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HomeMy WebLinkAboutC12-371 Colorado Immunization Program Statement of Work EAGLE COUNTY HEALTH AND HUMAN SERVICES Colorado Department of Public Health and Environment Colorado Immunization Program Statement of Work Agency Name: Eagle County Public Health Agency Project Name: Reimbursement Immunization Opportunity Billing Project Part II — RIZO Lite Funding Period: September 1, 2012 through August 31, 2013 I. Project Description: This one -time grant funding is provided through the ACA Prevention Fund and the Colorado Department of Public Health and Environment to provide capacity building assistance to strengthen public health immunization infrastructure and performance. The purpose of this funding is to provide support for LPHAs in developing the capacity and knowledge necessary to bill public and private health plans for immunizations given to insured patients. Project Goal: LPHAs will pursue agreement(s) with public and /or private health plan(s) licensed in their jurisdiction which allow them to bill for services given to that health plan's beneficiaries. II. Definitions: ACA Affordable Care Act CDPHE Colorado Department of Public Health and Environment CIP Colorado Immunization Program IZ Immunization LPHA Local Public Health Agency PHN Public Health Nurse RIZO Reimbursement Immunization Opportunity SOW Scope of Work/Statement of Work III. Performance Requirements/Deliverables By 8/31/13, the LPHA will: a) Work with the identified health plan(s) to pursue an in- network agreement that was not previously in process prior to September 1, 2011. b) Successfully complete and submit the first application to the identified health plan. c) Successfully complete and submit any subsequent applications to additional identified health plan(s). d) Respond to identified health plan(s) to resolve any application issues or missing documentation to satisfy health plan requirements. e) Submit this completed SOW by 12/31/12. f) List here the health plan(s) with which you intend to pursue an in- network agreement: 1) Rocky Mountain Health Plans 2) Anthem Blue Cross Blue Shield 551 Broadway 1 PO. Box 660 1 Eagle, CO 81631 1 970 =A. Connecting People, Strengthening Communities C(91'3T • IV. Personnel: a) Agency information: Agency name Eagle County Public Health Agency Agency mailing address PO Box 660 Eagle CO 81620 Phone number 970 - 748 -3281 Fax number 855- 848 -8829 Agency DUNS # Agency FEIN # b) Agency project contact person: Name Rebecca Larson Phone number 970 - 748 -3281 Email address Rebecca.larson@eaglecounty.us c) CIP project manager: Name Cathleen Beaver Phone number 303- 691 -4952 Email address Cathleen.Beaver@astate.co.us d) CIP contract monitor: Name Cindy Wait Phone number 303 - 692 -2972 Email address Cythia.Wait@state.co.us V. Payment/Invoicing: a) Maximum reimbursement available to each LPHA is $5,000 and is not available for existing payer agreements in place prior to 9/1/11 or approved through ARRA RIZO or ACA RIZO projects. b) LPHA must choose no more than two (2) of the following health plan options, each with a corresponding reimbursement of $2,500. • Medicaid: Straight Medicaid • Medicaid: Managed Care Org (MCO) • CHP +: State Managed Care Network (SMCN) • CHP +: Managed Care Org (MCO) • Medicare: Part B. Please be aware that Medicare charges a $505 application fee to be covered by the $2,500 reimbursement. • Private Health Plans: Contracts with payers who are also MCOs for Medicaid and CHP+ are eligible for one $2,500 reimbursement only. c) Funds are 100% Federal Dollars. d) Proof of contract approval(s) must be submitted with the invoice. The only accepted proof of contract approval will be a copy of the approval letter or signature page of the contract that comes from the health plan with the appropriate signatures. This is generally a one -page document that is notification of approval and is signed by the health plan. Please do not send the entire contract. e) To receive compensation under this agreement, the Contractor shall submit Health Plan approval(s) with the appropriate CDPHE Reimbursement Invoice Form (included). f) The CDPHE Reimbursement Invoice Form must be submitted within thirty (30) calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work and payment schedule. g) Submit completed CDPHE Reimbursement Invoice Form and required documentation to: Cindy Wait, Contract Monitor DCEED Immunization Program Colorado Department of Public Health and Environment IMM -A3 -3620 4300 Cherry Creek Drive South Denver, Colorado 80246 h) Final billings under this agreement must be received by the State within a reasonable time after the expiration or termination of this agreement; but in no event no later than sixty (60) calendar days from the effective expiration or termination date of this agreement. VI. Monitoring: CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout the purchase order period by the CIP Project Manager and CIP Contract Monitor. Methods used will include review of documentation reflective of performance to include progress reports and invoices. VII. Resolution of Non - Compliance: The Contractor will be notified by email within 15 days of discovery of a compliance issue. Within 30 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 by email and agreed to by both parties. If extenuating circumstances arise that require an extension to the time line, the Contractor must email a request to the CIP Project Manager 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 Terms and Conditions of this agreement. i Contractor Name (Print) and Title r ntractor Signature Date