HomeMy WebLinkAbout20181818.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT #3 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 #3 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, 2018, and ending June 30, 2019, 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 #3 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 11th day of June, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: di:04v v• itD;ei
Weld County Clerk to the Board
Deputy Clerk to the B
APP '• ED
unty Attorney
Date of signature: &7-42-4)
Steve Moreno, Chair
EXCUSED
Barbara Kirkmeyer, P -Tem
Mike Freeman
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2018-1818
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Memorandum
TO: Steve Moreno, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: June 7, 2018
SUBJECT: Healthy Communities Continuation Contract
For the Board's approval is a FY2018-2019 Healthy Communities a contract amendment 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, 2018, through June 30, 2019. 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, Frank Haug, has reviewed this contract and determined that the terms
are acceptable.
This contract was approved for placement on the Board's agenda via pass -around dated June 4,
2018.
I recommend approval of this Healthy Communities renewal contract.
2018-1818
A.0O50
(p/it
Contract Number 20160000000000000029A3
CONTRACT AMENDMENT NO.3
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 2018-19, 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:
Initial Term
The parties' respective performances under this Contract shall commence on the later of July 1, 2018
or the effective date. This Contract shall expire June 30, 2019, 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
Page 1 of 3
o?o/F- gl8(1)
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
135000
State Fiscal Year 2016-2017
137000
State Fiscal Year 2017-2018
137000
State Fiscal Year 2018-2019
142382
Total for All State Fiscal Years
551382
C. Exhibit A2, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit A3,
Statement of Work, attached hereto and incorporated by reference into the Contract. All references
within the Contract to Exhibit A, Exhibit Al, and/or Exhibit A2, shall be deemed to reference to
Exhibit A3.
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 event of 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
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.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 2 of 3
Contract Number 20160000000000000029A3
THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT
Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf
and acknowledge that the State is relying on their representations to that effect.
By:
CONTRACTOR:
Board of County Commissioners of Weld
County
Signature of Authorized Officer
Date: JUN 11 2018
Steve Moreno
By:
Date:
STATE OF COLORADO:
John W. Hicklpoper, Governor
Kith Bimeste
Executive Director
Department of Health Care Policy and
Financ' g
Lo( -1‘(
LEGAL REVIEW:
Printed Name of Authorized Officer Cynthia H. Coffinan, Attorney General
By:
Chair
Printed Title of Authorized Officer Date:
ALL CONTRACTS REQUIRE 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:
Delia
Date:
STATE CONTROLLER:
erl J •_ CPA, MBA, JD
th Ca ,Policy and Financing'' 0
Page 3 of 3
O24 / k- /k/$(z)
Contract Routing Number 20160000000000000029A3
EXHIBIT A-3, STATEMENT OF WORK
SECTION 1.0 PROGRAM PURPOSE
1.1. The purpose of the Healthy Communities program 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.
1.1.1. Toward that end, the Contractor:
1.1. I.1. 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 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.
2.1.1. 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.
2.1.2. 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.
Exhibit A-3 Page 1 of 20
2.1.3. 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.
2.1.4. 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.
2.1.5. 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.
2.1.6. 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.
2.1.7. 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.
2.1.8. 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.
2.1.9. 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.
2.1.10. 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.
2.1.11. Health First Colorado, Colorado's Medicaid Program — The name for Colorado's
Medicaid program beginning in July 2016.
2.1.12. 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.
2.1.13. Member Onboarding — Outreach, navigation and education services to Members or their
family representative.
2.1.14. Operational Start Date - The later of July 1, 2018 or when the Department authorizes the
Contractor to begin fulfilling its obligations under the Contract.
Exhibit A-3 Page 2 of 20
2.1.15. 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.
2.1.16. 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.
2.1.17. Provider — Any health care professional or entity that has been accepted as a provider in
the Colorado Medicaid program, Colorado's CHP+ program, or the Colorado Indigent
Care Program, as determined by the Department.
2.1.18. Regional Accountable Entity (RAE) — Under Phase II of the Accountable Care
Collaborative (ACC), it is a single regional entity responsible for administering the ACC
program in a designated region. Under Phase I of the ACC, it was known as Regional
Care Collaborative Organization (RCCO).
2.1.19. 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.
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.
Exhibit A-3 Page 3 of 20
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
3.5.1. All deliverables shall meet Department -approved format and content requirements. The
Department will specify the number of copies and media for each deliverable.
3.5.2. 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.
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.
3.5.2.2.1. 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.
3.5.2.3. 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.
3.5.2.4. 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.
3.5.3. 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.
3.5.4. 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.
3.5.5. All due dates or timelines that reference a period of days, months or quarters shall be
measured in calendar days, months and quarters unless specifically stated as being
measured in Business Days or otherwise. All times stated in the Contract shall be in
Mountain Time, adjusted for Daylight Saving Time as appropriate, unless specifically
stated otherwise.
Exhibit A-3
Page 4 of 20
3.5.6. 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.
3.5.7. 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.
3.5.8. Any deliverable described as an update of another deliverable shall be considered a
version of the original deliverable for the purposes of this subsection.
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
3.7.2.1. The Contractor shall use SMS/text messaging, e-mail and letter templates stored in the
Healthy Communities Client Relationship Management Database for all written
Member communications when appropriate to use them.
3.7.2.2. 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 Client
Relationship Management Database through its non -group communication (chat,
individual messaging and @messaging) methods.
3.7.2.3. Program Presence and Information Assurance
3.7.2.3.1. The Contractor shall maintain a dedicated phone line to receive calls from Members
with questions about the Healthy Communities Program.
Exhibit A-3 Page 5 of 20
3.7.2.3.2. The Contractor shall maintain an office that Healthy Communities Members may
visit with questions about the Healthy Communities Program.
3.7.2.3.3. The Contractor shall assure that Members have access to program staff and
information by:
3.7.2.3.3.1. 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.
3.7.2.3.3.2. 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 program staff for in -person visits, links to Department
program website, and basic information about how the program may help the
member.
3.7.2.3.3.3. 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.
3.7.2.3.3.4. Reporting to the Department the Contractor's published program phone number,
the link to the program website, the hours staff are available and how internal
reception staff are trained to meet this requirement.
3.7.2.3.4. DELIVERABLE: Program Presence and Information Assurance Report
3.7.2.3.5. DUE: Within Sixty (60) days of the Contract Effective Date.
3.7.3. The Contractor shall create a Communication Plan that includes, but is not limited to,
following:
3.7.3.1. 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.
3.7.3.2. 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.
3.7.3.3. The specific means of immediate communication with Members and a method for
accelerating the internal approval and communication process to address urgent
communications or crisis situations.
3.7.3.4. 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.
3.7.3.5. A listing of the following individuals within the Contractor's organization, that
includes cell phone numbers and email addresses:
Exhibit A-3 Page 6 of 20
3.7.3.5.1. An individual who is authorized to speak on the record regarding the Work, the
Contract or any issues that arise that are related to the Work.
3.7.3.5.2. An individual who is responsible for any website or marketing related to the Work.
3.7.3.5.3. Back-up communication staff that can respond if the other individuals listed are
unavailable.
3.7.3.6. The Contractor shall deliver the Communication Plan to the Department for review
and approval.
3.7.3.6.1. DELIVERABLE: Communication Plan
3.7.3.6.2. DUE: Within forty-five (45) Business Days after the Effective Date
3.7.4. 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.
3.7.4.1. DELIVERABLE: Annual Communication Plan Update
3.7.4.2. DUE: Annually, by September 30th of each year
3.7.5. 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.
3.7.5.1. DELIVERABLE: Communication Plan Update
3.7.5.2. 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.
Exhibit A-3 Page 7 of 20
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: Semi-annually, by August 15th and February 15th of each year
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
Exhibit A-3 Page 8 of 20
3.10.2. 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: Annually, by June 30th of each year
3.1 L 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 15 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.
4.1.1.1. 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.
4.1.1.2. 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.
4.1.1.3. 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.
4.1.1.3.1. DELIVERABLE: Final list of names of the personnel assigned to the Contract,
including, at minimum, the Project Lead, Backup Project Lead and Accounting
Contact.
4.1.1.3.2. DUE: Within five (5) Business Days following the Effective Date
Exhibit A-3 Page 9 of 20
4.1.2. 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.
4.1.3. 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. The Contractor may subcontract to complete Work required by the Contract. The
conditions for using a Subcontractor or Subcontractors are as follows:
4.1.4.1. The Contractor shall provide the organizational name of each Subcontractor and all
items to be worked on by each Subcontractor to the Department.
4.1.4.2. The Contractor shall obtain the Department's prior consent and written approval for
any use of Subcontractor(s).
4.1.4.3. 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.
4.1.4.3.1. 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.
4.1.4.3.2. 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 30 days of entering the agreement.
4.1.5. 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
Exhibit A-3 Page 10 of 20
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 Member Relationship Management procedures. These procedures may
be updated regularly by the Department via a web site. The Contractor shall comply with
all updated procedures.
5.3. Regional Accountable Entity (RAE) Coordination Plan
5.3.1. The Contractor shall work collaboratively with its RAE to align and coordinate
onboarding and outreach activities.
5.3.1.1. 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 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.
5.3.1.2. DELIVERABLE:Copy of MOU or Contract with RAE
5.3.1.3. DUE: Within 30 days of the completion of the agreement and 30 days from the date
of any modifications to the agreement but no later than October 31, 2018 without
written approval from the Department.
5.4. EBNE Outreach
5.4.1. The Contractor shall conduct, on average throughout the contract period, a minimum of
four (4) EBNE outreach activities per quarter.
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.
5.4.2. The outreach information shall, at a minimum, include the following program
information:
5.4.2.1. 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.
5.4.2.2. How and where the EBNE individual can apply for Medical Assistance.
5.4.2.3. Information about the role of the RAE in coordinating Member care and providing
other support in accordance with the Onboarding Plan.
5.4.2.4. Information about the services and resources provided by Family Health Coordinators.
5.4.3. The Contractor shall assist EBNEs with the application process, which may include any
of the following:
Exhibit A-3 Page 11 of 20
5.4.3.1. 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.
5.4.3.2. Providing onsite presumptive eligibility (PE) determinations for those who may
qualify.
5.4.3.3. 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:
5.5.2.1.1. Follow up with pregnant women, children, families, and EBNEs regarding the status
of their application as requested by the Member.
5.5.2.1.2. Provide Healthy Communities Program Members with a list of appropriate Health
First Colorado and CHP+ Providers and referrals when appropriate.
5.5.2.1.3. Provide assistance setting appointments when requested by Healthy Communities
Members.
5.5.2.1.4. Provide referrals for medical and non -medical programs to Healthy Communities
Program Members as requested by the Member.
5.5.2.1.5. Follow up with Members who missed their appointment as requested by physical,
oral and mental health Providers.
5.5.3. The Contractor shall assist Members in finding or accessing appropriate community
resources and ensure families have access to the programs.
5.5.3.1.1. 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.
5.5.3.1.2. 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.
5.5.3.1.3. 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.
Exhibit A-3
Page 12 of 20
5.5.3.1.4. 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.
5.5.3.2. 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 Client Relationship
Management database, 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.
5.6.2. The Contractor shall assist Providers to confirm program eligibility and resolve
eligibility verification discrepancies to prevent rescheduling or members missing
appointments.
5.6.3. 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.
5.6.5. 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 Database
5.7.1. The Contractor shall provide access for employees performing the Work to use the
Healthy Communities Client Relationship Management Database as required.
5.7.2. The Contractor shall assure that all information needed to assist Members, such as
Providers and community resources are added to the Healthy Communities Client
Relationship Management Database 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.
Exhibit A-3 Page 13 of 20
5.7.3. The Contractor shall assure that all Healthy Communities staff are computer literate and
able to use the Healthy Communities Client Relationship Management Database 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 Client Relationship Management proficiency
testing and to complete, at the Contractor's expense, training deemed appropriate by
the Department.
5.7.4. The Contractor shall enter data accurately into the Healthy Communities Client
Relationship Management Database according to conventions agreed upon by the
collaboration between the Contractor and the Department, such as outreach events,
referrals and interactions with Members.
5.7.5. The Contractor shall assure the Healthy Communities Client Relationship Management
Database 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.
5.7.5.1.1. 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 Database
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.
5.8.2.1. Training curriculum will include, but not be limited to, information regarding the
following topics:
5.8.2.1.1. Healthy Communities Member Relationship Management Database 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
Exhibit A-3 Page 14 of 20
5.9.1.1. By the 10th day 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.
5.9.1.2.
5.9.1.3.
5.9.2.
5.9.2.1.
5.9.2.1.1.
5.9.2.1.2.
5.9.3.
Other information requested by the Department from the Member Relationship
Management system.
DELIVERABLE: Contractor Quarterly Report.
DUE: By the 10th day of the month following each fiscal quarter
Proposed Program Budget
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.
DELIVERABLE: Proposed Program Budget.
DUE: Within thirty (30) days of the issuance or renewal of the Contract with the
Department.
Final Report
5.9.3.1. The Contractor shall submit a Final Report to the Department utilizing reporting and
information from the Healthy Communities Client Relationship Management
Database.
5.9.3.1.1. The Final Report shall include, at a minimum, all of the following:
5.9.3.1.1.1.
5.9.3.1.1.2.
5.9.3.1.1.3.
5.9.3.1.1.4.
5.9.3.1.1.4.1.
An analysis of any successes and challenges faced by the Contractor, based on the
Contractor's individual program and location, related to the Healthy Communities
Program during the contracted period;
An analysis of the activities, outcomes, trends, and results over the course of the
year;
An analysis of the Contractor's ability to meet CMS EPSDT requirements for well
child, oral health, and lead testing;
An analysis of the Contractor's ability to meet the oral health periodicity schedule
for CHP+ eligible children.
DELIVERABLE: Final Report.
5.9.3.1.1.4.2. DUE: Thirty (30) days after the Contract expires, renews or is terminated.
5.9.4. Ad Hoc Reporting
Exhibit A-3
Page 15 of 20
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
Client Relationship Management Database, training materials or periodic Departmental
communications.
6.1.1. Newly Enrolled Member Communication Standard
6.1.1.1 Contractor shall reach out to newly enrolled members to inform them of their benefits,
offer navigation assistance, provider or resource referral within 60 days of the
member's enrollment or within two weeks of appearing on the newly enrolled member
list whichever is later.
6.1.1.2. 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 should 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.
6.1.1.3. Contractor using automated calling systems (RoboCalls) shall attempt to make such
calls only after initial attempts to reach members have failed. Regardless, all use of
such systems is to be carried out within strict adherence to HIPAA guidelines, the
Business Associate Agreement with the Department providing only the minimum
information required to providers of such services as necessary. Such service providers
must comply with all other state rules and regulation regarding contacting members in
such a manner. 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 must 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
Exhibit A-3 Page 16 of 20
7.1. By the Effective Date of this Contract, the Department shall 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.
7.2. Contractor goals will be established to help improve the screening participation rates for
child wellness visits to or above eighty (80) percent and increase oral health screenings by
ten (10) percentage points over FFY 2015 CMS EPSDT 416 Report per CMS criteria.
7.3. 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 (80) percent, 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 (60) percent 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 (60) percent 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 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 Client Relationship Management Database.
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.
8.1.1.2. This Closeout Period may extend past the termination of the Contract and the
requirements of the Closeout Period shall survive termination of the Contract.
8.1.2. Closeout Period
8.1.2.1. During the Closeout Period, the Contractor shall complete the following:
Exhibit A-3 Page 17 of 20
8.1.2.1.1.
8.1.2.1.2.
8.1.2.1.3.
8.1.2.1.4.
8.1.2.1.5.
8.1.2.1.5.1.
8.1.2.1.5.2.
8.1.2.2.
Implement the most recent Closeout Plan or Closeout Plan Update that has been
approved by the Department, as described in Section 1.10.4.2 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.
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.
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.
Notify any Subcontractor of the termination of the Contract, as directed by the
Department.
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.
DELIVERABLE: Member Notifications
DUE: Thirty (30) days prior to termination of the Contract
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
Exhibit A-3 Page 18 of 20
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.
8.1.3.1.1.1. DELIVERABLE: Closeout Plan
8.1.3.1.1.2. 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.
8.1.3.2.1. DELIVERABLE: Closeout Plan Update
8.1.3.2.2. DUE: Annually, by June 30th of each year
SECTION 9.0 PAYMENT
9.1. The Contractor shall submit an invoice based on the Contractor's actual expenditures for
the period specified. All invoices shall be submitted using the Contract Reimbursement
Form, attached as Exhibit C. The Department, at its discretion, may make edits to the
reimbursement form. The Contractor shall use the most recently updated reimbursement
form.
9.2. All invoices shall reference the Contract by the Contract routing number that appears on
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. Invoice shall be based upon the cost of the Work performed during the
term of this Contract and all items for which reimbursement is requested shall be itemized
on the reimbursement form. Supporting documentation such as copies of invoices, time
sheets, statements, payroll logs are to be retained by the Contractor and made available for
site visits, audits or otherwise upon request, but are not to be submitted with the
reimbursement form unless requested.
9.2.1. All fields of the reimbursement form/invoice shall be completed or reflect "N/A" or
$0.00 as appropriate.
9.2.2. The "Personal Services" section of the reimbursement form shall include the percentage
of time each staff spent working on the program/contract for the billing period. All salary
and percentages shall be based on a full-time equivalency regardless of the staffs actual
employment status.
9.2.3. Invoices shall be submitted quarterly reflecting one fiscal quarter each.
Exhibit A-3 Page 19 of 20
9.2.4. Invoices shall be submitted as soon as possible after the close of the billing quarter but
no later than the end of the month following the billing quarter.
9.2.5. The Department will honor Contractor requests to continue to submit and be reimbursed
on a monthly basis.
9.2.6. Contractor shall be paid by Electronic Funds Transfer (EFT) unless other arrangements
have been made with the Department's Accounting Section per Department policy.
9.2.7. Invoices shall be submitted electronically to the designated email mailbox 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'
9.2.8. All invoices must be signed. Use Adobe eSign to create and apply an electronic signature
is permitted.
9.3. The Department shall reimburse Indirect Costs at the Contractor's federally approved
Indirect Cost rate or at the de minimus rate of ten percent (10%) of the total amount for
each billing period.
9.4. In lieu of any Indirect Cost charges, the Contractor may elect to charge the program for
supervision expenses up to five percent (5%) of the total amount for each billing period.
Supervision shall be defined as work performed by any employee or subcontractor who is
not a regular contributor to the Healthy Communities Program as evidenced by the
Contractor's work recorded (or lack thereof) in the Healthy Communities Member
Relations Management Database.
9.5. 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. Each invoice submitted shall not exceed 110% the proportional share of the annual contract
budget amount for the invoicing period without prior written approval by the Department.
Exhibit A-3
Page 20 of 20
EXHIBIT C
CONTRACT REIMBURSEMENT FORM
Exhibit C
INSTRUCTIONS
Please follow these instructions carefully when filling out this form and submitting it for reimbursement
1) Save the TEMPLATE as a regular .xlsx file so the template document remains in -tact.
e Expenditure worksheet (tab highlighted yellow).
3) Save the document with all your permanent information so you don't have to do these steps again.
If you like, Save As a Template document replacing the original Template.
4) Each month, fill out the light yellow highlighted sections of the expenditures worksheet.
Leave blank if not applicable.
PLEASE NOTE: All Invoices must have a unique Invoice Number to be paid through CORE.
5) Print the entire spreadsheet excluding page 1 (print pages 2 through 5 or the last page if you've adde
Please do not print/send this instruction page.
If you are able, print the document as a PDF. This is preferred over Saving the document as a PDF as it
tends to create too many blank pages.
6) The Invoice MUST be signed and dated. If you have Adobe eSign capabilities, that will be accepted
and you will not need to print the document at all. Otherwise, print the signature page (page 5 or the
last page if you've inserted additional rows in the document), sign it, scan that page and merge
it with the rest of the document. If you don't have the ability to merge pages, print and scan the entire
document when you sign it.
7) Please give the document the following filename: ##MonYR — Contractor Name - $#,###.## -
8) Send the single, PDF document to hcpf_healthycomm@state.co.us. You will receive a return email
acknowledging our receipt. Please retain this email message for your records and tracking purposes.
2) Fill out the light green shaded sections of th
PLEASE NOTE: Please do NOT send receipts and other supporting documents unless they are requested
You are responsible to keep them on file for up to seven years after the contract period for auditing
purposes.
COLORADO
Department of Health Car.
Policy & Financing
Contractor/
Vendor Invoice e
Vendor Code
i-4C'
PO/
Encumbrance ►
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To:
HCPF Program:
HCPF Contact
Mail Code:
Address:
City:
State:
Zip Code:
Fug
Telephone:
Email:
EXPENDITURE DETAILS for REIMBURSEMENT INVOICE FORM
Contractor Name
Invoice Period
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Final Invoice
Colorado Dept of Health Care Policy and Financing
Healthy Communities
Jeff Helm
1570 Grant St
Denver
CO
80203-1818
303-866-2573
303 866-2267
Jeff heimfstate. co.us
From:
Contact Name:
Address:
City:
State:
Zip Code:
Fax:
Telephone:
Email:
pease Email a PDF version of the signed Invoke AN2 Exependiture Details as well as any supporting mater'at
Expenditure Categories
Match or In -Kind (If Applicable)
Total Amount Requested from HCPF
Personal Services
Gross Salary
Fringe
Percent of Actual Time on Contract/
Purchase Order
Employee Name and/or position title
50.00
$0.00
$0.00
50.00
$0.00
$0.00
$0.00
$0.00
$0.00
50.00
--
,r 00
o
Total Personal Section
C
$0.00
Supplies & Operating Expenses
Printing/Copying
Postage/Shipping
Phone/Fax/Internet
Supplies
Meeting
Total Supplies
,..,
$0.00
Travel
Mileage
Lodging
Meals
Other Travel
Total Travel
- - >c .-•_
$0.00
Other Costs
Equipment
Evaluation (completed
in-house)
Screening
Treatment
Training
Total Other Costs
50 0
$0.00
Contractual (payments to third parties or entities)
Consulting
Evaluation (outsourced)
Other sub -contract (if any)
Total Contractual
5o.CC
50.00
SUBTOTAL BEFORE INDIRECT
$0.00
$0.00
Indirect
'--.d<rect (Maximum 5% of contract annually)
Indirect (Supervision • Non -direct program staff - Maximum 5% of contract annually)
(Fiscal
Agent Fee) - Total Indirect
$0.00
50.00
TOTAL MATCH OP. IN KIND
$0.00
TOTAL THIS INVOICE
$o.ao
Billing Summary
Contract or Purchase Order Budget Amount
Cumulative Amount Previously Invoiced
Amount of this Invoice
$0.00
Total Invoiced to Date
$0.00
Budget Amount Remaining
$0.00
Colorado Department of Health Care Policy 81 Financing
Invoice Period:
Invoice #:
FEIN or Vendor Code:
PO/Encumbrance #:
Final Invoice:
Invoice
Period
To
##/##/####
Contractor/i3endor
Pr
Vendor
Code
PO/ Ehcumbrance
#
0
Colorado Dept. of Health Care Policy
To: and Financing
Program: HCPF Program:
Contact: HCPF Contact:
lail Code:
Mail Code:
Address: 1570 Grant St.
City: City:
State: State:
Zip Code: 80203
Fax: Fax:
?lephone: Telephone:
Email: Email:
From: From:
Contact Name:
Contact Name:
Address: Address:
0
0
City: City:
State: State:
Zip Code: Zip Code:
Fax: Fax:
Telephone: Telephone:
Email: Email:
Please Email a PDF version of the signed invoice AND Exependiture Details as well as any supporting materials.
Expenditure
Categories
Total
Amount Requested
Personal
Services including
Fringe
Benefits
$0.00
Supplies & Operating Expenses
$0.00
Travel
$0.00
Other
Costs
$0.00
Contractual (payments to third
parties or entities)
$0.00
SUB
-TOTAL
BEFORE INDIRECT
$0.00
Indirect j
$0.00
TOTAL
THIS
INVOICE
$0.00
TOTAL
IN
-KIND
$0.00
To
be Signed
by Contractor/Vendor
I/We affirm the claimed expenses comply with the budget provisions of the contract and ore reasonable and necessary, that all relevant progress or other
reports have been filed, and all contract milestones and/or tasks related to the invoice period have been achieved.
Print Name, Title & Sign Signature Date
To
be Signed by
HCPF Program
Director or
Delegate(s)
I/We affirm that I or my staff have reviewed the contractor invoice and supporting documentation, if required, progress reports and other communications with the contractor/vendor, and believe to
the best of my knowledge, that the contractor/vendor is in compliance with all contract provisions.
Print Name, Title & Sign Date
To
be Signed by
HCPF
Fiscal
Officer or
Delegate(s)
I certify that the claimed expenses have been reviewed by
funding source Contract 4/Purchase Order#
me for compliance with the requirements
CMS#
of
Contract
the funding source and the State of Colorado Fiscal Rules, and are charged to the appropriate
Routing 4 and we arerequesting reimbursenment for same
Print Name, Title & Sign Date
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