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HomeMy WebLinkAboutC13-230 Health Care Policy & Financing Contract Contract Routing Number 14-56561 STATE OF COLORADO Department of Health Care Policy and Financing Contract with 'Eagle County Department of Social and Human Services TABLE OF CONTENTS 1. PARTIES 1 2. EFFECTIVE DATE AND NOTICE OF NONLIABILITY 2 3. RECITALS 2 4. DEFINITIONS 2 5. TERM 3 6. STATEMENT OF WORK 4 7. PAYMENTS TO CONTRACTOR 4 8. REPORTING NOTIFICATION 5 9. CONTRACTOR RECORDS 6 10. CONFIDENTIAL INFORMATION 7 11. CONFLICTS OF INTEREST 9 12. REPRESENTATIONS AND WARRANTIES 9 13. INSURANCE 10 14. BREACH 13 15. REMEDIES 13 16. NOTICES AND REPRESENTATIVES 16 17. RIGHTS IN DATA,DOCUMENTS,AND COMPUTER SOFTWARE 16 18. GOVERNMENTAL IMMUNITY 17 19. GENERAL PROVISIONS 17 20. ADDITIONAL GENERAL PROVISIONS 20 21. COLORADO SPECIAL PROVISIONS 24 HIPAA BUSINESS ASSOCIATE ADDENDUM 1 EXHIBIT A, STATEMENT OF WORK 1 EXHIBIT B, SAMPLE OPTION LETTER 1 EXHIBIT C,CUSTOMER RELATIONSHIP MANAGEMENT PROCEDURES 1 1. PARTIES This Contract (hereinafter called "Contract") is entered into by and between Eagle County Department of Social and Human Services, P.O. Box 850, Eagle CO 81631, (hereinafter called "Contractor"), and the STATE OF COLORADO acting by and through the Department of Health Care Policy and Financing, 1570 Grant Street, Denver, Colorado 80203 (hereinafter called the "State" or "Department"). Contractor and the State hereby agree to the following terms and conditions. 2. EFFECTIVE DATE AND NOTICE OF NONLIABILITY This Contract shall not be effective or enforceable until it is approved and signed by the Colorado State Controller or designee(hereinafter called the"Effective Date").The State shall not be liable to pay or reimburse Contractor for any performance hereunder including, but not limited to, costs or expenses incurred, or be bound by any provision hereof prior to the Effective Date. 3. RECITALS A. Authority,Appropriation,and Approval Authority to enter into this Contract exists in 42 U.S.0 Sections 1396 (a)(43)and 1396d(2)(4)(B) and 10 C.C.R. 2505-10.8.280, 42CFR 457.90 through 42 (;Ft 457.110 and 42 CFR 457.340 and funds have been budgeted, appropriated and otherwise made available pursuant to 42 U.S.0 Sections 1396(a)(43) and 1396d(2)(4)(B) and 10 C.C.R. 2505-10.8.280, 42 CFR 457.90 through 42 CFR 457.110 and 42 CFR 457.340 and a sufficient unencumbered balance thereof remains available for payment. Required approvals, clearance and coordination have been accomplished from and with appropriate agencies. B. Consideration The Parties acknowledge that the mutual promises and covenants contained herein and other good and valuable consideration are sufficient and adequate to support this Contract. C. Purpose The purpose of this Contract is to serve the following county,Eagle, in support of the Early and Periodic Screening,Diagnosis and Treatment(EPSDT) Services. D. References All references in this Contract to sections (whether spelled out or using the §symbol), subsections, exhibits or other attachments, are references to sections, subsections, exhibits or other attachments contained herein or incorporated as a part hereof,unless otherwise noted. 4. DEFINITIONS The following terms as used herein shall be construed and interpreted as follows: A. "Contract" means this Contract, its terms and conditions, attached addenda, exhibits, documents incorporated by reference under the terms of this Contract, and any future modifying agreements, exhibits, attachments or references incorporated herein pursuant to Colorado State law, Fiscal Rules, and State Controller Policies. B. Exhibits and other Attachments. The following documents are attached hereto and incorporated by reference herein: HIPAA Business Associate Addendum Exhibit A, Statement of Work Page 2 of 27 Exhibit B, Sample Option Letter Exhibit C,Customer Relationship Management Procedures C. "Goods" means tangible material acquired, produced, or delivered by Contractor either separately or in conjunction with the Services Contractor renders hereunder. D. "Party" means the State or Contractor and Parties means both the State and Contractor. E. "Review" means examining Contractor's Work to ensure that it is adequate, accurate,correct,and in accordance with the standards described in this Contract. F. "Services"means the required services to be performed by Contractor pursuant to this Contract. G. "State Fiscal Year" or "SFY" means the twelve (12) month period beginning on July 1st of a year and ending on June 30th of the following year. H. "Subcontractor" means third-parties, if any, engaged by Contractor to aid in performance of its obligations. I. "Work"means the tasks and activities Contractor is required to perform to fulfill its obligations under this Contract, including the performance of the Services and delivery of the Goods. J. "Work Product" means the tangible or intangible results of Contractor's Work, including, but not limited to, software, research, reports, studies, data, photographs, negatives or other finished or unfinished documents, drawings, models, surveys,maps,materials,or work product of any type,including drafts. Any terms used herein which are defined in Exhibit A, Statement of Work shall be construed and interpreted as defined therein. 5. TERM A. Initial Term-Work Commencement The Parties' respective performances under this Contract shall commence the Effective Date. This Contract shall expire on June 30, 2014, unless sooner terminated or further extended as specified elsewhere herein. B. Two Month Extension The State, at its sole discretion, upon written notice to Contractor as provided in §16, may unilaterally extend the term of this Contract for a period not to exceed two months if the Parties desire to continue the services and a replacement Contract has not been fully executed by the expiration of any initial term or renewal term. The provisions of this Contract in effect when such notice is given, including,but not limited to,prices, rates and delivery requirements, shall remain in effect during the two month extension. The two (2) month extension shall immediately terminate when and if a replacement contract is approved and signed Page 3 of 27 by the Colorado State Controller or an authorized designee, or at the end of two (2)months,whichever is earlier. C. Option to Extend The State may require continued performance for a period of one (1) year or less at the same rates and same terms specified in the Contract. If the State exercises this option, it shall provide written notice to Contractor at least thirty (30) days prior to the end of the current Contract term in form substantially equivalent to Exhibit C. If exercised, the provisions of the Option Letter shall become part of and be incorporated into this Contract. In no event shall the total duration of this Contract, from the Operational Start Date until termination and including the exercise of any options under this clause, exceed five (5) years, unless the State receives approval from the State Purchasing Director or delegate. 6. STATEMENT OF WORK A. Completion Contractor shall complete the Work and its other obligations as described in this Contract on or before the end of the term of this Contract. The State shall not be liable to compensate Contractor for any Work performed prior to the Effective Date or after the expiration or termination of this Contract. B. Goods and Services Contractor shall procure Goods and Services necessary to complete the Work. Such procurement shall not increase the maximum amount payable hereunder by the State. C. Independent Contractor All persons employed by Contractor or Subcontractors to perform Work under this Contract shall be Contractor's or Subcontractors' employee(s) for all purposes hereunder and shall not be employees of the State for any purpose as a result of this Contract. 7. PAYMENTS TO CONTRACTOR The State shall, in accordance with the provisions of this §7 and Exhibit A, Statement of Work,pay Contractor in the amounts and using the methods set forth below: A. Maximum Amount The maximum amount payable under this Contract to Contractor by the Department is shown in the following table, as determined by the Department from available funds. Payments to Contractor are limited to the unpaid obligated balance of the Contract at the rates set forth in Exhibit B. The maximum amount payable by the Department to Contractor is: State Fiscal Year 2013-14 $26,000 Total for All State Fiscal Years $26,000 Page 4 of 27 B. Payment Payment pursuant to this Contract will be made as earned. Any advance payments allowed under this Contract shall comply with State Fiscal Rules and be made in accordance with the provisions of this Contract. Contractor shall initiate any payment requests by submitting invoices to the State in the form and manner prescribed by the State. C. Interest The State shall fully pay each invoice within forty-five (45) days of receipt thereof if the amount invoiced represents performance by Contractor previously accepted by the State. Uncontested amounts not paid by the State within forty-five (45) days shall bear interest on the unpaid balance beginning on the forty-sixth (46th) day at a rate not to exceed one percent (1%)per month until paid in full; provided, however, that interest shall not accrue on unpaid amounts that are subject to a good faith dispute. Contractor shall invoice the State separately for accrued interest on delinquent amounts. The billing shall reference the delinquent payment,the number of days' interest to be paid and the interest rate. D. Available Funds-Contingency-Termination The State is prohibited by law from making commitments beyond the term of the State's current fiscal year. Therefore, Contractor's compensation beyond the State's current fiscal year is contingent upon the continuing availability of State appropriations as provided in the Colorado Special Provisions, set forth below. If federal funds are used to fund this Contract, in whole or in part, the State's performance hereunder is contingent upon the continuing availability of such funds. Payments pursuant to this Contract shall be made only from available funds and the State's liability for such payments shall be limited to the amount remaining of such available funds. If State or federal funds are not appropriated, or otherwise become unavailable to fund this Contract, the State may terminate this Contract immediately, in whole or in part, without further liability notwithstanding any notice and cure period in§14.B. E. Erroneous Payments At the State's sole discretion, payments made to Contractor in error for any reason,including,but not limited to, overpayments or improper payments,may be recovered from Contractor by deduction from subsequent payments under this Contract or other contracts, grants or agreements between the State and Contractor or by other appropriate methods and collected as a debt due to the State. Such funds shall not be paid to any party other than the State. 8. REPORTING NOTIFICATION Reports required under this Contract shall be in accordance with the procedures and in such form as prescribed by the State and as described in Exhibit A. Page 5 of 27 A. Litigation Reporting Within ten (10) days after being served with any pleading in a legal action filed with a court or administrative agency,related to this Contract or which may affect Contractor's ability to perform its obligations hereunder, Contractor shall notify the State of such action and deliver copies of such pleadings to the State's principal representative as identified herein. If the State's principal representative is not then serving, such notice an d copies shall be delivered to the Executive Director of the Department. B. Noncompliance Contractor's failure to provide reports and notify the State in a timely manner in accordance with this §8 may result in the delay of payment of funds and/or termination as provided under this Contract. 9. CONTRACTOR RECORDS A. Maintenance Contractor shall make, keep, maintain, and allow inspection and monitoring by the State of a complete file of all records,documents, communications,notes, and other written materials, electronic media files and electronic communications, pertaining in any manner to the Work or the delivery of Services or Goods hereunder. Contractor shall maintain such records until the last to occur of: (i) a period of six (6)years after the date this Contract expires or is sooner terminated, or (ii) a period of six (6) years after final payment is made hereunder, or (iii) a period of six(6)years after the resolution of any pending Contract matters, or(iv) if an audit is occurring, or Contractor has received notice that an audit is pending, until such audit has been completed and its findings have been resolved (collectively, the "Record Retention Period"). All such records, documents, communications and other materials shall be the property of the State, and shall be maintained by the Contractor in a central location and the Contractor shall be custodian on behalf of the State. B. Inspection Contractor shall permit the State, the federal government and any other duly authorized agent of a governmental agency to audit, inspect, examine, excerpt, copy and/or transcribe Contractor's records related to this Contract during the Record Retention Period, to assure compliance with the terms hereof or to evaluate performance hereunder. The State reserves the right to inspect the Work at all reasonable times and places during the term of this Contract, including any extensions or renewals. If the Work fails to conform with the requirements of this Contract, the State may require Contractor promptly to bring the Work into conformity with Contract requirements, at Contractor's sole expense. If the Work cannot be brought into conformance by re-performance or other corrective measures,the State may require Contractor to take necessary action to ensure that future performance conforms to Contract requirements and exercise the remedies Page 6 of 27 available under this Contract, at law or in equity, in lieu of or in conjunction with such corrective measures. C. Monitoring Contractor shall permit the State, the federal government and any other duly authorized agent of a government agency, in their sole discretion, to monitor all activities conducted by Contractor pursuant to the terms of this Contract using any reasonable procedure, including, but not limited to: internal evaluation procedures, examination of program data, special analyses, on-site checking, formal audit examinations, or any other procedure. All monitoring controlled by the State shall be performed in a manner that shall not unduly interfere with Contractor's performance hereunder. D. Final Audit Report If an audit is performed on Contractor's records for any fiscal year covering a portion of the term of this Contract, Contractor shall submit a copy of the final audit report to the State or its principal representative at the address specified herein. 10. CONFIDENTIAL INFORMATION Contractor shall comply with the provisions of this§10 if it becomes privy to confidential information in connection with its performance hereunder. Confidential information includes, but is not necessarily limited to, any state records, personnel records, and information concerning individuals. Such information shall not include information required to be disclosed pursuant to the Colorado Open Records Act, CRS §24-72-101,et seq. A. Confidentiality Contractor shall keep all State records and information confidential at all times and comply with all laws and regulations concerning confidentiality of information. Any request or demand by a third party for State records and information in the possession of Contractor shall be immediately forwarded to the State's principal representative. B. Health Insurance Portability&Accountability Act of 1996("HIPAA") i. Federal Law and Regulations Pursuant to federal law and regulations governing the privacy of certain health information, the Contractor, to the extent applicable, shall comply with the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. §1320d — 1320d-8 ("HIPAA") and its implementing regulations promulgated by the U.S. Department of Health and Human Services, 45 C.F.R. Parts 160 and 164 (the "Privacy Rule") and other applicable laws, as amended. Page 7 of 27 ii. Business Associate Contract Federal law and regulations governing the privacy of certain health information requires a "Business Associate Contract" between the State and the Contractor, 45 C.F.R. Section 164.504(e). Attached and incorporated herein by reference and agreed to by the parties is a HIPAA Business Associate Addendum ("Addendum") for HIPAA compliance. Terms of the Addendum shall be considered binding upon execution of this Contract and shall remain in effect during the term of the Contract including any extensions. iii. Confidentiality of Records Whether or not an Addendum is attached to this Contract, the Contractor shall protect the confidentiality of all records and other materials containing personally identifying information that are maintained in accordance with the Contract and comply with HIPAA rules and regulations. Except as provided by law, no information in possession of the Contractor about any individual constituent shall be disclosed in a form including identifying information without the prior written consent of the person in interest, a minor's parent, or guardian. The Contractor shall have written policies governing access to, duplication and dissemination of, all such information. The Contractor shall advise its employees, agents and subcontractors, if any,that they are subject to these confidentiality requirements. The Contractor shall provide its employees, agents and subcontractors, if any, with a copy or written explanation of these confidentiality requirements before access to confidential data is permitted. No confidentiality requirements contained in this Contract shall negate or supersede the provisions of the federal Health Insurance Portability and Accountability Act of 1996. C. Notification Contractor shall notify its agents, employees, Subcontractors and assigns who may come into contact with State records or other confidential information that each is subject to the confidentiality requirements set forth herein, and shall provide each with a written explanation of such requirements before permitting them to access such records and information. D. Use,Security,and Retention Confidential information of any kind shall not be distributed or sold to any third party or used by Contractor or its agents in any way, except as authorized by this Contract or approved in writing by the State. Contractor shall provide and maintain a secure environment that ensures confidentiality of all State records and other confidential information wherever located. Confidential information shall not be retained in any files or otherwise by Contractor or its agents, except as permitted in this Contract or approved in writing by the State. Page 8 of 27 E. Disclosure-Liability Disclosure of State records or other confidential information by Contractor for any reason may be cause for legal action by third parties against Contractor, the State or their respective agents. To the extent permitted by law, the Contractor shall indemnify, save, and hold harmless the State, its employees and agents, against any and all claims, damages, liability and court awards including costs, expenses, and attorney fees and related costs, incurred as a result of any act or omission by Contractor, or its employees, agents, Subcontractors, or assignees pursuant to this§10. 11. CONFLICTS OF INTEREST A. Contractor shall not engage in any business or personal activities or practices or maintain any relationships which conflict in any way with the full performance of Contractor's obligations hereunder. Contractor acknowledges that with respect to this Contract,even the appearance of a conflict of interest is harmful to the State's interests. Absent the State's prior written approval, Contractor shall refrain from any practices, activities or relationships that reasonably appear to be in conflict with the full performance of Contractor's obligations to the State hereunder. If a conflict or appearance exists, or if Contractor is uncertain whether a conflict or the appearance of a conflict of interest exists, Contractor shall submit to the State a disclosure statement setting forth the relevant details for the State's consideration. Failure to promptly submit a disclosure statement or to follow the State's direction in regard to the apparent conflict constitutes a breach of this Contract. B. The Contractor (and Subcontractors or subgrantees permitted under the terms of this Contract) shall maintain a written code of standards governing the performance of its employees engaged in the award and administration of contracts. No employee, officer or agent of the Contractor, Subcontractor, or subgrantee shall participate in the selection,or in the award or administration of a contract or subcontract supported by federal funds if a conflict of interest, real or apparent,would be involved. Such a conflict would arise when: i. The employee,officer or agent; ii. Any member of the employee's immediate family; iii. The employee's partner,or iv. An organization which employs, or is about to employ, any of the above, has a financial or other interest in the firm selected for award. The Contractor's, Subcontractor's, or subgrantee's officers, employees, or agents will neither solicit nor accept gratuities, favors, or anything of monetary value from Contractors, potential Contractors, or parties to subagreements. 12. REPRESENTATIONS AND WARRANTIES Contractor makes the following specific representations and warranties, each of which was relied on by the State in entering into this Contract. Page 9 of 27 A. Standard and Manner of Performance Contractor shall perform its obligations hereunder in accordance with the highest standards of care, skill and diligence in Contractor's industry, trade, or profession and in the sequence and manner set forth in this Contract. B. Legal Authority—Contractor Signatory Contractor warrants that it possesses the legal authority to enter into this Contract and that it has taken all actions required by its procedures, and bylaws, and/or applicable laws to exercise that authority, and to• lawfully authorize its undersigned signatory to execute this Contract, or any part thereof and to bind Contractor to its terms. If requested by the State, Contractor shall provide the State with proof of Contractor's authority to enter into this Contract within five (5)days of receiving such request. C. Licenses,Permits,Etc. Contractor represents and warrants that as of the Effective Date it has, and that at all times during the team hereof it shall have and maintain, at its sole expense, all licenses, certifications, approvals, insurance, permits and other authorizations required by law to perform its obligations hereunder. Contractor warrants that it shall maintain all necessary licenses, certifications, approvals, insurance, permits, and other authorizations required to properly perform this Contract, without reimbursement by the State or other adjustment in the Contract. Additionally, all employees, agents, and Subcontractors of Contractor performing Services under this Contract shall hold all required licenses or certifications, if any, to perform their responsibilities. Contractor, if a foreign corporation or other foreign entity transacting business in the State of Colorado, further warrants that it currently has obtained and shall maintain any applicable certificate of authority to transact business in the State of Colorado and has designated a registered agent in Colorado to accept service of process.Any revocation,withdrawal or non-renewal of licenses, certifications, approvals, insurance, permits or any such similar requirements necessary for Contractor to properly perform the terms of this Contract is a material breach by Contractor and constitutes grounds for termination of this Contract. 13. INSURANCE Contractor and its Subcontractors shall obtain and maintain insurance as specified in this section at all times during the term of this Contract.All policies evidencing the insurance coverage required hereunder shall be issued by insurance companies satisfactory to Contractor and the State. A. Contractor i. Public Entities If Contractor is a "public entity" within the meaning of the Colorado Governmental Immunity Act, CRS §24-10-101, et seq., as amended (the "GIA"), then Contractor shall maintain at all times during the term of this Contract such liability insurance, by commercial policy or self-insurance, Page 10 of 27 } as is necessary to meet its liabilities under the GIA. Contractor shall show proof of such insurance satisfactory to the State, if requested by the State. Contractor shall require each contract with a Subcontractor that is a public entity, to include the insurance requirements necessary to meet such Subcontractor's liabilities under the GIA. ii. Non-Public Entities If Contractor is not a "public entity" within the meaning of the GIA, Contractor shall obtain and maintain during the term of this Contract insurance coverage and policies meeting the requirements set forth in §13.B. B. Contractors—Subcontractors Contractor shall require each contract with Subcontractors other than those that are public entities, providing Goods or Services in connection with this Contract, to include insurance requirements substantially similar to the following: Worker's Compensation Worker's Compensation Insurance as required by State statute, and Employer's Liability Insurance covering all of Contractor's or Subcontractor's employees acting within the course and scope of their employment. ii. General Liability Commercial General Liability Insurance written on ISO occurrence form CG 00 01 10/93 or equivalent, covering premises operations, fire damage, independent contractors, products and completed operations, blanket contractual liability, personal injury, and advertising liability with minimum limits as follows: a. $1,000,000 each occurrence; b. $1,000,000 general aggregate; c. $1,000,000 products and completed operations aggregate; and d. $50,000 any one fire. If any aggregate limit is reduced below $1,000,000 because of claims made or paid, Subcontractor shall immediately obtain additional insurance to restore the full aggregate limit and furnish to Contractor a certificate or other document satisfactory to Contractor showing compliance with this provision. iii. Protected Health Information Insurance Liability insurance covering all loss of Protected Health Information data and claims based upon alleged violations of privacy rights through improper use or disclosure of Protected Health Information with minimum limits as follows: a. $1,000,000 each occurrence; and b. $2,000,000 general aggregate. Page 11 of 27 iv. Automobile Liability Automobile Liability Insurance covering any auto(including owned,hired and non-owned autos)with a minimum limit of$1,000,000 each accident combined single limit. v. Crime Insurance Crime Insurance including Employee Dishonesty coverage with minimum limits as follows: a. $1,000,000 each occurrence;and b. $1,000,000 general aggregate. vi. Additional Insured The State shall be named as additional insured on all Commercial General Liability and protected health information insurance policies (leases and construction contracts require additional insured coverage for completed operations on endorsements CG 2010 11/85, CG 2037, or equivalent) required of Contractor and any Subcontractors hereunder. vii. Primacy of Coverage Coverage required of Contractor and Subcontractor shall be primary over any insurance or self-insurance program carried by Contractor or the State. viii. Cancellation The above insurance policies shall include provisions preventing cancellation or non-renewal without at least 30 days prior notice to Contractor and Contractor shall forward such notice to the State in accordance with §16 (Notices and Representatives) within seven days of Contractor's receipt of such notice. ix. Subrogation Waiver All insurance policies in any way related to this Contract and secured and maintained by Contractor or its Subcontractors as required herein shall include clauses stating that each carrier shall waive all rights of recovery, under subrogation or otherwise, against Contractor or the State, its agencies, institutions, organizations, officers, agents, employees, and volunteers. C. Certificates Contractor and all Subcontractors shall provide certificates showing insurance coverage required hereunder to the State within seven (7) business days of the Effective Date of this Contract. No later than fifteen (15) days prior to the expiration date of any such coverage, Contractor and each Subcontractor shall deliver to the State or Contractor certificates of insurance evidencing renewals thereof. In addition,upon request by the State at any other time during the term of this Contract or any subcontract, Contractor and each Subcontractor shall, within ten(10)days of such request, supply to the State evidence satisfactory to the State of compliance with the provisions of this§13. Page 12 of 27 �......... 14. BREACH A. Defined In addition to any breaches specified in other sections of this Contract, the failure of the Contractor to perform any of its material obligations hereunder in whole or in part or in a timely or satisfactory manner, constitutes a breach. The institution of proceedings under any bankruptcy, insolvency, reorganization or similar law, by or against Contractor, or the appointment of a receiver or similar officer for Contractor or any of its property, which is not vacated or fully stayed within twenty(20) days after the institution or occurrence thereof, shall also constitute a breach. B. Notice and Cure Period In the event of a breach,the State shall notify the Contractor of such in writing in the manner provided in §16. If such breach is not cured within ten (10) days of receipt of written notice, the State may exercise any of the remedies set forth in §15. Notwithstanding anything to the contrary herein, the State, in its sole discretion,need not provide advance notice or a cure period and may immediately terminate this Contract in whole or in part if reasonably necessary to preserve public safety or to prevent immediate public crisis. 15. REMEDIES A. Termination for Cause and/or Breach If Contractor is in breach under any provision of this Contract, the State shall have all of the remedies listed in this§15 in addition to all other remedies set forth in other sections of this Contract, and without limiting its remedies otherwise available at law or equity, following the notice and cure period set forth in§14.B. Remedies are cumulative and the State may exercise any or all of the remedies available to it, in its sole discretion,concurrently or consecutively. The State may terminate this entire Contract or any part of this Contract. Exercise by the State of this right shall not be a breach of its obligations hereunder. i. Obligations and Rights To the extent specified in any termination notice, Contractor shall not incur further obligations or render further performance hereunder past the effective date of such notice, and shall terminate outstanding orders and subcontracts with third parties. However, Contractor shall complete and deliver to the State all Work, Services and Goods not cancelled by the termination notice. Contractor shall continue performance of this Contract up to the effective date of the termination. To the extent the Contract is not terminated, if any, Contractor shall continue performance until the expiration of this Contract. At the sole discretion of the State, Contractor shall assign to the State all of Contractor's right, title, and interest under such terminated orders or subcontracts. Upon termination,Contractor shall take timely, reasonable and necessary action to protect and preserve Page 13 of 27 property in the possession of Contractor in which the State has an interest. All materials owned by the State in the possession of Contractor shall be immediately returned to the State. All Work Product, at the option of the State, shall be delivered by Contractor to the State and shall become the State's property. The Contractor shall be obligated to return any payment advanced under the provisions of this Contract. ii. Payments The State shall reimburse Contractor only for accepted performance up to the effective date of the termination. If, after termination by the State,it is determined that Contractor was not in breach or that Contractor's action or inaction was excusable, such termination shall be treated as a termination in the public interest and the rights and obligations of the Parties shall be the same as if this Contract had been terminated in the public interest, as described herein. iii. Damages and Withholding Notwithstanding any other remedial action by the State, Contractor shall remain liable to the State for any damages sustained by the State by virtue of any breach under this Contract by Contractor and the State may withhold any payment to Contractor for the purpose of mitigating the . State's damages, until such time as the exact amount of damages due to the State from Contractor is determined. The State may withhold any amount that may be due Contractor as the State deems necessary to protect the State against loss,including loss as a result of outstanding liens, claims of former lien holders,or for the excess costs incurred in procuring similar goods or services. Contractor shall be liable for excess costs incurred by the State in procuring from third parties replacement Work, Services or substitute Goods as cover. B. Early Termination in the Public Interest The State is entering into this Contract for the purpose of carrying out the public policy of the State of Colorado, as determined by its Governor, General Assembly, and/or courts. If this Contract ceases to further the public policy of the State, the State, in its sole discretion, may terminate this Contract, in whole or in part. Exercise by the State of this right shall not constitute a breach of the State's obligations hereunder. This subsection shall not apply to a termination of this Contract by the State for cause or breach by Contractor, which shall be governed by§15.A or as otherwise specifically provided for herein. i. Method and Content The State shall notify Contractor of such termination in accordance with §16. The notice shall specify the effective date of the termination, which shall be at least twenty(20)days, and whether it affects all or a portion of this Contract. Page 14 of 27 ii. Obligations and Rights Upon receipt of a termination notice, Contractor shall be subject to and comply with the same obligations and rights set forth in§15.A.i. iii. Payments If this Contract is terminated by the State pursuant to this §15.B, Contractor shall be paid an amount which bears the same ratio to the total reimbursement under this Contract as Contractor's obligations that were satisfactorily performed bear to the total obligations set forth in this Contract, less payments previously made. Additionally, if this Contract is less than 60% completed upon the effective date of such termination, the State may reimburse Contractor for a portion of actual out-of-pocket expenses (not otherwise reimbursed under this Contract) incurred by Contractor prior to'the effective date of the termination in the public interest which are directly attributable to the uncompleted portion of Contractor's obligations hereunder; provided that the sum of any and all reimbursement shall not exceed the maximum amount payable to Contractor hereunder. C. Additional Remedies The State, in its sole discretion, may exercise one or more of the following remedies in addition to other remedies available to it: Suspend Performance Suspend Contractor's performance with respect to all or any portion of this Contract pending necessary corrective action as specified by the State without entitling Contractor to an adjustment in price/cost or performance schedule. Contractor shall promptly cease performance of such portions of the contract. ii. Withhold Payment Withhold payment to Contractor until Contractor's performance or corrections in Contractor's performance are satisfactorily made and completed. iii. Deny/Reduce Payment Deny payment for those obligations not performed in conformance with Contract requirements, that due to Contractor's actions or inactions, cannot be performed or, if performed, would be of no value to the State; provided, that any denial or reduction of payment shall be reasonably related to the value to the State of the obligations not performed. iv. Removal Notwithstanding any other provision herein, the State may demand immediate removal of any of Contractor's employees, agents, or Subcontractors whom the State deems incompetent, careless, insubordinate, unsuitable, or otherwise unacceptable, or whose continued Page 15 of 27 relation to this Contract is deemed to be contrary to the public interest or � the State's best interest. v. Intellectual Property If Contractor infringes on a patent, copyright, trademark, trade secret or other intellectual property right while performing its obligations under this Contract,Contractor shall, at the State's option: a. Obtain for the State or Contractor the right to use such products and services; b. Replace any Goods, Services,or other product involved with non- infringing products or modify them so that they become non- infringing;or, c. If neither of the foregoing alternatives are reasonably available, remove any infringing Goods, Services, or products and refund the price paid therefore to the State. 16. NOTICES AND REPRESENTATIVES Each individual identified below is the principal representative of the designating Party. All notices required to be given hereunder shall be hand delivered with receipt required or sent by certified or registered mail to such Party's principal representative at the address set forth below. In addition to, but not in lieu of, a hard-copy notice, notice also may be sent by a-mail to the e-mail addresses, if any, set forth below. Either Party may from time to time designate by written notice substitute addresses or persons to whom such notices shall be sent. Unless otherwise provided herein, all notices shall be effective upon receipt. For the State: Olivia Covey,Healthy Communities Program Manager Department of Health Care Policy and Financing 1570 Grant Street Denver,Colorado 80203 Olivia.covey®state.co.us For the Contractor: Megan Burch Eagle County Department of Social and Human Services P.O.Box 850 Eagle,Co, 81613 megan.burch@a,eaglecounty.us 17. RIGHTS IN DATA,DOCUMENTS,AND COMPUTER SOFTWARE Any software,research,reports,studies,data,photographs,negatives or other documents, drawings, models, materials, or Work Product of any type, including drafts, prepared by Contractor in the performance of its obligations under this Contract shall be the exclusive property of the State, and all Work Product shall be delivered to the State by Contractor upon completion or termination hereof. The State's exclusive rights in such Work Product shall include, but not be limited to, the right to copy, publish, display, transfer, Page 16 of 27 and prepare derivative works. Contractor shall not use, willingly allow, cause or permit such Work Product to be used for any purpose other than the performance of Contractor's obligations hereunder without the prior written consent of the State. 18. GOVERNMENTAL IMMUNITY Liability for claims for injuries to persons or property arising from the negligence of the State of Colorado,its departments,institutions,agencies,boards,officials,and employees is controlled and limited by the provisions of the Colorado Governmental Immunity Act, CRS §24-10-101,et seq., and the risk management statutes,CRS §24-30-1501,et seq., as now or hereafter amended. 19. GENERAL PROVISIONS A. Assignment and Subcontracts Contractor's rights and obligations hereunder are personal and may not be transferred, assigned or subcontracted without the prior, written consent of the State.Any attempt at assignment,transfer or subcontracting without such consent shall be void. All assignments, subcontracts, or Subcontractors approved by the Contractor or the State are subject to all of the provisions hereof. Contractor shall be solely responsible for all of the Work performed under this Contract, regardless of whether Subcontractors are used and for all aspects of subcontracting arrangements and performance. Copies of any and all subcontracts entered into by Contractor to perform its obligations hereunder shall be in writing and submitted to the State upon request. Any and all subcontracts entered into by Contractor related to its performance hereunder shall require the Subcontractor to perform in accordance with the terms and conditions of this Contract and to comply with all applicable federal and state laws. Any and all subcontracts shall include a provision that such subcontracts are governed by the laws of the State of Colorado. B. Binding Effect Except as otherwise provided in §19.A, all provisions herein contained, including the benefits and burdens, shall extend to and be binding upon the Parties' respective heirs,legal representatives,successors, and assigns. C. Captions The captions and headings in this Contract are for convenience of reference only, and shall not be used to interpret,define, or limit its provisions. D. Counterparts This Contract may be executed in multiple identical original counterparts, all of which shall constitute one agreement. E. Entire Understanding This Contract represents the complete integration of all understandings between the Parties regarding the Work and all prior representations and understandings, oral or written, related to the Work are merged herein. Prior or contemporaneous Page 17 of 27 IF ; additions, deletions, or other changes hereto shall not have any force or effect whatsoever,unless embodied herein. F. Indemnification To the extent permitted by law, the Contractor shall indemnify, save, and hold harmless the State,its employees and agents, against any and all claims,damages, liability and court awards including costs, expenses, and attorney fees and related costs, incurred as a result of any act or omission by Contractor, or its employees, agents, Subcontractors, or assignees pursuant to the terms of this Contract; however, the provisions hereof shall not 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 or hereafter amended. G. Jurisdiction and Venue All suits or actions related to this Contract shall be filed and proceedings held in the State of Colorado and exclusive venue shall be in the City and County of Denver. H. Modification i. By the Parties Except as specifically provided in this Contract, modifications of this Contract shall not be effective unless agreed to in writing by the Parties in an amendment to this Contract, properly executed and approved in accordance with applicable Colorado State law and State Fiscal Rules. Modifications permitted under this Contract, other than contract amendments, shall conform to the policies of the Office of the State Controller, including, but not limited to, the policy entitled MODIFICATIONS OF CONTRACTS-TOOLS AND FORMS. ii. By Operation of Law This Contract is subject to such modifications as may be required by changes in Federal or Colorado State law, or their implementing regulations. Any such required modification automatically shall be incorporated into and be part of this Contract on the effective date of such change, as if fully set forth herein. Order of Precedence The provisions of this Contract shall govern the relationship of the State and Contractor. In the event of conflicts or inconsistencies between this Contract and its exhibits and attachments, including, but not limited to, those provided by Contractor, such conflicts or inconsistencies shall be resolved by reference to the documents in the following order of priority: i. Colorado Special Provisions ii. HIPAA Business Associate Addendum Page 18 of 27 iii. The provisions of the main body of this Contract iv. Exhibit A,Statement of Work v. Exhibit B, Sample Option Letter vi. Exhibit C, Customer Relationship Management Procedures J. Severability Provided this Contract can be executed and performance of the obligations of the Parties accomplished within its intent,the provisions hereof are severable and any provision that is declared invalid or becomes inoperable for any reason shall not affect the validity of any other provision hereof. K. Survival of Certain Contract Terms Notwithstanding anything herein to the contrary, provisions of this Contract requiring continued performance, compliance, or effect after termination hereof, shall survive such termination and shall be enforceable by the State if Contractor fails to perform or comply as required. L. Taxes The State is exempt from all federal excise taxes under IRC Chapter 32 (No. 84- 730123K)and from all State and local government sales and use taxes under CRS §§39-26-101 and 201, et seq. Such exemptions apply when materials are purchased or services are rendered to benefit the State; provided, however, that certain political subdivisions (e.g., City of Denver) may require payment of sales or use taxes even though the product or service is provided to the State. Contractor shall be solely liable for paying such taxes as the State is prohibited • from paying or reimbursing Contractor for such taxes. M. Third Party Beneficiaries Enforcement of this Contract and all rights and obligations hereunder are reserved solely to the Parties. Any services or benefits which third parties receive as a result of this Contract are incidental to the Contract, and do not create any rights for such third parties. N. Waiver Waiver of any breach under a term, provision,or requirement of this Contract,or any right or remedy hereunder,whether explicitly or by lack of enforcement, shall not be construed or deemed as a waiver of any subsequent breach of such term, provision or requirement, or of any other term,provision,or requirement. O. CORA Disclosure To the extent not prohibited by federal law, this Contract and the performance measures and standards under CRS §24-103.5-101, if any, are subject to public release through the Colorado Open Records Act, CRS §24-72-101, et seq. Page 19 of 27 20. ADDITIONAL GENERAL PROVISIONS A. Compliance with Applicable Law The Contractor shall at all times during the execution of this Contract strictly adhere to, and comply with, all applicable federal and state laws, and their implementing regulations, as they currently exist and may hereafter be amended, which are incorporated herein by this reference as terms and conditions of this Contract. The Contractor shall also require compliance with these statutes and regulations in subcontracts and subgrants permitted under this contract. The federal laws and regulations include: Age Discrimination Act of 1975,as amended 42 U.S.C. 6101,et seq. Age Discrimination in Employment Act of 1967 29 U.S.C. 621-634 Americans with Disabilities Act of 1990 (ADA) 42 U.S.C. 12101, et seq. Clean Air Act 42 U.S.C. 7401, et seq. Equal Employment Opportunity E.O. 11246,as amended by E.O. 11375,amending E.O. 11246 and as supplemented by 41 C.F.R.Part 60 Equal Pay Act of 1963 29 U.S.C.206(d) Federal Water Pollution Control Act,as 33 U.S.C. 1251,et seq. amended Immigration Reform and Control Act of 1986 8 U.S.C. 1324b Section 504 of the Rehabilitation Act of 1973, as 29 U.S.C. 794 amended Title VI of the Civil Rights Act of 1964, as 42 U.S.C. 2000d,et seq. amended Title VII of the Civil Rights Act of 1964 42 U.S.C.2000e Title DC of the Education Amendments of 1972, 20 U.S.C. 1681 as amended State laws include: Civil Rights Division Section 24-34-301,CRS,et seq. The Contractor also shall comply with any and all laws and regulations prohibiting discrimination in the specific program(s) which is/are the subject of this Contract. In consideration of and for the purpose of obtaining any and all Page 20 of 27 federal and/or state financial assistance, the Contractor makes the following assurances,upon which the State relies. i. The Contractor will not discriminate against any person on the basis of race, color, national origin, age, sex, religion or handicap, including Acquired Immune Deficiency Syndrome (AIDS) or AIDS-related conditions,in performance of Work under this Contract. ii. At all times during the performance of this Contract, no qualified individual with a disability shall,by reason of such disability,be excluded from participation in, or denied benefits of the service, programs, or activities performed by the Contractor, or be subjected to any discrimination by the Contractor. The Contractor shall take all necessary affirmative steps, as required by 45 C.F.R. 92.36(e), Colorado Executive Order and Procurement Rules, to assure that small and minority businesses and women's business enterprises are used, when possible, as sources of supplies, equipment, construction, and services purchased under this Contract. B. Federal Audit Provisions Office of Management and Budget(OMB) Circular No. A-133, Audits of States, Local Governments, and Non-Profit Organizations, defines audit requirements under the Single Audit Act of 1996 (Public Law 104-156). All state and local governments and non-profit organizations expending $500,000.00 or more from all sources (direct or from pass-through entities) are required to comply with the provisions of Circular No. A-133.The Circular also requires pass-through entities to monitor the activities of subrecipients and ensure that subrecipients meet the audit requirements. To identify its pass-through responsibilities, the State of Colorado requires all subrecipients to notify the State when expected or actual expenditures of federal assistance from all sources equal or exceed$500,000.00. C. Debarment and Suspension i. If this is a covered transaction or the Contract amount exceeds $100,000.00, the Contractor certifies to the best of its knowledge and belief that it and its principals and Subcontractors are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded by any Federal department or agency. ii. This certification is a material representation of fact upon which reliance was placed when the State determined to enter into this transaction. If it is later determined that the Contractor knowingly rendered an erroneous certification, in addition to other remedies available at law or by contract, the State may terminate this Contract for default. iii. The Contractor shall provide immediate written notice to the State if it has been debarred, suspended, proposed for debarment, declared ineligible or voluntarily excluded by any Federal department or agency. Page 21 of 27 i c i s iv. The terms "covered transaction," "debarment," "suspension,""ineligible," "lower tier covered transaction," "principal," and"voluntarily excluded," as used in this paragraph, have the meanings set out in 2 C.F.R. Parts 180 and 376. v. The Contractor agrees that it will include this certification in all lower tier covered transactions and subcontracts that exceed$100,000.00. D. Force Majeure Neither the Contractor nor the State shall be liable to the other for any delay in,or failure of performance of,any covenant or promise contained in this Contract,nor shall any delay or failure constitute default or give rise to any liability for damages if, and only to the extent that, such delay or failure is caused by "force majeure."As used in this Contract, "force majeure"means acts of God; acts of the public enemy; acts of the state and any governmental entity in its sovereign or contractual capacity; fires; floods; epidemics; quarantine restrictions; strikes or other labor disputes; freight embargoes;or unusually severe weather. E. Disputes Except as herein specifically provided otherwise, disputes concerning the performance of this Contract which cannot be resolved by the designated Contract representatives shall be referred in writing to a senior departmental management staff designated by the State and a senior manager designated by the Contractor. Failing resolution at that level, disputes shall be presented in writing to the Executive Director of the State and the Contractor's Chief Executive Officer for resolution. This process is not intended to supersede any other process for the resolution of controversies provided by law. F. Lobbying Contractor certifies,to the best of his or her knowledge and belief,that: i. No Federal appropriated funds have been paid'or will be paid, by or on behalf of the undersigned, to any person for influencing or attempting to influence an officer or employee of an agency, a Member of Congress,an officer or employee of Congress, or an employee of a Member of Congress in connection with the awarding.of any Federal contract, the making of any Federal grant,the making of any Federal loan, the entering into of any cooperative Contract, and the extension, continuation,renewal, amendment, or modification of any Federal contract, grant, loan, or cooperative Contract. ii. If any funds other than Federal appropriated funds have been paid or will be paid to any person for influencing or attempting to influence an office or employee of any agency, a Member of Congress, an office or employee of Congress, or an employee of a Member of Congress in connection with this Federal contract, grant, loan, or cooperative Contract, the undersigned shall complete and submit Standard Form-LLL, "Disclosure Form to Report Lobbying,"in accordance with its instructions. Page 22 of 27 iii. The undersigned shall require that the language of this certification be included in the award documents for all sub awards at all tiers (including subcontracts, subgrants, and contracts under grants,loans, and cooperative Contracts)and that all subrecipients shall certify and disclose accordingly. iv. This certification is a material representation of fact upon which reliance was placed when the transaction was made or entered into. Submission of the certification is a requisite for making or entering into transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required certification shall be subject to a civil penalty of not less than$10,000.00 and not more than$100,000.00 for each such failure. THE REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Page 23 of 27 s � 21. COLORADO SPECIAL PROVISIONS The Special Provisions apply to all contracts except where noted in italics. A. 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. B. 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. C. 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. D. 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. E. 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. F. 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. Rule 3-1,Issued by the Office of the State Controller Page 24 of 27 Date Revised: 1/1/09 G. 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. H. 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. 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 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. J. 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. K. 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 Rule 3-I,Issued by the Office of the State Controller Page 25 of 27 Date Revised:1/1/09 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. L. 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. Rule 3-1,Issued by the Office of the State Controller Page 26 of 27 Date Revised:1/1/09 Contract Routing Number 14-56561 SIGNATURE PAGE 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 Eagle County •vernment John W.Hickenlooper,Governor dik Ii1 I Department of Health .re P. 'cy and Financing 4 qv rI , , *signal re Susan E.Birch,MBA,BSN,RN Executive Director Date: _ Signatory avers to the State Controller or delegate that Contractor has not begun performance or that a Statutory By: 1 /,,.,1 h1 / Violation waiver has been requested under Fiscal Rules Name of Authorized Individual !_ Date: J Title... ...x_ N4/A412.40 4.1 _. . Official Title of Authorized Individual LEGAL REVIEW John W.Suthers,Attorney General By: 1\4A Signature-Assistant Attorney General Date: ALL CONTRACTS REOUIRE APPROVAL BY THE STATE CONTROLLER CRS§24-30-202 requires the State Controller to approve all State Contracts.This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time.If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. ST CONTRO LER Ro , ' • ,MBA,JD By: jJ ;itt( Department ofdigi th a Polic and Financing 0 Date: • Page 27 of 27 Contract Routing Number 14-56561 EXHIBIT B,SAMPLE OPTION LETTER Date: Original Contract Routing# Option Letter# Contract Routing# CMS# 1) OPTIONS:Choose all applicable options listed in§1 and in§2 and delete the rest. a.Option to renew only(for an additional term) b.Change in the amount of goods within current term c. Change in amount of goods in conjunction with renewal for additional term d.Level of service change within current term e. Level of service change in conjunction with renewal for additional term f. Option to initiate next phase of a contract 2) REQUIRED PROVISIONS.All Option Letters shall contain the appropriate provisions set forth below: a.For use with Options 1(a-e):In accordance with Section(s) of the Original Contract between the State of Colorado,Department of Health Care Policy and Financing,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 Option 1(f),please use the following: In accordance with Section(s) of the Original Contract between the State of Colorado,Department of Health Care Policy and Financing,and Contractor's Name,the State hereby exercises its option to initiate Phase indicate which Phase:2,3,4,etc for the term beginning Insert start date and ending on Insert ending date at the cost/price specified in Section c. For use with all Options 1(a-f):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 Health Care Policy and Financing By:Insert Name&Title of Person Signing for Agency or IHE 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 David J.McDermott,CPA By: Insert Name of Agency or IHE Delegate-Please delete if contract will be routed to OSC for approval Date: Exhibit B Page 1 of 1 • ATTACHMENT A This Attachment sets forth additional terms to the .HIPAA Business Associate Addendum, which is part of the Contract between the State of Colorado, Department of Health Care Policy and Financing and the Contractor and is effective as of the date of the Contract(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: No additional permitted uses. 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: No additional permitted disclosures. 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: No subcontractors. 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 receipt of PHI from the Department. 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: No additional restrictions on use of data. 6. Additional Terms. No additional terms. HCPF HIPAA BA,Attachment A Page 1 of 1 Revised 8/12 Contract Routing Number 14-56561 EXHIBIT A,STATEMENT OF WORK 1.0 GENERAL REQUIREMENTS 1.1 The Contractor shall perform all work in accordance with all applicable Federal and State statutes, regulations and rules, as now and hereafter amended, and the requirements described within this Statement of Work and the purchase order. 1.2 The Contractor shall work closely and collaboratively with the Department, discuss suggestions or issues as they occur and incorporate suggestions or guidance from the Department while.performing the work described within this Statement of Work and the purchase order. 1.3 The Contractor shall coordinate and prioritize all work to ensure that all deliverables and deadlines are met. 1.4 The Contractor shall employ an internal quality control process to ensure that all deliverables are complete, accurate, easy to understand, and of high quality. The Contractor shall provide deliverables that, at a minimum, are responsive to the specific requirements, organized into a logical order, contain no spelling or grammatical errors, formatted uniformly, and contain accurate information and correct calculations. The Contractor shall retain all work papers generated for reference through the duration of the project and project acceptance. The Contractor shall participate in the review and revision p P rocess until the Department provides written acceptance of the deliverable. 1.5 The Contractor shall provide copies of any supporting documentation to the Department upon request of the Department and without charge. 1.6 The Contractor shall respond to all telephone calls and e-mail inquiries from the Department within one(1)business day. 1.7 The Contractor shall provide electronic deliverables using Microsoft 2007 software. 1.8 The Contractor shall understand Community Partners to include any individual or organization who assists with any of the programs offered by the Healthy Communities program. 2.0 PROJECT REQUIREMENTS 2.1 The Contractor shall notify the Department of any new employee within thirty(30) days of hire. 2.2 The.Contractor shall provide outreach and case management on all of the following: 2.2.1 Client Outreach and Program Education 2.2.1.1 The Contractor shall conduct a minimum of four(4)outreach activities per month to actively generate awareness and provide education to women and children Exhibit A Page 1 of 5 • currently enrolled in the Healthy Communities Program and those who are eligible for the Healthy Community Program, but are not enrolled(EBNE). The outreach activities shall, at a minimum, include information describing available programs and eligibility requirements on all of the following: 2.2.1.1.1 Medical assistance programs other than Medicaid and Child Health Plan.Plus (CHP+). 2.2.1.1.2 Medicaid and CHP+ benefits, including, but not limited to public health, mental health, and education programs. 2.2.1.1.3 Supplemental food programs for women,infants,and children. 2.2.1.1.4 Family Health Coordinators as a resource. 2.2.1.2 The Contractor shall assist clients in finding or accessing appropriate community resources and ensure families have access to the abovementioned programs. 2.2.1.3 The Contractor shall work to increase the number of well child visits as counted on the Centers for Medicare and Medicaid Services Early and Periodic Screening, Diagnostic, and Treatment(CMS EPSDT)416 report to 80%for all ages 0-20 and eligible for Medicaid. 2.2.1.4 The Contractor shall work to increase oral health visits by 10% over 5 years. 2.2.1.4.1 The Contractor shall use the 2010 CMS EPSDT 416 report as the baseline for the abovementioned increase. 2.2.2 Community Outreach and Program Education 2.2.2.1 The Contractor shall train and educate the client regarding the availability of services offered by the Healthy Communities Program. 2.2.2.2 The Contractor shall assist Community Partners in understanding the Medicaid and CHP+ medical assistance programs, program benefits, and program administration. 2.2.2.3 The Contractor shall plan, manage, and coordinate collaborative efforts and/or activities with Community Partners to ensure better service delivery and education to the populations served. ' 2.2.2.4 The Contractor shall attend all relevant meetings, conferences, and other channels of collaboration in conjunction.with Community Partners at no additional cost to the Department. 2.2.3 Provider Outreach and Program Education 2.2.3.1 The Contractor shall educate providers on all services provided by or available through Healthy Communities Program. 2.2.3.2 The Contractor shall educate and assist providers with services covered by Medicaid and CHP+. 2.2.3.3 The Contractor shall educate the providers on all of the following: 2.2.3.3.1 The importance of well care. Exhibit A Page 2 of 5 2.2.3.3.2 Federal mandates that eighty percent(80%) of children between the ages of four(4)and twenty(20)receive one(1)well child visit per year 2.2.3.3.3 Federal mandates that children between the ages of zero(0)and three(3) 2.2.3.4 The Contractor shall refer providers to the appropriate local department of human or social services,the Department, and/or community resource(s)as necessary 2.2.3.5 The Contractor shall assist providers with missed appointment follow-up as requested. 2.2.4 Case Management and Program Navigation 2.2.4.1 The Contractor shall assist all EBNEs and clients enrolled in the Healthy Communities Program with the overall program navigation of the Medicaid and CHP+programs. 2.2.4.2 The Contractor shall assist EBNEs with the application process, which includes all of the following: 2.2.4.2.1 Assisting the EBNEs with a paper Medicaid application or the Colorado Program Eligibility and Application Kit(PEAK). 2.2.4.2.2 Providing on site presumptive eligibility (PE) determinations for those who may qualify. 2.2.4.2.3 Providing an appropriate referral, when necessary, to another application assistance site, including, but not limited to a local department of human or social services, a PE site, a Certified Application Assistant Site(CAAS), or a Medicaid Assistance(MA)site. 2.2.4.3 The Contractor shall perform the following tasks for all individuals who qualify for the Healthy Communities Program: 2.2.4.3.1 Follow-up with pregnant women,children,families, and EBNEs regarding the status of their application as requested by the client. 2.2.4.3.2 Provide Healthy Communities Program clients with a list of appropriate Medicaid and CHP+providers and referrals when appropriate. 2.2.4.3.3 Provide appointment assistance as requested by Medicaid eligible clients. 2.2.4.3.4 Provide referrals for medical and non-medical programs to Health Communities Program clients and their family members as requested by the client. 2.2.4.3.5 Provide missed appointment follow up as requested by physical, oral and mental health providers. 2.2.4.3.6 Provide follow-up assistance to clients who have not received services within six (6) months and/or annually for services defined in the Colorado Periodicity Schedule or by the CHP+oral health periodicity schedule. 2.2.4.3.7 Assist in resolving any issues or concerns regarding enrollment into Medicaid or CHP+ and/or eligibility issues, including, but not limited to, facilitating contact with CHP+contractors. . Exhibit A Page 3 of 5 2.2.4.3.8 Assist clients with scheduling appointments and transportation needs through the Medicaid Transportation Broker or local department of human or social services. 2.2.4.3.9 Assist clients with billing issues and/or any additional questions and issues regarding program benefits and/or navigation. 2.3 Customer Relationship Management System 23.1 The Contractor shall provide all employees' access for the program to use the Healthy Communities Customer Relationship Management System as required. 2.3.2 The Contractor shall assure that all local information needed to assist clients, such as providers, community resources, etc are added to the Healthy Communities Customer Relationship Management System as they relate to the Healthy Communities Program in a timely manner to assure lists are available for use by clients and community partners as needed. 2.3.3 The Contractor shall assure that staff are computer literate and able to use the Healthy Communities Customer Relationship Management System to its full potential. 2.4 Reporting 2.4.1.1 The Contractor shall utilize the Healthy Communities Customer Relationship Management System in accordance with the Department's established procedures (Exhibit C)to provide reporting on program deliverables. 2.4.1.2 The Contractor shall submit a detailed Budget Report to the Department within 60 days of the issuance or renewal of a contract with the Department.At a minimum, the Budget Report shall include all anticipated program related expenses for full time employee(s)and operating expenses for the entire contractual period. 2.4.1.3 The Contractor shall assure the Healthy Communities Customer Relationship Management System database is up to date by the 10th of the month following the reporting month. The Department will pull reports for monthly contacts,referrals, and outreach activities after the 10`h and before the 15`h of the month to meet the monthly reporting requirements. 2.4.1.3.1 The Contractor shall submit all requests for extensions of this deadline to the Department in writing no later than the 5`11 of the month. 2.4.1.4 The Contractor shall submit a Final Report to the Department utilizing reporting and information from the Healthy Communities Customer Relationship Management System database. The Final Report shall include, at a minimum, all of the following: 2.4.1.4.1 An analysis of any successes and challenges faced by the Contractor,based on their individual program and location, related to the Healthy Communities program during the contracted period. 2.4.1.4.2 An analysis of the contract year's activities, outcomes,trends, and results. 2.4.1.4.3 An analysis of their ability to meet CMS EPSDT requirements for well child, oral health, and lead testing. Exhibit A Page 4 of 5 2.4.1.4.4 An analysis of their ability to meet the oral h ealth periodicity schedule for CHP+eligible children. 2.4.1.5 The Contractor shall provide Ad Hoc Reports as requested by the Department. 2.4.1.5.1 When an Ad Hoc Report is requested, the Contractor shall coordinate with the Department to confirm its understanding of the request and identify the best method for response. 2.4.1.5.2 The Contractor shall provide all ad hoc reports within thirty (30) days of the Department's request at no additional cost to the Department. 3.0 PAYMENT 3.1 The Contractor shall submit an invoice monthly based on the Contractor's actual expenditures for the period specified. All invoices shall be submitted using the Contract Reimbursement Statement Form attached to this Contract as Exhibit B. All invoices shall reference the Contract by the Contract routing number that appears on the first page of the Contract. Invoice shall be based upon the cost of the Work performed during the term of this Contract, and, shall be supplemented or accompanied by supporting data and subcontractor invoices, if any, covering the Work shown on the invoice. Indirect costs shall not exceed five percent (5%) of the Contract Maximum Amount for the Contract year. The total of the invoice submitted by the Contractor for all periods during a Contract year shall not exceed the Contract maximum amount for that year. 4.0 DEPARTMENT RESPONSIBILITIES 4.1 The Department will: 4.1.1 Arrange for training on the Healthy Communities Customer Relationship Management System database and access to the system for all of the Contractor's current employees working with the Healthy Communities Program in a timely manner. 4.1.2 Arrange for training on the Healthy_ Communities Customer Relationship Management System database and access to the system for any new employee hired by the Contractor working with the Healthy Communities Program within 60 days of being notified of the new hire. 4.1.3 Submit payment to the Contractor upon the Department's review and acceptance of deliverables and invoicing received from the Contractor. • Exhibit A Page 5 of 5 Contract Routing Number 14-56561 EXHIBIT C,CUSTOMER RELATIONSHIP MANAGEMENT PROCEDURES REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK • Exhibit C Page 1 of 1 C C HIPAA BUSINESS ASSOCIATE ADDENDUM This Business Associate Addendum ("Addendum") is part of the Contract between the State of Colorado, Department of Health Care Policy and Financing and the Contractor. For purposes of this Addendum, the State is referred to as "Department", "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")1HITECH 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 "Privacy Rule")and other applicable laws,as amended. C. As part of the HIPAA regulations, the Privacy Rule requires CE to enter into a contract containing specific requirements with Associate prior to 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 Privacy Rule at 45 C.F.R. Parts 160, 162 and 164, as amended. In the event of any conflict between the mandatory provisions of the Privacy Rule and the provisions of this Contract, the Privacy Rule shall control. Where the provisions of this Contract differ from those mandated by the Privacy Rule, but are nonetheless permitted by the Privacy Rule,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 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 Privacy Rule,including,but not limited to,45 C.F.R. Section 164.501. HCPF HIPAA BA Page 1 of 9 Revised 8/12 c. "Protected Information shall mean PHI provided by CE to Associate or created or received 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. 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 Privacy Rule 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 Privacy Rule. b. Permitted Disclosures. Associate shall not disclose Protected Information in any manner that would constitute a violation of the Privacy Rule 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, Associate must obtain,prior to making any such disclosure: (i)reasonable assurances from 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 (ii) an agreement from such third party to notify Associate within two 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 Security Rules, 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. 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. HCPF HIPAA BA Page 2 of 9 Revised 8/12 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 substantially 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. Associate shall implement and maintain sanctions against agents and subcontractors that violate such restrictions and conditions shall mitigate the effects of any such violation. f. Access to Protected Information. Associate shall make Protected Information maintained by Associate or its agents or subcontractors in 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 Privacy Rule, including, but not limited to,45 C.F.R. Section 164.524. g. Amendment of PHI. 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, Associate or its agents or subcontractors shall make such Protected Information available to CE for amendment and incorporate any such amendment to enable CE to fulfill its obligations with respect to requests by individuals to amend their PHI under the Privacy Rule, 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.Within ten(10)business days of notice by CE of a request for an accounting of disclosures of Protected Information, Associate and its agents or subcontractors shall make available to CE the information required to provide an accounting of disclosures to enable CE to fulfill its obligations under the Privacy Rule, including, but not limited to, 45 C.F.R. Section 164.528. As set forth in, and as limited by, 45 C.F.R. Section 164.528, Associate shall not provide an accounting to CE of disclosures: (i) to carry out treatment, payment or health care operations, as set forth in 45 C.F.R. Section 164.506; (ii)to individuals of Protected Information about them as set forth in 45 C.F.R. Section 164.502; (iii) pursuant to an authorization as provided in 45 C.F.R. Section 164.508; (iv) to persons involved in the individual's care or other notification purposes as set forth in 45 C.F.R. Section 164.510; (v)for national security or intelligence purposes as set forth in 45 C.F.R. Section 164.512(k)(2); (vi)to correctional institutions or law enforcement officials as set forth in 45 C.F.R. Section 164.512(k)(5); (vii) incident to a use or disclosure otherwise permitted by the Privacy Rule; (viii) as part of a limited data set under 45 C.F.R. Section 164.514(e); or(ix) disclosures prior to April 14, 2003. Associate agrees to implement a process that allows for an accounting to be collected and maintained by Associate and its agents or subcontractors for at least six(6)years prior to the request,but not before the compliance date of the Privacy Rule.At a minimum, such information shall include: (i) the date of disclosure; (ii) the name of the entity or person who received Protected Information and, if known, the address of the entity or person; (iii) a brief description of Protected Information disclosed; and (iv) a brief statement of purpose of the disclosure that HCPF HIPAA BA Page 3 of 9 Revised 8/12 ' r C reasonably informs the individual of the basis for the disclosure, or a copy of the individual's authorization, or a copy of the written request for disclosure. 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 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 compliance with the Privacy Rule. 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. 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 Privacy Rule 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 agents or subcontractors 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 casualty and liability 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. Notification of Breach. During the term of this Contract, Associate shall notify CE within two (2) 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. Such notice 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. HCPF HIPAA BA Page 4 of 9 Revised 8/12 o. Audits, Inspections 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; (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; and (iii) CE shall execute a nondisclosure agreement,upon terms mutually agreed upon by the parties, if requested by Associate.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. p. Safeguards During Transmission. Associate shall be responsible for using appropriate safeguards to maintain and ensure the confidentiality, privacy and security of Protected 'Information transmitted to CE pursuant to the Contract, in accordance with the standards and requirements of the Privacy Rule, until such Protected Information is received by CE, and in accordance with any specifications set forth in Attachment A. q. 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, provided Associate has agreed to such a restriction. 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 Protected 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 to maintain and ensure the confidentiality, privacy and security of PHI transmitted to Associate pursuant to this Contract, in accordance with the standards and requirements of the Privacy Rule,until such PHI is received by Associate, and in accordance with any specifications set forth in Attachment A. b. Notice of Changes. CE shall provide Associate with a copy of its notice of privacy practices produced in accordance with 45 C.F.R. Section 164.520, as well as any subsequent changes or limitation(s) to such notice, to the extent such changes or limitation(s) may affect Associate's use or disclosure of Protected Information. CE shall provide Associate with any changes in, or revocation of,permission to use or disclose Protected Information,to the extent 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 HCPF HIPAA BA Page 5 of 9 Revised 8/12 accordance with 45 C.F.R. Section 164.522. CE may effectuate any and all such notices of non- private'information via posting on.CE's web site. Associate shall review CE's designated web site for notice of changes to CE's HIPAA privacy policies and practices on the last day of each calendar quarter. 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: (1) 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 4(a),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 the public interest, and the rights and obligations of the parties shall be the same as if this Contract had been terminated for the public interest,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, as applicable. 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. HCPF HIPAA BA Page 6 of 9 Revised 8/12 ----... ... 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 HIPAA, the HIPAA Regulations or other security or privacy laws or(ii) a finding or stipulation that the other party has violated any standard or requirement of HIPAA, the HIPAA Regulations 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 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. Upon mutual agreement of CE and Associate that return or destruction of Protected Information is 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 information,and shall limit further use of such PHI to those purposes that make the return or destruction of such PHI infeasible. 5. Injunctive Relief CE shall have the right to injunctive and other equitable and legal relief against Associate or any of its agents or subcontractors 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 24-10-100 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 Contract, HIPAA or HIPAA Regulations 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 HIPAA relating to certification of its 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 HCPF HIPAA BA Page 7 of 9 Revised 8/12 • certify to CE the extent to which Associate's security safeguards comply with HIPAA, the HIPAA Regulations 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 HIPAA, the Privacy Rule, the Final HIPAA Security Regulations at 68 Fed. Reg. 8334 (Feb 20, 2003), 45 C.F.R. §164.314 and other applicable laws relating to the security or privacy of PHI. The parties understand and agree that CE must receive satisfactory written assurance from Associate that Associate will adequately safeguard all Protected Information. 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 HIPAA, the Privacy Rule 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 HIPAA and the Privacy Rule. 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 thirty (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 HIPAA, the Privacy Rule 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 HIPAA and the Privacy Rule. The parties agree that any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is consistent with HIPAA and the Privacy Rule. This Contract supersedes and replaces any previous separately executed HIPAA addendum between the parties. HCPF HIPAA BA Page 8 of 9 Revised 8/12 1 ' 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. • HCPF HIPAA BA Page 9 of 9 Revised 8/12 • • Polity and Procedures Manual T ;• .7/ . - •"' . . • ' - . . . . -," - _ n . ' , • . • , • , , • '1,;\ • • , • • Healthy Communities Pmgrarn • DE-![:}ailment of Health Care Policy and Financing of State of Colorado • . Prepared by the Client Services Section 110, 5, 201.2 • WHAT ARE POLICIES AND PROCEDURES 4 PROCEDURE WRITING BEST PRACTICES 4 HEALTHY COMMUNITIES PROGRAM POLICIES 6 CLIENT OUTREACH AND PROGRAM EDUCATION POLICY 9 - COMMUNITY AND PROGRAM EDUCATION POLICY 11 PROVIDER OUTREACH AND PROGRAM EDUCATION POLICY 13 CASE MANAGEMENT AND PROGRAM POLICY 15 PRIVACY AND CONFIDENTIALITY POLICY 18 PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION SERVICES 21 TRAIN AND EDUCATE COMMUNITY ORGANIZATIONS AND PARTNERS ON THE AVAILABILITY OF SERVICES PROVIDED BY HEALTHY COMMUNITIES 22 ASSIST COMMUNITY PARTNERS IN UNDERSTANDING THE MEDICAID AND CHP+ MEDICAL ASSISTANCE PROGRAMS, PROGRAM BENEFITS, AND GENERAL PROGRAM ADMINISTRATION GUIDELINES 23 PLAN, MANAGE, AND COORDINATE COLLABORATIVE EFFORTS OR ACTIVITIES WITH OTHER COMMUNITY PARTNERS TO ENSURE BETTER SERVICE DELIVERY AND EDUCATION TO THE POPULATIONS SERVED 24 ATTEND MEETINGS, CONFERENCES, AND OTHER CHANNELS OF COLLABORATION IN CONJUNCTION WITH COMMUNITY ORGANIZATIONS AND COMMUNITY PARTNERS 25 EDUCATE PROVIDERS ON THE SERVICES PROVIDED BY OR AVAILABLE THROUGH HEALTHY COMMUNITIES 26 EDUCATE AND ASSIST PROVIDERS WITH SERVICES COVERED BY THE MEDICAID AND CHP+MEDICAL ASSISTANCE PROGRAMS 28 REFER PROVIDERS TO APPROPRIATE DEPARTMENT OR COMMUNITY RESOURCES INCLUDING THOSE THAT WOULD LIKE TO BECOME MEDICAID OR CHP+ PROVIDERS 29 ASSIST CLIENTS WITH THE OVERALL PROGRAM NAVIGATION OF THE MEDICAID AND CHP+MEDICAL ASSISTANCE PROGRAMS ON A DAY TO DAY BASIS 31 CONTACT AND ASSIST ALL CLIENTS REFERRED TO THE HEALTHY COMMUNITIES PROGRAM THROUGH FACE TO FACE, WRITTEN, ORAL, AND OTHER METHODS OF COMMUNICATION INCLUDING THE USE OF SOCIAL MEDIA 33 ASSIST CLIENTS WITH THE APPLICATION PROCESS 34 PROVIDE FOLLOW UP TO PREGNANT WOMEN AND CHILDREN, FAMILIES, AND EBNE'S ON THE STATUS OF THEIR APPLICATION AS REQUESTED AND/OR ASSIST THE CLIENT 2 IN RESOLVING ANY ISSUES OR.CONCERNS REGARDING THEIR ENROLLMENT INTO A MEDICAL ASSISTANCE PROGRAM AND/OR ELIGIBILITY ISSUES 36 ASSIST CLIENTS WITH THE REPORTING OF NEWBORNS 37 PROVIDE CLIENTS WITH A LIST AND REFERRAL TO AN APPROPRIATE MEDICAID OR CHP+ PROVIDER 38 ASSIST CLIENTS WITH SCHEDULING OF APPOINTMENTS AND TRANSPORTATION NEEDS 39 MANAGE COMPLAINTS OF PRIVACY BREACHES 40 CONTACT CLIENTS ATTENDING INMUNIZATION CLINICS 41 OUTREACH TO EPSDT CLIENTS AT EVENTS 42 OUTREACH TO CHILD CARE CENTERS/ HOMES 43 OUTREACH TO COMMUNITY 44 PROVIDE CASE FOLLOW-UP 45 3 WHAT ARE POLICIES AND PROCEDURES Policies reflect the"rules"governing the implementation of the project processes. Procedures,on the other hand,represent an implementation of policy and should evolve over time as new tools emerge,new processes are designed,and the risks associated with an area change in response to internal or external environmental changes.(In fact,there should be an expectation that individuals will"challenge"outdated procedures and call them to the attention of their owners.) PROCEDURE WRITING BEST PRACTICES The overall goal for any policy or procedure document is for the design to be simple,consistent, and easy to use.In order to ensure a consistent format between documents,we'll be providing Microsoft Word templates to help us get started. • GOOD POLICIES • Policies are written in clear,concise,simple language. • Policy statements address what is the rule rather than how to implement the rule. • Policy statements are readily available to contractors and their authority is clear. • As a body,they represent a consistent, logical framework for project action. GOOD PRO( I.DURE`=5 • Procedures are tied to policies.Making explicit this relationship along with how the procedure helps the project achieve its goals or strategic plan helps ensure understanding and compliance. • Procedures are developed with the customer/user in mind.Well developed and thought out procedures provide benefits to the procedure user. • There is a sense of ownership among procedure users.For this reason,it helps to involve users in the development of procedures. • The procedures are understandable.Procedures should be written so that what needs to be done can be easily followed by all users. • 4 WRITING STYLE FOR POLICY AND PROCEDURE DOCUMENTS • Concise, minimum of verbiage. • If you use an acronym,spell it out the first time you use it. • Include step-by-step instructions for completing(paper or electronic)forms(procedures only). • Not too technical—simple enough to be understood by a new employee. • Fill in the holes-Ask yourself if your existing procedures cover all of the tasks users need to complete.If you have a set of well written FAQs(and you should!),make sure there are procedures for addressing the details of each FAQ. • State the goal-Unless it is already obvious,begin by telling users the reason for performing the procedure,and in what conditions it is applicable. • Break it down-Lengthy procedures are harder to follow.Break these behemoths down into smaller chunks and use hyperlinks to guide users from one granular task to the next. Aim for so steps or less in each procedure. • Don't assume-Read carefully through your procedures and ask,"Is there anything a user would need to know that I've left out?"Don't assume that users know everything you know about the process. • Use warnings-For each step in your procedures,carefully consider whether there are any potential risks or dangers that you haven't documented. • Link related procedures-Whenever possible,especially in help, use cross-references to point users to related procedures.Most users need to perform multiple related tasks in order to complete their goals. • Tell users what to expect-Consider whether the results of each step need to be documented.Good candidates are those that result in changes in the state of the product (e.g.an important prompt appears in the software).Your description of the result should immediately follow the instructions for that step. • Watch for branches-Often a step in a procedure can have multiple results.If your procedure branches,consider making each branch a separate procedure.Use links or cross- references to guide users through. • Combine small steps-Usually it is best to write only one instruction per numbered step. However,small steps can often be combined.For example,"Click the save button"and "Close the application"can be combined into"Click the save button and close the application."Combine multiple small steps only when the concepts are simple enough for users to think of them as one. • Give users an overview-Use a flowchart, list of links,or other visual cue to help users see how procedures are related.This will provide users with an overview to guide them through a complex series of tasks. • Follow up with results-At the end of the procedure,clearly describe the results so that users can assess whether they were successful in completing the task.The more complicated the task,the more assurance users will need. 5 HEALTHY COMMUNITIES PROGRAM POLICIES • DEFINITIONS The Healthy Communities Outreach and Case Management Program focuses on providing comprehensive outreach and case management services to all pregnant women and children, and youth aged 20 and under for the Early Periodic Screening Diagnosis and Treatment (EPSDT)Medicaid program,clients enrolled into the Child Health Plan Plus(CHP+)program and the Eligible But Not Enrolled(EBNE)populations. The authorities governing Healthy Communities Outreach and Case Management Program for Medicaid are contained within the Social Security Act: • Section 19o5(a)(4)(b) • Section 1905(r)-(OBRA 1989) • Section 19o2(a)(43) • Section 19o2(a)(1o),following(g) • Part 5 of the State Medicaid Manual • Part 2 of the State Medicaid Manual • 42 CFR 441.56-42 CFR 441.62, 42 CFR 457.50 through 42 CFR 457.110 and 42 CFR. 457.340. PURPOSE AND SCOPE: • The purpose of this policy is to establish and define the responsibilities of the Family Health Coordinators that are related to performing outreach and case management services forthe Healthy Communities Outreach and Case management Program. • All staff of the program shall perform these functions as defined in each of the contractors Statement of Work. PA110NAI...E Family Health Coordinators are responsible for performing all outreach and case management services to the defined populations. GENERA'... I'h I1,ICIPI..f S • Family Health Coordinators shall perform all functions as outlined by the State of Colorado,Department of Health Care Policy and Financing. • Family Health Coordinators shall ensure the all appropriate and defined services and provided to the outlined populations in accordance with state and federal regulations. • Ensure all program deliverables are met within the established guidelines and the Department provided Statement of Work. PC)! I( 'Y 1 Al I=k/I 11,1 1 6 All Family Health Coordinators shall provide comprehensive outreach and case management services to all pregnant women, as well as all children and youth aged 20 and underas all are EPSDT(Medicaid)eligible,;along with those who are CHP+eligible,; and those that are Eligible But Not Enrolled(EBNE)populations. POLICIES Client Outreach and Program Education 2. Community Outreach and Program Education 3. Provider Outreach and Program Education 4. Case Management Services 5. Privacy and Confidentiality • PROGRAM POI ICU S 8 CLIENT OUTREACH AND PROGRAM EDUCATION POL ICY Issue Date: mm/dd/yy Effective Date:mm/dd fry Policy No.s Page No.i of a DEFINITIONS Family Health Coordinators shall perform"Client Outreach and Program Education"services by actively generating awareness and provide education to all pregnant women,and children, youth aged 20 and under,as well as the EBNE populations on the availability of medical assistance program through face to face,written,oral and other methods of communication. Family Health Coordinators shall educate the outlined populations on the Medicaid and CHP+ program benefits including public health,mental health,education programs,and related programs such as Health Care Program for Children with Special Health Care Needs(HCP), Head Start,Title IXX social services programs,supplemental food programs for women,infants, and children(WIC)to ensure the effectiveness of child health programs. Family Health Coordinators shall assist clients in finding or accessing appropriate medical and non medical community resources and ensure families have access to these programs. Family Health Coordinators shall educate clients on the availability of Family Health Coordinators as a resource to all outlined populations,community partners,providers,and all other interested parties. Pt po.:i`;I AND SCOPE • The purpose of this policy is to establish and define the responsibilities of the Family Health Coordinators as they related to Client Outreach Activities • All staff of the program shall perform these functions as defined in each of the contractors Statement of Work • All services described shall be performed in accordance with all applicable state and federal regulations and policies PA.I..IONALE Clients eligible to receive services of this program shall be provided all appropriate resources that will assist in the clients ability to be educated about their program benefits and other community resources to ensure positive outcomes for program members. GFIJEl'PI. PRINCIPLES • Family Health Coordinators shall provide all outlined services in accordance with state and federal regulations and policies. • Perform Program client outreach and program education services on a daily basis to best meet the needs of the clients served. 9 PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION SERVICES TO ALL ELIGIBLE CLIENT OF THE HEALTHY COMMUNITIES PROGRAM AND IN - A TIMELY MANNERPOLICY STATEMENT Family Health Coordinators shall provide"Client Outreach.and Program Education"services to all eligible clients of the Healthy Communities Outreach and Case Management Program. IMPLEMENTATION PROCEDURES 3.. Provide client outreach and program education services through face to face,written, oral or other methods of communication • 10 COMMUNITY AND PROGRAM EDUCATION POLICY Issue Date:mm/dd/yy Effective Date:mm/dd/yy Policy No.1 Page No.n.of 1 DEFINITIONS Family Health Coordinators shall provide"Community Outreach and Program Education" services by providing training and education on the availability of services offered by the Healthy Communities Program to community organizations and other program related partners. Family Health Coordinators shall assist community partners in understanding the Medicaid and CHP+medical assistance programs,program benefits,and general program administration principles. Family Health Coordinators shall plan,manage,and coordinate collaborative efforts or activities with other community organizations and partners to ensure better service delivery and education to the populations served. Family Health Coordinators shall attend meetings,conferences,and other channels of collaboration in conjunction with community organizations and community partners and actively represent the program at those meetings. PUPPiuSI.: A(JD SCOFF • The purpose of this policy is to establish and define the responsibilities of the Family Health Coordinators as they related to Community Outreach activities • All staff of the program shall perform these functions as defined in each of the contractors Statement of Work • All services described shall be performed in accordance with all applicable state and federal regulations and policies RATIONALE Clients eligible to receive services of this program shall be provided all appropriate resources that will assist in the clients ability to be educated about their program benefits and other community resources to ensure positive outcomes for program members. GENERAL PRINCIPLES • Family Health Coordinators shall provide all outlined services in accordance with state and federal regulations and policies. • Family Health Coordinators shall perform these activities to ensure community partners,providers,and all other interested parties are informed about the services provided by Healthy Communities. 11 • Family Health Coordinators shall perform these activities to ensure all appropriate resources and referrals and provided to the populations served. PO!ICY STATEMENT Family Health Coordinators shall provide "Community Outreach and Program Education" services to community partners, providers, and all other interested parties on the services provided by the Healthy Communities Outreach and Case Management Program. IMPLEMENTATION PROCEDURES 1. Train and educate community organizations and partners on the availability of services provided by Healthy Communities. 2. Assist community partners in understanding the Medicaid and CHP+Medical Assistance programs,program benefits,and general program administration guidelines. 3. Plan,manage,and coordinate collaborative efforts or activities with other community partners to ensure better service delivery and education to the populations served and assure services are duplicated between partners. 4. Attend meetings,conferences,and other channels of collaboration in conjunction with community organizations and community partners and actively representthe program. 12 PROVIDER OUTREACH AND PROGRAM EDUCATION POLICY Issue Date:mm/dd/yy Effective Date:mm/dd/yy Policy No.a Page No.z of i L)EF€IV€..IIONS Family Health Coordinators shall provide education to providers on the services provided by or available through Healthy Communities including but not limited to:Assisting with missed appointment follow up; Provider office visits;Resolving or clarifying the client's program eligibility:Reporting of the clients newborn; Scheduling or contacting the client for follow up services or other visits;and other services needed by the client. Family Health Coordinators shall educate and assist providers with services covered by the Medicaid and CHP+medical assistance programs. Family Health Coordinators shall refer provider to the appropriate Department or other community resources including those that would like to become Medicaid or CHP+providers. PURPOSE AND SLOPE • The purpose of this policy is to establish and define the responsibilities of the Family Health Coordinators as they related to Provider Outreach activities • All staff of the program shall perform these functions as defined in each of the contractors Statement of Work • All services described shall be performed in accordance with all applicable state and federal regulations and policies RA-I ION.AI_E Family Health Coordinators shall ensure good relationships with external partners to ensure all appropriate services can be offered to the populations served. GEHFRAI... PRINC,IPLE.S • Family Health Coordinators shall provide all outlined services in accordance with state and federal regulations and policies. • Family Health Coordinators shall perform these activities to ensure providers and all other interested parties are informed about the services provided by Healthy Communities. • Family Health Coordinators shall perform these activities to ensure all appropriate resources and referrals and provided to the populations served. POLICY. S FATTMFIJT 13 • Family Health Coordinators shall provide "Provider Outreach and Program Education"services to providers and all other interested parties on the services provided by the Healthy Communities Outreach and Case Management Program. IMPLEMENTATION PROCEDURES 1. Educate providers on the services provided by or available through Healthy Communities including but not limited to:Assisting with missed appointment follow up;Provider office visits; Resolving or clarifying the clients program eligibility; Reporting of clients newborn;Scheduling or contacting the client for follow up services or other visits;and other services needed by the client. 2. Educate and assist providers with services covered by the Medicaid and CHP+medical assistance programs. 3. Refer providers to appropriate Department or community resources including those that would like to become Medicaid or CHP+providers. • • 14 • CASE MANAGEMENT AND PROGRAM POLICY Issue Date:mm/dd/yy Effective Date:mm/dd/yy Policy No.1 Page No.s of UEFINITIONS Family Health Coordinators shall assist clients with the overall program navigation of the Medicaid and CHP+medical assistance programs on a day to day basis including but not limited to: Contacting and assisting all clients through face to face,written,oral,and other methods of communication; assist clients with the application process which can include assisting the client face to face with a paper or PEAK application; Providing PE determinations on site to those that may qualify, and/or an appropriate referral to another application assistance site such as aocal department of social/human services,PEAK,CAAS,other PE,or MA Site to facilitate the client's enrollment into Medicaid and CHP+; Provide follow up to pregnant women and children,families,and EBNE's on the status of their application as requested and/or assist the client in resolving any issues or concerns regarding their enrollment into a medical assistance program and/or eligibility issues; Assist clients with the reporting of newborns;includes processing Add-A-Baby request for cases that are emergent or if services need to be expedited; provide clients with a list and referral to an appropriate Medicaid or CHP+provider; Assist clients with scheduling of appointments and transportation needs through the Medicaid Transportation Broker or appropriate local department of social/human services; Provide follow up and assistance to clients who have not received services within six months of initial eligibility and annually thereafter for services defined in the Colorado Periodicity Schedule;and, Assist clients with billing issues or other questions and issues regarding program benefits or navigation. F't,IRPOSI:" AND )C DPI • The purpose of this policy is to establish and define the responsibilities of the Family Health Coordinators as they related to case management activities • All staff of the program shall perform these functions as defined in each of the contractors Statement of Work • All services described shall be performed in accordance with all applicable state and federal regulations and policies I t F ltsIJAl 15 All Family Health Coordinators shall provide comprehensive outreach and case management services to all pregnant women, and children and youth aged 20 and under who are EPSDT (Medicaid) eligible, CHP+ eligible, and those that are Eligible But Not Enrolled (EBNE) populations. • GENERAL PRINCIPLES • Family Health Coordinators shall provide all outlined services in accordance with state and federal regulations and policies. • Family Health Coordinators shall perform these activities to ensure providers and all other interested parties are informed about the services provided by Healthy Communities. • Family Health Coordinators shall perform these activities to ensure all appropriate resources and referrals and provided to the populations served. POLICY STATEMENT Family Health Coordinators shall provide case management to all eligible pregnant women,and children,youth aged 20 and under. IMPI I`MENTATION F'I'.C)C.F..DUPES i. Assist clients with the overall program navigation of the Medicaid and CHP+medical assistance programs on a day to day basis; 2. Contact and assist all clients through face to face,written,oral,and other methods of communication including the use of social media. Initial contact shall be within 6o days of eligibility determination. 3. Assist clients with the application process; includes assisting the client face to face with a paper or PEAK application;Providing PE determinations on site to those that may qualify,and/or an appropriate referral to another application assistance site such as the local department of social/human services,PEAK,CAAS,other PE,or MA Site to facilitate the client's enrollment into Medicaid and CHP+. 4. Provide follow up to pregnant women and children,families,and EBNE's on the status of their application as requested and/or assist the client in resolving any issues or concerns regarding their enrollment into a medical assistance program and/or eligibility issues. 5. Assist clients with the reporting of newborns which can include processing Add-A-Baby request for cases that are emergent or if services need to be expedited. 6. Provide clients with a list and referral to an appropriate Medicaid or CHP+provider; 7. Assist clients with scheduling of appointments and transportation needs through the Medicaid Transportation Broker or appropriate local department of social/human services. 8. Provide follow up and assistance to clients who have not received services within six months from initial eligibility and annually thereafter for services defined in the Colorado Periodicity Schedule. g. Assist clients with billing issues or other questions and issues regarding program benefits or navigation. 16 so. Assist other family members in the home with referrals to low cost or free medical or non-medical services within their community as needed. • 17 PRIVACY AND CONFIDENTIALITY POLICY Issue Date: mm/dd/yy Effective Date:mm/dd/yy Policy No.3. Page No.1 of 1 DEFINITIONS Privacy protects beneficiaries from unfair or unauthorized use of personal or sensitive information.Personal information is any information that can lead to an individual being identified or reasonably ascertained.Healthy Communities is obliged to meet the standards required in The Health Insurance Portability and Accountability Act of 1996(HIPAA). Confidentiality relates to how information that has been disclosed in the course of a professional relationship is treated.The Healthy Communities staff have an obligation to take all reasonable measures to ensure all information disclosed in confidence,is not disclosed without beneficiary consent or otherwise unfairly or inappropriately. PURPOSE AND SCOPE • The purpose of this policy is to establish standards of privacy and confidentiality for all aspects of the program's dealings with all beneficiaries(including family members)of the service; • The Privacy and Confidentiality Policy applies to all beneficiaries.The offices where service is provided and any online presence of the program display brochures and/or pamphlets in an appropriate range of languages and formats about beneficiaries rights to privacy and confidentiality.The Privacy and Confidentiality Policy is to be provided to beneficiaries on request; • All staff of the program will be made aware of the Privacy and Confidentiality Policy, and contribute to any review of the policy based on its applicability to practice. PA I IONlALE Healthy Communities is obliged to meet the standards required in the The Health Insurance Portability and Accountability Act of 1996(HIPAA). GENERAL. PPINCIPI.F'> • Beneficiaries are to be informed of the purpose for collecting any information; • Information will be collected in a non-intrusive,non-coerced mannerfollowing the expressed or implied consent,as appropriate; • The only information about a beneficiary held by the service will be information necessary to provide the service; • Information about beneficiaries will be held securely; • Details about beneficiaries are kept confidential,and only disclosed with the beneficiary's consent for the purpose of ensuring that beneficiaries receive the service they need; 18 • The beneficiary will be made aware of,and be required to consent to,any exchange of information about the beneficiary made with another person,including family/ significant others,and with another service. POLICY STATEMENT The Healthy Communities Program has a responsibility to respect its beneficiary's right for privacy and confidentiality by protecting them from unfair or unauthorised use of personal/sensitive information and applying standards on how information is collected, used, secured and disclosed. IMPLEMENTATION PROCEDURES 1. Create New and Edit Beneficiary Records 2. Manage Enrollments 3. Log Interactions 4. Internal Communications 5. Reporting 6. System Security 7. Complaints of Privacy Breaches • 19 PROGRAM PROCEDURES 20 PROVIDE CLIENT OUTREACH AND PROGRAM EDUCATION SERVICES Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.3. Page No.a of 1 OVERVIEW By reaching out to all current and potential clients and providing program education,clients can receive the optimal services from their Healthy Communities'Coordinator and therefore best utilize the Medicaid/CHP+Services and community services for the best health outcomes. Provide client outreach and program education services through face to face,written,oral or other methods of communication POLICIE c..t ARPLICABE_E. Client.Outreach and Program Education Policy • I'ROC.E DUm:: I)E I AILS • 1. Check CBMS for Medicaid/CHP+Status by checking Med Span for each family memberthat is an HC Client. Do not assume that all members are active because you find one member active. 2. If active,then you will check to see if this client is in the NC Data Base. If not,a new household will need to be entered. This includes all active Medicaid/CHP+members. 3. A contact will be made to the family by face to face,phone,letter,email or text as appropriate. Warning:All communications by email with client data must be encrypted. q. Educate families on EPSDT benefits for Medicaid eligible families,including well child and oral health care as outlined by the Colorado Periodicity Schedule. Education shall include the need for lead testing at 12 and 24 months as well as between 36 and 72 months if not previously tested. 5. Educate families on benefits available for CHP+eligible families,including well child and oral health care. 6. Educate on dangers of second-hand smoke and provide information on the Quit Line for those clients wanting to quit smoking. 7. Provide information on the Nurse Support Line by explaining what it is,and giving the State Flyer.Provide information and flyer for the pregnant women interested in Text4baby. 8. Assist families to find a provider for all Medicaid/CHP+services by accessing the Provider list in the HC data base. 9. Make necessary and appropriate referrals to Community Programs and Organizations. 10. All contacts,referrals and follow up will be entered in the HC Data system. 21 TRAIN AND EDUCATE COMMUNITY ORGANIZATIONS AND PARTNERS ON THE AVAILABILITY OF SERVICES PROVIDED BY HEALTHY COMMUNITIES Issue Date:mm/dd/yy Effective Date: mm/dd/yy Procedure No.3. Page No.i of i OVERVIEW Utilizing community organizations and partners is one of the best ways to reach out to many families that could utilize HC Services. Community outreach must be done so that organizations have a clear comprehension on the services provided by HC,understand the value of the program,and therefore eager to refer their clients to HC. Community Outreach must also be done to assure services are not duplicated within the programs used by a family or pregnant woman. POLtC:IE AI:'IpLIC.ABI .. ._..................... Community and Program education policy PROCEl.)UFF. OF I AIL S; 1. Contact community partner or organization to schedule a time to meet. 2. Meetings can be scheduled during monthly or quarterly team meetings.to attempt to meet with all staff. Sometimes early morning or lunch times are better times to try to meet with many organizations/partners 3. Educate their teams about Healthy Communities,explaining the services you provide to clients(ie educating families on their benefits,assisting families finding providers, referring to appropriate resources)and the continued follow up. 4. Explain to the organization how you assist the Eligible But Not Enrolled. If you are a PE Site,explain the benefits of receiving a PE and your role in the PE Process. If not a PE Site,explain how you referto the appropriate site to apply and how you follow-up with the families to assure they have applied: 5. Stress the important role that the community partner or organization plays in referring clients to you.Even if the partner is not sure it is an appropriate referral,they should refer anyway and your office can either process PE or refer to appropriate site to apply. 6. Inform community partners and organizations that Healthy Communities is a neutral program,and we do not favor any provider. HC offers the client options and allows the client to make their own decision when selecting any provider. 7. All contacts,referrals and follow up will be entered in the HC Data system. 22 ASSIST COMMUNITY PARTNERS IN UNDERSTANDING THE MEDICAID AND CHP+ MEDICAL ASSIS1ANCE PROGRAMS, PROGRAM BENEFITS, AND GENERAL PROGRAM ADMINISTRATION GUIDELINES Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.1 of 1 OVERVIEW Educating your community partners/organizations on the Medicaid/CHP+benefits will allow the agency/organization to better serve theirfamilies when they present to them having medical/health problems or concerns. The organization/agency will know the best assistance they can offer their family would be to referthem to HC for services and follow-up. POLICIES APPLICABLE Community and Program education policy PRO(F:oul:L DI:: IA.iI_ 1. Educate the community partner/organizations on the benefits provided to Medicaid and CHP+Eligible children and pregnant women. 2. Educate community partners that we refer to PCMP/Pediatricians,OB/Gyn,Dental,Vision, Mental Health,and Specialty providers that are taking new and existing Medicaid and CHP+ families and individuals. 3. Inform community partners and/or organizations that HC is a State and Federally funded program and must provide neutral navigation to services,and assistance is provided to all Families,no matter their choice of provider or hospital. 4. Inform community partners and/or organizations that assists all Medicaid/CHP+ • Providers no matter their affiliation. 5. Inform community partners and/or organizations that follow-up services are provided to families and referrals made to community organizations for other assistance as needed or requested. 6. Educate our community partners and/or organizations concerning Medicaid and CHP+ medical assistance programs,by introducing and informing about Presumptive Eligibility,PEAK,MA sites, DHS and other avenues clients may access other Medical assistance programs. 7. All contacts,referrals and follow up will be entered in the HC Data system. • 23 PLAN, MANAGE, AND COORDINATE COL.1_ABORATIVE EFFORTS OR ACTIVITIES WITH OTHER COMMUNITY PARTNERS TO ENSURE BETTER SERVICE DELIVERY AND EDUCATION TO THE POPULATIONS SERVED Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.s Page No.a of OVERVIEW Collaborating with community partners/organizations is an exceptional way to build strong working relationships with the partners and organizations in your community. This is imperative since many of these organizations/agencies work with the same families as Healthy Communities. This also allows you to become aware and knowledgeable of the resources in your community so that you can refer HC clients to agencies/programs and therefore provide complete services. Collaboration also allows programs not to duplicate services within the community or family structure. POE.ICI "., APPI...I(ABLE : Community and Program education policy FROGprojRE~ DE 1. Attend Health fairs put on by your community and partner in planning as appropriate. 2. Participate with schools to host a table to provide HC information to families at open houses,parent/teacher conferences,enrollment days 3. Contact any college/university in your area since some students may have children of their own and may be eligible for Family Medicaid,or may now qualify for Medicaid under the Adults without Dependent Children Program and are under the age of 21. 4. Coordinate with other HC Programs for annual festivities held in certain cities or towns. 5. Build strong working relationship with community partners. a. Local library,schools(office staff,school counselor or nurse),fire departments, senior citizen groups(many grandparents raising grandchildren),father's groups,pregnancy centers,homeless shelters,food banks,head start programs,early care and education providers,domestic violence shelters,to name a few. These locations should know who you are and how you can assist their clients through HC Services. 6. Actively participate with community partners in planning and attending events in your community. 7. All contacts,referrals and follow up will be entered in the HC Data system. 24 ATTEND MEETINGS, CONFERENCES, AND OTHER CHANNELS OF COLLABORATION IN CONJUNCTION WITH COMMUNITY ORGANIZATIONS AND COMMUNITY PARTNERS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.i of s OVERVIEW Becoming involved in your community is an essential piece of the HC Program.These are excellent opportunities for community outreach,building working relationships,decision making in programs that that are utilized by HC Families,and educating the public on the services provided by HC to families and providers. POLICIES APPLICABLE Community and Program education policy PROCEDM: DETAILS i. Participate as a member of Advisory Boards,representing HC,not a Department or Unit 2. Participate as a member of coalitions 3. Participate in early childhood councils 4. Participate in child welfare activities and meetings 5. Attend local city or county government meetings 6. Participate in your local school boards or PTA meetings 7. Participate in Health Fairs or other fairs in your community or surrounding communities 8. Network with other vendors at fairs;possibly set a time for an in-service g. Network at local or state conferences 3.0. All contacts and follow up will be entered in the HC Data system. 25 EDUCATE PROVIDERS ON THE SERVICES PROVIDED BY OR AVAILABLE THROUGH HEALTHY COMMUNITIES Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.i Page No.iofl OVERVIEW The assistance HC offers to Providers can be a deciding factor as to whether that provider may choose to accept new Medicaid/CHP+patients,which is imperative with the shortage of providers in many areas. Providers appreciate having a`local'office to contact when having issues/questions regarding patients and/or Medicaid/CHP+benefits or billing.Advocating for providers is mandated for HC FHCs. POLICIES APPLICABLE Provider Outreach and Program Education Policy PROCEDUPF I.)FTAILS 1. Explain to Providers how you can assist to find`real'time eligibility on patients by using CBMS. 2. Train providers how to read the eligibility documentation from CMRS or another eligibility system,including managed care and RCCO assignments as well as BHO assignments and what those may mean to a practice. 3. If you are a presumptive eligibility site,explain what presumptive eligibility is,the importance,and how Providers can use PE. A. Provide samples of PE Cards to the providers so their office knows what to expect when a patient presents coverage under PE. 4. Explain to the Provider the benefits that are covered under PE. A. Make it clear in-patient is covered for children,while it is not for pregnant women. B. Dental is not covered under CHP+until the client has received their Delta Dental Card C. PARs must be completed under PE as they would be required under Medicaid Guidelines. 5 Offer assistance with problems that may arise from accepting a PE Card and billing being rejected by State. The Family Health Coordinator will contact the state for any denials for services provided under Presumptive Eligibility if a service was a benefit of Medicaid/CHP+and did not require a PAR. 6. Assist Providers with clients that have excessive missed appointments. A. Contact the family to see what barriers may be preventing them from attending their appointment. 26 B. Inform Providers that it will be stressed to families that a provider may chose to not continue serving the patient for excessive missed appointments. 7. Inform providers that accept new Medicaid and or CHP+patients that they will be on a list given to clients who are looking for a provider. HC staff must work with the current provider recruitment and retention staff as to best explain their options related to accepting new or existing clients. 8. Inform Providers that if transportation is a barrier for their patients keeping their appointments,providers should refer to Healthy Communities so we may make the necessary referrals for the clients to receive transportation assistance. 9. Inform providers that Healthy Communities offices will coordinate with other Healthy Communities teams to assist their patients that live in other counties. z. Give providers contact information to their local Healthy Communities office. • is. All contacts and follow up will be entered in the HC Data system. • • 27 • EDUCATE AND ASSIST PROVIDERS WITH SERVICES COVERED BY THE MEDICAID AND CHP+ MEDICAL ASSISTANCE PROGRAMS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.a of 3. OVERVIEW Knowledge of Medicaid/CHP+benefits and understanding treatment options will allow providers to build relations with their patients and provide complete health care services. Providers can also offer better health services to their patients by knowing about Presumptive Eligibility(EBNE)and the referral process to HC P0I_I( IES APPI..ICABI.E Provider Outreach and Program Education Policy PROCEDURF DE TAI1. S 1. Provide the ACS Automated Voice Response System (AVRS)(1-800-237-0757 or 1-800- 237-0044) regarding questions on Client Eligibility Verification, Claims Submission, Claims Status,Claims Inquiry, and Provider Warrants Verification.Inform Providers that there is no longer a limit of inquiries. 2. Provide information for the Provider services available in the HCPF website, including providers interested in becoming a Colorado Medicaid Provider 3. Inform Providers they can visit the Benefits Collaborative section of the HCPF website for ensuring that benefit coverage decisions are based on the best available clinical evidence and that all benefit coverage policies promote the improved health and functioning of Medicaid clients. 4. Refer Providers to the Provider tab in the HCPF for information regarding provider services: Billing Manuals,Provider Bulletins,Colorado PAR Program,forms,frequently asked questions,comprehending the reimbursement and supplemental payments. 5. Refer Providers to the Colorado Medical Assistance Program Web Portal. The user guides and EDI Support for enrollment purposes is available also on the HCPF website. 6. All contacts and follow up will be entered in the HC Data system. 7. Referral process to other providers including the use of the Early Intervention Colorado and Behavioral Health referral forms. Providers shall also be trained to understand the different needs for managed care and accountable care related to referrals. 28 • REFER PROVIDERS TO APPROPRIATE DEPARTMENT OR COMMUNITY RESOURCES INCLUDING THOSE THAT WOULD LIKE TO BECOME MEDICAID OR (HP+ PROVIDERS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No. Page No.s of 1 0VEP.VIEW Educating Providers on the community resources will allow the provider to not only care for his/her patient's medical/health needs but also provide assistance to their patients with other needs(social and/or or mental)which can attribute to better health outcomes. POL.ICIFS APPLICABLE Provider Outreach and Program Education Policy PROCED JRL: DETAILS .._._.._...._ 1. Refer Provider to HCPF Website,Provider tab to include the Provider Services page for the Colorado Medical Assistance Program. 2. Site includes the Medicaid Fee Schedule information 3. Provider then will go to enrollment tab which will provide FAQs,link for Provider not yet enrolled,and link for providers already enrolled. 4. Information for the Provider Enrollment Application Workshop that providers are strongly encouraged to attend. 5. Standard Billing enrollment documents are also provided in this web site. 6. The Department's fiscal agent offers technical assistance to providers who electronically submit Colorado Medical Assistance Program claims.This assistance includes: 7. Enrolling providers in Electronic Claims Submission and Report Retrieval 8. Identifying and troubleshooting technical problems g. Providing assistance with Submitter testing io. Providing technical assistance to Billing Agents,Clearinghouses,and Software ii. Vendors 12. Verifying claim receipt 13. The Support Unit can provide practices with detailed information that will make a transition to an electronic environment an easy one. Support is available Monday through Friday,8:oo AM to 5:0o PM at 1-80o-237-0757 or 1-80o-237-0044,toll free. 14. Contact State Recruiter and/or give contact information 15. Refer to the provider to the accountable care section of the HCPF website,including but not limited to their local agency and/or ACC recruitment staff 16. Refer the provider to the managed care section of the website for information related to referrals and plans 17. Refer the provider to the behavioral section of the website for information related to plans,coverage and referrals including the Department referral form 29 • 18. All contacts and follow up will be entered in the HC Data system. • 30 ASSIST CLIENTS WITH THE OVERALL PROGRAM NAVIGATION OF THE MEDICAID AND CHP+ MEDICAL ASSISTANCE PROGRAMS ON A DAY TO DAY BASIS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No. Page No.1 of 1 OVERVIEW Educating,advocating,and continual follow up on the Medicaid/CHP+Medical assistance programs will empower your clients and encourage self-sufficiency. Clients can accept the responsibility of their family's health care more readily with your enduring assistance and support. POLICIES APPLICABL E • Case Management and Program Policy PROCEDURE iDETAII. S • 11. Make sure families know: those under 21 years of age should have an EPSDT complete physical yearly,(or more frequent for those under age 2),developmental and autism screenings,dental checkups are every 6 months beginning at age 1,lead testing is required at 12 and 24 months or between 36 and 73 months if not previously tested,vision screenings and glasses are covered as needed and not limited to 1 pair/yr,hearing screenings,and mental health screenings,depression screenings(including for teens)per the Colorado Periodicity Schedule.Ask families if their children are current on their Immunizations,and.provide an immunization schedule. Provide information on Family Planning. 1. Educate on the dangers of second-hand smoke and provide information on the Quit Line for those clients wanting to quit smoking. 2. Provide information on the Nurse Support Line by explaining what it is,and giving the State Flyer.Provide information and flyer for the pregnant women interested in Text4baby. 12. You will offer assistance in scheduling of appointments to both pregnant women and children with their selected providers,unless the client prefers to schedule their own appointment(s). 13. If client prefers to utilize a provider list without assistance,follow up will be required with the family to ensure a provider was selected and an appointment was scheduled. You will inform the family at time of visit that you will follow up within 2weeks.You must create a task to flag yourself in the data system for follow up within 2 week time period. 14. Screening protocols should be followed to allow the HC staff to make necessary and appropriate referrals to Community Programs and Organizations. 15. Assist family with the Medicaid/CHP+application and process PE. a. If not a PE Site,then refer family to the PE Site in your county.It is strongly recommended you call the PE site and schedule an appointment for your family so they know the time,date,and location where they need to apply. b. You will create a task to follow up after scheduled PE appt.to check PE status in CBMS.The follow up task ensures that the family applied and received a PE. • c. If not in CBMS showing active PE,then a follow up contact is required to assist families in accessing services needed. 16. All contacts,referrals and follow up will be entered in the HC Data system. 17. Provide the contact information for Health Colorado and explain why a client or family will need to contact them,including upcoming letters for passive enrollment into managed care or accountable care organizations • 31 3.8. Provide the contact for the Ombudsman for Medicaid Managed Care and explain when they can assist a client with specific issues or concerns. 19. Provide education and assistance in using Colorado PEAK zo. Give all contact information for their local HC Office 21. All contacts,referrals and follow up will be entered in the HC Data system. 32 CONTACT AND ASSIST AL CLIENTS REFERRED TO THE HEALTHY COMMUNITIES PROGRAM THROUGH FACE TO FACE, WRITTEN, ORAL, AND OTHER METHODS OF COMMUNICATION • INCLUDING THE USE OF SOCIAL. MEDIA Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.z of 1 OVERVIEW • Making a contact is not what is relevant,but the manner in which the contact is made is of most importance.It allows you to build the relationships with your clients,which is crucial to the success of the program. Whether a face to face,phone call,letter,text or email,if a client is shown compassion,treated with respect,and knows that their FHC has done ALL that is possible to assist him/her,clients will bond with their FHC and reach out to them for future assistance. P'OLICIIT5 APPLICABLE . _.._._...._............. ...... . . .. .. Case Management and Program Policy • PROC1=:DURE DF FAILS i. Face to Face could be scheduled or walk-in either at the clients home,a community location or at the HC office. a. Face to Face contacts are encouraged to create a relationship between Family Health Coordinators and families. 2. Hospital visits/ER visits 3. Letter a. State authorized correspondence only. 4. Email • a. Warning:must be encrypted for HIPPA if contains Personal Health Information 5. Telephone contacts 6. FAX 7. Text messages from HC date system 33 ASSIST CLIENTS WITH THE APPLICATION PROCESS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.1 of 1 OVERVIEW Applying for Medicaid/CHP+can be a very confusing,time consuming,and very frustrating process for many families,to the point where some would rather do without. The responsibility of HC is to remove these barriers,provide a more friendly experience,and assure families apply • and receive the medical services they need and deserve. Assisting clients with the application process includes assisting the client face to face with a paper or PEAK application,providing PE determinations on site to those that may qualify, and/or an appropriate referral to another application assistance site;local department of social/human services,PEAK,CAAS,other PE,or MA Site to facilitate the client's enrollment into Medicaid and CHP+ P()I..IC IE A.PPI..!CABI_E Case Management and Program Policy PROC I i)I.JI∎I I:;!E (AlI_`,�; • 1. Complete a financial screen by phone to see if client could be eligible for Medicaid and/or CHP+. This avoids having a client come in if they will not be eligible for either program and then referrals can be made to other programs for assistance. 2. If a PE Site,meet with the client as soon as they are able, so client is readily served. If not a PE site,refer to appropriate location to apply(ie:PE Site, MA Site,DSS,or PEAK) 3. Follow up with client or site to assure client applied. 4. If a PE Site,Inform client of the documents required to complete an application. Although not a requirement for PE,it can make the processing of the application more expedient. 5. If a pregnant client,inform client proof of pregnancy is required. This must be signed by a clinic,physician or nurse. 6. Meet with the client face to face. 7. Assist client with completing application,by answering questions and confirming all sections that apply to the client have been completed. 8. Make sure application has been signed and dated. a. Date stamp on application,date on affidavit(bottom of each child's page),and the signature date'must all be the same. g. Enter data in CBMS and run PE, print PE Cards. 10. Explain the PE Card and all services provided under the PE Card 11. Assure that each applicant has a PCP/Pediatrician,dental,vision provider. If pregnant, assure the client has an OB Provider. 12. If a PE Site,follow up with your DSS or MA Site for status on application. 34 13. Assist clients to collect and submit necessary documents(income verification,birth certificate,photo ID or other acceptable documents)if not provided at time of application. 14. All contact and client interaction must be entered into HC data base. 35 PROVIDE FOLLOW UP TO PREGNANT WOMEN AND CHI! DREN, FAMILIES, AND EBNE'S ON THE STATUS OF THEIR APPLICATION AS REQUESTED AND/OR ASSIST THE CLIENT IN RESOLVING ANY ISSUES OR CONCERNS REGARDING THEIR ENROLLMENT INTO A MEDICAL ASSISTANCE PROGRAM AND/OR ELIGIBILITY ISSUES Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.s Page No.z of s OVERVIEW Families will receive the medical benefits they need and deserve because providers will not hesitate to serve them when the client's application has been processed and has been approved. POI_I( IES APPLICABLE Case Management and Program Policy PROM:ORE Of [AILS Assist clients to collect and submit necessary documents(income verification,birth certificate,photo IdD if not provided at time of application 2. The FHC will advocate for clients,when they have questions or concerns about eligibility and application status,by contacting the MA sites,County Department of Human Services,CBMS system, HCPF, MAXIMUS,and/or assist the client navigate PEAK.** **Resolving the family's issues is not just giving a phone number to the client so the client can call. Many families have already attempted these options,have gotten no response,and are now reaching out to their FHCforfurther assistance.it is the responsibility of the FHC to acquire the information for the family by making all necessary contacts. 36 ASSIST CLIENTS WITH THE REPORTING OF NEWBORNS NS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.1 of 1 c 'ERVIE `I When Add-a-babies are completed immediately after birth and processed by the client's County DHS or MA Site,new babies born to Medicaid/CHP+mothers can access health care from their provider(s)from time of birth and through the baby's first year Assisting clients with the reporting of newborns includes processing Add-A-Baby request for cases that are emergent or if services need to be expedited POLICIES APPLICABLE Case Management and Program Policy PPUcF[)I.JRF f�I TAII a 1. All Healthy Communities will complete an Add-a-baby form for babies born to Medicaid or CHP+mothers a. Make sure spelling is correct and verify date of birth and gender 2. Encourage mom to select a provider for her newborn baby,if she does not have one already selected. a. Provide appropriate provider list and offer assistance to schedule an appointment. 3. Inform mom that her newborn should be seen by baby's provider according to the Colorado Periodicity Schedule. 4. Inform mom of the process and give an approximate time when she may receive a Medicaid Card. 5. Inform mom of the benefits her newborn is eligible for under Medicaid or CHP+ 6. Give mom your contact information so that she can contact your for a vision provider list at 6 months,and a dental provider list before 1yr. 7. Inform mom of the periodicity schedule for well child visits 8. Provide an immunization schedule g. Give other educational materials 10. Send Add-a-baby form to be processed by MA Site or DHS 11. Follow up with Site to see when baby is added and contact mom to give her State ID and ensure she is able to access services. 12. If it has been more than 2 weeks and baby has not been added,it is the responsibility of the FHC to follow up with the necessary agencies so that baby is added.Some providers may not be willing to provide services until baby has a State ID. 37 PROVIDE CLIENTS WITH A LIST AND REFERRAL TO AN APPROPRIATE MEDICAID OR CFP+ PROVIDER Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.3. Page No.3.of s OVERVIEW Clients may have a Medicaid/CHP+card,but may still not access health care for all benefits offered by their health plan if they do not have the appropriate providers.FHC's will provide lists of the providers currently accepting new patients. Clients can overcome many of their barriers with the assistance of their FHC so they can receive the preventive health care services and receive health care when ill. P01 IC IF') APPS ICABLE Case Management and Program Policy PROC:EDu RE: DETAILS i. Compile and keep a list of all Providers that are taking new Medicaid and CHP+families that is accessible to clients and community agencies and providers. a. Enter all providers into the HC data base, including hours,ages,working hours, P � 9 9 � 9 affiliations,ADA accessible,etc. 2. Notify the provider that you will be emailing them every 6 months to assure all of the information in the data base is up to date: 3. Every 6 months send out an email compiled from the HC data base to update provider information. 4. Assure all clients have the appropriate providers,have scheduled the necessary appointments for preventive health,and assist with barriers preventing them from receiving these services. 38 ASSIST CLIENTS WITH SCHEDULING OF APPOINTMENTS AND TRANSPORTATION NEEDS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.3. Page No.i of OVERVIEW Some clients are more likely to receive health care,in a timely manner,if an appointment is made for him/her,so by assisting in scheduling an appointment,you are assured that the client has been scheduled to be seen by the provider of their choice. Clients state a barrier to receiving health care is the inability to get to the provider. By assisting clients with transportation issues,the client will receive the health care needed. Assist clients with scheduling of appointments and transportation needs through the Medicaid Transportation Broker or appropriate local department of social/human services POL.IC lE S A.PPI.ICABLF Case Management and Program Policy PR'OCE LiJPE DETAIL` 1. You will offer assistance in scheduling of appointments to both pregnant women and children with their selected providers,unless the client prefers to schedule their own appointment(s). 2. If client prefers to utilize a provider list without assistance,follow up will be required with the family to ensure a provider was selected and an appointment was scheduled. You will inform the family at time of visit that you will follow up within zweeks.You must create a task to flag yourself in the data system for follow up within 2 week time period. 3. Have working knowledge of your Transportation broker or DHS contact person in your area,so that a referral can be given to a client needing transportation for Medical appointments. 39 • MANAGE COMPLAINTS OF PRIVACY BREACHES Issue Date:trim/dd/yy Effective Date:mm/dd/yy Procedure No.i Page No.3.of 1 OVEPVIEW Keeping protected health information safe is of primary concern. FHC staff will share only the minimal information that is needed to assure services or benefits are accessed. Information will not be shared with other programs or units within FHC offices unless approved by the State. Data sharing for data sake is not allowed. Data requests can be made directly with the Department for other programs or units needed information related to Medicaid clients. POLICIES APPLICABLE Privacy and Confidentiality Policy EC)IJPE DETAIL' • 1. All FHC staff need to assure data is kept in a manner that meets federal privacy standards. 2. ALL FHC staff need to meet their own employers policies related to HIPAA. 3. All FHC staff must only share minimal information with others that is needed to assure the service or benefit can be accessed. 4. All FHC staff will understand a business associate of the program and share information accordingly 5. All staff have the ability to access data from their local WIC programs and should assure this option is exercised when tracking clients 40 CONTACT CLIENTS ATTENDING INMUNIZATION CLINICS Issue Date: mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.1 of a OVERVIEW Contacting clients while attending Immunization clinics,assures clients are current with their immunizations. You can assist clients find a provider for other preventive health care benefits, and to receive medical attention when ill. This also offers an opportunity to provide education on other health issues and refer to other community services. POLICIES APPLICABLE Privacy policy related to immunization clinics and appropriate outreach to clients PROCE:PI.IRI DETAILS 1. Contact local Health Department to participate in immunization clinics a. Bring provider lists and applications to assist those clients without a medical home or those that are uninsured EBNE's to apply for Medicaid or CHP+. 2. If applicable and necessary,contact your Immunization Coalition for local opportunities and to provide information on your availability and services to the shared clients in the area 41 OUTREACH 1 0 EPSDT (I. 1E=NTS AT EVENTS Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No. Page No.1 of 1 • OVERVILW Outreach to clients at events is an avenue FHCs can use to provide information about the services provided by HC. Information can be given to large number of current and/or potential clients(EBNE). Events include Healthy Children Clinic,HCP Ortho and Neuro Clinics,Child Find,Head Start registration,Boo at the Zoo in October for Lead Testing,WIC clinics,health fairs,school functions,or any other local event where there will be families and children. POI..K IE S APPI.I(..AL3l.E Network with all programs that provide services to clients who are HC clients I'I CCEEDUPE DE TAIL', 1. Provide educational material, Healthy Community brochures 2. Provider lists 3. Community Resources 4. Applications 5. Answer questions and concerns concerning barriers or requests to receive services 6. Provide contact information 7. Enter Outreach/Event in HC data base • 42 OUTREACH l O CHILD CARE CENTERS / HOMES Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.s Page No.i of i OVERVIEW Families with very young children(birth to pre-school ages)can be informed of the services provided by HC. POLICIES APPLICABLE Outreach to early care and education providers(day care)as well as regular meetings with Head Start,Early HeadStart and other early care and education programs in your service areas. PROCEDURE DETAILS 3.. Network with school districts for Colorado Preschool Program enrollments 2. Work with your local Early Childhood Council 3. Call local daycare and childcare facilities to schedule an in-service 4. Meet with local HeadStart and Early HeadStart offices at least twice a year. • 43 OUTREACH TO COMMUNITY Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.a Page No.a of 1 OVERVIEW More families can be informed about HC services through several avenues,one being collaborative efforts with other county HCs. Current or potential clients can be contacted at regional events,fairs,and festivities. Community outreach does not mean providers only, but can also include any location or event where current/potential clients can be found,information about HC can be provided,and therefore your yearly quota can be met. Establish a yearly quota that takes into account the size of the county. POI ICIFS APPI._I( AB€..E Establish quota for outreach'in the community to a realistic number,but not one that is less than 2 contacts per month. Partner with other HC offices when your service areas overlap(ie RCCO or HCP regions) P€_',C)(:El)UP1=: D€'TAI L_S a. Health Fair participation 2. In service to Providers 3. In service to community organizations and partners such as food banks or other non- profit organizations in your service area. 4. Schools a. School based clinic b. Child Find c. Enrollment d. Back to school nights e. Open houses 5. Health Department 6. Fire stations 7. DHS 8. Police Departments g. Community coalitions and advisory boards 44 PROVIDE CASE FOL L OW-U ' Issue Date:mm/dd/yy Effective Date:mm/dd/yy Procedure No.1 Page No.i of i OVERVIEW A state requirement for all Healthy Communities is care coordination. That includes not only the initial contact you have with a client,but the continued assistance to the client. The follow- up will assure you your clients are receiving all medical services required to be healthy (physically and emotionally)and that your clients receive the care they need when they become ill. Prioritize dental and depression screening follow-up,come up with other priorities for follow-up POLI( €ES APPI 'CABLE HC offices are required to assure that at least 8o%of the children in their service areas are accessing well child visits onetime per year HC offices are required to assure at least 8o%of their children in their service areas are accessing a oral health service one time per year. As of 2013,a 5%increase in required over 2010 EPSDT 416 rates. HC offices are required to assure that applicable lead testing is being completed in the community and to make provides aware this is required in Colorado. HC offices are required to assure that applicable and needed behavioral health assessments are being referred to local BHO providers to complete. PRO(:E-.DUPE DI': IA.11 1. Assure that local goals and objectives include those for EPSDT 2. Choose priority areas,but understand that all areas will need to be reached in order to meet state and federal goals 3. Priorities can include: a. Children with special needs b. Children with severe medical conditions c. Pregnant teens d. High risk pregnancies e. Dental screenings f. Depression screenings for teens • g. Immunizations h. EPSDT well child visits--- 45 46