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Home My WebLink About20141790.tiff RESOLUTION RE: APPROVE CONTINUATION CONTRACT FOR NURSE HOME VISITOR 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 a Continuation Contract for the Nurse Home Visitor Program (NHVP) 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 Public Health and Environment, commencing July 1, 2014, and ending June 30, 2015, with further terms and conditions being as stated in said contract, and WHEREAS, after review, the Board deems it advisable to approve said contract, 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 Continuation Contract for the Nurse Home Visitor 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 Public Health and Environment be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said contract. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 16th day of June, A.D., 2014. BOARD OF COUNTY COMMISSIONERS WELD COUNTY COLORADO ATTEST: "jet �C rte • d � o< (c9-, Y�fe Douglas/Rademac er, hair Weld County Clerk to the Board a ` ii- •ara Kirkmeyer, Pro-Tem BYA(1oIl1l40 (� De Clerk to the Board ISM o,,;•o' it P. Conway• AP V AS � �hi ike Freeman ou rney William F F. G a Date of signature: 9'9 cc rrit � ttsb(S) 811 2014-1790 HL0044 \-4.‘ Memorandum jt r TO: Douglas Rademacher, Chair — Board of County Commissioners GOUNT� FROM: Mark E. Wallace, MD, MPH, Executive Director Department of Public Health & Environment DATE: June 12, 2014 SUBJECT: FY2014-15 Nurse Home Visitor Program (NHVP) Continuation Contract Enclosed for Board review and approval is a contract between the Weld County Department of Public Health and Environment and The Colorado Department of Human Services. With the approval of this FY2014-15 Nurse Home Visitor Program (NHVP) Continuation Contract, the Weld County Department of Public Health and Environment will be receiving funding of $802,175 for this one-year contract to cover activities performed beginning July 1, 2014, and ending June 30, 2015. The contract is funded by the Colorado State Tobacco Settlement Funds ($752,175) and Medicaid reimbursements (estimated at $50,000). The grant will fund 8 FTE including 1 FTE Office Technician, 6 FTE Public Health Nurse II and .75 FTE Public Health Nurse III, Supervisor. At no cost to the client, specially trained registered nurses provide bi-monthly home visits to low-income, first time mothers residing in Weld County beginning in pregnancy and continuing until the client's child reaches the age of two years. Clients are educated and encouraged to develop positive maternal/child health practices, an understanding of infant/toddler developmental needs, effective parenting and maternal economic self-sufficiency. This contract was approved for placement on the agenda by the Board via pass-around dated June 3, 2014. I recommend approval of this FY2014-15 Nurse Home Visitor Program (NHVP) Continuation Contract with The Colorado Department of Human Services. 2014-1790 • DEPARTMENT OF HUMAN SERVICES ROUTING NO. 15 IHA 68641 CONTRACT This contract is made and entered into by and between the named parties. In accordance with the purposes stated herein, it is hereby agreed as follows: STATE: CONTRACTOR State of Colorado for the use&benefit of the Weld County Dept.of Public Health and Environment Department of Human Services 1555 N 17th Avenue Division of Early Childhood Greeley,CO 80621 1575 Sherman,1st Floor Denver,CO 80203 CONTRACT MADE DATE: CONTRACTOR'S ENTITY TYPE: 04/30/2014 Government CONTRACTOR'S STATE OF INCORPORATION: PO/SC ENCUMBRANCE NUMBER N/A PO II-IA BILLING STATEMENTS RECEIVED TERM Monthly This contract shall be effective upon approval STATUTORY AUTHORITY by the State Controller,or designee,or on C.RS. §26-6.4-101 07/01/2014,whichever is later. The contract CONTRACT PRICE NOT TO EXCEED shall end on 06/30/2015. $752,175.00 MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR PROCUREMENT METHOD FY 15: $752,175.00 Law Specified Vendor BID/REP/LIST PRICE AGREEMENT NUMBER Not Applicable LAW SPECIFIED VENDOR STATUTE PRICE STRUCTURE C.RS.26.4-107 Cost Reimbursement FUND SOURCE-NAME OF FEDERAL PROGRAM/GRANT AND FUNDS ID# NHVP 13M STATE REPRESENTATIVE CONTRACTOR REPRESENTATIVE: Mary Martin, Program Director Tanya Geiser Division of Early Childhood Director,Administrative Services Weld County DPHE 1575 Sherman, 1st Floor 1555 N 17th Avenue Denver, CO 80203 Greeley, CO 80621 SCOPE OF WORK: In accordance with the provisions of this contract and its exhibits and attachments, the Contractor shall: Provide trained visiting nurses to help educate mothers on the importance of nutrition and avoiding alcohol and drugs,including nicotine,and to assist and educate mothers in providing general care for their children. For Contract Wizard Version 3.16 Page 1 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management RECEIVE D • O,90B/- /29D JUL 0 8 2014 EXHIBITS: The following exhibits are hereby incorporated: Exhibit A- Statement of Work Exhibit B- Budget Exhibit C- Additional Provisions Exhibit D- HIPAA Business Associate Addendum Exhibit E- Sample Option Letter Exhibit F- 2014-2015 NHVP Continuation Application Review Summary COORDINATION: The State warrants that required approval, clearance and coordination has been accomplished from and with appropriate agencies. APPROVAL In no event shall this contract be deemed valid until it shall have been approved by the State Controller or his/her designee. PROCUREMENT: This contractor has been selected in accordance with the requirements of the Colorado Procurement Code. PRICE PROVISIONS: Payments pursuant to this contract shall be made as earned, in whole or in part, from available funds, encumbered for the purchase of the described services and/or deliverables. The liability of the State at any time for such payments shall be limited to the encumbered amount remaining of such funds. Authority exists in the laws and funds have been budgeted, appropriated and otherwise made available, and a sufficient unencumbered balance thereof remains available for payment. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted and otherwise made available. The Contractor understands and agrees that the State shall not be liable for payment for work or services or for costs or expenses incurred by the Contractor prior to the proper execution and State Controller approval of this contract. For Contract Wizard Version 3.16 Page 2 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management GENERAL PROVISIONS The following clauses apply to this contract: documents in the following order of priority: I) the Special Provisions of this contract shall always be A. Governmental Immunity/Limitation of Liability: controlling over other provisions in the contract or Notwithstanding anything herein to the contrary, amendments; 2) the contract "cover" pages; 3) the no term or condition of this contract shall be General Provisions of this contract;4)the exhibits to construed or interpreted as a waiver, express or this contract, except that any exhibit entitled: implied, of any of the immunities,rights,benefits, "Modifications to the General Provisions"shall take protection, or other provisions of the "Colorado priority over the General Provisions of this contract. Governmental Immunity Act",C.R.S. §24-10-101, et seq.,as now or hereinafter amended.The parties E. Notice and Representatives:For the purposes of this understand and agree that the liability of the State contract, the representative for each party is as for claims for injuries to persons or property designated herein. Any notice required or permitted arising out of negligence of the State of Colorado, may be delivered in person or sent by registered or its departments, institutions, agencies, boards, certified mail,return receipt requested,to the party at officials and employees is controlled and limited the address provided, and if sent by mail it is by the provisions of C.R.S. §24-10-101,et seq.,as effective when posted in a U.S. Mail Depository now or hereafter amended and the risk with sufficient postage attached thereto. Notice of management statutes, C.R.S. §24-30-1501, et seq., change of address or change or representative shall as now or hereafter amended. Any liability of the be treated as any other notice. State created under any other provision of this contract, whether or not incorporated herein by F. Contractor Representations: reference, shall be controlled by, limited to, and 1. Licenses and Certifications: The Contractor otherwise modified so as to conform with, the certifies that, at the time of entering into this above cited laws. contract, it and its agents have currently in effect all necessary licenses, certifications, B. Federal Funds Contingency: Payment pursuant to approvals, insurance, etc. required to properly this contract, if in federal funds, whether in whole provide the services and/or supplies covered or in part, is subject to and contingent upon the by this contract in the state of Colorado.Proof continuing availability of federal funds for the of such licenses, certifications, approvals, purposes hereof. In the event that said funds, or insurance, etc. shall be provided upon the any part thereof, become unavailable, as State's request. Any revocation, withdrawal or determined by the State, the State may nonrenewal of necessary license, certification, immediately terminate this contract or amend it approval, insurance, etc. required for the accordingly. Contractor to properly perform this contract, shall be grounds for termination of this C. Billing Procedures: The State shall establish billing contract by the State. procedures and requirements for payment due the 2. Qualification: Contractor certifies that it is Contractor in providing performance pursuant to this qualified to perform such services or provide contract. The Contractor shall comply with the such deliverables as delineated in this contract. established billing procedures and requirements for 3. Exclusion. Debarment and/or Suspension: submission of billing statements. The State shall Contractor represents and warrants that comply with CRS 24-30-202(24) when paying Contractor, or its employees or authorized vendors upon receipt of a correct notice of the subcontractors, are not presently excluded from amount due for goods or services provided participation,debarred,suspended,proposed for hereunder. debarment, declared ineligible, voluntarily excluded, or otherwise ineligible to participate D. Exhibits- Interpretation: Unless otherwise stated, all in a"federal health care program"as defined in referenced exhibits are incorporated herein and made 42 U.S.C. § 1320a-7b(f) or in any other a part of this contract. And,unless otherwise stated, government payment program by any federal or in the event of conflicts or inconsistencies between State of Colorado department or agency. In the this contract and its exhibits or attachments, such event Contractor, or one of its employees or conflicts shall be resolved by reference to the authorized subcontractors, is excluded from For Contract Wizard Version 3.16 Page 3 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management participation,or becomes otherwise ineligible to section at all times during the term of this participate in any such program during the Contract. All policies evidencing the insurance Term,Contractor will notify the State in writing coverage required hereunder shall be issued by within three(3)days after such event. Upon the insurance companies satisfactory to Contractor and occurrence of such event, whether or not such the State. notice is given to Contractor, the State reserves I. Contractor the right to immediately cease contracting with a. Public Entities: If Contractor is a "public Contractor. entity" within the meaning of the Colorado 4. Work Performed Outside the United States or Governmental Immunity Act, CRS §24-10- Colorado,pursuant to C.R.S. §24-102-206: The 101, et seq., as amended (the "GIA"), then Contractor certifies all work performed under Contractor shall maintain at all times during this Contract, including any subcontracts, is the term of this Contract such liability anticipated to be and will be performed within insurance, by commercial policy or self- the United States or Colorado,unless otherwise insurance, as is necessary to meet its specified in the Statement of Work If work liabilities under the GIA. Contractor shall under this Contract is anticipated to be or will show proof of such insurance satisfactory to be performed outside the United States or the State, if requested by the State. Cqlorado, the countries and/or states where Coptractor shall require each contract with a work will be performed, and the reasons it is Subcontractor that is a public entity, to necessary or advantageous to go outside the include the insurance requirements United States or Colorado to perform the work necessary to meet such Subcontractor's are also specified in the Statement of Work. liabilities under the GIA. b. Non-Public Entities: If Contractor is not a G. Legal Authority: The Contractor warrants that it "public entity" within the meaning of the possesses the legal authority to enter into this GIA, Contractor shall obtain and maintain contract and that it has taken all actions required during the term of this Contract insurance by its procedures, by-laws, and/or applicable law coverage and policies meeting the same to exercise that authority,and to lawfully authorize requirements set forth in provision 1.2 its undersigned signatory to execute this contract below with respect to Subcontractors that and bind the Contractor to its terms. The person(s) are not"public entities". executing this contract on behalf of the Contractor 2. Contractors—Subcontractors warrant(s) that such person(s) have full Contractor shall require each contract with authorization to execute this contract. Subcontractors other than those that are public entities, providing Goods or Services in H. Indemnification: Contractor shall indemnify, connection with this Contract, to include save, and hold harmless the State, its employees insurance requirements substantially similar to and agents, against any and all claims, damages, the following: liability and court awards including costs, a.Worker's Compensation: Worker's expenses, and attorney fees and related costs, Compensation Insurance as required by incurred as a result of any act or omission by State statute, and Employer's Liability Contractor, or its employees, agents, Insurance covering all of Contractor or subcontractors, or assignees pursuant to the terms Subcontractor employees acting within the of this contract. course and scope of their employment. b.General Liability: Commercial General (Applicable Only to Intergovernmental Liability Insurance written on ISO Contracts) No term or condition of this contract occurrence form CG 00 01 10/93 or shall be construed or interpreted as a waiver, equivalent, covering premises operations, express or implied, of any of the immunities, fire damage, independent contractors, rights, benefits, protection, or other provisions, of products and completed operations, blanket the Colorado Governmental Immunity Act, CRS contractual liability, personal injury, and §24-10-101 et seq., or the Federal Tort Claims advertising liability with minimum limits as Act, 28 U.S.C. 2671 et seq., as applicable, as now follows: or hereafter amended. (a)$1,000,000 each occurrence; (b)$1,000,000 general aggregate; I. Insurance: Contractor and its Subcontractors shall (c) $1,000,000 products and completed obtain and maintain insurance as specified in this operations aggregate;and For Contract Wizard Version 3.16 Page 4 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management (d)$50,000 any one fire. include clauses stating that each carrier shall waive all rights of recovery, under If any aggregate limit is reduced below subrogation or otherwise,against Contractor $1,000,000 because of claims made or paid, or the State, its agencies, institutions, Subcontractor shall immediately obtain organizations, officers, agents, employees, additional insurance to restore the full and volunteers. aggregate limit and furnish to Contractor a 3.Certificates: Contractor and all Subcontractors certificate or other document satisfactory to shall provide certificates showing insurance Contractor showing compliance with this coverage required hereunder to the State within provision. seven business days of the Effective Date of this c.Automobile Liability: Automobile Liability Contract. No later than 15 days prior to the Insurance covering any auto (including expiration date of any such coverage, Contractor owned, hired and non-owned autos) with a and each Subcontractor shall deliver to the State minimum limit of$1,000,000 each accident or Contractor certificates of insurance combined single limit. evidencing renewals thereof. In addition, upon d. Professional Liability: Professional liability request by the State at any other time during the insurance with minimum limits of liability term of this Contract or any subcontract, of not less than $1,000,000, unless waived Contractor and each Subcontractor shall, within by the State. 10 days of such request, supply to the State e.Privacy Insurance evidence satisfactory to the State of compliance If this Contract includes a HIPAA Business with the provisions of this provision I. Associates Addendum exhibit, Contractor shall obtain and maintain during the term of J. Disaster Planning and Pandemic Outbreaks: The this Contract liability insurance covering all State may require the Contractor to submit a loss of Protected Health Information data Disaster Response Plan (Plan) to ensure the and claims based upon alleged violations of delivery hereunder of essential government privacy rights through improper use or services during a disaster, declared emergency, disclosure of Protected Health Information and/or pandemic outbreak. The Plan would take with a minimum annual limit of$1,000,000. precedence over and nullify any contractual f. Additional Insured: The State shall be provision relating to force majeure or "Acts of named as additional insured on all God."Accordingly, should the work performed by Commercial General Liability and the Contractor under this contract include the Automobile Liability Insurance policies provision of any essential government services,the (leases and construction contracts require State may request a Plan from the Contractor,and, additional insured coverage for completed upon such request, the Contractor shall forthwith operations on endorsements CG 2010 submit a Plan,and the Contractor shall be bound to 11/85, CG 2037, or equivalent) required of perform hereunder in accordance therewith. Contractor and any Subcontractors hereunder. K. Rights in Data, Documents and Computer g. Primacy of Coverage: Coverage required of Software or Other Intellectual Property: Contractor and Subcontractor shall be All intellectual property including without primary over any insurance or self- limitation, databases, software, documents, insurance program carried by Contractor or research, programs and codes, as well as all, the State. reports, studies, data, photographs, negatives or h. Cancellation: The above insurance policies other documents, drawings or materials prepared shall include provisions preventing by the contractor in the performance of its cancellation or non-renewal without at least obligations under this contract shall be the 30 days prior notice to Contractor and exclusive property of the State. Unless otherwise Contractor shall forward such notice to the stated, all such materials shall be delivered to the State in accordance with provision E. State by the contractor upon completion, Notice and Representatives within seven termination, or cancellation of this contract. days of Contractor's receipt of such notice. Contractor shall not use, willingly allow or cause i. Subrogation Waiver: All insurance policies to have such materials used for any purpose other in any way related to this Contract and than the performance of the contractor's secured and maintained by Contractor or its obligations under this contract without a prior Subcontractors as required herein shall written consent of the State. All documentation, For Contract Wizard Version 3.16 Page 5 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management accompanying the intellectual property or requirements before access to confidential data is otherwise, shall comply with the State permitted. requirements which include but is not limited to all documentation being in a paper, human readable The Contractor authorizes the State, the federal format which is useable by one who is reasonably government or their designee, to perform audits proficient in the given subject area. and/or inspections of its records,at any reasonable time,to assure compliance with the state or federal L. Proprietary Information: Proprietary information for government's terms and/or to evaluate the the purpose of this contract is information relating to Contractor's performance. Any amounts the State a party's research, development, trade secrets, paid improperly shall be immediately returned to business affairs,internal operations and management the State or may be recovered in accordance with procedures and those of its customers, clients or other remedies. affiliates, but does not include information lawfully obtained by third parties, which is in the public All such records,documents,communications,and domain,or which is developed independently. other materials shall be the property of the State unless otherwise specified herein and shall be Neither party shall use or disclose directly or maintained by the Contractor, for a period of three indirectly without prior written authorization any (3) years from the date of fmal payment or proprietary information concerning the other party submission of the final federal expenditure report obtained as a result of this contract. Any proprietary under this contract, unless the State requests that information removed from the State's site by the the records be retained for a longer period, or until Contractor in the course of providing services under an audit has been completed with the following this contract will be accorded at least the same qualification. If an audit by or on behalf of the precautions as are employed by the Contractor for federal and/or state government has begun but is similar information in the course of its own business. not completed at the end of the three (3) year period, or if audit findings have not been resolved M. Records Maintenance, Performance Monitoring & after a three (3) year period, the materials shall be Audits: The Contractor shall maintain a complete retained until the resolution of the audit findings. file of all records, documents, communications, and other materials that pertain to the operation of The Contractor shall permit the State, any other the program/project or the delivery of services governmental agency authorized by law, or an under this contract. Such files shall be sufficient to authorized designee thereof, in its sole discretion, properly reflect all direct and indirect costs of to monitor all activities conducted by the labor, materials, equipment, supplies and services, Contractor pursuant to the terms of this contract. and other costs of whatever nature for which a Monitoring may consist of internal evaluation contract payment was made. These records shall procedures,reexamination of program data,special be maintained according to generally accepted analyses, on-site verification, formal audit accounting principles and shall be easily separable examinations, or any other procedures as deemed from other Contractor records. reasonable and relevant. All such monitoring shall be performed in a manner that will not unduly The Contractor shall protect the confidentiality of interfere with contract work. all records and other materials containing personally identifying information that are N. Taxes: The State, as purchaser, is exempt from all maintained in accordance with this contract. federal excise taxes under Chapter 32 of the Except as provided by law, no information in Internal Revenue Code [No. 84-730123K] and possession of the Contractor about any individual from all state and local government use taxes constituent shall be disclosed in a form including [C.R.S. §39- 26-114(a)and 203,as amended]. The identifying information without the prior written contractor is hereby notified that when materials consent of the person in interest, a minor's parent, are purchased for the benefit of the State, such guardian, or the State. The Contractor shall have exemptions apply except that in certain political written policies governing access to, duplication subdivisions the vendor may be required to pay and dissemination of, all such information and sales or use taxes even though the ultimate product advise its agents, if any, that they are subject to or service is provided to the State. These sales or these confidentiality requirements. The Contractor use taxes will not be reimbursed by the State. shall provide its agents, if any, with a copy or written explanation of these confidentiality For Contract Wizard Version 3.16 Page 6 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management O. Conflict of Interest: During the term of this • Age Discrimination Act of 1975, 42 U.S.C. contract, the Contractor shall not engage in any Section 6101 et seq. and its implementing business or personal activities or practices or regulation,45 C.F.R.Part 91; maintain any relationships which conflict in any • Age Discrimination in Employment Act of way with the Contractor fully performing his/her 1967,29 U.S.C.621 et sea.; obligations under this contract. • Americans with Disabilities Act of 1990 (ADA),42 U.S.C. 12101 et seq.; Additionally, the Contractor acknowledges that, in • The Drug Free Workplace Act of 1988, 41 governmental contracting, even the appearance of U.S.C.701 et seq.; a conflict of interest is harmful to the interests of • Equal Pay Act of 1963,29 U.S.C.206; the State. Thus, the Contractor agrees to refrain • Health Insurance Portability and from any practices, activities or relationships Accountability Act of 1996, 42 U.S.C. which could reasonably be considered to be in § 1320d et seq. and implementing regulations, conflict with the Contractor's fully performing 45 C.F.R.Parts 160 and 164; his/her obligations to the State under the terms of • Immigration Reform and Control Act of 1986,8 this contract, without the prior written approval of U.S.C. 1324b; the State. • Pro-Children Act of 1994, 20 U.S.C. 6081 et In the event that the Contractor is uncertain seq.; whether the appearance of a conflict of interest • Section 504 of the Rehabilitation Act of 1973, may reasonably exist, the Contractor shall submit 29 U.S.C. 794, as amended, and implementing to the State a full disclosure statement setting forth regulation 45 C.F.R.Part 84; the relevant details for the State's consideration • Titles VI&VII of the Civil Rights Act of 1964, and direction. Failure to promptly submit a 42 U.S.C.2000(d)&(e); disclosure statement or to follow the State's • The Personal Responsibility and Work direction in regard to the apparent conflict shall be Opportunity Reconciliation Act of 1996, 42 grounds for termination of the contract. USC 604a, PL 104-193. See also State Executive Order D 015 00; Further, the Contractor shall maintain a written • Title IX of the Education Amendments of 1972, code of standards governing the performance of its 20 U.S.C. 1681 et seq.; agent(s) engaged in the award and administration • The Uniform Administrative Requirements for of contracts. Neither the Contractor nor its Grants and Cooperative Agreements to State agent(s) shall participate in the selection, or in the and Local Governments(Common Rule), at 45 award or administration of a contract or CFR,Part 92; subcontract supported by Federal funds if a • The Uniform Administrative Requirements for conflict of interest, real or apparent, would be Awards and Subawards to Institutions of Higher involved. Such a conflict would arise when: Education, Hospitals, Other Non-Profit 1. The employee,officer or agent; Organizations, and Commercial Organizations 2. Any member of the employee's immediate (Common Rule),at 2 CFR 215; family; • Office of Management and Budget Circulars A- 3. The employee's partner;or 87, A-21 or A-122, and A-102 or A-110, 4. An organization which employees, or is about whichever is applicable. to employ,any of the above, • The Hatch Act (5 USC 1501-1508) and Civil has a financial or other interest in the firm selected Service Reform Act, Public Law 95-454 for award. Neither the Contractor nor its agent(s) Section 4728. will solicit nor accept gratuities, favors, or • Departments of Labor, Health and Human anything of monetary value from Contractor's Services, and Education and Related Agencies potential contractors,or parties to subagreements. Appropriations Act, 1990,PL 101-166, Section 511. P. Conformance with Law: The Contractor and its • 45 CFR Subtitle A, Department of Health and agent(s) shall at all times during the term of this Human Services regulations. contract strictly adhere to all applicable federal • The Single Audit Act Amendments of 1996,31 laws, state laws, Executive Orders and USC 7501,Public Law 104-156,OMB Circular implementing regulations as they currently exist A-133,and 45 CRF 74.26. and may hereafter be amended.Without limitation, • The Federal Funding Accountability and these federal laws and regulations include: Transparency Act of 2006 (Public Law 109- For Contract Wizard Version 3.16 Page 7 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management 282), as amended by §6062 of Public Law Contract Management System. Areas of 110-252, including without limitation all data Evaluation and Review shall include without reporting requirements required thereunder. limitation quality, cost and timeliness. This Act is also referred to as FFATA. Collection of information relevant to the • The American Recovery and Reinvestment performance of Contractor's obligations under Act of 2009 (Public Law 111-5), including this Contract shall be determined by the without limitation all data reporting specific requirements of such obligations and requirements required thereunder. This Act is shall include factors tailored to match the also referred to as ARRA. requirements of Contractor's obligations hereunder. Such performance information Q. Restrictions on Public Benefits: Pursuant to House shall be entered into the statewide Contract Bill 06S-1023,as codified at C.R.S.§24-76.5-101 et Management System at intervals during the seq., except as otherwise provided therein or where term hereof determined appropriate by the exempt by federal law,the State is required to verify State, and a final Evaluation, Review and the lawful presence in the United States of each Rating shall be rendered by the State within natural person 18 years of age or older who applies 30 days of the end of the Contract term. for state or local public benefits or for federal public Contractor shall be notified following each benefits for the applicant. Accordingly, should the performance Evaluation and Review,and shall work performed by the Contractor under this address or correct any identified problem in a contract include the provision of any of said benefits timely manner and maintain work progress. to any natural person 18 years of age or older who 4. Gross Failure to Meet Performance Measures. applies therefore for the applicant, the Contractor Should the final performance Evaluation and shall follow the requirements of said law in the Review determine that Contractor provision of said benefits as if it were the State. The demonstrated a gross failure to meet the State will provide the Contractor with specific performance measures established hereunder, instruction on the identification documentation the Executive Director of the Colorado required and the process to be followed by the Department of Personnel and Administration Contractor to properly comply with the law if the (Executive Director), upon request by the work done under this contract is subject to these Department of Human Services, for good requirements. cause shown, may debar Contractor and prohibit Contractor from bidding on future R. Statewide Contract Management System: contracts. Contractor may contest the final I. When Applicable. If the maximum amount Evaluation and Review and Rating by: (a) payable to Contractor under this Contract is filing rebuttal statement(s), which may result $100,000 or greater, either on the Effective in either removal or correction of the Date or at anytime thereafter, this provision evaluation (CRS §24-105-102(6)), or (b) applies. under CRS §24-105-102(6), exercising the 2. Governing State Statutes. Contractor agrees debarment protest and appeal rights provided to be governed,and to abide,by the provisions in CRS §§24-109-106, 107,201 or 202,which of CRS §24-102-205, §24-102-206, §24-103- may result in the reversal of the debarment 601, §24-103.5-101 and §24-105-102 and reinstatement of Contractor by the concerning the monitoring of vendor Executive Director upon showing of good performance on state contracts and inclusion cause. of contract performance information in a 5. CORA Disclosure: To the extent not statewide contract management system. prohibited by federal law, this Contract and 3. Performance Evaluation and Review. the performance measures and standards Contractor's performance shall be subject to under CRS §24-103.5-101 are subject to Evaluation and Review in accordance with the public release through the Colorado Open terms and conditions of this Contract, State Records Act,CRS §24-72-101,et seq. law (including without limitation CRS §24- 103.5-101), and State Fiscal Rules, Policies S. Performance Ratings and Guidelines: and Guidance. Evaluation and Review of The Contractor will be given a Final Contractor Contractor's performance shall be part of the Performance Evaluation at the end of the contract normal contract administration process and term in accordance with C.R.S. §24-102-205(6) Contractor's performance will be and General Provision R. above. The list of systematically recorded in the statewide available Performance Ratings, along with For Contract Wizard Version 3.16 Page 8 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management guidelines for what final rating will be given, are a contracting employee under C.R.S. §27-90-111, as follows: who has direct contact with vulner able persons in a 1. Above Standard: This rating may be given state-operated facility, or who provides state- where Contractor consistently performs in a funded services that involve direct contact with manner that exceeds the requirements of this vulnerable persons in the vulnerable person's home Contract, and where such performance is or residence,shall: measurable against objective factors 1. submit to a criminal background check,and specifically identified for use in achieving the 2. report any arrests, charges, or summonses for purposes of this provision. If applicable to any disqualifying offense as specified by work performed under this Contract, the C.R.S. §27-90-111 to the State. objective factors and performance required to Any Contractor or its agent(s), who does not merit an "Above Standard" rating are comply with C.R.S. §27-90-111 and DHS Policy specified in a so dedicated Exhibit to this VI-2.4, may, at the sole discretion of the State, be Contract, which may be included herein from suspended or terminated. the start of the contract or subsequently be added by formal contract amendment at any V. Litigation: The Contractor shall within five (5) time before the end of the contract term. If calendar days after being served with a summons, there is no such dedicated Exhibit included or complaint, or other pleading which has been filed subsequently added herein, this rating is in any federal or state court or administrative unavailable. agency notify the State that it is a party defendant 2. Standard: This rating will be given where: I.) in a case which involves services provided under Contractor's performance hereunder meets the this contract. The Contractor shall deliver copies requirements of this Contract in areas of of such document(s) to the State's Executive quality, cost, and timeliness; 2.) Contractor's Director. The term "litigation" includes an work is accepted by the State; and 3.) full assignment for the benefit of creditors, and filings payment hereunder is made to Contractor for in bankruptcy,reorganization and/or foreclosure. such performance. 3. Below Standard: This rating may be given W. Disputes: Except as herein specifically provided where Contractor materially fails to perform otherwise, disputes concerning the performance of the requirements of this Contract and such this contract which cannot be resolved by the failure results in the State's invocation of designated contract representatives shall be contract remedies and/or contract termination referred in writing to a senior departmental in accordance with General Provision X. management staff designated by the department below. and a senior manager designated by the Contractor. Failing resolution at that level, T. Discrimination: The Contractor during the disputes shall be presented in writing to the performance of this contract shall: Executive Director and the Contractor's chief 1. not discriminate against any person on the basis executive officer for resolution. This process is of race,color,national origin,age,sex,religion not intended to supersede any other process for the and handicap, including Acquired Immune resolution of controversies provided by law. Deficiency Syndrome (AIDS) or AIDS related conditions. X. Remedies: Acceptance is dependent upon 2. not exclude from participation in, or deny completion of all applicable inspection procedures. benefits to any qualified individual with a The State reserves the right to inspect the goods disability,by reason of such disability. and/or services provided under this contract at all Any person who thinks he/she has been reasonable times and places. The Executive discriminated against as related to the performance Director of the State or her/his designee may of this contract has the right to assert a claim, exercise the following remedial actions should s/he Colorado Civil Rights Division, C.R.S. §24-34- find the Contractor substantially failed to satisfy 302,et seq. the scope of work found in this contract. Substantial failure to satisfy the scope of work U. Criminal Background Check: Pursuant to C.R.S. shall be defined to mean substantially insufficient, §27-90-111 and Department of Human Services incorrect or improper activities or inaction by the Policy VI-2.4, any independent contractor, and its Contractor. Without limitation, the State has the agent(s), who is designated by the Executive right to: Director or the Executive Director's designee to be 1. withhold payment until performance is cured, For Contract Wizard Version 3.16 Page 9 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management 2. require the vendor to take necessary action to 3. Immediate Termination: This contract is ensure that the future performance conforms subject to immediate termination by the State to contract requirements, in the event that the State determines that the 3. request removal of a Contractor's agent from health,safety, or welfare of persons receiving contract work, services may be in jeopardy. Additionally,the 4. equitably reduce the payment due the vendor State may immediately terminate this contract to reflect the reduced value of the services upon verifying that the Contractor has performed, engaged in or is about to participate in 5. recover payment for work that due to the fraudulent or other illegal acts. Contractor cannot be performed or would be 4. Termination for Financial Exigency: The State of no value to the State, shall have the right to terminate this contract 6. modify or recover payments (from payments for financial exigency by giving the under this contract or other contracts between Contractor at least thirty (30) days prior the State and the vendor as a debt due to the written notice. For the purposes of this State) to correct an error due to omission, provision, a financial exigency shall be a error,fraud and/or defalcation, determination made by the Colorado 7. terminate the contract legislature or its Joint Budget Committee that the financial circumstances of the State are These remedies in no way limit the remedies such that it is in the best interest of the State to available to the State in the termination provisions of terminate this contract. If notice of such this contract,or remedies otherwise available at law. termination is so given, this contract shall terminate on the expiration of the time period Y. Termination: specified in the notice, and the liability of the 1. Termination for Default: The State may parties hereunder for further performance of terminate the contract for cause. If the State the terms of this contract shall thereupon terminates the contract for cause, it will first cease, but the parties shall not be released give ten (10) days prior written notice to the from the duty to perform their obligations up Contractor, stating the reasons for to the date of termination. cancellation, procedures to correct problems, if any, and the date the contract will be In the event that the State terminates this terminated in the event problems have not contract under the Termination for been corrected. In the event this contract is Convenience or Termination for Financial terminated for cause, the State will only Exigency provisions,the Contractor is entitled reimburse the Contractor for accepted work or to submit a termination claim within ten (10) deliverables received up to the date of days of the effective date of termination. The termination. In the event this contract is termination claim shall address and the State terminated for cause, final payment to the shall consider paying the following costs: Contractor may be withheld at the discretion a. the contract price for performance of of the State until completion of final audit. work, which is accepted by the State, up Notwithstanding the above, the Contractor to the effective date of the termination. may be liable to the State for the State's b. reasonable and necessary costs incurred damages. If it is determined that the in preparing to perform the terminated Contractor was not in default then such portion of the contract termination shall be treated as a termination c. reasonable profit on the completed but for convenience as described herein. undelivered work up to the date of 2. Termination for Convenience: The State shall termination have the right to terminate this contract by d. the costs of settling claims arising out of giving the Contractor at least twenty(20)days the termination of subcontracts or orders, prior written notice. If notice is so given, this not to exceed 30 days pay for each contract shall terminate on the expiration of subcontractor the specified time period, and the liability of e. reasonable accounting,legal, clerical, and the parties hereunder for further performance other costs arising out of the termination of the terms of this contract shall thereupon settlement. cease, but the parties shall not be released from the duty to perform their obligations up In no event shall reimbursement under this to the date of termination. clause exceed the contract amount reduced by For Contract Wizard Version 3.16 Page 10 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management amounts previously paid by the State to the necessary to give effect to the intent and Contractor. understanding of the parties. 6. Subcontracting: Except as herein specifically Z. Venue: The parties agree that venue for any action provided otherwise, the duties and obligations related to performance of this contract shall be in the of the Contractor arising hereunder cannot be City and County of Denver,Colorado. assigned, delegated, subgranted or subcontracted except with the express prior AA.Understanding of the Parties: written consent of the State. The subgrants I. Complete Understanding: This contract is and subcontracts permitted by the State shall intended as the complete integration of all be subject to the requirements of this contract. understandings between the parties. No prior The Contractor is responsible for all or contemporaneous addition, deletion, or subcontracting arrangements, delivery of other amendment hereto shall have any force services, and performance of any subgrantor or effect whatsoever, unless embodied herein or subcontractor.The Contractor warrants and in writing. No subsequent novation, renewal, agrees that any subgrant or subcontract, addition, deletion, or other amendment hereto resulting from its performance under the terms shall have any force or effect unless embodied and conditions of this contract, shall include a in a written contract executed and approved provision that the said subgrantor or pursuant to the State Fiscal Rules. Descriptive subcontractor shall abide by the terms and headings as used herein are for convenience conditions hereof. Also, the Contractor and shall not control or affect the meaning or warrants and agrees that all subgrants or construction of any provision of this contract. subcontracts shall include a provision that the 2. Severability: To the extent that this contract subgrantor or subcontractor shall indemnify may be executed and performance of the and hold harmless the State. The subgrantors obligations of the parties may be or subcontractors must be certified to work on accomplished within the intent of the contract, any equipment for which their services are the terms of this contract are severable, and obtained. should any term or provision hereof be declared invalid or become inoperative for any BB.Holdover: In the event that the State desires to reason, such invalidity or failure shall not continue the services provided for in this Contract affect the validity of any other term or and a replacement contract has not been fully provision hereof. executed by the expiration date of the Contract, 3. Benefit and Right of Action: Except as herein this Contract may be extended unilaterally by the specifically provided otherwise, it is expressly State for a period of up to two (2) months upon understood and agreed that this contract shall written notice to the Contractor under the same inure to the benefit of and be binding upon the terms and conditions of the original Contract parties hereto and their respective successors including, but not limited to, prices, rates, and and assigns. All rights of action relating to service delivery requirements. However, this enforcement of the terms and conditions shall extension terminates when the replacement be strictly reserved to the State and the named contract becomes effective when signed by the Contractor. Nothing contained in this State Controller or an authorized delegate. agreement shall give or allow any claim or right of action whatsoever by any other third CC.Health Insurance Portability& Accountability Act person. It is the express intention of the State of 1996 ("HIPAA"). Federal law and regulations and the Contractor that any such person or governing the privacy of certain health information entity, other than the State or the Contractor, requires a "Business Associate Contract"between receiving services or benefits under this the State and the Contractor. 45 C.F.R. Section agreement shall be deemed an incidental 164.504(e). If applicable to this Contract,attached beneficiary only. and incorporated herein by reference and agreed to 4. Waiver: The waiver of any breach of a term by the parties is a HIPAA Business Associate hereof shall not be construed as a waiver of Addendum for HIPAA compliance. Terms of the any other term, or the same term upon Addendum shall be considered binding upon subsequent breach. execution of this contract and shall remain in 5. Survival: The State and the Contractor's effect during the term of the contract including any obligations under this contract shall survive extensions. following termination or expiration to the extent For Contract Wizard Version 3.16 Page 11 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management DD.Colorado Department of Human Services (CDHS) internal C-Stat Strategy,the parties understand and Fraud Policy. The CDHS Fraud Policy addresses agree that upon request from the State,and without the need for effective and consistent measures for any additional cost to the State,the Contractor preventing, detecting, and deterring fraud. The shall collect,maintain,and provide to the State relevant parties discussed in the policy include certain contract performance data determined by CDHS employees, CDHS management, CDHS the State during the term hereof to assist the State appointees, and community partners, including to measure and assess the programmatic contractors, grantees, vendors, and other sub- effectiveness of the Contractor's performance recipients. CDHS employees, clients, and hereunder,all in support of the State's internal community partners will all benefit from an continuous quality improvement working towards effective fraud prevention, detection, and positive outcomes and managing its performance deterrence policy because fraud can damage the for the betterment of all Colorado residents. reputation and public trust of CDHS. The parties understand and agree that the exercise All appointees and employees of the CDHS must of the requirements of this provision shall not be comply with the standards of conduct set forth in used by the State to effect unilateral changes to the Title 24, Article 18 of the Colorado Revised performance requirements of the Contractor Statutes, known as the Code of Ethics, including hereunder. exposing corruption or impropriety in government, whenever discovered. The CDHS Fraud Policy outlines how the CDHS employees and community partners should report fraud and how fraud will be investigated once it is reported. The full text of the CDHS Fraud Policy, which Contractor hereby agrees to be subject to and abide by, can be found on the CDHS Fraud Policy and Training web page at: http://www.colorado.gov/cs/S atellite/CDH S- Emp/CBON/1 2 5 1 6 10724004. EE. Performance Outside the State of Colorado and/or the United States: Not applicable if Contract Funds include any federal finds] Following the Effective Date, Contractor shall provide written notice to the State, in accordance with General Provision E. (Notices and Representatives), within 20 days of the earlier to occur of Contractor's decision to perform, or its execution of an agreement with a Subcontractor to perform, Services outside the State of Colorado and/or the United States. Such notice shall specify the type of Services to be performed outside the State of Colorado and/or the United States and the reason why it is necessary or advantageous to perform such Services at such location or locations. All notices received by the State pursuant to this requirement shall be posted on the Colorado Department of Personnel & Administration's website. Knowing failure by Contractor to provide notice to the State under this requirement shall constitute a material breach of this Contract EF. C-Stat-Performance Based Program Analysis and Management Strategy(C-Stat Strategyl: For the sole purpose of providing support to the State's For Contract Wizard Version 3.16 Page 12 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management SPd.I 3Al , PR )V 1SIONS These Special Provisions apply to all contracts except where noted in italics. 1. CONTROLLER'S APPROVAL.CRS§24-30-202(1).This contract shall not be valid until it has been approved by the Colorado State Controller or designee. 2. FUND AVAILABILITY. CRS§24-30-202(5.5).Financial obligations of the State payable after the current fiscal year are contingent upon funds for that purpose being appropriated,budgeted,and otherwise made available. 3. GOVERNMENTAL IMMUNITY.No term or condition of this contract shall be construed or interpreted as a waiver, express or implied,of any of the immunities,rights,benefits,protections,or other provisions,of the Colorado Governmental Immunity Act,CRS §24-10-101 et seq.,or the Federal Tort Claims Act,28 U.S.C. §§1346(b)and 2671 et seq.,as applicable now or hereafter amended. 4. INDEPENDENT CONTRACTOR. Contractor shall perform its duties hereunder as an independent contractor and not as an employee.Neither Contractor nor any agent or employee of Contractor shall be deemed to be an agent or employee of the State.Contractor and its employees and agents are not entitled to unemployment insurance or workers compensation benefits through the State and the State shall not pay for or otherwise provide such coverage for Contractor or any of its agents or employees.Unemployment insurance benefits will be available to Contractor and its employees and agents only if such coverage is made available by Contractor or a third party.Contractor shall pay when due all applicable employment taxes and income taxes and local head taxes incurred pursuant to this contract.Contractor shall not have authorization,express or implied,to bind the State to any agreement, liability or understanding,except as expressly set forth herein.Contractor shall (a)provide and keep in force workers'compensation and unemployment compensation insurance in the amounts required by law,(b)provide proof thereof when requested by the State,and(c)be solely responsible for its acts and those of its employees and agents. 5. COMPLIANCE WITH LAW.Contractor shall strictly comply with all applicable federal and State laws, rules,and regulations in effect or hereafter established, including,without limitation,laws applicable to discrimination and unfair employment practices. 6. CHOICE OF LAW.Colorado law,and rules and regulations issued pursuant thereto,shall be applied in the interpretation,execution,and enforcement of this contract.Any provision included or incorporated herein by reference which conflicts with said laws,rules,and regulations shall be null and void.Any provision incorporated herein by reference which purports to negate this or any other Special Provision in whole or in part shall not be valid or enforceable or available in any action at law,whether by way of complaint,defense,or otherwise.Any provision rendered null and void by the operation of this provision shall not invalidate the remainder of this contract,to the extent capable of execution. 7. BINDING ARBITRATION PROHIBITED.The State of Colorado does not agree to binding arbitration by any extra judicial body or person.Any provision to the contrary in this contact or incorporated herein by reference shall be null and void. 8. SOFTWARE PIRACY PROHIBITION.Governor's Executive Order D 002 00.State or other public funds payable under this contract shall not be used for the acquisition,operation,or maintenance of computer software in violation of federal copyright laws or applicable licensing restrictions.Contractor hereby certifies and warrants that,during the term of this contract and any extensions,Contractor has and shall maintain in place appropriate systems and controls to prevent such improper use of public funds.If the State determines that Contractor is in violation of this provision,the State may exercise any remedy available at law or in equity or under this contract,including,without limitation,immediate termination of this contract and any remedy consistent with federal copyright laws or applicable licensing restrictions. 9. EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST.CRS§§24-18-201 and 24-50- 507.The signatories aver that to their knowledge,no employee of the State has any personal or beneficial For Contract Wizard Version 3.16 Page 13 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management interest whatsoever in the service or property described in this contract.Contractor has no interest and shall not acquire any interest,direct or indirect,that would conflict in any manner or degree with the performance of Contractor's services and Contractor shall not employ any person having such known interests. 10. VENDOR OFFSET.CRS§§24-30-202(1)and 24-30-202.4. [Not Applicable to intergovernmental agreements] Subject to CRS §24-30-202.4(3.5),the State Controller may withhold payment under the State's vendor offset intercept system for debts owed to State agencies for: (a)unpaid child support debts or child support arrearages;(b)unpaid balances of tax,accrued interest,or other charges specified in CRS §39-21-101,et seq.;(c)unpaid loans due to the Student Loan Division of the Department of Higher Education;(d)amounts required to be paid to the Unemployment Compensation Fund;and(e)other unpaid debts owing to the State as a result of final agency determination or judicial action. 11. PUBLIC CONTRACTS FOR SERVICES. CRS§8-17.5-101. [Not Applicable to agreements relating to the offer, issuance, or sale of securities,investment advisory services or fund management services, sponsored projects, intergovernmental agreements,or information technology services or products and services] Contractor certifies, warrants, and agrees that it does not knowingly employ or contract with an illegal alien who will perform work under this contract and will confirm the employment eligibility of all employees who are newly hired for employment in the United States to perform work under this contract through participation in the E-Verify Program or the Department program established pursuant to CRS §8- 17.5-102(5)(c),Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subcontractor that fails to certify to Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract.Contractor(a)shall not use E-Verify Program or Department program procedures to undertake pre- employment screening of job applicants while this contract is being performed,(b)shall notify the subcontractor and the contracting State agency within three days if Contractor has actual knowledge that a subcontractor is employing or contracting with an illegal alien for work under this contract, (c)shall terminate the subcontract if a subcontractor does not stop employing or contracting with the illegal alien within three days of receiving the notice,and(d)shall comply with reasonable requests made in the course of an investigation,undertaken pursuant to CRS §8-17.5-102(5),by the Colorado Department of Labor and Employment. If Contractor participates in the Department program, Contractor shall deliver to the contracting State agency,Institution of Higher Education or political subdivision a written,notarized affirmation, affirming that Contractor has examined the legal work status of such employee, and shall comply with all of the other requirements of the Department program. If Contractor fails to comply with any requirement of this provision or CRS §8-17.5-101 et seq.,the contracting State agency, institution of higher education or political subdivision may terminate this contract for breach and, if so terminated,Contractor shall be liable for damages. 12. PUBLIC CONTRACTS WITH NATURAL PERSONS.CRS §24-76.5-101.Contractor,if a natural person eighteen(18) years of age or older, hereby swears and affirms under penalty of perjury that he or she (a)is a citizen or otherwise lawfully present in the United States pursuant to federal law,(b)shall comply with the provisions of CRS §24-76.5-101 et seq.,and(c)has produced one form of identification required by CRS §24-76.5-103 prior to the effective date of this contract. Revised 1-1-09 For Contract Wizard Version 3.16 Page 14 of 15 Revised 02/06/2014 Colorado Department of Human Services Division of Contract Management Contract Routing Number 15 IHA 68641 THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT 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. CONTRACTOR STATE OF COLORADO Weld County Department of Public Health and John W.Hickenlooper,GOVERNOR Environment Department of Human Services By: Douglas Radermacher Reggie Bicha, Executive Director Title: Chair,Weld County Board of Commissioners By: Nikki Hatch *Signature Deputy Executive Director of Operations 04.2Y. /4 Date: JUN 1 6 2014 2nd Contractor Signature if Needed LEGAL REVIEW By: Name of Authorized Individual John W. Suthers, Attorney General Title: Official Title of Authorized Individual By Signature-Assistant Attorney General *Signature Date: 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. STATE CONTROLLER Robert Taros, CPA,MBA,JD By: A�/ifPJ Clint Woodruff Vain Dimple Date: !�/56/�40/')"[ I � For Contract Wizard Version 3.16 Page 15 of 15 Revised 02:06,2014 Colorado Department of Human Services Division of Contract Management c2e9 57-779,0 EXHIBIT A STATEMENT OF WORK These provisions are to be read and interpreted in conjunction with the provisions of the Amendment specified above. I. Project Description: In order to implement the Nurse Home Visitor Program(NHVP)efficiently and effectively and to promote the successful partnerships between state public entities and the private sector,responsibility for the program is divided between the Colorado Department of Human Services,which is responsible for financial administration of the program,and the Regents of University of Colorado,a body corporate,for and on behalf of the University of Colorado Denver(UCD)located at the Anschutz Medical Campus which is responsible for programmatic,clinical and technical support,monitoring and evaluation, including data collection,for the program. It is the intent of the general assembly that the stale department and the health sciences facility work collaboratively to share information in order to promote efficient and effective program implementation;however,neither entity is responsible for the other entity's statutorily prescribed duties. II. Performance Requirements/Deliverables: I. The Contractor, in accordance with the terms and conditions of the Contract and this Exhibit, shall perform and complete, in a timely and satisfactory manner, all activities and services related to the fiscal management of the Colorado Nurse Home Visitor Program as set forth in CRS 26-6.4-107.2(a.5). The fiscal management provided by the contractor for the program must be deemed by the State to be acceptable and in good faith. For fiscal management to be"acceptable"it must comply with all,but not limited to, the items listed below, which are incorporated and made part hereof by reference. Links to all said documents are located at: http://www.coloradoofficeofearlychildhood.com/#!nurse-home-visitor-program/c I hey • Colorado Nurse Home Visitor Program Act,as described in§ 26-6.4.101,C.R.S. • Colorado Nurse Home Visitor Program Fiscal Compliance Requirements • Rules Concerning the Nurse Home Visitor Program • Nurse Home Visitor Program Targeted Case Management Medicaid Billing Manual 2. The Contractor shall submit the following report,when requested.These documents are located at the link shown above. • Year-to-Date Expenditure/Mid-Year Projections Report 3. The Contractor shall complete in a satisfactory manner and by the indicated date, all activities stated in the Areas Requiring Performance Improvement Plan or Funding Conditions in the NHVP Application Review Summary which is incorporated and made part hereof by reference(see Exhibit F). 4. The Contractor shall participate in meetings or trainings as requested by the State,including attendance by the Contractor's Nurse Supervisor and fiscal staff at the NHVP grantee workshop;and the Contractor must cover all costs as applicable. 5. The Contractor shall provide the nurse home visitor services in accordance with the grantee application and the FY2015 Budget,Exhibit B. 6. Funding adjustments may be executed during the term of this Contract in accordance with Additional Provisions, Exhibit C. Grant awards are made using NHVP funding and Medicaid reimbursement estimates. The total amount of funding for the term of this Contract may not exceed the Total Amount Requested from the CDHS as provided in the attached Budget, Exhibit B. If the Contractor draws more Medicaid funding, the State will reduce the NHVP funding. Unless otherwise approved, overages of Medicaid funding in one fiscal year are reconciled in the subsequent fiscal year. If the contractor draws less Medicaid funding the Page I of 3 Exhibit A-Statement of Work EXHIBIT A state may increase the NHVP funding, if funding is available, during the Mid-Year Budget Projections process. Medicaid income generated from Nurse Home Visitor Program services shall be spent on the Nurse Home Visitor Program. 7. Contractor shall submit Medicaid reimbursement requests for all eligible clients. Department of Health Care Policy and Financing (HCPF) oversees the submission of Medicaid reimbursement requests for compliance with HCPF procedures and the Medicaid Billing Manual. The Medicaid Billing Manual can be accessed at the link shown under Item 1. 8. Contractor shall refer families participating in any and all programs in its agency such as the Special Supplemental Program for Women, Infants and Children(WIC),Early and Periodic Screening,Diagnosis and Treatment (EPSDT), Immunization Clinics, Health Care Program for Children with Special Health Care Needs (HCP), Prenatal Plus (PNP), etc. to appropriate enabling and direct care service programs in the community. Contractor shall provide all pregnant women in need of resources for prenatal medical care information about programs such as WIC, PNP, etc. as needed; provide all individuals seeking reproductive health services with information about pregnancy planning, preconception health, the consequences of unintended pregnancies, and referrals to comprehensive family planning services; and shall ensure that all children ages birth through two years who may be eligible for early intervention services are referred to Early Intervention Colorado. 9. Contractor shall notify the State within thirty (30) days of a change of the NHVP Nurse Coordinator/Supervisor or fiscal staff and shall require any new NHVP Nurse Coordinator/Supervisor and fiscal staff working on NHVP services to participate in Fiscal Orientation within forty-five (45) days of employment. 10. In order to fulfill model requirements as an implementation site for the Nurse Family Partnership home visiting program,Contractor shall comply with all elements of the FY 2014-2015 Nurse Home Visitor Program Non-Competing Continuation Application Review Summary which is incorporated and made a part of this contract as Exhibit F. III. Monitoring: The monitoring of this contract for compliance with fiscal performance requirements is based in part on a fiscal risk assessment conducted prior to contracting,contractor fiscal and programmatic performance during the contract period and contractor compliance with contractual terms and conditions during the contract period. Monitoring will be conducted by the Program Manager(State Representative)and methods used will include review of documentation reflective of performance,including reimbursement requests and other documentation as applicable. The contractor's performance will be evaluated at set intervals and communicated to the contractor. A Final Contractor Performance Evaluation will be conducted at the end of the life of the contract. IV. Resolution of Non-Compliance: The Contractor will be notified in writing within 30 calendar days of discovery of a compliance issue. Within 45 calendar days of discovery,the Contractor and the State will collaborate,when appropriate,to determine the action(s)necessary to rectify the compliance issue and determine when the action(s)must be completed. The action(s)and time line for completion will be documented in writing and agreed to by both parties. If extenuating circumstances arise that requires an extension to the time line,the Contractor must email a request to the Program Manager(State Representative)and receive approval for a new due date.The State will oversee the completion/implementation of the action(s)to ensure time lines are met and the issue(s)is resolved. If the Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may exercise its rights under the Remedies section of the General Provisions of this contract. Page 2 of 3 Exhibit A-Statement of Work EXHIBIT A V. Option to Extend the Term of the Contract: • The State may require continued performance for a period of 4(four)additional one-year periods at the same rates and same terms specified in the Contract,except the Contractor shall be allowed State approved funding increases subject to funding availability. If the State exercises the option,it will provide written notice to Contractor at least 30 days prior to the end of the current contract term in a form substantially equivalent to Exhibit E.If exercised,the provisions of the Option Letter shall become part of and be incorporated into the original contract. The total duration of this Contract, including any options under this clause,shall not exceed 5(five)years. • The State may increase or decrease the quantity of goods/services described in section/schedule/exhibit based upon the rates established in the Contract.If the State exercises the option,it will provide written notice to Contractor as least 30 days prior to the end of the current contract term in a form substantially equivalent to Exhibit E.Delivery/performance of the goods/service shall continue at the same rates and terms. If exercised,the provisions of the Option Letter shall become part of and be incorporated into the original contract. VI. Performance Measures and Monitoring L Fiscal performance monitoring by the State for this contract includes without limitation using the following criteria: •Contractor maintains a caseload commensurate with funding allocation throughout the contract period •Contractor's Medicaid revenue will be commensurate with the estimate in the approved budget •Contractor's cost reimbursement requests will be submitted on time(within 60 days of the last day of the month for which you are requesting reimbursement)and will be accurate(line items in the reimbursement request will align with line items in your approved budget). Page 3 of 3 Exhibit A-Statement of Work s a Eshlbtt 8 NHVP FY2014.15 Proposed Budget FOR THE PERIOD: July 1,2014-June 30,2015 APPLICANT: Weld County Department of Public Health&Environment FUNDED CASELOAD: 150 COUNTIES SERVED: Weld Enter whole amounts only/Do not create new formulas TOTAL CONS FY14-15 Oily 1,2013 to tune 30.201.4 CONTRACT BUDGET TOTAL AGENCY FY 1415 lei NHVP BUDGET(A+6+C) A.Other C.CONS 46+C)Madlald Sources of Funding Estimates CDHS (A+1I+C) Flan rq J ': ;,:.,y, (NHVP) funding lNl9vpl PERSONNEL COSTS(Detail Expenses) Me Salary Fringe rote 14 Effort lA,i iaf) aan4Pts (All Funding Sources) Personnel Services(Tide and Namel 38.93% Morse Home Moor-Ann Nair _ _ _ $5_4383 5$,393 __- $72,776 100 _ _ _ 572 572,776 572776 572.:76 Nurse Home Victor-Arlane RoweOenning $6_J42g, 525,460 592,286 _ L00 $92255 592.286 592286 Nurse Nome Vlstor-Dana Garve2 _.�_.. 1.$114/ 523.141 582,583 100 $82.583, 547543 $12583 Nurse Nome Vhtor-Geraldine Holton _ 566,109 __. 525,736 191,615 1,001 _ _ ____ 59J,o4s0 591.645, 591,645 Nurse Nome Visitor-Jodi Woodward . --7-7557,780 $22,494 580,274 1_f00 -_ 27 540.274 580,274 Nurse Home Visitor-Kathleen Hatters _ $61,277 $23,355 585,132 _. _ _- 1001 _ 545,132 585,132 585,132 Office Tedmldan-VACANT _ $33,533 533,054 546,507 100 _ - $,$11 546,587 546,587 Supervisor-Barbara Frandsrn 566,912 5X,049 592,961 0.75,, _ 544.409 $2S 569,721 569.721 _�_ __ 50 50 {ommulty Heald,M.nger-Kathy Smith-Stetson ,_ 568,586 _ 526,701 595..287 _' 0,05--- $A.7.§1. _ 54.764 54,764 - - - -__ 4- - - _ SO 50 ____. ----l- 1_ _ _ _... �_. $a 50 . So SO SO W _..-._ _'1- 00 50 -- ---- ----- .. _ -- -_ -- 50 50 Sa SO $D S0 - so[ 4444411 $911,559 $625468 $QS,Iig OPERATING(Oats ll Expenses) _ ) I Office erating.Eaaensesli.e.suppilespens,etc.)lincudlr�aroations for suchdf ant 555< 5800 5800 Client Support Matenah _ , -_ »Sou L. 55 300 55300 PrletJ &Publiatlons flnaudbta allocations for such if art _ __ _ - 52,000 52.000 52,000 Postal ishipping_Seruices_,.}Induding allocations for such,.4 arty!. ._. - Sy3S01. 51.350, 51.350 y Communiotlonz I e long distance,cellular,airords and network service}linduding allocations far such,If any) . SS,�Gy 55,400 55.400 idlol/Ptcypam SuppBes _ _ 53600 53,000 53,000 Outside Services + 51 51 Retgtdred model materfaissirs Care Givinh Bealnnirsg_Rhyth Ms,etc.; - - <::0 5500 5300 Sc Sc r �_ -- . __ $0 1 TOTA►OFEMTING3 $01 %II $11343, $14,352 $12,381 Tralnpy and TechnicalAWetanse Fee N Total Cost ) Nurse initial Education Tenon Per NHV 54,069 1 54,069 _ 54.069 06T- $4.069 Supervisor Initial Education Tuition Per Sup 54,803 SD _ Sl $_ .__ $1 I Administrator Orientation Per Administrator $480 - _ SO _- 51 Si j1 S%Aerator Expansianl9eplecement Fee $2,764( _ SO, 51 _ _ _ ___� �-___ 1 Nurse Education Matedalsi New Supervisor/RN ONLY) Per NHV&Sup $917 SO _ _ _ 51 SI $1 DANCE Education Per NHV&Sup $595. _ 1 5595e 5595 $595 $595 -DANCE t cansi I Per NNV&Sup 055 _ 1 $55 _ 555 $55 $55 Program Support Fee Per sup 57,044 1 57,046 57.046 $7,044. 7`046 Professional Development Per Nurse $600 7 54.200 54.100^_,__£4,204`_ 200 Nurse Consultation lst Supervisor 52,534 1 52,534 _ 52,534 $_4534 534 Nurse Consultation _ Per add.Supervisor 51,520 SO 51 _I 57 {{ :dank SC_ SD CH. 3 TOTAL TRAINING and TENICALA5$ISTANCEL SO! Pi if $18,504 $18,004 Page:of 3 NHVP FY2014-15 Proposed Budget FOR THE PERIOD: July 1,2014-June 30.2015 APPLICANT. Weld County Department of Publk Health&Environment •;LADED CTS El.7 AD. 150 COUNTIES SERVED: Weld Enter whole amounts only/Do not create new formulas I TOTAL CDHS PY1415 TOTAL AGENCY fY14.1S ratty L 1013 to lune 30 2014 CONTRACT BUDGET NHV►CUDGEr(AMaC2 lest) A MA C CONS M.CJ Medicaid Sources of Funding Estimate&CDH5 (Ara eg Funding (NHVP( (muting(NHVP) Equipment _ _ _ Computers w/Software513W -_-----_51300 Cellular Phones ` 250 le--- D ________n. , . _....7.:<-_:.r ,-=''-. - 4 TOTAL ttC(UIPM • - --512; .$0 - ic1,950 SI,Sso TRAVEL'Detail Eapenses} Visit Outreach Maeaee 2_._. 521000 521000 NFP Tralnln¢and Mesen[Teasel 5rwrvbars.Nurses! 5400 5400 Other taro ..----- - -- - ---- - ----- -. --. - Si $1 SO -- _. ..---------- - --- - — ------ ---_."..".R/ -5o ----------JO "d 50, SA101, 52$,QI 521401. OEtf*COSTS(WWI OthsaProgram Odd Maternal Mental Health Consultant Kate Brockman -- _ _ __ _ Si_:3 SL2 51,200 Electronic Medical Record Data Base a Assodehd IT Costa —_—__.„. _.. S10.i.0 511500 511500 __... 50 SO SO SO r 5 TOTAL OTHER COSTS $0 s19,700t $53300 $1!,700 TOTAL DIVER PROGRAM COSTS(Add budget categories 141 S0 I $44,4095651,045 , 5712.471 5712.474 ADMINSTRATIVE COSTS(Detail Administrative Cos u( :- Indirect tit app l_cablej Administrative Personnel Servkes($v acdin[,admin.HRl _ S SO Administrative Supplies b e not rogram suechesl - SO _ - 50 Ilccounnn((I a nadt.bank ee�en_sc*,Oabtlity) 50 50 sspporting Costs(1 a mileage reauitsnentl - - SO SO Board of Health S0 SO WserAdmlnistratlue Costs 0a Postage,Occup$ ,_Cemluarl __ __—__ S S0 - - _ ___ .. SO 50 I. Os 50 SO 50 SO Indirect Rate at 12 59%for 2014 tdds Is also an estimate for 2015.that will very likely charge and we request that we be able to bell X91 $_MH( 564,7 519,700 for new 2015COPHE negotiated rate 412(11$ 4. S0 SO —_._ _ - �,. SO SO s 50 So -- ---�-- — { SO 50 P SO So r So SO TOTALADMINISTRATIVECOSTS SO 14501 $[4101b7D0 515,700 ilk OTALPROOMM COSTS IOrad Proeram+AdmlnistAdve Costs) SO $50000 5752175 02,175 5102.175 ile1Y'aMER somas-hosts or In-kbsdl hem the column A.above _..I 1 Total 0Msrsoures SO.00 . Page 2 al • FV14-15 Non-Competitive Continuation Budget Proposal Narrative FY2014-15 BUDGET NARRATIVE Budget Period:July 1,2014—June 30,2015 PERSONNEL:5 625,968 (Do nor complete this section unless needed to provide information or a calculation not included in the Budget template) Increases due to expected COLA of 15%-3%for 2015. Also salary increases for 2014-2015. OPERATING EXPENSES:$ 18,351 All costs should be itemized within this category by major types(Office Supplies;Client Support Materials;Printing&Publications;Postal& Shipping;Communications;Medical Supplies;Outside Services).The basis for cost computations should be shown(ie:"x"dollars per month for Office Supplies;"y"dollars per person for Training Materials;Communications-Cell Phone long distance of"z"dollars per month times 4 staff, etc.). Office Operating Expenses. $66.66 per month $800 divided by 12 months=$66 66 Client Support Materials:55,300 divided by 12 months=5441.66 divided by 150 clients=$295. Printing and Publications: $1,000 divided by 12 months=$166.66 Postal&Shipping:$1,350 divided by 12 months=$112.50 Communication'55400 divided by 12 months=54501 This includes cell phone plan that includes unlimited testing and air cards far 6 laptop computers Medical/Program Supplies. $3,000 divided by 12 months=$350 Required model materials:$500 one time purchase EQUIPMENT:$1,550 All costs should be itemized within this category by major types,os above(Computers,Cell Phones,Tablets,etc.). Potential replacement costs of laptop and/or purchase of new iPhane.Current replacement costs for laptops are running anywhere from$1,300 to$1,600 depending on the model and features selected.Our current cost to purchase a new iPhone is approximately 5250 TRAINING AND TECHNICAL ASSISTANCE:$ 18,504 (Do not complete this section unless needed to provide information or a calculation not included in the Budget template) TRAVEL:$ $28,401 All costs should be itemized with this category by major types(Visit Outreach Mileage,Training and Meeting Travel,etc.).The basis for cost computations should be shown(4 nurse home visitors X average 500 miles/month/nurse x I2 months=x). Visit Outreach Mileage: $28,000 6 NHVs♦1 Supervisor X average of 600 miles/month/nurse X 12 months= 50,400 miles=527,720(Includes lodging costs for NPF Symposium and other training opportunities). NFP Training&Meeting Travel: $400 One time charge for travel to Vail for 4 vehicles for NEP Mandatory Symposium(The $400 is a very conservative estimate for the transportation costs to attend the NFP Mandatory Symposium in Vail.Colorado.Weld reimburses at the current rate of $0 54/mile.A one-way trip from Greeley to Vail is approximately 147 miles per MapQuest,so approximately 294 miles round trip.Not knowing who well be able to carpool leaves us with an estimate of 2-4 vehicles driving the 6 nurses and a supervisor to the required Symposium in Vail.Therefore,transportation costs will range anywhere from approximately$318 to$635.The mid-range of that figure is$477 but we took it down to$400 because not everybody lives in Greeley and wouldn't be leaving from here). OTHER:$ 19,700 All costs should be itemized within this category by major types(e.g.,Contractual Staff) $1,200 divided by 12 months=$100 for Mental Health Consultant to participate and offer guidance and insight during one case conference per month tia$100 per consultation. $18,500 divided by 12 months=51,541.67 far computer and data processing expenses related to mamtainance&upgrades to the Electronic Metal Record data base,EMR licenses,operation and tech support ADMINISTRATIVE COSTS or INDIRECT:$ 84,109 Administrative Costs: itemize details for each direct administrative cost using the categories listed on the budget. Indirect Rate:itemize details used to calculate the indirect rote Current 2014 C0PHE negotiated rate of 1359%;this is also an estimate for 2015 but this will very likely change and we request that we be able to bill our new 2015 CDPHE 2015 negottated rate Page 3 of 3 EXHIBIT C ADDITIONAL PROVISIONS These provisions are to be read and interpreted in conjunction with the provisions of the original contract and made a part thereof. 1. This Contract contains state funds. 2. To receive compensation under this Contract,the Contractor shall submit a signed monthly Contract Reimbursement Statement in a format acceptable to the State. "Other Funding Sources,"if any,shall be included on all Contract Reimbursement Statements as required. The Contract Reimbursement Statement must be submitted within sixty(60)calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit A and incorporated herein and the associated Budget attached hereto as Exhibit B and incorporated herein. To be considered for payment,billings for payments pursuant to this Contract must be received within a reasonable time after the period for which payment is requested, but in no event no later than sixty (60)calendar days after the relevant performance period has passed. Final billings under this Contract must be received by the State within a reasonable time after the expiration or termination of this Contract;but in no event no later than sixty(60)calendar days from the effective expiration or termination date of this Contract. The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless approved in writing by the State. 3. Time Limit For Acceptance Of Deliverables. a. Evaluation Period. The State shall have thirty(30)calendar days from the date a deliverable is delivered to the State by the Contractor to evaluate that deliverable,except for those deliverables that have a different time negotiated by the State and the Contractor. b. Not ice of Defect. If the State believes in good faith that a deliverable fails to meet the design specifications for that particular deliverable,or is otherwise deficient,then the State shall notify the Contractor of the failure or deficiencies,in writing,within thirty(30)calendar days of: 1)the date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or deficiency at the time of delivery;or 2)the date the State becomes aware of the failure or deficiency. The above time frame shall apply to all deliverables except for those deliverables that have a different time negotiated by the State and the Contractor in writing pursuant to the State's fiscal rules. c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed deliverable,the Contractor shall have a reasonable period of time,not to exceed ten(10)calendar days,to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within ten(10)calendar days,the Contractor shall be in default of its obligations under this Contract and the State,at its 9ption,may elect to terminate this Contract or the Contract and all Contracts entered into pursuant to the Contract. Page 1 of 3 EXHIBIT C 4. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or for any modification to direct costs in excess of ten percent(10%)of the total budget for direct costs. Contractor shall submit a Budget Revision Request Form to request prior approval for all budget modifications in excess of ten percent (10%)of the total budget for direct costs. The Budget Revision Request Form is is located at, htto://www.coloradoofficeofearlychildhood.com/#!nurse-home-visitor-program/clhey under the Fiscal Resources for Contractors tab. Any request for a modification to the Budget in excess of ten percent(10%)of the total budget for direct costs shall be submitted to the State at least 90 days prior to the end of the contract period. 5. Notwithstanding the terms contained in General Provisions of the Contract,Section K,Rights in Data, Documents and Computo-Software or Otherhnellectual Property,unless otherwise provided for,all data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this Contract shall remain the sole property of the State,whether in individual,aggregate, identified or de- identified form or any other form required by the State. To facilitate follow-up, research, surveillance and evaluation,any such data collected,used or acquired shall be made available in any form required by the State, to the State and any other entity designated by the State. Any such data collected,used or acquired shall be used solely for the purposes of this Contract. The Contractor and its subcontractors agree not to release,divulge,publish, transfer, sell,or otherwise make known any such data to unauthorized persons without the express prior written consent of the State or as otherwise required by law.This includes a prior written request by the Contractor to the State for submission of abstracts or reports to conferences, which utilize data collected under this Contract. Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or work papers necessary to perform its duties under this Contract and in accordance with professional standards. 6. Notwithstanding the terms contained in General Provisions or the Contract,Section K,Rights in Data. Documents and ComputerSofnvare or Otherlruellectual Property.or Section 23.i,General Provisions. Media or Public Announcements, the State of Colorado shall be the owner of all printed materials,graphic representations, educational materials, audio-visual products,or any other media, in whatever form,created under this Contract.This requirement applies,but is not limited to,any brochure, flyer,presentation. billboard, radio spot,website, banner advertisement. The State reserves the right to require logos,or other wording on any material, representation, product or other media form created under this Contract. Any material, representation, product or other media form that will use the State's or logo or information must he approved by the State prior to production and distribution. A minimum of ten(10)business days is required for the review and approval process. 7. Notwithstanding the tenns contained in the General Provisions of the Contract,Section P,Conformance with Law, the Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act of 1964,as amended, which states that"no person in the United States shall on the grounds of race,color or national origin,be excluded from participation in,be denied the benefits of,or be subjected to discrimination under any program actively receiving Federal financial assistance." The Office for Civil Rights has established that it is the responsibility of any program that is a recipient of federal funds to ensure that any Limited English Proficient(LEP)person or beneficiary have meaningful access to programs, services and information. The Contractor and contract personnel shall adopt and implement policies and procedures in which reasonable steps are taken to provide language assistance in order to Page 2 of 3 EXHIBIT C ensure equal access to LEP persons or beneficiaries. The Contractor and contract personnel shall advise LEP individuals that language assistance will be provided at no cost to the LEP person or beneficiary. 8 Contractor agrees to provide services to all Program participants and employees in a smoke-free environment in accordance with Public Law 103-227,also known as"the Pro-Children Act of 1994",(Act).Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health,day care,early childhood development services,education or library services to children under the age of 18,if the services are funded by Federal programs either directly or through State or local governments,by Federal grant,contract,loan, or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed,operated,or maintained with such Federal funds. The law does not apply to children's services provided in private residences;portions of facilities used for inpatient drug or alcohol treatment;service providers whose sole source of applicable Federal funds is Medicare or Medicaid;or facilities where Women,Infants and Children(WIC)coupons are redeemed. Failure to comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty of up to$1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. By signing this Contract,Contractor certifies that Contractor shall comply with the requirements of the Act and shall not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. Contractor agrees that it shall require the language of the Act be included in any subcontracts which contain provisions for children's services and that all subcontractors shall sign and agree accordingly. 9.0 Notwithstanding the terms contained in the General Provisions of the Contract,Section K,Rights in Data. Documents and Computer Software or Other Intellectual Property, the Contractor shall protect the confidentiality of all applicant or recipient records and other materials that are maintained in accordance with this Contract. Except for purposes directly connected with the administration of this Contract,no information about or obtained from any applicant or recipient shall be disclosed in a form identifiable with the applicant or recipient without the prior written consent of the applicant or recipient,or the parent or legal guardian of a minor applicant or recipient with the exception of information protected by Colorado Statute as it applies to confidentiality for adolescent services in which case the adolescent minor and not the parent or legal guardian must provide consent or as otherwise properly ordered by a court of competent jurisdiction. Contractor shall have written policies governing access,duplication,and dissemination of all such information. Contractor shall advise its employees,agents,servants,and any subcontractors that they are subject to these confidentiality requirements. 10. The State shall be the owner of all equipment as defined by Federal Accounting Standards Advisory Board(FASAB) Generally Accepted Accounting Principles(GAAP)purchased under this Contract.At the end of the term of this Contract, the State shall approve the disposition of all equipment. I I. The Contractor shall not use funds provided under this Contract for the purpose of lobbying as defined in Colorado Revised Statutes(C.R.S.)24-6-301(3.5Xa). 12. The State may increase or decrease funds available under this Contract using an Option Letter substantially equivalent to Exhibit E.The Option Letter is not valid until it has been approved by the State Controller or designee. page 3 of 3 Exhibit D HIPAA BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum("Addendum")is a part of the Contract dated 04/30/2014 effective upon approval by the State Controller or designee or on 07/01/2014, whichever is later. The contract shall end 6/30/2015 between the Department of Human Services, Division of Early Childhood and Weld County Department of Health and Environment, contract number 15 IHA 68641, For purposes of this Addendum, the State is referred to as "Covered Entity" or"CE" and the Contractor is referred to as "Associate". Unless the context clearly requires a distinction between the Contract document and this Addendum, all references herein to"the Contract"or"this Contract"include this Addendum. RECITALS A. CE wishes to disclose certain information to Associate pursuant to the terms of the Contract, some of which may constitute Protected Health Information("PHI") (defined below). B. CE and Associate intend to protect the privacy and provide for the security of PHI disclosed to Associate pursuant to this Contract in compliance with the Health Insurance Portability and Accountability Act of 1996,42 U.S.C. § 1320d— 1320d-8 ("HIPAA") as amended by the American Recovery and Reinvestment Act of 2009 ("ARRA")/HITECH Act(P.L. 111-005), and its implementing regulations promulgated by the U.S. Department of Health and Human Services, 45 C.F.R. Parts 160, 162 and 164 (the "HIPAA Rules") and other applicable laws, as amended. C. As part of the HIPAA Rules,the CE is required to enter into a written contract containing specific requirements with Associate prior to the disclosure of PHI, as set forth in,but not limited to, Title 45, Sections 160.103, 164.502(e) and 164.504(e)of the Code of Federal Regulations ("C.F.R.")and contained in this Addendum. The parties agree as follows: 1. Definitions. a. Except as otherwise defined herein, capitalized terms in this Addendum shall have the definitions set forth in the HIPAA Rules at 45 C.F.R. Parts 160, 162 and 164, as amended. In the event of any conflict between the mandatory provisions of the HIPAA Rules and the provisions of this Contract, the HIPAA Rules shall control. Where the provisions of this Contract differ from those mandated by the HIPAA Rules,but are nonetheless permitted by the HIPAA Rules,the provisions of this Contract shall control. b. "Protected Health Information"or"PHI"means 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 Page 1 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D individual or with respect to which there is a reasonable basis to believe the information can be used to identify the individual, and shall have the meaning given to such term under the HIPAA Rules, including,but not limited to, 45 C.F.R. Section 164.501. c. "Protected Information"shall mean PHI provided by CE to Associate or created received, maintained or transmitted by Associate on CE's behalf. To the extent Associate is a covered entity under HIPAA and creates or obtains its own PHI for treatment,payment and health care operations, Protected Information under this Contract does not include any PHI created or obtained by Associate as a covered entity and Associate shall follow its own policies and procedures for accounting, access and amendment of Associate's PHI. d. "Subcontractor"shall mean a third party to whom Associate delegates a function, activity, or service that involves CE's Protected Information, in order to carry out the responsibilities of this Agreement. 2. Obligations of Associate. a. Permitted Uses. Associate shall not use Protected Information except for the purpose of performing Associate's obligations under this Contract and as permitted under this Addendum. Further, Associate shall not use Protected Information in any manner that would constitute a violation of the HIPAA Rules if so used by CE, except that Associate may use Protected Information: (i) for the proper management and administration of Associate; (ii)to carry out the legal responsibilities of Associate; or(iii)for Data Aggregation purposes for the Health Care Operations of CE. Additional provisions, if any, governing permitted uses of Protected Information are set forth in Attachment A to this Addendum.Associate accepts full responsibility for any penalties incurred as a result of Associate's breach of the HIPAA Rules. b. Permitted Disclosures. Associate shall not disclose Protected Information in any manner that would constitute a violation of the HIPAA Rules if disclosed by CE, except that Associate may disclose Protected Information: (i) in a manner permitted pursuant to this Contract; (ii) for the proper management and administration of Associate; (iii) as required by law; (iv) for Data Aggregation purposes for the Health Care Operations of CE; or(v)to report violations of law to appropriate federal or state authorities, consistent with 45 C.F.R. Section 164.502(j)(1). To the extent that Associate discloses Protected Information to a third party Subcontractor,Associate must obtain, prior to making any such disclosure: (i)reasonable assurances through execution of a written agreement with such third party that such Protected Information will be held confidential as provided pursuant to this Addendum and only disclosed as required by law or for the purposes for which it was disclosed to such third party; and that such third party will notify Associate within two (2)business days of any breaches of confidentiality of the Protected Information, to the extent it has obtained knowledge of such breach. Additional provisions, if any, governing permitted disclosures of Protected Information are set forth in Attachment A. c. Appropriate Safeguards. Associate shall implement appropriate safeguards as are necessary to prevent the use or disclosure of Protected Information other than as permitted by this Contract. Associate shall comply with the requirements of the HIPAA Security Rule at 45 Page 2 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D C.F.R. Sections 164.308, 164.310, 164.312, and 164.316. Associate shall maintain a comprehensive written information privacy and security program that includes administrative, technical and physical safeguards appropriate to the size and complexity of the Associate's operations and the nature and scope of its activities. Associate shall review,modify, and update documentation of, its safeguards as needed to ensure continued provision of reasonable and appropriate protection of Protected Information. d. Reporting of Improper Use or Disclosure. Associate shall report to CE in writing any use or disclosure of Protected Information other than as provided for by this Contract within five(5)business days of becoming aware of such use or disclosure. e. Associate's Agents. If Associate uses one or more Subcontractors or agents to provide services under the Contract, and such Subcontractors or agents receive or have access to Protected Information, each Subcontractor or agent shall sign an agreement with Associate containing the same provisions as this Addendum and further identifying CE as a third party beneficiary with rights of enforcement and indemnification from such Subcontractors or agents in the event of any violation of such Subcontractor or agent agreement. The Agreement between the Associate and Subcontractor or agent shall ensure that the Subcontractor or agent agrees to at least the same restrictions and conditions that apply to Associate with respect to such Protected Information. Associate shall implement and maintain sanctions against agents and Subcontractors that violate such restrictions and conditions and shall mitigate the effects of any such violation. f Access to Protected Information. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate shall make Protected Information maintained by Associate or its agents or Subcontractors in such Designated Record Sets available to CE for inspection and copying within ten (10)business days of a request by CE to enable CE to fulfill its obligations to permit individual access to PHI under the HIPAA Rules, including, but not limited to, 45 C.F.R. Section 164.524. If such Protected Information is maintained by Associate in an electronic form or format, Associate must make such Protected Information available to CE in a mutually agreed upon electronic form or format. g. Amendment of PHI. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate or its agents or Subcontractors shall make such Protected Information available to CE for amendment within ten(10)business days of receipt of a request from CE for an amendment of Protected Information or a record about an individual contained in a Designated Record Set, and shall incorporate any such amendment to enable CE to fulfill its obligations with respect to requests by individuals to amend their PHI under the HIPAA Rules, including, but not limited to,45 C.F.R. Section 164.526. If any individual requests an amendment of Protected Information directly from Associate or its agents or Subcontractors, Associate must notify CE in writing within five(5)business days of receipt of the request. Any denial of amendment of Protected Information maintained by Associate or its agents or Subcontractors shall be the responsibility of CE. h. Accounting Rights. If Associate maintains Protected Information contained within CE's Designated Record Set, Associate and its agents or Subcontractors shall make Page 3 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 Exhibit D available to CE within ten (10)business days of notice by CE, the information required to provide an accounting of disclosures to enable CE to fulfill its obligations under the HIPAA Rules, including,but not limited to,45 C.F.R. Section 164.528. In the event that the request for an accounting is delivered directly to Associate or its agents or Subcontractors, Associate shall within five(5)business days of the receipt of the request forward it to CE in writing. It shall be CE's responsibility to prepare and deliver any such accounting requested. Associate shall not disclose any Protected Information except as set forth in Section 2(b) of this Addendum. i. Governmental Access to Records. Associate shall keep records and make its internal practices,books and records relating to the use and disclosure of Protected Information available to the Secretary of the U.S. Department of Health and Human Services(the "Secretary"), in a time and manner designated by the Secretary, for purposes of determining CE's or Associate's compliance with the HIPAA Rules. Associate shall provide to CE a copy of any Protected Information that Associate provides to the Secretary concurrently with providing such Protected Information to the Secretary when the Secretary is investigating CE. Associate shall cooperate with the Secretary if the Secretary undertakes an investigation or compliance review of Associate's policies,procedures or practices to determine whether Associate is complying with the HIPAA Rules, and permit access by the Secretary during normal business hours to its facilities,books,records, accounts, and other sources of information, including Protected Information, that are pertinent to ascertaining compliance. j. Minimum Necessary. Associate (and its agents or subcontractors)shall only request, use and disclose the minimum amount of Protected Information necessary to accomplish the purpose of the request, use or disclosure, in accordance with the Minimum Necessary requirements of the HIPAA Rules including,but not limited to 45 C.F.R. Sections 164.502(b) and 164.514(d). k. Data Ownership. Associate acknowledges that Associate has no ownership rights with respect to the Protected Information. 1. Retention of Protected Information. Except upon termination of the Contract as provided in Section 4(d)of this Addendum, Associate and its Subcontractors or agents shall retain all Protected Information throughout the term of this Contract and shall continue to maintain the information required under Section 2(h) of this Addendum for a period of six (6) years. m. Associate's Insurance. Associate shall maintain insurance to cover loss of PHI data and claims based upon alleged violations of privacy rights through improper use or disclosure of PHI. All such policies shall meet or exceed the minimum insurance requirements of the Contract(e.g., occurrence basis, combined single dollar limits, annual aggregate dollar limits, additional insured status and notice of cancellation). n. Notice of Privacy Practices. Associate shall be responsible for reviewing CE's Notice of Privacy Practices, available on CE's external website,to determine any requirements applicable to Associate per this Contract. Page 4 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D o. Notification of Breach. During the term of this Contract, Associate shall notify CE within five(5) business days of any suspected or actual breach of security, intrusion or unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in violation of any applicable federal or state laws or regulations. Associate shall not initiate notification to affected individuals per the HIPAA Rules without prior notification and approval of CE. Information provided to CE shall include the identification of each individual whose unsecured PHI has been, or is reasonably believed to have been accessed, acquired or disclosed during the breach. Associate shall take(i)prompt corrective action to cure any such deficiencies and(ii) any action pertaining to such unauthorized disclosure required by applicable federal and state laws and regulations. p. Audits,Inspection and Enforcement. Within ten (10)business days of a written request by CE, Associate and its agents or subcontractors shall allow CE to conduct a reasonable inspection of the facilities, systems,books, records, agreements,policies and procedures relating to the use or disclosure of Protected Information pursuant to this Addendum for the purpose of determining whether Associate has complied with this Addendum;provided, however,that: (i) Associate and CE shall mutually agree in advance upon the scope,timing and location of such an inspection; and (ii) CE shall protect the confidentiality of all confidential and proprietary information of Associate to which CE has access during the course of such inspection. The fact that CE inspects, or fails to inspect, or has the right to inspect, Associate's facilities, systems, books, records, agreements,policies and procedures does not relieve Associate of its responsibility to comply with this Addendum, nor does CE's (i)failure to detect or(ii) detection, but failure to notify Associate or require Associate's remediation of any unsatisfactory practices, constitute acceptance of such practice or a waiver of CE's enforcement rights under the Contract. q. Safeguards During Transmission. Associate shall be responsible for using appropriate safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and security of Protected Information transmitted pursuant to the Contract, in accordance with the standards and requirements of the HIPAA Rules. r. Restrictions and Confidential Communications. Within ten (10) business days of notice by CE of a restriction upon uses or disclosures or request for confidential communications pursuant to 45 C.F.R. Section 164.522, Associate will restrict the use or disclosure of an individual's Protected Information. Associate will not respond directly to an individual's requests to restrict the use or disclosure of Protected Information or to send all communication of Protect Information to an alternate address. Associate will refer such requests to the CE so that the CE can coordinate and prepare a timely response to the requesting individual and provide direction to Associate. 3. Obligations of CE. a. Safeguards During Transmission. CE shall be responsible for using appropriate safeguards, including encryption of PHI, to maintain and ensure the confidentiality, integrity and security of Protected Information transmitted pursuant to the Contract, in accordance with the standards and requirements of the HIPAA Rules. Page 5 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D b. Notice of Changes. CE maintains a copy of its Notice of Privacy Practices on its website. CE shall provide Associate with any changes in, or revocation of,permission to use or disclose Protected Information, to the extent that it may affect Associate's permitted or required uses or disclosures. To the extent that it may affect Associate's permitted use or disclosure of PHI, CE shall notify Associate of any restriction on the use or disclosure of Protected Information that CE has agreed to in accordance with 45 C.F.R. Section 164.522. 4. Termination. a. Material Breach. In addition to any other provisions in the Contract regarding breach, a breach by Associate of any provision of this Addendum, as determined by CE, shall constitute a material breach of this Contract and shall provide grounds for immediate termination of this Contract by CE pursuant to the provisions of the Contract covering termination for cause, if any. If the Contract contains no express provisions regarding termination for cause, the following terms and conditions shall apply: (I) Default. If Associate refuses or fails to timely perform any of the provisions of this Contract, CE may notify Associate in writing of the non-performance, and if not promptly corrected within the time specified, CE may terminate this Contract. Associate shall continue performance of this Contract to the extent it is not terminated and shall be liable for excess costs incurred in procuring similar goods or services elsewhere. (2) Associate's Duties. Notwithstanding termination of this Contract,and subject to any directions from CE, Associate shall take timely,reasonable and necessary action to protect and preserve property in the possession of Associate in which CE has an interest. (3) Compensation. Payment for completed supplies delivered and accepted by CE shall be at the Contract price. In the event of a material breach under paragraph 4a, CE may withhold amounts due Associate as CE deems necessary to protect CE against loss from third party claims of improper use or disclosure and to reimburse CE for the excess costs incurred in procuring similar goods and services elsewhere. (4) Erroneous Termination for Default. If after such termination it is determined, for any reason,that Associate was not in default, or that Associate's action/inaction was excusable, such termination shall be treated as a termination for convenience, and the rights and obligations of the parties shall be the same as if this Contract had been terminated for convenience, as described in this Contract. b. Reasonable Steps to Cure Breach. If CE knows of a pattern of activity or practice of Associate that constitutes a material breach or violation of the Associate's obligations under the provisions of this Addendum or another arrangement and does not terminate this Contract pursuant to Section 4(a), then CE shall take reasonable steps to cure such breach or end such violation.. If CE's efforts to cure such breach or end such violation are unsuccessful, CE shall either(i) terminate the Contract, if feasible or(ii) if termination of this Contract is not feasible, CE shall report Associate's breach or violation to the Secretary of the Department of Health and Human Services. If Associate knows of a pattern of activity or practice of a Subcontractor or Page 6 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D agent that constitutes a material breach or violation of the Subcontractor's or agent's obligations under the written agreement between Associate and the Subcontractor or agent, Associate shall take reasonable steps to cure such breach or end such violation, if feasible. c. Judicial or Administrative Proceedings. Either party may terminate the Contract, effective immediately, if(i) the other party is named as a defendant in a criminal proceeding for a violation of the HIPAA Rules or other security or privacy laws or(ii) a finding or stipulation that the other party has violated any standard or requirement of the HIPAA Rules or other security or privacy laws is made in any administrative or civil proceeding in which the party has been joined. d. Effect of Termination. (1) Except as provided in paragraph (2) of this subsection, upon termination of this Contract, for any reason, Associate shall return or destroy all Protected Information that Associate or its agents or Subcontractors still maintain in any form, and shall retain no copies of such Protected Information. If Associate elects to destroy the PHI, Associate shall certify in writing to CE that such PHI has been destroyed. (2) If Associate believes that returning or destroying the Protected Information is not feasible, Associate shall promptly provide CE notice of the conditions making return or destruction infeasible. Associate shall continue to extend the protections of Sections 2(a), 2(b), 2(c), 2(d) and 2(e) of this Addendum to such Protected Information, and shall limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. 5. Iniunctive Relief. CE shall have the right to injunctive and other equitable and legal relief against Associate or any of its Subcontractors or agents in the event of any use or disclosure of Protected Information in violation of this Contract or applicable law. 6. No Waiver of Immunity. No term or condition of this Contract shall be construed or interpreted as a waiver, express or implied, of any of the immunities,rights,benefits,protection, or other provisions of the Colorado Governmental Immunity Act, CRS 24-10-101 et seq. or the Federal Tort Claims Act, 28 U.S.C. 2671 et seq. as applicable, as now in effect or hereafter amended. 7. Limitation of Liability. Any limitation of Associate's liability in the Contract shall be inapplicable to the terms and conditions of this Addendum. 8. Disclaimer. CE makes no warranty or representation that compliance by Associate with this Contractor the HIPAA Rules will be adequate or satisfactory for Associate's own purposes. Associate is solely responsible for all decisions made by Associate regarding the safeguarding of PHI. 9. Certification. To the extent that CE determines an examination is necessary in order to comply with CE's legal obligations pursuant to the HIPAA Rules relating to certification of its Page 7 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D security practices, CE or its authorized agents or contractors, may, at CE's expense,examine Associate's facilities, systems,procedures and records as may be necessary for such agents or contractors to certify to CE the extent to which Associate's security safeguards comply with the HIPAA Rules or this Addendum. 10. Amendment. a. Amendment to Comply with Law. The parties acknowledge that state and federal laws relating to data security and privacy are rapidly evolving and that amendment of this Addendum may be required to provide for procedures to ensure compliance with such developments. The parties specifically agree to take such action as is necessary to implement the standards and requirements of the HIPAA Rules and other applicable laws relating to the confidentiality, integrity, availability and security of PHI. The parties understand and agree that CE must receive satisfactory written assurance from Associate that Associate will adequately safeguard all Protected Information and that it is Associate's responsibility to receive satisfactory written assurances from Associate's Subcontractors and agents. Upon the request of either party, the other party agrees to promptly enter into negotiations concerning the terms of an amendment to this Addendum embodying written assurances consistent with the standards and requirements of the HIPAA Rules or other applicable laws. CE may terminate this Contract upon thirty(30) days written notice in the event(i)Associate does not promptly enter into negotiations to amend this Contract when requested by CE pursuant to this Section, or(ii)Associate does not enter into an amendment to this Contract providing assurances regarding the safeguarding of PHI that CE, in its sole discretion,deems sufficient to satisfy the standards and requirements of the HIPAA Rules. b. Amendment of Attachment A. Attachment A may be modified or amended by mutual agreement of the parties in writing from time to time without formal amendment of this Addendum. 11. Assistance in Litigation or Administrative Proceedings. Associate shall make itself, and any Subcontractors, employees or agents assisting Associate in the performance of its obligations under the Contract, available to CE, at no cost to CE up to a maximum of 30 hours,to testify as witnesses, or otherwise, in the event of litigation or administrative proceedings being commenced against CE, its directors, officers or employees based upon a claimed violation of the HIPAA Rules or other laws relating to security and privacy or PHI, except where Associate or its Subcontractor, employee or agent is a named adverse party. 12. No Third Party Beneficiaries. Nothing express or implied in this Contract is intended to confer, nor shall anything herein confer, upon any person other than CE, Associate and their respective successors or assigns, any rights, remedies,obligations or liabilities whatsoever. 13. Interpretation and Order of Precedence. The provisions of this Addendum shall prevail over any provisions in the Contract that may conflict or appear inconsistent with any provision in this Addendum. Together, the Contract and this Addendum shall be interpreted as broadly as necessary to implement and comply with the HIPAA Rules. The parties agree that any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is consistent Page 8 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 Exhibit D with the HIPAA Rules. This Contract supercedes and replaces any previous separately executed HIPAA addendum between the parties. 14. Survival of Certain Contract Terms. Notwithstanding anything herein to the contrary, Associate's obligations under Section 4(d) ("Effect of Termination") and Section 12("No Third Party Beneficiaries") shall survive termination of this Contract and shall be enforceable by CE as provided herein in the event of such failure to perform or comply by the Associate. This Addendum shall remain in effect during the term of the Contract including any extensions. 15. Representatives and Notice. a. Representatives. For the purpose of the Contract, the individuals identified elsewhere in this Contract shall be the representatives of the respective parties. If no representatives are identified in the Contract, the individuals listed below are hereby designated as the parties' respective representatives for purposes of this Contract. Either party may from time to time designate in writing new or substitute representatives. b. Notices. All required notices shall be in writing and shall be hand delivered or given by certified or registered mail to the representatives at the addresses set forth below. State/Covered Entity Representative: Name: Mary Martin, MSW,LCSW Title: Home Visit Program Manager Department and Division: CDHS- Office of Early Childhood Address: 1575 Sherman Street, First Floor Denver, CO 80203 Contractor/Business Associate Representative: Name: Tanya Geiser Title: Director, Administrative Services Department and Division: Weld County Department of Public Health and Environment Address: 1555 N 17th Avenue Greeley, CO 806218U:31 Weld County Department of Public Health and Environment By: Douglas Rademacher Title: Chair, Weld County Board of County Commissioners igna re Date: JUN 1 6 2014 page 9 of 9 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 o?D/ '—/79a ATTACHMENT A This Attachment sets forth additional terms to the HIPAA Business Associate Addendum,which is part of the Contract dated 07/01/14, between Colorado Department of Human Services and Weld County Dept. of Public Health and Environment, contract number 15 IHA 68641 ("Contract") and is effective as of 07/01/14(the"Attachment Effective Date"). This Attachment may be amended from time to time as provided in Section 10(b) of the Addendum. 1. Additional Permitted Uses. In addition to those purposes set forth in Section 2(a)of the Addendum,Associate may use Protected Information as follows: None except as otherwise directed in writing by the State 2. Additional Permitted Disclosures. In addition to those purposes set forth in Section 2(b) of the Addendum, Associate may disclose Protected Information as follows: None except as otherwise directed in writing by the State. 3. Subcontractor(s). The parties acknowledge that the following subcontractors or agents of Associate shall receive Protected Information in the course of assisting Associate in the performance of its obligations under this Contract: None except as otherwise directed in writing by the State. 4. Receipt. Associate's receipt of Protected Information pursuant to this Contract shall be deemed to occur as follows, and Associate's obligations under the Addendum shall commence with respect to such PHI upon such receipt: Upon effective date of contract 5. Additional Restrictions on Use of Data. CE is a Business Associate of certain other Covered Entities and,pursuant to such obligations of CE,Associate shall comply with the following restrictions on the use and disclosure of Protected Information: As may be directed in writing by the State. Page 1 of 2 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev. May 2013 6. Additional Terms. [This section may include specifications for disclosure format, method of transmission, use of an intermediary, use of digital signatures or PKI, authentication, additional security of privacy specifications, de-identification or re-identification of data and other additional terms] None Page 2 of 2 Colorado Model BA Provision and Addendum For New or Amended Contracts Rev.May 2013 SAMPLE OPTION LETTER EXHIBIT E Date: State Fiscal Year: Option Letter No. CMS Routing# 1) OPTIONS: a.Option to renew only(for an additional term) b..Level of service change within current term c. Level of service change in conjunction with renewal for additional term 2) REQUIRED PROVISIONS. a. For use with Options 1(a-e): In accordance with Section(s) of the Original Contract routing number between the State of Colorado, Department of Human Services, and Contractor's Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on Insert ending date at a cost/price specified in Section ,AND/OR an increase/decrease in the amount of goods/services at the same rate(s)as specified in Identify the Section, Schedule, Attachment, Exhibit etc. b. For use with all Options: The amount of the current Fiscal Year contract value is increased/decreased by$ amount of change to a new contract value of Insert New$Amt to as consideration for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year.The first sentence in Section is hereby modified accordingly.The total contract value including all previous amendments, option letters, etc. is Insert New$Amt. 3) Effective Date.The effective date of this Option Letter is upon approval of the State Controller or , whichever is later. STATE OF COLORADO John W. Hickenlooper,GOVERNOR Department of Human Services Reggie Bicha, Executive Director By: Mary Anne Snyder, Director, Office of Early Childhood Date: ALL CONTRACTS REOLIRE 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. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Date: Effective Date:1/6/09-Rev 8/25/09 Exhibit F FY 2014-2015 NHVP Continuation Application Review Summary by the Nurse-Family Partnership National Service Office, Invest in Kids and Colorado Department of Human Services—Office of Early Childhood Weld County Department of Public Health and Environment Continuation Funding: NHVP Amount: $752,175 Medicaid Estimate: $50,000 County: Weld Caseload: 150 Contractor shall comply with all elements of the FY 2014-2015 Nurse Home Visitor Program Non-Competing Continuation Application Review Summary below to operate in compliance with the terms of this contract and to fulfill model requirements as an implementation site for the Nurse Family Partnership home visiting program. 1.Overall Strengths: • Nice support of nurses during the prolonged time that it took to hire a new nurse. • Data entry is mostly accurate and has improved,which is reflected in the reports. • Good ideas to increase client retention in toddlerhood. 2.Areas Recommended for Enhancement&Continued Focus: • By July 1, 2014, provide your Nurse Consultant with a specific plan to prioritize and meet the reflective supervision Model Element. • For Element 7 (retention in all phases)suggestions are: 1. Review referral information and client contact information to try to get as many pieces of contact info as possible.Ask at every visit if contact info is changed or if there are additions(cell numbers of friends,family who client always maintains contact with, email if applicable) in order to facilitate RNs'ease of locating clients. 2. Increase focus on teaming up with other providers of prenatal care, pediatric care, etc. Perhaps send letters regarding client's participation in NFP as reminder.Work with providers to help keep clients engaged in NFP by highlighting the partnership toward reaching common goals. 3. Use DANCE to identify client strengths in infancy and toddlerhood and to identify areas to focus on to develop mutual agendas with clients through Motivational Interviewing with clients. 4. Dig deeper into amenable attrition data. Discuss your findings with your Nurse Consultant. • Use Joint Visit Observation as an opportunity to discuss time spent in domain after observing a home visit and auditing charting. • Enter"0"for previous live birth on maternal health assessment when enrolling a postpartum client. • Review transition plans with your Nurse Consultant. Page 1 of 2 Exhibit F 3.Areas Requiring Performance Improvement Plan: N/A 4. Funding Conditions: none 5. Fiscal Review: Invoices should accurately reflect the approved budget in your contract.All expenses in the invoice should be easy to identify as part of your approved budget. 6.The following Assurances:Signed by contractor as part of the FY2014-15 Nurse Home Visitor Program Non- Competing Continuation Application,are hereby incorporated as requirements for continued funding: • Assurance of Intention to Meet Program Requirements • Assurance of Intention to be an Active Medicaid Provider • Assurance of Intention to Follow Caseload Guidelines Page 2 of 2 A O CERTIFICATE OF LIABILITY INSURANCE 5/2/2014 THIS THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Arthur J. Gallagher Risk Management Services, Inc. PHONE IAIC No.Eatc303-773-9999 FA/c.No):303-773-9776 6399 S. Fiddler's Green Cir.,#200 E-MAIL Greenwood Village CO 80111-4949 ADDRESS: INSURER(S1AFFORDING COVERAGE NAIC# INSURER A:Illinois Union Insurance Company 27960 INSURED COLOCOU-04 INSURER B: Weld County INSURER C: P.O. Box 758 - - ------- -- _ Greeley,CO 80632 INSURER o: INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER:1211916415 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ILTR TYPE OF INSURANCE INSR WVD S I POUCY NUMBER POLICY EFF POLICY ESP LIMITS IMWDDIYYYYI IMMIOD/YYYYI' GENERAL LIABILITY ! EACH OCCURRENCE I 3 DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occuoence) 3 �� CLAIMS-MADE ', I OCCUR MED EXP(Any one person) $ PERSONAL 8.ADV INJURY $ GENERAL AGGREGATE $ GENII.AGGREGATE LIMIT APPLIES PER: • [PRODUCTS-COMP/OP AGG $PRO- I I POLICY JECT LOC . i $ AUTOMOBILE LIABILITY UGMHINEU SINGLE LIMI I (Ea aeeiaent) I ANY AUTO I BODILY INJURY(Per person) I$ I ALL OWNED I SCHEDULED BODILY INJURY(Per accident).I% ' AUTOS AUTOS I • • PROPERTY DAMAGE $ HIRED AUTOS I ATOS NON-OWNED L(Pl accident'_ UMBRELLA LIAB OCCUR EACH OCCURRENCE i3 EXCESS LIAB CLAIMS-MADE ! i AGGREGATE I$ DEO RETENTION 8 3 ' WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTVE E N/A L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under I I —. DESCRIPTION OF OPERATIONS below I I E.L DISEASE-POLICY LIMIT $ A I Network Security and Privacy Liab G25660328001 1/1/2014 1/1/2015 Privacy Liability $1,000,000 I Aggregate $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more apace is required) RE: Evidence of coverage. • • CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Colorado Department of Human Services ACCORDANCE WITH THE POLICY PROVISIONS. 1575 Sherman Street, First Floor Denver CO 80203 AUDI RIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Hello