HomeMy WebLinkAbout20181809.tiffRESOLUTION
RE: APPROVE AMENDMENT #4 TO INTERGOVERNMENTAL AGREEMENT FOR
COUNTY INCENTIVES 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 Amendment #4 to the Intergovernmental
Agreement for the County Incentives Program between the County of Weld, State of Colorado,
by and through the Board of County Commissioners of Weld County, on behalf of the Department
of Human Services, and the Colorado Department of Health Care Policy and Financing,
commencing upon full execution of signatures, and ending June 30, 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 the Amendment #4 to the Intergovernmental Agreement for the County
Incentives Program between the County of Weld, State of Colorado, by and through the Board of
County Commissioners of Weld County, on behalf of the Department of Human Services, and the
Colorado Department of Health Care Policy and Financing, be and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign 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.
ATTEST: j„dcJ;e,k,
Weld County Clerk to the Board
BY:
Depu y Clerk to the
APP ! ED AS
County Attorney
BOARD OF COUNTY COMMISSIONERS
WELD pOUNTY, COLORADO
LE • 0
Steve Moreno, Chair
EXCUSED
Barbara Kirkmeyer, Pro-Tem
2C 67
ie A. Cozad
Mike Freeman
Date of signature: O 7-/62-/S2
cc-: N50, GCTCG)
q/Il/Ig'
2018-1809
HR0089
PRIVILEGED AND CONFIDENTIAL
MEMORANDUM
DATE: June 1, 2018
TO: Board of County Commissioners — Pass -Around.
FR: Judy A. Griego, Director, Human Services
RE: Weld County Department of Human Services' 2018-19 County
Incentives Agreement Amendment No. 4
Please review and indicate if you would like a work session prior to placing this item on the Board's agenda.
Request Board Approval of the. Department's Fiscal Year 2018-19 County Incentives Agreement
Amendment No. 4. This is the fourth amendment to the original agreement implemented in 2014 and
identified in Tyler as 2014-3923. For Fiscal Year 2018-19 (date of execution through June 30, 2019), the
Colorado Department of Health Care Policy and Finance (HCPF) has allocated up to $207,908.67 to Weld
County if performance measurements set by HCPF are Met. Weld County is eligible for an additional
$69,302.90 if other counties do not meet their performance measurements, resulting in a maximum incentive
allocation up to $277,211.57.
I do not recommend a Work Session. I recommend approval of this Amendment and authorize the Chair to sign.
Approve Schedule
Recommendation Work Session
Sean P. Conway
Julie A. Cozad
Mike Freeman
Barbara Kirkmeyer, Pro -Tern Vi e1 ici L
Steve Moreno, Chair
Other/Comments:
2018-1809
HRoo
Pass -Around Memorandum; June I, 2018 — CMS 1865 Page 1
Lehi
I
Karla Ford
From:
Sent:
To:
Cc:
Subject:
Barbara Kirkmeyer
Friday, June 01, 2018 2:17 PM
•Karla Ford
Sean Conway
Re: PA for Routing (County Incentives Amendment - CMS 1865)
Ok with putting on agenda
Have a great day
On Jun 1, 2018, at 1:27 PM, Karla Ford <kford@weldgov.com>wrote:
Please iet me know if you are ok with this pass around. They are looking to have it on the agenda on
June 11th. Thanks!
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
970.336-7204 :: kfordt7a.weldgov.com :: www.weldaov.com :.
My working hours are Monday -Thursday 7:00a.m.-4:00 p.m.
Friday 7:00a.m. - Noon
<image002.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for the person or entity to
which it is addressed and may contain information that is privileged, confidential or otherwise protected from disclosure. If you have received
this communication in error, please immediately notify sender by return e-mail and destroy the communication. Any disclosure, copying,
distribution or the taking of any action concerning the contents of this communication or any attachments by anyone other than the named
recipient is strictly prohibited.
From: Tobi Vegter
Sent: Friday, June 01, 2018 12:44 PM
To: Karla Ford <kfordpweldeov.com>
Cc: Barb Connolly <bconnolly@weldgov.com>; Bruce Barker <bbarker@weldeov.com>; Esther Gesick
<egesick@weldgov.com>; HS Contract Management <HS Contract Management@co.weld.co.us>;
Jamie Ulrich <ulrichiI@weldgov.com>; Judy Griego <grieeoia@weldeov.com>; Lennie Bottorff
<bottorll@weldgov.com>
Subject: PA for Routing (County Incentives Amendment - CMS 1865)
Good afternoon, Karla.
Please see attached PA for routing. This item is slated for the June 11 Agenda so we will need the PA
returned prior to that.
Thank you.
Regards,
Tobi A. Vegter
Contract and Services Coordinator
1
1
•
Karla Ford
From:
Sent:
To:
Cc:
Subject:
Sean Conway
Saturday, June 02, 2018 8:25 PM
Barbara Kirkmeyer
Karla Ford
Re: PA for Routing (County Incentives Amendment - CMS 1865)
Ok with it. Sean
Sent from my iPhone
On Jun 1, 2018, at 4:17 PM, Barbara Kirkmeyer <bkirkmever@weldgov.com> wrote:
Ok with putting on agenda
Have a great day
On Jun 1, 2018, at 1:27 PM, Karla Ford <kford@weldgov.com>wrote:
Please let me know if you are ok with this pass around. They are looking to have it on
the agenda on June 11th. Thanks!
Karla Ford
Office Manager, Board of Weld County Commissioners
1150 O Street, P.O. Box 758, Greeley, Colorado 80632
:: 970.336-7204 :: kfordaweldgov.com :: www.weldnov.com
My working hours are Monday -Thursday 7:00a.m.-4:00 p.m.
Friday 7:00a.m. - Noon
<lmage002.jpg>
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return e-
mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tobi Vegter
sent: Friday, June 01, 2018 12:44 PM
To: Karla Ford <kford@weldgov.com>
Cc: Barb Connolly <bconnoliv@weldgov.cam>; Bruce Barker <bbarker@weldeov.com>;
Esther Gesick <egesick@weldgov.com>; HS Contract Management
<HS Contract Management@co.weld.co.us>; Jamie Ulrich <ulrichii@weldgov.com>;
Judy Griego <griegoia@weldgov.com>; Lennie Bottorff <bottorll@weldgov.com>
Subject: PA for Routing (County Incentives Amendment - CMS 1865)
Good afternoon, Karla.
Please see attached PA for routing. This item is slated for the June 11 Agenda so we will
need the PA returned prior to that. •
Department of Health Care Policy and Financing
Agreement Routing Number 2015CM1P123A4
AGREEMENT AMENDMENT NO. 4
Original Agreement Routing Number 2015CMIP123
1. PARTIES
This Amendment to the above -referenced Original Agreement (hereinafter called the
"Agreement") is entered into by and between 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"), and Weld County (hereinafter called "Contractor").
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 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 Agreement to create performance -related benchmarks for county
departments of human/social services that achieve certain Performance Incentive Standards related
to determining and redetermining Medicaid eligibility, those populations currently enrolled in
Medicaid and cooperation with other Medicaid -related entities. The purpose of this Amendment
is to add exhibits and update the Performance Incentives Standards.
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 Agreement, and the Agreement and all prior
amendments thereto, if any, remain in full force and effect except as specifically modified herein.
6. MODIFICATIONS
The Agreement and all prior amendments thereto, if any, are modified as follows:
A. Section 4, Definitions, Subsection B is hereby deleted in its entirety and replaced with the
following:
B. Exhibits and other Attachments. The following documents are attached hereto and
incorporated by reference herein:
oZoi - /Yb96
Exhibit A-4, Statement of Work
Exhibit B, Rates
Exhibit C, Small, Medium, Large County List
B. Section 5, Term, Subsection A, Initial Term, is hereby deleted in its entirety and replaced
with the following:
A. Initial Term
The Parties' respective performances under this Contract shall commence on the later
of the Effective Date or January 1, 2015. This Contract shall expire June 30, 2019,
unless sooner terminated or further extended as specified elsewhere herein.
C. Section 7, Payments to Contractor, Subsection A, Maximum Amount, is hereby deleted in
its entirety and replaced with the following:
A. 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 the Contractor are limited to the unpaid obligated balance of the Contract
at the rates set forth in Exhibit B. The maximum amount payable by the Department
to the Contractor is:
State Fiscal Year 2014-15
$284,064.50
State Fiscal Year 2015-16
$281,962.66
State Fiscal Year 2016-17
$277,327.85
State Fiscal Year 2017-18
$293,733.16
State Fiscal Year 2018-19
$277,211.57
Total for All State Fiscal Years
$1,414,299.74
D. Exhibit A-3, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A-4, Statement of Work, attached hereto and incorporated by reference into the Agreement.
All references within the Agreement to Exhibit A, Exhibit A-1, Exhibit A-2 or Exhibit A-
3 shall be deemed to reference to Exhibit A-4.
E. Exhibit B, Rates, Section 1.4., SFY 2018-19 Incentives Payment Table, is hereby added as
follows:
1.4. SFY 2018-19 Incentives Payment Table
Incentive Payment Name
% of Funding
Payment Amount
Eligibility Timeliness and Backlog
Performance Incentive Payment
30%
$62,372.60
Case Maintenance Performance Incentive
Payment
15%
$31,186.30
Long Term Services and Supports
(LTSS) Performance Incentive Payment
15%
$31,186.30
Page 2 of 24
Training Performance Incentive
15%
$31,186.30
Child Welfare Performance Incentive
Payment
15%
$31,186.30
Improved Member Correspondence
Performance Incentive Payment
10%
$20,790.87
Total Maximum
Available for all
Incentive Payments
$207,908.67
F. Exhibit B, Rates, Section 2.4., SFY 2018-19 Pool Maximum County Share Table, is hereby
added as follows:
2.4. SFY 2018-19 Pool Maximum County Share Table
Pool Name
Pool Maximum Distribution
Amount
Total Maximum Available for
all Pool Distributions
$69,302.90
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
In the event of any conflict, inconsistency, variance, or contradiction between the provisions of
this Amendment and any of the provisions of the Agreement, the provisions of this Amendment
shall in all respects supersede, govern, and control.
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 3 of 24
THIS PAGE INTENTIONALLY LEFT BLANK
Page 4 of 25
Amendment Routing Number 2015CM[P123A4
THE PARTIES HERETO HAVE EXECUTED THIS INTERAGENCY AGREEMENT
Persons signing for Parties hereby swear and affirm that they are authorized to act on behalf of
their respective Party and acknowledge that the other Party is relying on their representations to
that effect.
STATE OF COLORADO
John W. Hickenlooper, Governor
Weld County
Department of Health Care Policy and
Finng
Steve Moreno, Chair Kim Bimestefe
Board of County Commissioners
Date: JUN i I 2018
Date:
Executive Director
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
By:
STA %. ' OLLER
Ro - ' aros, CPA, MBA, JD
Department of ' =.Ith Cie Policy and Financing
Date:
Page 5 of 25
Lie 9(3)
EXHIBIT A-4, STATEMENT OF WORK
1. TERMINOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms, abbreviations
and terminology used throughout this document.
1.1.1. Accountable Care Collaborative (ACC) — the Department's program for care
coordination and cost containment for Medicaid members in Colorado's 64 counties.
1.1.2. Applicant — An individual for whom the Contractor is performing a Determination.
1.1.3. Backlogged Determination — Any Untimely Determination that was not completed by
the timeliness requirements as set in Section 1.1.11.
1.1.4. Backlogged Redetermination — Any Untimely Redetermination that was not completed
by the timeliness requirements as set in Section 1.1.12.
1.1.5. COGNOS/Decision Support System 01 (DSS01) — the Department's data reporting
systems that use information from the Colorado Benefits Management System
(CBMS).
1.1.6. Colorado Benefits Management System (CBMS) — the State's eligibility determination
system.
1.1.7. Colorado interChange (interChange) — the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data
related to those payments.
1.1.8. County Administration website — the Department's public -facing website where
contract documentation is kept for the County Incentives Program
(http://www.colorado.gov/hcpf/county-admin).
1.1.9. Determination — The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program based on information submitted on a new application.
1.1.10. Disenrollment — The act of processing a change in circumstance that affect's a
member's eligibility and makes them ineligible for coverage within Health First
Colorado or Child Health Plan Plus.
1.1.11. Health First Colorado — the member -facing name for Colorado's Medical Assistance
Program.
1.1.12. Home and Community -Based Services (HCBS) - HCBS waiver programs provide
additional benefits and services to eligible populations in addition to the standard
benefit package offered to all members.
1.1.13. Long Term Care (LTC) - Long -Term Care is a Medical Assistance program that
provides nursing -home care, home -health care, personal or adult day care for
individuals aged at least 65 years or with a chronic or disabling condition.
1.1.14. Member — An individual who is eligible for the Colorado Medical Assistance Program.
Also known as a client.
1.1.15. Memo Series — The Department's policy, operational, and informational
communications that are utilized to provide contract clarifications, provide data and
Page 6 of 25
operational guidance, and share information pertaining to the County Incentives
Program.
1.1.16. Program for the All -Inclusive Care for the Elderly (PACE) — Program provides
comprehensive medical and social support services to certain frail individuals 55 years
of age and over. The goal of PACE is to keep individuals in their homes and
communities through comprehensive care coordination.
1.1.17. Regional Accountable Entity (RAE) — contracted entities of the Department that are
responsible for carrying out the goals of the Accountable Care Collaborative by
providing physical and behavioral care coordination and wrap -around supports for
members.
1.1.18. Reporting Period — The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.18.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.18.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and
end on June 30 of that SFY.
1.1.19. Redetermination — A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.20. State Fiscal Year (SFY) — The period beginning July 1 of each calendar year and ending
on June 30 of the following calendar year.
1.1.21. Status Report — a communication to the Contractor that details which Performance
Incentive Standards were met for the Reporting Period in question.
1.1.22. Timely Determination — Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.23. Timely Disenrollment — Processing a change in a member's circumstance and making
a determination within fifteen (15) calendar days.
1.1.24. Timely Redetermination — Any Redetermination that is completed by the last day of
the month prior to the month in which the member's new annual enrollment period
begins.
1.1.25. Untimely Determination — Any Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.26. Untimely Redetermination — Any Redetermination that is not completed by the last day
of the month prior to the month in which the member's new annual enrollment period
begins. This is based on the CBMS RRR Due Date.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility -related work within the Contractor's
county, required under C.R.S. §25.5-1-101 et. seq. The Department and the Contractor
share the costs of this work performed by the Contractor as defined in those statutes and
this Contract shall not impact the allocated amount of that cost sharing.
3. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
Page 7 of 25
3.1.1. To determine whether the Contractor met any or all the Incentives Performance
Standards when completing determinations and redeterminations within the
Contractor's county, the Department will utilize the COGNOS/DSSO1 systems to pull
data tracking and reports that track the Contractor's compliance with certain
Performance Incentive Standards.
3.1.2. To determine whether the Contractor met any or all the Incentives Performance
Standards when working with Medicaid populations within the Contractor's county,
the Department may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive and the Department will, at its discretion,
utilize additional data and reports from the COGNOS/DSS01, interChange, and/or
other systems to determine whether the Contractor met any or all the Incentives
Performance Standards.
3.1.4. The date the data or reports will be pulled from the COGNOS/DSS01, interChange,
and/or other systems will be defined in each applicable Incentives Performance
Standard.
3.1.5. The Contractor should utilize the information provided for each Performance Incentive
Standard and information issued through the Memo Series in the County Incentives
Program Guide, to assist with pulling applicable data and reports to determine the
Contractor's compliance with any or all the Performance Incentives Standards.
3.2. Communications Utilized to Determine Compliance
3.2.1 To fulfill the requirements in Exhibit A-4 Statement of Work and earn a Performance
Incentive Payment, the Contractor shall utilize and comply with guidance issued
through the HCPF Memo Series.
3.2.2. The Contractor will utilize the HCPF Memo Series to find any forms, templates,
program contacts, or additional information needed to operationalize the Incentives
Performance Standard Program referenced throughout this Agreement.
3.2.3. In the event that additional guidance or contract clarification is needed, the Department
may release additional guidance to the Contractor through the HCPF Memo Series.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor may earn Performance Incentive Payments to reimburse it for a portion of
its cost sharing as described in Section 2.
4.2. Eligibility Timeliness and Backlog Performance Incentive Standard
4.2.1.
4.2.1.1.
4.2.1.1.1
4.2.1.1.2.
The Contractor may earn an Eligibility Timeliness and Backlog Performance Incentive
Payment for each Reporting Period in which the Contractor meets timeliness and
backlog requirements as found in section 4.2.
Timeliness of Determinations and Redeterminations
The Contractor shall complete at least ninety-five percent (95%) of all
Determinations and Redeterminations as Timely Determinations and Timely
Redeterminations.
The Department will total all Timely Determinations and Timely
Redeterminations the Contractor completed within the Reporting Period and
divide that by the total number of Determinations and Redeterminations the
Page 8 of 25
4.2.1.1.3.
Contractor completed during that Reporting Period to determine the timeliness
percent. The Department will round these calculated percentages to two (2)
decimal places.
Determining Compliance with the Timeliness of Determinations and
Redeterminations
4.2.1.1.3.1. The Department will utilize the MA County Incentives Timeliness Report
— Summary and MA County Incentives Timeliness Report — Detail to
determine compliance with timeliness benchmark of the Eligibility
Timeliness and Backlog Performance Incentive Standard.
4.2.1.1.3.2. The MA County Incentives Timeliness Report — Summary and MA County
Incentives Timeliness Report — Detail will be pulled the first working day
after the end of each Reporting Period to determine the Contractor's
performance over the entire six-month Reporting Period.
4.2.1.2. Backlogged Determinations and Redeterminations
4.2.1.2.1. The Contractor's Backlogged Determinations average and Backlogged
Redeterminations average at the end of each Reporting Period shall be within
the limits described in the following table:
4.2.1.2.2. County Backlog Table
4.2.1.2.3.
4.2.1.2.3.1.
4.2.1.2.3.2.
New Applications
Redeterminations
County Size
Large
Medium
Large
Medium
To determine the Backlogged Determinations average, the Department will
total the Backlogged Determinations of each month of the Reporting Period and
divide by the number of months in the Reporting Period.
The MA County Incentives Backlog Report — Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Contractor's amount of Backlogged Determinations for each month of each
Reporting Period.
The MA County Incentives Backlog Report — Summary and MA County
Incentives Backlog Report — Detail will be pulled on the first working day
of each month.
Page 9 of 25
4.2.1.2.4.
4.2.1.2.4.1.
4.2.1.2.4.2.
4.2.1.2.4.3.
4.2.1.2.5.
4.2.1.2.5.1.
4.2.1.2.5.2.
4.2.1.3.
4.2.1.3.1.
4.2.1.3.2.
To determine the Backlogged Redeterminations average, the Department will
total the Backlogged Redeterminations of each month of the Reporting Period
and divide by the number of months in the Reporting Period.
The MA County Incentives Backlog Report — Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Contractor's amount of Backlogged Redeterminations for each month of
each Reporting Period.
The MA County Incentives Backlog Report — Summary and MA County
Incentives Backlog Report — Detail will be pulled on the first working day
of each month.
The Department will round both the Backlogged Determinations average
and Backlogged Redeterminations average to a whole number.
When a Determination or Redetermination is Considered Backlogged
A Determination or Redetermination will be considered backlogged for the
First Reporting Period if the due date for the Determination or
Redetermination is on or before December 31 and the Determination or
Redetermination was not completed on or before the due date.
A Determination or Redetermination will be considered backlogged for the
Second Reporting Period if the due date for the Determination or
Redetermination is on or before June 30 and the Determination or
Redetermination was not completed on or before the due date.
Small County Exemption
If the Contractor processes a total of two -hundred and forty (240) or fewer
Determinations and two -hundred and forty (240) or fewer Redeterminations per
month, the Contractor shall be deemed to have met the timeliness percentage of
this performance standard so long as they had eighteen (18) or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
There is no Small County Exemption for backlogged Determinations and
Redeterminations.
4.2.2. Exemptions for Unusual Circumstances
4.2.2.1. The Contractor may request an exemption for unusual circumstances for failure to
meet the timeliness benchmark as described in section 4.2.1.1 or failure to meet
backlog benchmark as described in section 4.2.1.2.
4.2.2.2. The exemption process for unusual circumstances is described in section 6,
Exemptions.
4.2.3. BENCHMARK: 95.00% timeliness average over each Reporting Period for
determinations and redeterminations as described in section 4.2.1.1; backlogged
determination and redetermination averages over each Reporting Period below limit
based on county size as described in section 4.2.1.2.
4.3. Child Welfare Performance Incentive Standard
4.3.1. The Contractor may earn a Child Welfare Performance Incentive Payment for each
Reporting Period in which it hosted or attended quarterly collaboration meetings with
Page 10 of 25
all required partners and submits the required documentation as listed in sections
4.3.1.1, 4.3.1.2 and 4.3.1.3.
4.3.1.1. Quarterly Meetings and Data Collection
4.3.1.1.1. The Contractor will host or convene collaboration meetings at least once each
calendar quarter with the required partners listed in section 4.3.1.2. and ensure
documentation requirements are met per section 4.3.1.3.
4.3.1.1.2. The Contractor may host any or all meetings in collaboration with other
counties, but if it does combine any meeting with another county or other
counties, the Contractor shall provide at least one (1) representative from child
welfare staff and one (1) representative from eligibility staff to attend that
meeting.
4.3.1.1.3. The Contractor may use existing collaboration meetings or combine other
meetings to meet the quarterly collaboration meeting requirement so long as all
required partners listed in section 4.3.1.2 are invited and present, except for the
RAE, DYS or CMP representatives per section 4.3.1.2.2.
4.3.1.2. Required and Optional Partners for the Child Welfare Performance Incentive
Standard
4.3.1.2.1. Required partners for the Child Welfare Performance Incentive Payment
include a representative from the Regional Accountable Entity (RAE), a
representative from the Contractor's child welfare staff, a representative from
the Division of Youth Services (DYS), a representative from the Collaborative
Management Program (CMP), and a representative from the Contractor's
eligibility staff.
4.3.1.2.2. All required partners shall be invited to participate in the quarterly collaboration
meetings. If a representative from the DYS, CMP, or RAE is not able to attend,
the Contractor shall provide documentation from the required partner that the
representative was not able to attend.
4.3.1.2.3. If the Contractor does not have a DYS facility or representative in their county
and/or region, the Contractor can invite a local correctional representative in
place of the DYS representative.
4.3.1.2.4. The Contractor may, at its discretion, invite additional partners such as Healthy
Communities, Family Resource Centers, Dependency & Neglect System
Reform (DANCR) and Multisystemic Therapy (MST).
4.3.1.3. Documentation Requirements for the Child Welfare Performance Incentive
Standard
4.3.1.3.1.
4.3.1.3.1.1.
4.3.1.3.2.
The Contractor shall develop the meeting agenda for each meeting it hosts.
If the Contractor hosts a meeting in collaboration with another county or
other counties, then the Contractor may develop the agenda in collaboration
with those other counties.
The Contractor shall take meeting minutes and compile a list of attendees for
each meeting it hosts. The list of attendees shall clearly identify which agency
the attendee is representing.
Page 11 of 25
4.3.1.3.2.1. If the Contractor hosts a meeting in collaboration with another county or
other counties, the Contractor may create the meeting minutes and list of
attendees in collaboration with those other counties.
4.3.2. DELIVERABLE: Agenda, Meeting Minutes, Attendee List, and Child Welfare
Incentive Template for quarterly collaboration meetings submitted by January 5, 2019
for the First Reporting Period and July 5, 2019 for the Second Reporting Period as
described in section 4.3.1.3.
4.4. Training Performance Incentive Standard
4.4.1. The Contractor may earn the Training Performance Incentive Payment for each
Reporting Period if at least seventy five percent (75%) of its eligibility technicians
and/or supervisors complete the required number of training hours. The Contractor's
staff that are subject to the Training Performance Incentive Standard requirement is
described in section 4.4.1.1.
4.4.1.1. Staff Subject to Training Performance Incentive Standard and Training Hours
Requirement
4.4.1.1.1. The eligibility technician and/or supervisor will be responsible for eight (8)
hours of training in the contractual period if the eligibility technician and/or
supervisor has the security profile to authorize Medical Assistance as described
in section 4.4.1.1.4.
4.4.1.1.2.
4.4.1.1.3.
4.4.1.1.4.
4.4.1.2.
4.4.1.2.1.
4.4.1.2.2.
4.4.1.2.2.1.
4.4.1.3.
4.4.1.3.1.
The eight (8) hours of training shall be completed from the Approved Training
List. The Approved Training List will be provided to the Contractor at
implementation and will be posted on the Department's County Administration
website.
Trainings from the Approved Training List can be trained by the Staff
Development Center (SDC) or an SDC-certified trainer using SDC-approved
materials.
Management and Eligibility Enrollment Specialist (EES) CBMS access users
are subject to the Training Performance Incentive Standard.
Training Completion Timeframes and Previously Completed Trainings
The required amount of training can be completed during the First and Second
Reporting Periods, if the required amount is met by the conclusion of the
Second Reporting Period.
The Contractor's staff may re -take a previously completed course and be
granted credit so long as the course was not originally taken within the current
fiscal year.
Courses re -taken from a previous fiscal year shall be tracked per the
requirements in section 4.4.1.3.2.
Determining Compliance with the Training Performance Incentive Standard
The Contractor shall log all eligible training hours in the Department's Learning
Management System (LMS). Only training hours logged in the LMS system
will count towards the Training Performance Incentive Standard.
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4.4.1.3.1.1. Only eligible trainings as found on the Approved Training List should be
logged in LMS via the Add External Training feature.
4.4.1.3.1.2. Trainings added via Add External Training that are not included on the
Approved Training List will be rejected.
4.4.1.3.1.3. External Training requests must match the amount of training hours offered
as described on the Approved Training List. External Training requests that
request more hours than described on the Approved Training List will be
denied.
4.4.1.3.2. Courses re -taken shall be manually added into the LMS by utilizing the Add
External Training feature.
4.4.1.3.2.1. If a course has not been completed, then the Contractor's staff shall register
for the course and not request approval via Add External Training feature.
4.4.1.3.3. To determine compliance with the required number of training hours, the
Department will request data on users with security profiles listed in section
4.4.2.3. A cross -comparison with the security profiles data pull and LMS
completion reports will determine if the Contractor complied with the seventy
five percent (75%) requirement for the Training Performance Incentive
Standard.
4.4.2. BENCHMARK: 75% of eligibility technicians and supervisors with security profiles
listed in section 4.4.2.3 complete eight (8) hours of training from the Approved
Training List within the contract period as described in section 4.4.1.
4.5. Long Term Services and Supports (LTSS) Performance Incentive Standard
4.5.1.
4.5.1.1.
4.5.1.1.1.
4.5.1.1.1.1.
4.5.1.1.2.
The Contractor may earn a LTSS Performance Incentive Payment for each Reporting
Period if the Contractor achieves ninety five percent (95.00%) timeliness combined
average of Determinations and Redeterminations for Long Term Care (LTC), Home
and Community Based Services (HCBS), and the Program for the All -Inclusive Care
for the Elderly (PACE) over each Reporting Period; achieves eighty five percent
(85.00%) timeliness for Determinations for LTC, HCBS, and PACE; and the
Contractor completes the LTSS Communications Plan as described in section 4.5.1.2.
Timeliness of LTC, HCBS, and PACE Determinations and Redeterminations
The Contractor shall complete at least ninety-five percent (95%) of all LTC,
HCBS, and PACE Determinations and Redeterminations as Timely
Determinations and Timely Redeterminations.
The Department will total all Timely Determinations and Timely
Redeterminations for LTC, HCBS, and PACE the Contractor completed
within the Reporting Period and divide that by the total number of LTC,
HCBS, and PACE Determinations and Redeterminations the Contractor
completed during that Reporting Period to determine the timeliness percent.
The Department will round these calculated percentages to two (2) decimal
places.
The Contractor shall complete at least eighty-five percent of all LTC, HCBS,
and PACE Determinations as Timely Determinations.
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4.5.1.1.2.1.
4.5.1.1.3.
4.5.1.1.3.1.
4.5.1.1.3.2.
4.5.1.1.4.
4.5.1.1.4.1.
4.5.1.1.5.
4.5.1.1.5.1.
4.5.1.1.5.2.
4.5.1.2.
4.5.1.2.1.
4.5.1.2.1.1.
4.5.1.2.1.1.1.
4.5.1.2.1.1.2.
The Department will total all Timely Determinations for LTC, HCBS, and
PACE the Contractor completed within the Reporting Period and divide that
by the total number of LTC, HCBS, and PACE Determinations the
Contractor completed during that Reporting Period to determine the
timeliness percent. The Department will round these calculated percentages
to two (2) decimal places.
Determining Compliance with the Timeliness of LTC, HCBS, and PACE
Determinations and Redeterminations
The Department will utilize the MA County Incentives LTSS Timeliness
Report — Summary and MA County Incentives LTSS Timeliness Report —
Detail to determine compliance with the timeliness benchmarks of the LTSS
Performance Incentive Standard.
The MA County Incentives LTSS Timeliness Report — Summary and MA
County Incentives LTSS Timeliness Report — Detail will be pulled the first
working day after the end of each Reporting Period.
Small County Exemption
If the Contractor processes a total of ten (10) or fewer Determinations and
ten (10) or fewer Redeterminations per Reporting Period, the Contractor
shall be deemed to have met the timeliness percentage benchmark for the
LTSS Performance Incentive Standard so long as they had six (6) or fewer
Untimely Determinations and Untimely Redeterminations during that
Reporting Period.
Exemptions for Unusual Circumstances
The Contractor may request an exemption for unusual circumstances for
failure to meet the timeliness benchmarks as described in section 4.5.1.1.
The exemption process for unusual circumstances is described in section 6,
Exemptions.
Submission and Approval of the Contractor's LTSS Communications Plan
The Contractor shall complete the LTSS Communications Plan template,
provided by the Department, in collaboration with the Contractor's Single Entry
Point (SEP), Community Centered Board (CCB), nursing facilities, and other
providers that details the communications between the Contractor and those
partners.
Expectations for the LTSS Communications Plan
The Department expects that communications between LTSS partner
agencies and the Contractor are processed differently than
communications and interactions with members.
The Department expects that communications between LTSS partner
agencies and the Contractor have adequate, sufficient and documented
processes and timeframes in place to enable timely determinations,
redeterminations and changes in a member's circumstances.
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4.5.1.2.1.1.3.
4.5.1.2.1.1.4.
4.5.1.2.1.2.
4.5.1.2.1.2.1.
4.5.1.2.1.3.
4.5.1.2.1.3.1.
4.5.1.2.1.3.2.
4.5.1.2.1.4.
4.5.1.2.1.4.1.
The Department expects that communications between the LTSS
partner agencies and the Contractor have sufficient escalation processes
in the event the LTSS partner agencies and/or the Contractor are not
getting necessary information in a timely manner.
The Department expects that, if a member may lose access to LTSS
benefits and services and is notified through an LTSS partner agency,
the Contractor have sufficient processes in place to prioritize the
member's case.
Completion of LTSS Communications Plan Template
The Contractor shall complete all fields on the LTSS Communications
Plan Template. Incomplete submissions will make the Contractor
ineligible for a LTSS Performance Incentive Payment for the First
Reporting Period.
Department Review and Approval of LTSS Communications Plan
The Contractor's LTSS Communications plan is subject to approval by
the Department. The Department may request revisions to the plan if
any element of the plan is deemed unacceptable and/or not meeting the
Department's expectations as found in section 4.5.1.2.1.1.
The Contractor's LTSS Communications Plan is due to the Department
no later than the First Reporting Period due date, January 5, 2019.
Contractor's Revision of LTSS Communications Plan
If the Contractor's LTSS Communications Plan is deemed to require
modifications by the Department, the Contractor will work in
collaboration with the partners identified in section 4.5.1.2.1 to modify
the LTSS Communications Plan.
4.5.1.2.1.4.2. The Contractor's revision of the LTSS Communications Plan is due by
June 1, 2019.
4.5.1.2.1.4.3. The Contractor's revision of the LTSS Communications Plan is subject
to the Department's approval. If the revision is not accepted by the
Department, the Contractor will be ineligible for a LTSS Performance
Incentive Payment for the Second Reporting Period.
4.5.1.2.2. Determining Compliance with the LTSS Performance Incentive Standard
4.5.1.2.2.1. The Contractor shall comply with section 4.5.1.1 Timeliness of LTC,
HCBS, and PACE Determinations and Redeterminations and section
4.5.1.2 LTSS Communications Plan to be eligible to earn a LTSS
Performance Incentive Payment.
4.5.1.3. BENCHMARK: 95.00% combined timeliness average for Determinations and
Redeterminations; 85.00% timeliness average for Determinations.
4.5.1.4. DELIVERABLE: LTSS Communications Plan subject to Department approval.
4.6. Case Maintenance Performance Incentive Standard
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4.6.1. The Contractor may earn a Case Maintenance Performance Incentive Payment for each
Reporting Period in which eighty-five percent (85.00%) of the Contractor's
disenrollments are within fifteen (15) calendar days as described in section 4.6.
4.6.1.1. Processing and Timeframes for a Member's Change in Circumstances
4.6.1.1.1. The Contractor shall process all member and partner agency -reported change
in circumstances within fifteen (15) calendar days.
4.6.1.1.1.1. The fifteen (15) calendar day benchmark applies to changes reported by a
member, by a partner agency such as the Single Entry Point or Community
Centered Board or external agencies such as nursing facilities.
4.6.1.1.2. The Contractor shall not pre-screen changes in circumstances to determine if
the change results in a disenrollment. The Contractor shall process the change
in circumstance by entering the information into the Colorado Benefits
Management System (CBMS) within fifteen (15) calendar days.
4.6.1.1.3. The Contractor shall follow existing policy and operational guidance for
entering information relating to a change in circumstances into CBMS.
4.6.1.1.3.1. The calculation for Timely Disenrollments is based on data entry into
CBMS. The Contractor shall ensure that information is correctly entered
into CBMS, including the Date the change in circumstance was reported, to
ensure the Timely Disenrollment calculation is accurate.
4.6.1.2. Timely Disenrollments
4.6.1.2.1. The Contractor will disenroll all members where a change in circumstance has
resulted in ineligibility within fifteen (15) calendar days.
4.6.1.3. Determining Compliance for the Case Maintenance Performance Incentive
Standard
4.6.1.3.1. The Department will utilize the MA Disenrollment Processing Times Report to
determine the Contractor's compliance with the Case Maintenance
Performance Incentive Standard.
4.6.1.3.2. The MA Disenrollment Processing Times Report will be pulled the second
Sunday of the first month after the end of each Reporting Period.
4.6.1.3.3. To determine the Contractor's percentage of timely disenrollments, the
Department will take the total number of timely disenrollments over each
Reporting Period and divide that by the total number of disenrollments
completed. The Department will round the number to two decimal places.
4.6.1.4. BENCHMARK: Eighty-five percent (85.00%) of disenrollments completed within
fifteen (15) calendar days.
4.7. Improving Member Correspondence Performance Incentive Standard
4.7.1. The Contractor may earn an Improving Member Correspondence Performance
Incentive Payment in each Reporting Period in which the Contractor completes data
tracking and deliverable submission relating to customer service interactions with
members regarding member correspondence as found in section 4.7.
4.7.1.1. Contractor's Staff Subject to the Improving Member Correspondence Performance
Incentive Standard
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4.7.1.1.1. To participate in the Improving Member Correspondence Performance
Incentive Standard, the Contractor will designate one (1) staff member
responsible for implementation and contact with the Department.
4.7.1.1.1.1. The Contractor will provide the implementation lead's contact information
through the Data Collection Plan Agreement.
4.7.1.1.2. To earn an Improving Member Correspondence Performance Incentive
Payment, a minimum of ten percent (10%) of the Contractor's member -facing
staff will participate in the Data Collection and Tracking phase.
4.7.1.1.2.1. If ten percent (10%) of the Contractor's staff is equal to less than one (1)
Full Time Equivalent (FTE) position, then a minimum of one FTE will
participate in the Data Collection and Tracking phase.
4.7.1.1.2.2. Member -facing staff include, but are not limited to, eligibility technicians,
administrative assistants responsible for lobby and front desk work and call
center technicians.
4.7.1.1.2.3. If the Contractor identifies staff to participate in the Data Collection and
Tracking phase that cannot participate due to turnover, trainings, or other
issues, the Contractor can substitute other member -facing staff so long as
the ten percent (10%) requirement is met.
4.7.1.1.2.3.1. The Contractor shall identify all substitutes for staff participating in the
Data Collection and Tracking in the Data Collection Plan Agreement.
4.7.1.2. Data Collection Plan Agreement Submission
4.7.1.2.1. To earn an Improving Member Correspondence Performance Incentive
Payment, the Contractor will submit the Data Collection Plan Agreement to the
Department no later than July 31, 2018 for the First Reporting Period and no
later than January 31, 2019 for the Second Reporting Period.
4.7.1.2.1.1. If the Contractor fails to submit the Data Collection Plan Agreement by the
due dates listed in section 4.7.1.2.1, the Contractor will be ineligible for an
Improving Member Correspondence Performance Incentive Payment for
the Reporting Period in which the Data Collection Plan Agreement was due.
4.7.1.2.1.2. The Implementation Lead, identified in section 4.7.1.2.2.1, will submit the
Data Collection Plan Agreement electronically to the Department by the due
date.
4.7.1.2.2. The Contractor will complete the Data Collection Plan Agreement by providing
information on:
4.7.1.2.2.1. Who the Contractor's Implementation Lead is and a phone number and
email address for that individual.
4.7.1.2.2.2. Names of the Contractor's staff that will be responsible for the Data
Collection and Tracking phase and their respective roles/primary duties for
the Contractor. The number of staff subject to the Data Collection and
Tracking Phase is found in section 4.7.1.1.2.
4.7.1.2.2.3. The Contractor's selected twenty (20) consecutive business day timeframe
for the Data Collection and Tracking phase as described in section 4.7.1.3.
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4.7.1.2.2.4. Information on Contractor -specific site operations that may impact the Data
Collection and Tracking phase.
4.7.1.2.3. By submitting the Data Collection Plan Agreement, the Contractor agrees to
follow all guidelines and operational guidance to ensure complete and accurate
data collection and tracking.
4.7.1.2.4. By submitting the Data Collection Plan Agreement, the Contractor agrees not
to falsify any information during the Data Collection and Tracking phases.
4.7.1.2.4.1. The Department reserves the right to audit, without notice or prior
authorization, the results of the Contractor's data collection to ensure data
integrity.
4.7.1.2.4.2. If the Department's audit finds that the data collection was falsified, the
Contractor will be deemed ineligible for the Performance Incentive
Payment for the Reporting Period in which the data collection was audited.
4.7.1.2.5. The Contractor's submitted Data Collection Plan Agreement is subject to
review and approval by the Department. The Department can request revisions
by the Contractor if the Agreement fails to meet the requirements of the
Improving Member Correspondence Performance Incentive Standard.
4.7.1.3. Data Collection and Tracking
4.7.1.3.1. The Contractor shall identify in the Data Collection Plan Agreement a
timeframe of the Contractor's choosing in which the Contractor's staff will
participate in the Data Collection and tracking phase.
4.7.1.3.1.1. The Contractor's timeframe shall be twenty (20) consecutive business days
from August 1, 2018 through December 31, 2018 for the First Reporting
Period and February 1, 2019 through June 30, 2019 for the Second
Reporting Period.
4.7.1.3.2. The Contractor will ensure all designated staff participating in the Data
Collection and Tracking phases complete an online data collection tutorial prior
to implementation of the Data Collection and Tracking phases.
4.7.1.3.2.1. The data collection tutorial for the First Reporting Period will become
available online July 1, 2018 and will include training for the Data
Collection and Tracking phase to be completed prior to December 31, 2018.
4.7.1.3.2.2. The data collection tutorial for the Second Reporting Period will become
available online January 1, 2019 and will include training for the Data
Collection and Tracking phase to be completed prior to June 30, 2019.
4.7.1.3.3. The Contractor shall document member feedback through the online data
collection and tracking tool provided by the Department.
4.7.1.3.3.1. Only data collection submitted through the online data collection and
tracking tool shall be considered valid.
4.7.1.3.3.2. The Contractor will ensure only the Contractor's staff is collecting and
submitting the data through the online data collection and tracking tool.
Members should not have access to the online data collection and tracking
tool.
Page 18 of 25
4.7.1.3.3.3. The Contractor's staff will ensure that all data fields on the online data
collection and tracking tool are completed. Incomplete submissions will
not be accepted to ensure the validity of the data collected.
4.7.1.3.3.4. Data collection shall occur within a reasonable timeframe after each
customer service interaction, and not later than twenty-four (24) hours after
the interaction regarding member correspondence.
4.7.1.3.4. Correspondence subject to the Data Collection and Tracking phase is limited to
Medical Assistance (Medicaid/CHP+) member correspondence, including
noticing, forms, and speed letters sent from the Colorado Benefits Management
System (CBMS).
4.7.1.3.4.1. CBMS correspondence that includes Medical Assistance but also include
other public assistance programs managed by the Colorado Department of
Human Services (CDHS) or Connect for Health Colorado, where
applicable, are also subject to the Data Collection and Tracking phase.
4.7.1.3.4.2. CBMS correspondence that does not include Medical Assistance is not
subject to the Data Collection and Tracking phase.
4.7.1.4. Reporting Period Surveys
4.7.1.4.1. The Contractor will participate in a survey at the end of each Reporting Period
that provides feedback on the Data Collection and Tracking phase that occurred
within each Reporting Period.
4.7.1.4.2. The due date for completion of the survey is January 5, 2019 for the First
Reporting Period and July 5, 2019 for the Second Reporting Period.
4.7.1.5. Compliance with the Improving Member Correspondence Performance Incentive
Standard
4.7.1.5.1. To earn an Improving Member Correspondence Performance Incentive
Standard, the Contractor will comply with sections 4.7.1.1 Contractor's Staff
Subject to the Improving Member Correspondence Performance Incentive
Standard, section 4.7.1.2. Data Collection Plan Agreement, section 4.7.1.3.
Data Collection and Tracking, and section 4.7.1.4. Reporting Period Surveys.
4.7.1.5.1.1. Failure to meet the requirements as listed in section 4.7.1.5.1. will make the
Contractor ineligible to earn an Improving Member Correspondence
Performance Incentive Payment.
4.7.1.6. Department Implementation Support
4.7.1.6.1. The Contractor has the option of participating in a conference call at the
beginning and at the end of each Data Collection and Tracking phase to ask
questions and provide feedback to the Department.
4.7.1.6.2. The Contractor has the option of requesting implementation support conference
calls at any time during each Reporting Period.
4.7.1.7. DELIVERABLE: Data Collection Agreement Plan, Data Collection and Tracking,
and Reporting Period Survey for each Reporting Period.
5. SEMI-ANNUAL REPORTING
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5.1.1. The Contractor shall submit documentation to the Department to verify the
Contractor's compliance with each Performance Incentive Standard and will submit
such documentation on a semi-annual basis.
5.1.1.1. For the First Reporting Period, the Contractor will submit the following
documentation:
5.1.1.1.1. The meeting agendas, meeting minutes, lists of attendees, and Child Welfare
Incentive Template to document its compliance with the Child Welfare
Performance Incentive Standard.
5.1.1.1.2.
5.1.1.1.3.
5.1.1.1.4.
5.1.1.1.5.
5.1.1.2.
Any Eligibility Timeliness and Backlog Performance Incentive Standard
exemption forms for the Reporting Period.
Improved Member Correspondence documentation, including the Data
Collection Agreement Plan, Data Collection and Tracking, and Reporting
Period Survey.
The LTSS Communications Plan and any LTSS Performance Incentive
Standard exemption forms pertaining to the timeliness benchmarks for the
Reporting Period.
DUE DATE: January 5, 2019
For the Second Reporting Period, the Contractor will submit the following
documentation:
5.1.1.2.1. The meeting agendas, meeting minutes, lists of attendees, and Child Welfare
Incentive Template to document its compliance with the Child Welfare
Performance Incentive Standard.
5.1.1.2.2. Any Eligibility Timeliness and Backlog Performance Incentive Standard
exemption forms for the Reporting Period.
5.1.1.2.3. Improved Member Correspondence documentation, including the Data
Collection Agreement Plan, Data Collection and Tracking, and Reporting
Period Survey.
5.1.1.2.4. The LTSS Communications Plan revision and any LTSS Performance Incentive
Standard exemption forms pertaining to the timeliness benchmarks for the
Reporting Period.
5.1.1.2.5. DUE DATE: July 5, 2019
6. EXEMPTIONS
6.1. Exemptions for Unusual Circumstances for the Eligibility Timeliness and Backlog
Performance Incentive Standard and the LTSS Performance Incentive Standard
6.1.1. If a Determination or Redetermination is delayed for unusual circumstances as defined
under 10 C.C.R. 2505-8.100.3.D (d), the Contractor is eligible to submit an exemption
form.
6.1.1.1. The Department will not include any Untimely Determinations/Redeterminations
in its calculation of the Eligibility Timeliness and Backlog Performance Incentive
Standard and/or the LTSS Performance Incentive Standard if the Department has
approved that Untimely Determination/Redetermination as being untimely because
of unusual circumstances as specified in section 6.1.1.
Page 20 of 25
6.1.1.2. The Contractor shall be responsible for submitting one (1) exemption form that
details each of the cases for which the Contractor is requesting an exemption.
6.1.1.3. The Contractor shall provide adequate information on the exemption form for the
Department to quantify personnel issues if the Contractor requests an exemption
due to staff vacancies, staff training, or other personnel issues.
6.1.2. The Department may approve or reject any request for Untimely
Determination/Redetermination exemptions and may limit the total number of
exempted Untimely Determinations/Redeterminations for the Eligibility Timeliness
and Backlog Performance Incentive Standard and/or the LTSS Performance Incentive
Standard.
6.1.2.1. The Department will deny exemption requests that do not meet timeliness definition
set forth in 10 C.C.R. 2505-8.100.3.D (d) and Section 1.1.12 due to the fault of the
Contractor and/or any exemption requests based on the following:
6.1.2.1.1. Failure of the Contractor to timely act on a Determination or Redetermination
which resulted in a failure to meet the timeliness requirements in Sections
1.1.11 and 1.1.12.
6.1.2.1.2. Failure of the Contractor to act on client verification that was submitted timely
which was requested for a Determination or Redetermination.
6.1.2.1.3. Failure of the Contractor to manually authorize a Determination or
Redetermination with a mass update exception.
6.1.2.1.4. Failure of the Contractor to manually authorize a Redetermination when the
auto re -enrollment or Ex Parte processes were not successful.
6.1.2.1.5. Failure of the Contractor to pull all applicable COGNOS reports for the
purposes of fulfilling Exhibit A-4, Statement of Work.
6.1.2.2. The reasons for denial of an exemption as stated in section 6 are not all-inclusive
and the Department reserves the right to deny any exemption for reasons not stated
in section 6.
6.1.2.2.1. Prior to denying an exemption for reasons beyond those stated in section 6, the
Department may, at its discretion, request further information from the
Contractor to determine whether the request for exemption meets the exemption
standards as stated in section 6, Exemptions.
6.1.2.3. The Department may approve or reject any request for exemption due to unusual
circumstances and may limit the total number of exemption requests.
6.2. Exemptions for Unusual Circumstances for Performance Incentive Standards other than
the Eligibility Timeliness and Backlog Performance Incentive Standard and the LTSS
Performance Incentive Standard
6.2.1. Exemptions for unusual circumstances will not be considered for any Performance
Incentive Standard listed under section 6.2.1.
6.2.1.1. Child Welfare Performance Incentive Standard
6.2.1.2. Case Maintenance Performance Incentive Standard
6.2.1.3. Improved Member Correspondence Performance Incentive Standard
Page 21 of 25
6.2.1.4. Training Performance Incentive Standard
6.2.1.5. The LTSS Communications Plan deliverable of the LTSS Performance Incentive
Standard
6.2.2. The Contractor's performance and compliance with the Performance Incentive
Standards listed under section 6.2.1 will be deemed final and Performance Incentive
Payments made without the opportunity to submit an exemption for unusual
circumstances.
7. NOTIFICATIONS
7.1. After each Reporting Period, the Contractor will be provided a Status Report that details
which Incentive Performance Standards were met.
7.1.1. The Contractor's Status Report will only detail which Incentive Performance Standards
were met for the Reporting Period in question. Funding amounts will not be provided
until the conclusion of the fiscal year.
7.1.2. In the event the Contractor has more than one Reporting Period in the fiscal year to
meet any Incentive Performance Standards, the Status Report will not include the
Contractor's performance in those Performance Standards.
7.2. After the conclusion of the fiscal year, the Department will provide the Contractor a final
Status Report that details which Performance Incentive Standards were met and how much
Performance Incentive Payments were earned by the Contractor.
7.2.1. The final Status Report cannot be disputed; if the Contractor disagreed with the
Department's determination of compliance with any Performance Incentive Standard,
the Contractor shall have disputed that result based on the Reporting Period Status
Report.
7.3. Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor's
compliance with the Performance Incentives Standards.
7.4. Status Reports for each Reporting Period will be sent within ten (10) calendar days after
the Semi -Annual Reporting due date for each Reporting Period as found in Section 5, Semi -
Annual Reporting. The date on which the Status Report for each Reporting Period is sent
to the Contractor will be considered the Status Report Date.
7.5. The final Status Report will be sent upon the Department's determination of final
Performance Incentive Payment amounts.
7.6. The Contractor will have the opportunity to dispute the Status Report results as defined in
section 7, Dispute Resolution.
8. DISPUTE RESOLUTION
8.1. Opportunity and Timeframe for Dispute Resolution
8.1.1. In the event the Contractor disagrees with the findings of the official notification as
found in section 7, Notifications, the Contractor will have the opportunity to dispute
the Status Report for the Reporting Period in question.
8.1.1.1. The Contractor will have ten (10) calendar days from the Status Report Date to
review each Reporting Period Status Report and dispute the results.
Page 22 of 25
8.1.1.2. If the Contractor fails to dispute the Reporting Period Status Report within ten (10)
calendar days from the Status Report Date, the Status Report results will be deemed
final. No further disputes will be allowed, and compensation will be made per
section 9 based on the results of the non -disputed Status Report.
8.2. Allowable Disputes
8.2.1. The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
8.2.1.1. The Contractor submitted documentation that was required for an Incentive
Performance Standard, so long as the Contractor has proof that the required
documentation was submitted on or before the contractually -required due date.
8.2.1.2. The Contractor requests a re -review of the Contractor's submitted documentation
that was used to determine compliance with any Incentive Performance Standard.
8.2.2. The Department reserves the right to add additional allowable dispute reasons
throughout the fiscal year based on additional information made available from the
Department and/or Contractor. These additional allowable dispute reasons will be
considered on a case -by -case basis, and the Department's determination of additional
allowable dispute reasons are final and not subject to the Dispute Resolution process
as outlined in section 8.
8.3. Nonallowable Disputes
8.3.1. The Contractor will not be allowed to dispute the results of the Status Report based on
the following reasons:
8.3.1.1. The Contractor failed to meet contractually -specified requirements relating to the
content of submission of deliverables and the timely submission of deliverables.
8.3.1.2. The Contractor failed to meet contractually -specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3. The Contractor's failure to review and utilize County Incentives Program
documentation, including policy, informational, and operational guidance issued
through the HCPF Memo Series, that resulted in the Contractor failing to meet
performance benchmarks and deliverables relating to any Incentive Performance
Standard.
8.3.1.4. The Department's final determination of the Contractor's exemption request(s) for
the Eligibility Timeliness and Backlog Performance Incentive Standard and the
Long Term Services and Supports Performance Incentive Standard.
8.3.1.5. Any exemption requests for unusual circumstances for other Performance Incentive
Standards other than those listed in 8.3.1.4.
8.3.2. The Department reserves the right to deny a Contractor's dispute based on any reason
not included under section 8.3.1. The Department's determination is final and is not
subject to dispute or appeal.
9. COMPENSATION
9.1. Compensation
9.1.1. Performance Incentive Payment
Page 23 of 25
9.1.1.1. The Department shall pay the Contractor, after the end of the fiscal year in which
the work was performed, a Performance Incentive Payment for each Performance
Incentive Standard it meets during the applicable Reporting Period as follows:
9.1.1.1.1. The Department shall pay the Contractor an Eligibility Timeliness and Backlog
Performance Standard Payment as shown in Exhibit B for each Reporting
Period that the Contractor meets the requirements for that Performance
Incentive Standard.
9.1.1.1.2. The Department shall pay the Contractor a Collaboration Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.3. The Department shall pay the Contractor a LTSS Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.1.1.4. The Department shall pay the Contractor a Child Welfare Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.5. The Department shall pay the Contractor a Training Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.2. Remaining Funds Incentive Pool Payment
9.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
9.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.1.1. The total amount of all base Performance Incentive Payments allocated to
any Contractor that selected to not participate in the Performance Incentive
Standards Program for that SFY.
9.1.2.1.1.2. Each of the base Performance Incentive Payments that were not earned by
the Contractor during a Reporting Period in that SFY.
9.1.2.1.2. If the Remaining Funds Incentive Pool is zero dollars ($0.00) for any SFY, the
Contractor shall not receive a Remaining Funds Incentive Pool Payment for that
SFY.
9.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
9.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amount of Incentives met during that SFY.
9.1.2.2.2. Based on the proportion of total Incentive funds that the Contractor is eligible
to be paid in each SFY, the Contractor shall receive the same proportion of
funds from the Remaining Funds Incentive Pool.
9.1.2.2.3. The Contractor's payment of funds from the Remaining Funds Incentive Pool
shall never exceed the county's share of Medicaid expenditure, as specified in
Section 2, County Determinations.
9.2. Payment Procedures
Page 24 of 25
9.2.1. The Contractor shall receive Performance Incentive Payments for each Reporting
Period within ninety days (90) days following the end of the fiscal year in which the
Performance Incentive benchmarks were met. This allocation will reflect the maximum
the Contractor can earn for each Performance Incentive Standard per Reporting Period.
9.2.1.1. In the event that the Contractor's county administration line item is over -expended
during the county administration closeout process, the Department may utilize the
Contractor's earned Performance Incentive Payments during the closeout process.
9.2.2. Actual Performance Incentive Payment maximums are dependent on the Contractor's
share of Medicaid county administration expenditure. In no event shall the Contractor
be paid more than the Contractor's county share of Medicaid county administration
expenditure in any Reporting Period.
9.2.3. The Department may add any unearned funds from the First Reporting Period into to
the Second Reporting Period allocation for any SFY.
9.2.3.1. The Contractor shall receive the Incentive Performance Payments through the
County Financial Management System (CFMS).
9.2.4. The Department may use any unearned Second Reporting Period Incentive
Performance Payments during the county administration close out process.
Page 25 of 25
EXHIBIT B, RATES
FY 2018-19 HCPF County Administration Performance Incentive Funding Table
COUNTY
% of
TOTAL
ALLOCATI
ON
MAX- HCPF
County Share
Estimate
County Incentive
(if all counties
participate and
meet benchmarks)
30%- Eligibility
Timeliness and
Backlog
15%- Case
Maintenance
15%- Long
Term Services
and Supports
(LTSS)
15%-
Training
15%- Child
Welfare
10%- Improved
Member
Correspondence
Adams County
8.83%
$517,341.73
$388,006.27
$116,401.88
$58,200.94
$58,200.94
$58,200.94
$58,200.94
$38,800.63
Alamosa County
0.88%
$51,671.80
$38,753.85
$11,626.15
$5,813.08
$5,813.08
$5,813.08
$5,813.08
$3,875.38
Arapahoe County
10.14%
$594,265.55
$445,699.13
$133,709.74
$66,854.87
$66,854.87
$66,854.87
$66,854.87
$44,569.91
Archuleta County
0.32%
$18,738.63
$14,053.97
$4,216.19
$2,108.10
$2,108.10
$2,108.10
$2,108.10
$1,405.40
Baca County
0.12%
$7,166.32
$5,374.74
$1,612.42
$806.21
$806.21
$806.21
$806.21
$537.47
Bent County
0.20%
$11,769.83
$8,827.37
$2,648.21
$1,324.11
$1,324.11
$1,324.11
$1,324.11
$882.74
Boulder County
3.98%
$233,246.99
$174,935.23
$52,480.57
$26,240.28
$26,240.28
$26,240.28
$26,240.28
$17,493.52
Chaffee County
0.38%
$22,517.45
$16,888.09
$5,066.43
$2,533.21
$2,533.21
$2,533.21
$2,533.21
$1,688.81
Cheyenne County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Clear Creek County
0.17%
$9,743.76
$7,307.82
$2,192.34
$1,096.17
$1,096.17
$1,096.17
$1,096.17
$730.78
Conejos County
0.29%
$17,136.57
$12,852.43
$3,855.73
$1,927.86
$1,927.86
$1,927.86
$1,927.86
$1,285.24
Costilla County
0.24%
$14,060.19
$10,545.14
$3,163.54
$1,581.77
$1,581.77
$1,581.77
$1,581.77
$1,054.51
Crowley County
0.16%
$9,613.73
$7,210.30
$2,163.09
$1,081.54
$1,081.54
$1,081.54
$1,081.54
$721.03
Custer County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Delta County
0.89%
$52,129.67
$39,097.25
$11,729.18
$5,864.59
$5,864.59
$5,864.59
$5,864.59
$3,909.73
Denver County
16.82%
$985,660.41
$739,245.27
$221,773.58
$110,886.79
$110,886.79
$110,886.79
$110,886.79
$73,924.53
Dolores County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Douglas County
1.61%
$94,351.44
$70,763.58
$21,229.07
$10,614.54
$10,614.54
$10,614.54
$10,614.54
$7,076.36
Eagle County
0.51%
$29,848.65
$22,386.49
$6,715.95
$3,357.97
$3,357.97
$3,357.97
$3,357.97
$2,238.65
Elbert County
0.23%
$13,193.18
$9,894.88
$2,968.46
$1,484.23
$1,484.23
$1,484.23
$1,484.23
$989.49
El Paso County
13.22%
$774,798.49
$581,098.83
$174,329.65
$87,164.83
$87,164.83
$87,164.83
$87,164.83
$58,109.88
Fremont County
1.35%
$79,034.76
$59,276.07
$17,782.82
$8,891.41
$8,891.41
$8,891.41
$8,891.41
$5,927.61
Garfield County
1.13%
$66,124.38
$49,593.28
$14,877.99
$7,438.99
$7,438.99
$7,438.99
$7,438.99
$4,959.33
Gilpin County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Grand County
0.20%
$11,829.67
$8,872.25
$2,661.68
$1,330.84
$1,330.84
$1,330.84
$1,330.84
$887.23
Gunnison County
0.34%
$19,852.49
$14,889.36
$4,466.81
$2,233.40
$2,233.40
$2,233.40
$2,233.40
$1,488.94
Hinsdale County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Huerfano County
0.35%
$20,429.72
$15,322.29
$4,596.69
$2,298.34
$2,298.34
$2,298.34
$2,298.34
$1,532.23
Jackson County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Jefferson County
6.42%
$376,010.75
$282,008.04
$84,602.41
$42,301.21
$42,301.21
$42,301.21
$42,301.21
$28,200.80
Kiowa County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Kit Carson County
0.15%
$8,770.58
$6,577.94
$1,973.38
$986.69
$986.69
$986.69
$986.69
$657.79
Lake County
0.18%
$10,625.31
$7,968.98
$2,390.69
$1,195.35
$1,195.35
$1,195.35
$1,195.35
$796.90
La Plata County .
1.03%
$60,550.63
$45,412.97
$13,623.89
$6,811.95
$6,811.95
$6,811.95
$6,811.95
$4,541.30
Larimer County
4.95%
$290,006.77
$217,505.06
$65,251.52
$32,625.76
$32,625.76
$32,625.76
$32,625.76
$21,750.51
Las Animas County
0.63%
$36,950.81
$27,713.11
$8,313.93
$4,156.97
$4,156.97
$4,156.97
$4,156.97
$2,771.31
Lincoln County
0.12%
$7,106.82
$5,330.11
$1,599.03
$799.52
$799.52
$799.52
$799.52
$533.01
Logan County
0.53%
$30,767.36
$23,075.52
$6,922.66
$3,461.33
$3,461.33
$3,461.33
$3,461.33
$2,307.55
Mesa County
3.51%
$205,493.33
$154,119.99
$46,236.00
$23,118.00
$23,118.00
$23,118.00
$23,118.00
$15,412.00
Mineral County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Moffat County
0.36%
$21,235.27
$15,926.45
$4,777.94
$2,388.97
$2,388.97
$2,388.97
$2,388.97
$1,592.65
Montezuma County
0.86%
$50,335.13
$37,751.34
$11,325.40
$5,662.70
$5,662.70
$5,662.70
$5,662.70
$3,775.13
Montrose County
1.27%
$74,567.40
$55,925.55
$16,777.66
$8,388.83
$8,388.83
$8,388.83
$8,388.83
$5,592.55
Morgan County
0.69%
$40,705.73
$30,529.29
$9,158.79
$4,579.39
$4,579.39
$4,579.39
$4,579.39
$3,052.93
Otero County
0.78%
$45,607.58
$34,205.68
$10,261.71
$5,130.85
$5,130.85
$5,130.85
$5,130.85
$3,420.57
OurayCounty
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Park County
0.29%
$17,116.90
$12,837.68
$3,851.30
$1,925.65
$1,925.65
$1,925.65
$1,925.65
$1,283.77
Phillips County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Pitkin County
0.15%
$9,081.30
$6,810.97
$2,043.29
$1,021.65
$1,021.65
$1,021.65
$1,021.65
$681.10
Prowers County
0.49%
$28,841.53
$21,631.15
$6,489.34
$3,244.67
$3,244.67
$3,244.67
$3,244.67
$2,163.11
Pueblo County
6.38%
$373,559.30
$280,169.46
$84,050.84
$42,025.42
$42,025.42
$42,025.42
$42,025.42
$28,016.95
Rio Blanco County
0.12%
$6,890.04
$5,167.53
$1,550.26
$775.13
$775.13
$775.13
$775.13
$516.75
Rio Grande County
0.44%
$25,540.43
$19,155.32
$5,746.60
$2,873.30
$2,873.30
$2,873.30
$2,873.30
$1,915.53
Routt County
0.32%
$18,979.33
$14,234.50
$4,270.35
$2,135.17
$2,135.17
$2,135.17
$2,135.17
$1,423.45
Saguache County
0.26%
$15,489.75
$11,617.31
$3,485.19
$1,742.60
$1,742.60
$1,742.60
$1,742.60
$1,161.73
San Juan County
0.10%
$5,841.76
$4,331.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
San Miguel County
0.10%
$5,841.76
$4,331.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
SedgwickCounty
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Summit County
0.32%
$19,017.25
$14,262.94
$4,278.88
$2,139.44
$2,139.44
$2,139.44
$2,139.44
$1,426.29
Teller County
0.51%
$30,132.70
$22,599.52
$6,779.86
$3,389.93
$3,389.93
$3,389.93
$3,389.93
$2,259.95
Washington County
0.10%
$5,841.76
$4,381.32
$1,314.40
$657.20
$657.20
$657.20
$657.20
$438.13
Weld County
4.73%
$277,211.57
$207,908.67
$62,372.60
$31,186.30
$31,186.30
$31,186.30
$31,186.30
$20,790.87
Yuma County
0.21%
$12,036.05
$9,027.04
$2,708.11
$1,354.06
$1,354.06
$1,354.06
$1,354.06
$902.70
Broomfield County
0.52%
$30,683.36
$23,012.52
$6,903.76
$3,451.88
$3,451.88
$3,451.88
$3,451.88
$2,301.25
GRAND TOTALS
100.00%
$5,859,623.00
1 $4,394,717.00
$1,318,415.10
$659,207.55
$659,207.55
$659,207.55
$659,207.55
$439,471.70
EXHIBIT C, SMALL, MEDIUM AND LARGE COUNTY LIST
The below categorizes counties as small, medium and large for purposes of qualification of
exemptions for timeliness and/or backlog incentives.
Small
Archuleta
Baca
Bent
Cheyenne
Clear Creek
Costilla
Crowley
Custer
Dolores
Elbert
Gilpin
Medium
Alamosa
Broomfield
Chaffee
Conejos
Delta
Douglas
Eagle
Fremont
Large
Adams
Arapahoe
Boulder
Denver
Grand
Gunnison
Hinsdale
Jackson
Kiowa
Kit Carson
Lake
Lincoln
Mineral
Ouray
Park
Garfield
Huerfano
La Plata
Las Animas
Logan
Moffat
Montezuma
Montrose
El Paso
Jefferson
Larimer
Mesa
Page 1 of 1
Phillips
Pitkin
Rio Blanco
Routt
San Juan
San Miguel
Sedgwick
Summit
Washington
Yuma
Morgan
Otero
Prowers
Rio Grande
Saguache
Teller
Pueblo
Weld
Hello