted uniformly and contain
accurate information and correct calculations. The Contractor shall retain all draft and
marked -up documents and checklists utilized in reviewing deliverables for reference as
directed by the Department.
35.4. If any due date for a deliverable were to fall on a day that is not a Business Day, then the
due date shall be automatically extended to the next Business Day, unless otherwise
directed by the Department.
355. 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 in
Mountain Time, adjusted for Daylight Saving Time as appropriate, unless specifically
stated otherwise.
35.6. No deliverable, report, data, procedure or system created by the Contractor for the
Department that is necessary to fulfilling the Contractor's responsibilities under the
Contract, as determined by the Department, shall be considered proprietary.
35.7. If any deliverable contains ongoing responsibilities or requirements for the Contractor,
such as deliverables that are plans, policies or procedures, then the Contractor shall
comply with all requirements of the most recently approved version of that deliverable.
The Contractor shall 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 requirements, milestones and deliverables of this Contract.
35.8. Any deliverable described as an update of another deliverable shall be considered a
version of the original deliverable for the purposes of this subsection.
35.9. All Deliverables shall be submitted on the Department -provided template (if available).
All Deliverable submissions must be signed by an authorized Contractor
representative. Use of Adobe eSign to create and apply an electronic signature is
permitted.
3.6. Stated Deliverables and Performance Standards
3.6.1. 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 deliverables. The sections with these headings are not intended to
expand or limit the requirements or responsibilities related to any deliverable or
performance standard.
3.7. Communication Requirements
3.7.1. Communication with the Department
3.7.1.1. The 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 2013 and/or Microsoft Office 365 for
PC. If the Contractor uses a compatible program that is not the system used by the
Department, then the Contractor shall ensure that all documents or files delivered to
the Department are completely transferrable and reviewable, without error, on the
Department's systems.
3.7.2. Communication with Members, Providers and Other Entities
3.72.1. The Contractor shall use SMS/text messaging, e-mail and letter templates stored in the
Healthy Communities Member Relationship Management System for all written
Member communications when appropriate to use them.
3.722. The Contractor shall use an encrypted means of communication when conveying
member PHI or PII electronically. In all cases when communicating member
information to the Department, it is encouraged to use the Healthy Communities
Member Relationship Management System through its non -group communication
(chat, individual messaging and @messaging) methods.
3.7.3. Program Presence and Information Assurance
3.73.1. The Contractor shall maintain a dedicated phone line to receive calls from Members
with questions about the Healthy Communities Program.
3.732. The dedicated phone line shall be answered with a Healthy Communities Program -
specific greeting when answered live.
3.733. The dedicated phone line shall have a Healthy Communities Program -specific
outgoing voice message when the phone cannot be answered by a live agent.
3.734 Unless otherwise approved in writing by the Department, the outgoing voice
message shall include an English and Spanish version of the message or, provide a
phone -tree option for Spanish-speaking callers to select to receive the same
information in Spanish.
3.735. The Contractor shall maintain an office that Healthy Communities Members may
visit with questions about the Healthy Communities Program.
3.73.6. The Contractor shall assure that Members have access to Healthy Communities
Program staff and information by:
3.73.7. Providing and maintaining a means by which Members can communicate with staff
during regular business hours and ensure Members may leave voice messages, email
messages or text messages, if available, and have their messages returned within two
business days.
3.73.8. Making program information available on the Contractor organization's website
where it may be easily seen or found by members using a simple site search and
containing, at minimum: how to reach Contractor program staff, hours they are
available, location of Health Communities Program staff for in -person visits, links to
Department program website, and basic information about how the Healthy
Communities Program may help the member.
3.739. The Contractor shall publish the Healthy Communities Program's statewide toll -free
number (844 -511 -KIDS (5437)) on all its Healthy Communities Program
information sources in addition to, or instead of, the local telephone number it
currently publishes.
3.73.10. Ensuring all reception staff, including their backup and temporary replacement staff,
are familiar with how to connect Members with Healthy Communities Program staff
whether in person, telephone or routing email, voicemail or website inquiries.
3.73.11. Reporting to the Department the Contractor's published Healthy Communities
Program phone number, the link to the Healthy Communities Program website, the
hours staff are available and how internal reception staff are trained to meet this
requirement.
3.73.12. DELIVERABLE: Program Presence and Information Assurance Report
3.73.13. DUE: Within sixty (60) days of the Contract Effective Date.
3.7.4. Communication Plan
3.74.1. The Contractor shall create a Communication Plan that includes, but is not limited to,
following:
3.7.42. A description of how the Contractor will communicate to Members any changes to the
services those Members will receive or how those Members will receive the services.
3.743. A description of the communication methods, including things such as email lists,
newsletters and other methods, the Contractor will use to communicate with Providers
and Subcontractor.
3.7.44. 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.
3.745. A general plan for how the Contractor will address communication deficiencies or
crisis situations, including how the Contractor will increase staff, contact hours or
other steps the Contractor will take if existing communication methods for Members
or Providers are insufficient.
3.74.6. A listing of the following individuals within the Contractor's organization, that
includes cell phone numbers and email addresses:
3.74.7. 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.
3.74.8. An individual who is responsible for any website or marketing related to the Work.
3.749. Back-up communication staff that can respond if the other individuals listed are
unavailable.
3.74.10. The Contractor shall deliver the Communication Plan to the Department for review
and approval.
3.74.11. DELIVERABLE: Communication Plan
3.74.12. DUE: Within forty-five (45) Business Days after the Effective Date
3.74.13. The Contractor shall review its Communication Plan on an annual basis and
determine if any changes are required to account for any changes in the Work, in the
Department's processes and procedures or in the Contractor's processes and
procedures. The Contractor shall submit an Annual Communication Plan Update that
contains all changes from the most recently approved prior Communication Plan,
Annual Communication Plan Update or Interim Communication Plan Update or shall
note that there were no changes.
3.7.4.14. DELIVERABLE: Annual Communication Plan Update
3.7.4.15. DUE: Within thirty (30) days from the date of the change
3.74.16. The Department may request a change to the Communication Plan at any time to
account for any changes in the Work, in the Department's processes and procedures
or in the Contractor's processes and procedures, or to address any communication
related deficiencies determined by the Department. The Contractor shall modify the
Communication Plan as directed by the Department and submit an Interim
Communication Plan Update containing all changes directed by the Department.
3.7.4.17. DELIVERABLE: Communication Plan Update
3.74.18. DUE: Within thirty (30) Business Days following the receipt of the request from the
Department, unless the Department allows for a longer time in writing
3.8. Business Continuity
3.8.1. The Contractor shall create a Business Continuity Plan that the Contractor will follow to
continue operations after a Disaster or a Business Interruption. The Business Continuity
Plan shall include but is not limited to the following:
3.8.1.1. How the Contractor will replace staff that has been lost or is unavailable during or
after a Business Interruption so that the Work is performed in accordance with the
Contract.
3.8.1.2. How the Contractor will back-up all information necessary to continue performing the
Work, so that no information is lost because of a Business Interruption.
3.8.1.3. In the event of a Disaster, the plan shall also include how the Contractor will make all
information available at its back-up facilities.
3.8.1.4. How the Contractor will minimize the effects on Members of any Business
Interruption.
3.8.1.5. How the Contractor will communicate with the Department during the Business
Interruption and points of contact within the Contractor's organization the Department
can contact in the event of a Business Interruption.
3.8.1.6. Planned long-term back-up facilities out of which the Contractor can continue
operations after a Disaster.
3.8.1.7. The time it will take to transition all activities from the Contractor's regular facilities
to the back-up facilities after a Disaster.
3.8.2. The Contractor shall deliver the Business Continuity Plan to the Department for review
and approval.
3.8.2.1. DELIVERABLE: Business Continuity Plan
3.8.2.2. DUE: Within forty-five (45) Business days after the Effective Date
3.8.3. The Contractor shall review its Business Continuity Plan at least semi-annually and
update the plan as appropriate to account for any changes in the Contractor's processes,
procedures or circumstances. The Contractor shall submit an Updated Business
Continuity Plan that contains all changes from the most recently approved prior Business
Continuity Plan or Updated Business Continuity Plan or shall note that there were no
changes.
3.8.3.1. DELIVERABLE: Updated Business Continuity Plan
3.8.3.2. DUE: Within thirty (30) days from the date of the change.
3.8.4. In the event of any Business Interruption, the Contractor shall implement its most recently
approved Business Continuity Plan or Updated Business Continuity Plan immediately
after the Contractor becomes aware of the Business Interruption. In that event, the
Contractor shall comply with all requirements, deliverables, timelines and milestones
contained in the implemented plan.
3.9. Department System Access
3.9.1. If the Contractor requires access to any Department computer system to complete the
Work, the Contractor shall have and maintain all hardware, software and interfaces
necessary to access the system without requiring any modification to the Department's
system. The Contractor shall follow all Department policies, processes and procedures
necessary to gain access to the Department's systems.
3.10. HIPAA Policies
3.10.1. The Contractor shall develop and deliver a HIPAA Policy to the Department for review
and approval. The HIPAA Policy shall address the Contractor's policies for Protected
Health Information (PHI), technologies in place for protecting PHI, and trainings
provided to Contractor staff.
3.10.1.1. DELIVERABLE: HIPAA Policy
3.10.1.2. DUE: Ten (10) Business Days After the Effective Date
3.102. The Contractor shall update their HIPAA Policy, at least annually, to include any
technical, procedural or other changes and deliver this HIPAA Policy Update to the
Department for review and approval.
3.10.2.1. DELIVERABLE: Updated HIPAA Policy
3.10.2.2. DUE: Within thirty (30) days from the date of the change.
3.11. Onboarding Plan
3.11.1. The Healthy Communities Contractor shall create an annual onboarding plan to describe
how the Healthy Communities Contractor and the RAE will partner to onboard eligible
Members successfully. The annual onboarding plan shall include, but is not limited to,
the following information:
3.11.1.1. Shared goals and objectives for Member onboarding.
3.11.1.2. Targeted strategies and activities that will be implemented to maximize Member
outreach and improve health outcomes.
3.11.1.3. Any innovative pilot projects that are being initiated together.
3.11.1.4. Timelines.
3.11.2. DELIVERABLE: Onboarding Plan
3.11.3. DUE: Annually by September 30 and within thirty (30) days from when any agreed
modifications are made, thereafter.
3.11.4. The Contractor shall update the Onboarding Plan in collaboration with their RAE at least
annually.
SECTION 4.0 PERSONNEL GENERAL REQUIREMENTS
4.1. Personnel General Requirements
4.1.1. The Contractor shall provide qualified personnel as necessary to perform the Work
throughout the term of the Contract. The Contractor shall provide the Department with
a final list of personnel assigned to the Contract.
4.12. The Contractor shall designate a staff member to serve as Project Lead. The Project
Lead shall monitor all project activities, ensure the completion of all Work in
accordance with the Contract's requirements, and will act as the primary point of
contact with the Department for all communications, tasks and deliverables.
4.1.3. The Contractor shall designate a Backup Project Lead who will act as Project Lead in
the event of Project Lead's absence extending more than three (3) business days.
4.14. The Contractor shall designate the Accounting Contact who will act as the primary
point of contact for questions and concerns regarding budgets, reimbursement requests,
invoices or expenditures.
4.15. DELIVERABLE: Final list of names of the personnel assigned to the Contract,
including, at minimum, the Project Lead, Backup Project Lead and Accounting
Contact.
4.1.6. DUE: Within five (5) Business Days following the Effective Date
4.12. If any of the Contractor's personnel are required to have and maintain any professional
licensure or certification issued by any federal, state or local government agency, then
the Contractor shall maintain copies of such current licenses and certifications and
provide them to the Department upon request.
4.13. The Contractor shall ensure that all personnel have sufficient training and experience to
complete all portions of the Work assigned to them. The Contractor shall provide all
necessary training to its personnel, except for Department -provided training specifically
described in the Contract.
4.1.4. Subcontractors
4.1.4.1. The Contractor may subcontract to complete Work required by the Contract. The
conditions for using a Subcontractor or Subcontractors are as follows:
4.1.4.2. The Contractor shall provide the organizational name of each Subcontractor and all
items to be worked on by each Subcontractor to the Department.
4.1.4.3. The Contractor shall obtain the Department's prior consent and written approval for
any use of Subcontractor(s).
4.1.4.4. The Contractor shall make or allow for appropriate arrangements for Subcontractor
staff to fully participate in Department required trainings, annual conferences,
meetings and site visits, including site visits to the Subcontractor site.
4.1.4.5. DELIVERABLE: Name of each Subcontractor entity, contact information of staff
performing subcontract work, a list of items on which each Subcontractor will work
and a copy of any agreements, contracts, memoranda of understanding used to carry
out the work of the Contract regardless of whether funds are exchanged.
4.1.4.6. DUE: The later of thirty (30) days prior to the Subcontractor beginning work or the
Effective Date. For other agreements, contracts and memoranda of understanding,
copies of same are due within thirty (30) days of entering the agreement.
4.15. The Contractor shall fully cooperate with the scheduling of and participation in any site
reviews by a Department designee as well as any follow up meetings deemed necessary
by the Department to address specific issues requiring corrective action.
4.1.6. The Contractor shall have at least one (1) member of its staff attend, in person, via
conference call or web conferencing when available, at least ninety (90) percent of all
regular Healthy Communities Family Health Coordinator meetings.
4.1.7. If all appropriate staff and subcontractor staff cannot attend any given meeting, the
Contractor shall ensure they all are provided the same training as those in attendance.
4.1.8. The Contractor shall notify the Department at least within one (1) Business Day when
any individual, employee, intern, or subcontractor with access to Department data
systems leaves employment and at least within five (5) Business Days of hiring a new
employee.
4.1.9. The Contractor shall ensure all provisions of this Contract will be carried out during such
employment/subcontractor gaps or transitions and shall secure replacements within
thirty (30) days.
SECTION 5.0 PROJECT REQUIREMENTS
5.1. The Contractor shall serve as the Healthy Communities Contractor for Weld County.
5.2. The Contractor shall complete the Work pursuant to the Department's policies including
the Department's Healthy Communities Member Relationship Management System
procedures. These procedures may be updated regularly by the Department via a web site.
The Contractor shall comply with all updated procedures.
53. Regional Accountable Entity (RAE) Coordination
5.3.1. The Contractor shall work collaboratively with its RAE or RAEs, if applicable, to align
and coordinate onboarding and outreach activities.
53.1.1. To enable a collaborative partnership, the Contractor shall establish a documented
agreement, either a Memorandum of Understanding (MOU) or a contract, with the
RAE or RAEs, if applicable, that serve the same county or counties the Contractor
serves in accordance with the ACC Phase II Implementation — RAE and Healthy
Communities Collaboration policy document effective July 1, 2018.
53.12. DELIVERABLE: Copy of MOU or contract with RAE or RAEs, if applicable.
53.13. DUE: Within thirty (30) days of the completion of the agreement and thirty (30) days
from the date of any modifications to the agreement but no later than September 30,
2019, unless a date change is approved in writing by the Department.
53.1.4. DELIVERABLE: RAE Meeting Schedule for the contract period.
53.15. DUE: By July 31, 2019, unless a date change is approved in writing by the
Department.
5.4. EBNE Outreach
5.4.1. The Contractor shall conduct, on average throughout the contract period, a minimum of
one (1) EBNE outreach activity per quarter for each county it serves under the contract.
5.4.1.1. Outreach may include, but is not limited to, the following activities:
5.4.1.1.1. Health fairs.
5.4.1.1.2. Back -to -school nights.
5.4.1.1.3. Workshops, presentations, and in-service announcements to community -based
organizations and agencies who interact with the similar populations served by
Healthy Communities.
5.42. The outreach information shall, at a minimum, include the following program
information:
5.42.1. Information describing Health First Colorado (Colorado's Medicaid Program) and
Child Health Plan Plus (CHP+) including basic eligibility requirements for these
programs, benefits and services.
5.422. How and where the EBNE individual can apply for Medical Assistance.
5.423. Information about the role of the RAE in coordinating Member care and providing
other support in accordance with the Onboarding Plan.
5.42.4. Information about the services and resources provided by Family Health Coordinators.
543. The Contractor shall assist EBNEs with the application process, which may include any
of the following:
5.43.1. Completing a paper Colorado Medical Assistance Programs application or the
Colorado Program Eligibility and Application Kit (PEAK), downloading the
PEAKHealth (Smartphone) Application, linking the application to the Member's
PEAK account and providing basic information about how to use the application or
where to find additional help.
5.432. Providing onsite Presumptive Eligibility (PE) determinations for those who may
qualify.
5.433. Providing an appropriate referral, when necessary, to another application assistance
site, including, but not limited to, a local department of human or social services, a PE
site, a Certified Application Assistant Site (CAAS), or a Medical Assistance (MA)
site.
5.5. Member Onboarding
5.5.1. The Contractor shall assist Members enrolled in Health First Colorado and CHP+ with
navigating the programs.
5.5.2. In accordance with the Onboarding Plan, the Contractor shall perform the following
tasks for all individuals who qualify for the Healthy Communities Program:
5.5.2.1 Follow up with pregnant women, children, families, and EBNEs regarding the status
of their application as requested by the Member.
5.5.2.2 Provide Healthy Communities Program Members with a list of appropriate Health
First Colorado and CHP+ Providers and referrals when appropriate.
5.5.2.3 Provide assistance setting appointments when requested by Healthy Communities
Program Members.
5.5.2.4 Provide referrals for medical and non -medical programs to Healthy Communities
Program Members as requested by the Member.
5.5.2.5 Follow up with Members who missed their appointment as requested by physical,
oral and mental health Providers.
5.5.2.6 The Contractor shall assist Members in finding or accessing appropriate
community resources and ensure families have access to the programs.
5.5.2.7 Follow up with Members who have not received preventive oral or medical services
within the recommended time frame as outlined in the Department -adopted
periodicity schedules.
5.5.2.8 Assist in resolving any issues or concerns regarding enrollment into Health First
Colorado or CHP+ and eligibility issues, including by facilitating contact with
CHP+ contractor, county department of social or human services technicians, the
Department's Eligibility and Enrollment Medical Assistance Program contractor,
the Department's Enrollment Broker or other Medical Assistance sites as
appropriate.
5.5.2.9 Assist Health First Colorado Members with scheduling Non -Emergent Medical
Transportation (NEMT) through the Health First Colorado Transportation Broker or
local department of human or social services.
5.5.2.10 Assist Members with resolving issues including Provider demands for payment,
collections issues and any additional questions and issues regarding program
benefits or navigation, as requested by Members.
5.5.3 The Department will provide access to the database systems and information necessary
to carry out the provisions of this contract, including, but not limited to, the Colorado
Benefits Management System (CBMS), the Healthy Communities Member
Relationship Management System, Provider Web Portal, the Benefits Utilization
System (BUS), PEAK Pro, and interChange, on an as -needed basis as determined by
the Department's Healthy Communities Program and Contracts Manager.
5.5.4 The Contractor shall educate the Member regarding the availability of services offered
by the Healthy Communities Program.
5.6. Provider and Community Partner Outreach
5.6.1. The Contractor shall educate Providers on all services provided by or available through
Healthy Communities Program.
5.62. The Contractor shall assist Providers to confirm program eligibility and resolve
eligibility verification discrepancies to prevent rescheduling or members missing
appointments.
5.63. The Contractor shall assist Providers with missed appointment follow-up as requested.
This assistance shall include calling Members to coordinate assistance needed to attend
appointments. This may include providing to the Member resource referrals such as
transportation assistance or child care resources to allow the Member to attend an
appointment.
5.6.4. The Contractor shall assist community partners in understanding the Health First
Colorado and CHP+ medical assistance programs, program benefits, and program
administration.
5.65. The Contractor shall plan, manage, and coordinate collaborative efforts and activities
with community partners to ensure better service delivery and education to the
populations served.
5.6.6. The Contractor shall attend relevant meetings, conferences, and other channels of
collaboration in conjunction with community partners at no additional cost to the
Department.
5.7. Member Relationship Management System
5.7.1. The Contractor shall provide access for employees performing the Work to use the
Healthy Communities Member Relationship Management System as required.
5.72. The Contractor shall assure that all information needed to assist Members, such as
Providers and community resources are added to the Healthy Communities Member
Relationship Management System as they relate to the Healthy Communities Program
in a timely manner and assure lists are available for use by Members and Community
Partners as needed.
5.73. The Contractor shall assure that all Healthy Communities staff are computer literate and
able to use the Healthy Communities Client Relationship Management System to its
full potential.
5.7.3.1. At the Department's discretion, the Department may ask Contractor staff to complete
computer and Healthy Communities Member Relationship Management System
proficiency testing and to complete, at the Contractor's expense, training deemed
appropriate by the Department.
5.74. The Contractor shall enter data accurately into the Healthy Communities Member
Relationship Management System according to conventions agreed upon by the
collaboration between the Contractor and the Department, such as outreach events,
referrals and interactions with Members.
5.75. The Contractor shall assure the Healthy Communities Member Relationship
Management System is up to date prior to the 10th day of each month. The Department
will generate reports for monthly contacts, referrals, and outreach activities on the 10th
of the month to meet reporting requirements.
5.7.6. The Contractor shall submit all requests for extensions of the deadline to the Department in
writing no later than the 5th of the month.
5.8. Training
5.8.1. At the Department's request, the Contractor shall attend Departmental trainings.
Departmental trainings may include, but are not limited to:
5.8.1.1. Training on the Healthy Communities Member Relationship Management System
and access to the system for each of the Contractor's current employees working with
the Healthy Communities Program and those whom the Contractor may hire to work
on the program during the contract year.
5.8.1.2. Quality assurance and other trainings during site visits.
5.8.2. Contractor shall follow the Department's standardized training curriculum.
5.82.1. Training curriculum will include, but not be limited to, information regarding the
following topics:
5.8.2.1.1. Healthy Communities Member Relationship Management System data entry
including data entry conventions.
5.8.2.1.2. Health First Colorado and CHP+ benefits.
5.8.2.1.3. Health First Colorado and CHP+ eligibility.
5.8.2.1.4. CBMS use.
5.8.2.1.5. Use of PEAK to assist Members.
5.8.2.1.6. Other topics as needed to fulfill the program's purpose.
5.9. Reporting
5.9.1. Contractor Quarterly Report
5.9.1.1. By the end of the month after each fiscal quarter, the Contractor shall submit a report
summarizing, at a minimum, the following:
5.9.1.1.1. The activity of the previous quarter including noteworthy accomplishments, project
status, challenges or barriers to program efforts, and collaborations with community
or other agency partners;
5.9.1.1.2. A description of the outreach activities conducted by the Contractor that quarter;
5.9.1.1.3. A description of the events and activities that the Contractor conducted to increase
the number of well -child and oral health visits, increase physical health visits, and
increase oral health visits;
5.9.1.1.4. A list of staff who performed Work during the quarter;
5.9.1.1.5. The total number of Full Time Equivalent (FTE) hours the Contractor staff spent
on contract Work during the quarter; and
5.9.1.1.6. Other information requested by the Department from the Healthy Communities
Member Relationship Management System.
5.9.1.2. DELIVERABLE: Contractor Quarterly Report.
5.9.1.3. DUE: By the end of the month after each fiscal quarter
5.9.2. Proposed Program Budget
5.9.2.1. The Contractor shall submit a detailed Proposed Program Budget to the Department
within thirty (30) days of the issuance or renewal of the Contract with the Department.
At a minimum, the Budget Report shall include all anticipated program related
expenses for employee(s) and operating expenses for the entire Contractual period.
5.9.2.1.1. DELIVERABLE: Proposed Program Budget.
5.9.2.1.2. DUE: Within thirty (30) days of the issuance or renewal of the Contract with the
Department.
5.9.3. Final Report
5.9.3.1. The final report shall consist of the accumulation of the quarterly reports with an
additional summary representing the whole year.
5.9.3.2. DELIVERABLE: Final Report.
5.9.3.3. DUE: Thirty (30) days after the Contract expires, renews or is terminated.
5.9.4. Ad Hoc Reporting
5.9.4.1. The Contractor shall provide Ad Hoc Reports as requested by the Department.
5.9.4.2. When an Ad Hoc Report is requested, the Contractor shall coordinate with the
Department to confirm its understanding of the request and identify the best method
for response.
5.9.4.3. The Contractor shall provide all ad hoc reports within thirty (30) days of the
Department's request at no additional cost to the Department.
SECTION 6.0 PERFORMANCE STANDARDS
6.1. The Contractor shall adhere to all performance standards published by the Department via
policies and procedures documents, as well as those published on the Healthy Communities
Member Relationship Management System, training materials or periodic Departmental
communications.
6.1.1. New Member Communication Standard
6.1.1.1. The Contractor shall reach out to newly enrolled Members with an Inform to share
their benefits (Health First Colorado or CHP+), offer navigation assistance, and
provider or resource referral within sixty (60) days of the Member's enrollment or
within two (2) weeks of appearing on the Newly Enrolled Member List whichever is
later.
6.1.1.2. The Contractor shall attempt to reach members at least three (3) times within a two
(2) week period — preferably varying the times of day and days of week called.
Whenever possible, the Contractor shall leave a message for the Member to return the
call. Upon the final attempt to reach the Member, the Contractor shall leave a
program informational message (Inform) that provides information about the program
and how the member may access program services. Such messages may only be left
within strict adherence to HIPAA guidelines and the Business Associate Agreement
with the Department.
6.1.2. The Contactor may provide an Inform via mail under all of the following conditions:
6.1.2.1. After the Contractor has attempted, but was unable, to reach the member or family
representative or other means or no information for other communication methods
was provided by the Department;
6.1.2.2. The Inform via mail uses Department -approved letter template generated in the
Healthy Communities Member Relationship Management System, or other
Department -approved letter and the interaction is recorded in the database. While not
required, it is preferred that each letter contain some handwritten information or
message including hand -addressing the envelope whenever possible;
6.1.23. Informs are mailed with a "Return Service Requested" insignia on the envelope,
address information is corrected and logged in the database within one (1) week of
mail being returned, and another letter is sent to the new address; and
6.12.4. The Contractor has certified to the Department within five (5) days of the execution
of the Contract that it is following all requirements for Informs via mail herein.
6.1.3. If the Contractor used automated (robo) calling systems to reach Members, it shall use
such systems only after initial attempts to reach Members through other means have
failed. Regardless, the Contractor shall ensure that the use of such systems is carried
out within strict adherence to HIPAA guidelines, and the Business Associate
Agreement with the Department providing only the minimum information required to
providers of such services as necessary. The Contractor shall ensure that such service
providers comply with all other state rules and regulation regarding contacting Members
in such a manner. The Contractor is encouraged to stagger the time of day and days of
week, including evenings and weekends per Federal Communications Commission
limitations, to optimize chances of reaching members. When available, even if at
greater expense, the Contractor shall utilize interactive tools to allow member and
recipients to provide feedback such as answers to survey questions, requests for a call
back or additional information.
SECTION 7.0 PERFORMANCE METRICS
7.1. By the Effective Date of this Contract, the Department will provide the Contractor with
historical data with which to determine past performance and establish a baseline for
comparing future performance and performance change. Additionally, by that time, the
Contractor will have regular, timely access to benefit utilization data for well -child visits
and oral health screenings for all members in the Contractor service area.
72. Contractor goals will be established to help improve the screening participation rates for
child wellness visits and increase oral health screenings as reported by the Department on
the CMS EPSDT 416 Report per CMS criteria.
73. Performance expectations are as follows:
7.3.1. Child Wellness Visit Screening Participation Rates
7.3.1.1. Contractors whose baseline data is at or above CMS child wellness visit screening
participation criteria of eighty percent (80%), the expectation is to increase
performance by two (2) percentage points for the contract period.
7.3.1.2. Contractors whose baseline data is between sixty percent (60%) and 79.99 percent
for child wellness visit screening participation, the expectation is to increase
performance by a minimum of four (4) percentage points for the contract period.
7.3.1.3. Contractors whose baseline data is below sixty percent (60%) for child wellness visit
screening participation, the expectation is to increase performance by a minimum of
seven (7) percentage points for the contract period.
7.3.2. Child Oral Health Screening Participation Rates
7.3.2.1. The Contractor is expected to increase child oral health screening participation by
two (2) percentage points above their baseline for the contract period.
7.3.3. While the CMS EPSDT 416 Report data is how the Department is evaluated by CMS, for
purpose of these performance metrics with respect to this contract and any incentive
programs that may be developed for these purposes, the Department will use data
represented in the Healthy Communities Member Relationship Management System.
SECTION 8.0 CLOSEOUT PERIOD
8.1.1. The Contract shall have a Closeout Period.
8.1.1.1. The Closeout Period shall begin on the earlier of ninety (90) days prior to the end of
the last renewal year of the Contract or notice by the Department of non -renewal. The
Closeout Period shall end 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.
8.1.12. This Closeout Period may extend past the termination of the Contract and the
requirements of the Closeout Period shall survive termination of the Contract.
Closeout Period
During the Closeout Period, the Contractor shall complete the following:
Implement the most recent Closeout Plan or Closeout Plan Update that has been
approved by the Department, as described in Section 8.1.3 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.
8.12.12. 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.
8.12.13. 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.
8.12.1.4. Notify any Subcontractor of the termination of the Contract, as directed by the
Department.
8.12.1.5. Notify all Members that the Contractor will no longer be the Healthy Communities
Outreach and Case Management Contractor. The Contractor shall create these
notifications and deliver them to the Department for approval. Once the Department
has approved the notifications, the Contractor shall deliver these notifications to all
Members, but in no event shall the Contractor deliver any such notification prior to
approval of that notification by the Department.
8.12.1.6. DELIVERABLE: Member Notifications
8.12.1.7. DUE: Thirty (30) days prior to termination of the Contract
8.1.2.2. 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 sooner. The Department will determine when any specific requirement is being
performed by the Department or another contractor and will notify the Contractor of
this determination for that requirement.
8.1.2.3. The Department will perform a closeout review to ensure that the Contractor has
completed all requirements of the Closeout Period, In the event that the 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.
8.1.3. Closeout Planning
8.1.3.1. Closeout Plan
8.1.3.1.1. The 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 the Contractor to the Department to another
contractor selected by the Department to be the Healthy Communities Outreach and
Case Management Contractor after the termination of the Contract. 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 Members and the Department.
The Contractor shall deliver the Closeout Plan to the Department for review and
approval.
8.13.1.2. DELIVERABLE: Closeout Plan
8.13.13. DUE: Thirty (30) days following the Effective Date
8.1.3.2. The Contractor shall update the Closeout Plan, at least annually, to include any
technical, procedural or other changes that impact any steps, timelines or milestones
contained in the Closeout Plan, and deliver this Closeout Plan Update to the
Department for review and approval.
8.1.3.3. DELIVERABLE: Closeout Plan Update
8.1.3.4. DUE: Within thirty (30) days of the date changes are made
9 SECTION 9.0 PAYMENT Initiatives Reimbursed from Contract Funds Held in Reserve:
9.1 The Department will implement an incentive program through which the Contractor
may earn up to fifteen percent (15%) of the annual Contract amount to be paid out
quarterly and annually upon the successful completion of the following initiatives and
under the following circumstances.
9.2 Process Improvement Initiative
9.2.1 The Contractor shall be eligible each quarter to receive 1.25% of the total Contract
amount upon successful completion of the Process Improvement Initiative.
9.2.2 The Contractor shall submit on time all Contract process deliverables due within the
Contract period regardless of which Contract period the deliverable may cover.
9.2.3 Process deliverables are those listed in Exhibit D, Healthy Communities Contract
Deliverable Schedule - SFY2020.
9.2.4 The Department will provide the Contractor written notice of receipt of each
deliverable, indicating the date of receipt, within two (2) Business Days of receipt
by the Department.
9.2.5 The Department will provide the Contractor written notice of each deliverable's
Acceptance Status within ten (10) Business Days of receipt.
9.2.6 The Contractor shall complete all deliverable deficiencies (e.g. the Contractor was
notified by the Department that the deliverable was "Not Accepted" or "Accepted
with Changes") within ten (10) Business Days of the of Contractor notice.
9.2.7 Initiative completion payments will be paid out quarterly provided all deliverables
due during the period were submitted on time. Payments for subsequent quarters
will require all late prior quarter deliverables were submitted and the deliverables
for the payment period were received on time.
9.2.8 All deliverable deficiencies due within a deliverable completion payment period
must be remedied by the due date for the Contractor to be eligible for payment.
9.3 Program Improvement Initiative
9.3.1 The Contractor shall be eligible to receive up to five percent (5%) of the total
Contract amount upon successful completion of the Program Improvement Initiative.
9.3.2 The Program Improvement Initiative requires that the Contractor deliver Department -
approved training(s) or presentation(s)at one (1) or more quarterly meetings. As of
the date of Contract execution these are scheduled for August 21, 2019; November
13, 2019; February 19, 2020; and May 20, 2020.
9.3.3 Contractors with total annual contract amounts under $100,000.00 may, and are
encouraged to, present in collaboration with one (1) other contractor in the same
group. These contractors shall receive five percent (5%) of the total Contract amount
upon successful completion of the training or presentation included in the Program
Improvement Initiative.
9.3.4 Contractors with total annual contract amounts between $100,000.00 and
$200,000.00 shall complete one (1) training or presentation during the contract
period. These contractors shall receive five percent (5%) of the total Contract amount
upon successful completion of the training or presentation included in the Program
Improvement Initiative.
9.3.5 Contractors with total annual contract amounts over $200,000.00 shall conduct two
(2) such trainings or presentations during the contract period. These contractors shall
receive 2.5% of the total Contract amount upon successful completion of each
training or presentation included in the Program Improvement Initiative.
9.3.6 The Contractor shall submit its training or presentation topic(s) for approval no later
than July 24, 2019. Training or presentation topic submissions shall include:
9.3.6.1. Overview of the training or presentation including the intended presenter.
9.3.6.2. The training or presentation purpose, e.g. how it will help Family Health
Coordinators improve their work, etc.
9.3.6.3. A brief outline of the training or presentation including proposed handouts.
9.3.6.4. Requested date(s) of training or presentation
9.3.6.5. An indication of how the audience participation and understanding will be
evaluated.
9.3.7 DELIVERABLE: Training and presentation topic submission(s)
9.3.8 DUE: July 24, 2019
9.3.9 The Contractor's training shall be composed of the following:
9.3.9.1. A 20 -minute A/V presentation, either in -person or remotely via webinar
9.3.9.2. Up to ten (10) minutes for follow up, question and answer period, etc.
9.3.9.3. Handouts which shall consist of the presentation PowerPoint slides (3 slides per
page) but may also include any material relevant to the presentation topic
9.3.9.4. Examination which shall be comprised of at least three (3) (but no more than ten
(10)) questions that address the fundamental points of the presentation and will
gauge the audience's participation in and understanding of the presentation. The
Department will administer the examination to remote participants electronically
immediately after the presentation as an online survey and will administer to in -
person participants via a written examination.
9.3.9.5. DELIVERABLE: Presentation, handouts and examination
9.3.9.6. DUE: Fifteen (15) Business Days prior to the scheduled presentation
9.3.9.7. The Department will notify the Contractor within one (1) Business Day of receipt of
the presentation, handout and evaluation. The Department will notify the
Contractor of their Acceptance Status within three (3) business days of receipt. The
Contractor shall remedy any deficiency and resubmit to the Department. within
five (5) Business Days of Acceptance Status.
9.3.9.8. DELIVERABLE: Remedied presentation, handouts and examination
9.3.9.9. DUE: Five (5) Business Days from notification of Acceptance Status.
9.3.10 In lieu of each training or presentation as described above, the Contractor may
submit for Department approval by July 24, 2019, any other Program Improvement
Initiative of its choosing.
9.3.11 The Department will notify the Contractor of the Acceptance Status of the Program
Improvement Initiative within thirty (30) days of completion of the training or
presentation.
9.4 Program Outcomes Initiative
9.4.1 The Contractor shall be eligible to receive up to five percent (5%) of the total Contract
amount upon successful completion of the Program Outcomes Initiative.
9.4.2 The Contractor will be eligible for payment at the end of the contract period per the
following tiered payment structure:
9.4.2.1. 40%-44.99% of new Member Informs completed — Pays 1.25% reserve funds
9.4.2.2. 45%-49.99% of new Member Informs completed — Pays 2.5% reserve funds
9.4.2.3. 50%-54.99% of new Member Informs completed — Pays 3.75% reserve funds
9.4.2.4. 55% or greater of new Member Informs completed — Pays 5% reserve funds
9.4.3 A completed Inform means providing to members on the Newly Enrolled Member List
program -specific information including: name and contact information for their
managed care organization or RAE; Fee For Service treatment as applicable; an
overview of covered medical, behavioral and oral health benefits; non -covered
services and benefits (member reimbursement, etc.) and examples of services that may
require prior authorization; support for member identified needs for medical,
behavioral or oral health care or related services such as non -emergency medical
transportation, or community based services or supports.
9.4.4 Additionally, Contractor staff denoting a completed new Member Inform in the
Healthy Communities Member Relationship Management System shall be considered
an attestation that all or most of the above information was provided, in person or by
telephone, automated (robo) call message delivered in its entirety, text/SMS message,
to the member/family. Informs made via mail may only be used following the criteria
in Section 6.1.2 of this Contract and may account for no more than fifteen percent
(15%) of the Contractor's total Informs to Newly Enrolled for this initiative.
9.4.5 The Department will make available in the Member Relationship Management System
reports that the Contractor can review, at -will, its progress toward this measure.
9.4.6 An Inform may be denoted as "Completed" if the Contractor staff, after speaking with
the member/family, was able to address all of the member's/family's questions or
concerns identified in the interaction and provide information for them to find
additional help appropriate to their program.
9.5 Unclaimed Contractor Funds Pool
9.5.1 The Department will create a performance pool from any monies not distributed to the
contractors for performance on the Process Improvement, Program Improvement and
Program Outcomes Initiatives.
9.5.2 The Contractor is eligible for performance pool distributions if at least thirty-five
percent (35%) of their new Member Informs assigned are completed regardless of the
level of reimbursement, if any, they received for the Program Outcomes Initiative. The
Department will distribute the funds as follows:
9.5.2.1. 30% to the Healthy Communities contractor with greatest improvement in Well -
Child Screening Rates
9.5.2.2. 20% to the Healthy Communities contractor with second greatest improvement in
Well -Child Screening Rates
9.5.2.3. 10% to the Healthy Communities contractor with third greatest improvement in
Well Child Screening Rates
9.5.2.4. 20% to the Healthy Communities contractor with greatest improvement in Child
Oral Health Screening Rates
9.5.2.5. 12% to the Healthy Communities contractor with second greatest improvement in
Child Oral Health Screening Rates
9.5.2.6. 8% to the Healthy Communities contractor with third greatest improvement in Child
Oral Health Screening Rates
9.5.2.7. In the event of a tie, the tied contractors will split equally the available funds for the
category.
9.5.3 The amount of unclaimed pool funds shall be no more than $444,243.60 for the
contract period.
9.6 Contract Payment
9.6.1 The Contractor shall submit an invoice and Quarterly Report to the Department for
Work performed under this Contract. The Contractor shall submit these documents no
later than the last day of the month following the end of the fiscal quarter. The
Department will not pay out the invoice until the Contractor's Quarterly Report has
been received and Accepted.
9.6.2 The Contractor shall include on all invoices the Contract routing number (from the
first page of the Contract), the appropriate State of Colorado Vendor Code attributed to
the Contractor and a unique invoice number from any other programs/entities under
the same vendor code.
9.6.3 The Contractor shall submit quarterly invoices reflecting one fiscal quarter each.
9.6.4 The Contractor shall submit all invoices as soon as possible after the close of the fiscal
quarter but no later than the last day of the month following the end of the fiscal
quarter.
9.6.5 The Contractor shall submit invoices electronically to the designated email mailbox
(hcpf healthycomm@state.co.us) as a single file attachment in a searchable Adobe
Portable Document Format (.pdf) using the following file naming convention:
##MonYR — Contractor Name - $#,###.## - #####.pdf (The two -digit contract month
01-12 —three-letter month name and two -digit year —Contractor Name — dollar amount
of this invoice — Contractor invoice number.pdf — for example: "04Oct17 — Boulder
County Housing and Human Services - $6,543.21 — 0417.pdf')
9.6.6 The Contractor shall sign all invoices. Adobe eSign is permitted.
9.6.7 The total of the invoices submitted by the Contractor for all periods during a contract
period shall not exceed the Contract maximum amount for that year.
9.6.8 The Contractor shall not include on the quarterly invoice more than 21.25% of the
total Contract amount.
9.6.9 The Department will remit payment to the Contractor via Electronic Funds Transfer
(EFT) unless other arrangements have been made with the Department's Accounting
Section per Department policy.
Exhibit D
Healthy Communities: SFY20 Contractor Deliverables Schedule
Note: Please review the contract (SFY16) AND contract amendment for complete contract deliverable information.
Contract
Section
Due SFY2019
Due SFY2020
Notes
Base
Contract:
§13
Proof of Liability Insurance
... within 10 business days of new policy effective date
6.1.1.3
Mailed Informs Certification
7/5/2019
5.9.2
Proposed Budget
7/5/2019
4.1.1.3.1
Project Lead - Staffing
7/5/2019
...AND within 1 business day of staff leavining/5 business days of
new staff employment - notification required of backup when lead
will be absent for more than 3 days
3.7.3
Communication Plan*
9/30/2019
...AND within 30 days of changes
3.8
Business Continuity Plan*
8/15/2019
...AND within 30 days of changes
3.1
HIPAA Policies*
6/30/2019
6/30/2020
...AND within 30 days of changes
3.7.2.3
Program Presence Report
7/29/2019
...AND within 30 days of changes
4.1.4
Subcontractor List
7/30/2019
...AND within 30 days of changes
4.1.4
Submit Copy Subcontracts
7/30/2019
...AND within 30 days of changes
5.3
RAE Coordination Agreement Update
10/31/2019
...AND within 30 days of changes
5.3
RAE Coordination Meeting Schedule
7/31/2019
...AND within 30 days of changes
3.11
Onboarding Plan Update
9/30/2019
...AND within 30 days of changes
5.9.1
Quarterly Report - 4th Quarter = Cumulative
Annual Report
Within 1 month after fiscal quarter end (by end of October,
January, April, July - for prior year)
8.1.3.1
Closeout Plan*
6/30/2019
6/30/2020
...AND within 30 days of changes
9.2.4
Invoices Due (for previous period)
Within 1 month after end of billing period
4.1.6
Quarterly Meetings Attendance Certification
Within 2 business days after meeting
*
If no changes from previous submisison, It is permissible to submit a statement to that effect.
To be submitted on Department -provided template
Grant
YES
IGA
New Contract Request
Entity Information
Entity Name*
COLORADO DEPT OF HEALTH CARE
POLICY & FINANCING
Entity ID*
@,.0OO07174
Contract Name* Contract ID
HEALTH'rCOMMUNITIES PROGRAM FY20 CONTRACT 2785
AMENDMENT #4
Contract Le
Contract Status TGEISER
CTB REVIEW
Contract Lead Email
tgelseer cc .weld.co us
Contract Description*
CONTRACT AMENDMENT #4 FOR THE HEALTHY COMMUNITIES PROGRAM FY19-20
CONTRACT NUMBER 2015`"02914
Contract Description 2
PREVIOUS CONTRACT NUMBER 2016-029A3
ORIGINAL CONTRACT NUMBER 2015"029
Contract Type*
GRANT
Amount k
$142382.00
Renewable *
NO
De ;. e
HEALTH
nt
Department Email
CM-Hearth@teIdgova.com
Department Head Email
C M -Heath-
DeptHead@weldgov. Gorr
Automatic Renewal
NO County Attorney
GENERAL COUNTY
ATTORNEY EMAIL
County Attorney Email
CM-
COUNTYATTORNEY@V ELD
GOV. COM
Grant Deadline Date
if this is a renewal enter previous Contract ID
18'93
If this is part of a MSA enter MSA Contract ID
❑ New Entity?
Requested BOCC Agenda
Date*
06/17/2019
Parent Contract ID
Requires Board
YES
Department Project #
Due Date
061112019
Will a work session with BOCC be required?
NO
Does Contract require Purchasing Dept. to be included?
NO
Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in
OnBase
Contract Dates
Effective Date
07/01/2019
Review Date
05101/2020
Renewal Date
Termination Notice Period Committed Delivery Date
Expiration Date*
0613(2020
Contact Information
Contact Info
Contact Name
Purchasing
Purchasing Approver
Approval Process
Department Head
TANYA GESER
DH Approved Date
06/1712019
Final Approval
BOCC Approved
YES
BOCC Signed Date
06/24/2014
BOCC Agenda Date
06/24i2019
Originator
TGEISER
Contact Type Contact Email
Finance Approver
BARE CONNOLLY
Contact Phone 1 Contact Phone 2
Purchasing Approved Date
Finance Approved Date
0,5.'1712019
Tyler Ref #
CTE TEMP
Legal Counsel
KARlN MCD0UGAL
Legal Counsel Approved Date
06117/2019
2,214
Submit
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