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HomeMy WebLinkAboutC13-236 Connect for Health Assistance Network Grant Agreementsti A 4 CONNECTS HEALTH OI CIRADO Connect for Health Assistance Network Grant Agreement This Connect for Health Assistance Network Grant Agreement (Agreement), entered into between the Colorado Health Benefit Exchange C4HCO doing business as Connect for Health Colorado (C4HCO) and Eagle County (Grantee), is part of C4HCO's "Connect for Health Assistance Network" to fund and certify Assistance Sites and Regional Hubs to supervise Health Coverage Guides as part of C4HCO's efforts to serve Coloradans by providing impartial information and assistance with the application and enrollment experience. 1. Scope of Work: The grant shall be used exclusively for the purposes described in the Connect for Health Assistance Network Funding Opportunity Announcement, whose terms are incorporated by reference into this Agreement, the Grantee's application dated the 19th of April, 2013, as revised, including any subsequently submitted revised Scope of Work and/or Budget appended hereto as Attachment 1, and the terms of this Agreement. 2. Use of Grant Funds: A. Approved Budget: Expenditure of grant funds shall not exceed the amount approved in the Grantee's Final Revised Budget. Grant funds are for approved expenditures incurred during the grant period July 1, 2013 through December 31, 2014. The budget is considered to be a reimbursement of actual costs incurred. Grantees may submit requests for prospective funding disbursements. Financial reporting to justify advance disbursements must be submitted in accordance with Connect for Health Colorado instructions. B. Budget Revisions: Transfers between budget categories may be completed by the grantee if they do not exceed 25 percent of the total budget. Transfers between budget categories that exceed 25 percent of the total budget must receive prior written approval from C4HCO. Grantees must track cumulative transfer of funds between categories. C. Unexpended Funds: Grantees receiving advance disbursements shall return to Connect for Health Colorado any unexpended funds within 60 days after the close of the grant period or the Pt / 9,d �- termination of the grant. C4HCO, at its sole discretion, may extend the original time limit for expenditure of grant award funds following approval of an extended project timeline. This will be an extension with no additional funds. 3. Term: This Agreement is effective upon its execution by the parties and remains in force for eighteen months, July 1, 2013 -December 31, 2014 or until such time as the obligations and conditions imposed by or otherwise associated with the Grant expire. C4HCO may terminate this Agreement for Grantee's failure to meet any requirement of the Connect for Health Assistance Network or should it at any time determine that such termination is in C4HCO's best interest, provided that such termination shall be in writing and be provided to Grantee at least thirty (30) days in advance of the effective date of termination. In the event of such termination, C4HCO will pay Grantee for all services rendered, up to the effective date of termination, it being acknowledged that during the notice period, Grantee will wind -down its responsibilities under the Grantee's project proposal, and in consultation with C4HCO, determine which specific activities should be terminated as soon as possible and which should be continued until the effective date of termination. 4. Unapproved Expenditures. Any expenditure of grant funds not in accordance with the approved budget submitted or not consistent with the purposes stated in the Grantee proposal are subject to prior approval by the C4HCO, in its sole discretion. Should any expenditure be disallowed or should the Grantee violate any of the terms of this Agreement, C4HCO may require repayment, an offset from this Grant to the Grantee in the current or succeeding fiscal year, or other appropriate action. 5. Liability and Insurance: The Grantee will be liable, to the extent provided by the Colorado Governmental Immunity Act, for the conduct of individuals serving as Health Coverage Guides under its supervision, whether employed or volunteer, including (but not limited to) compliance with the roles and responsibilities set out in Connect for Health Assistance Network Funding Opportunity Announcement and this Connect for Health Assistance Network Grant Agreement, and processes and procedures developed by Connect for Health Colorado. The Grantee is a "public entity" within the meaning of the Colorado Governmental Immunity Act, §24-10-101, et seq., C.R.S., as amended ("Act"). The Grantee will maintain insurance, by commercial policy or self-insurance, as is necessary to meet the Grantee's liabilities under the Act. With respect to general liability, the Grantor recognizes that the County is self-insured for general liability in accordance with the provisions of the Colorado Governmental Immunity Act, as amended. Grantee will be required to show proof of insurance prior to disbursement of grant funding and provide C4HCO with satisfactory evidence of its compliance with this requirement during the term of this agreement upon request. Failure to comply with the insurance requirements may result in termination of this Grant Agreement. 6. Proiect Administration: 2 A. The Grantee will directly administer the project supported by the Grant and agrees that no Grant funds shall be disbursed to any organization or entity, whether or not formed by the Grantee, other than as specifically set forth in the project proposal cited above. B. Subcontracts: The Grantee must ensure that all subcontracts and consulting or partnership agreements are deliverables -based and in compliance with the terms of C4HCO's award and follow the Grantee's procurement policies. The Grantee is accountable for the deliverables of its subcontractors. C. Project Revisions: Any material changes in the project goals, objectives, timetable, deliverables, budget, or evaluation plan must receive prior written approval from C4HCO. D. Certification: The Grantee must meet certification requirements as defined by Connect for Health Colorado including, but not limited to agreeing to meet the terms of this Agreement. Grantee must ensure all Health Coverage Guides under its supervision, meet the requirements for certification as defined by Connect for Health Colorado and listed below, and obtain certification prior to assisting customers. Health Coverage Guide certification requires: o The individual is not on the OIG List of Excluded Individuals/Entities o The individual has agreed to Connect for Health Colorado Privacy and Security policies o A background check was completed for the individual with satisfactory results o The individual has agreed to the Conflict of Interest policy and submitted disclosures o The individual has completed and passed Connect for Health Colorado Health Coverage Guide training. 7. Reporting Requirements and Payment Schedule: The Grantee shall submit required reports on or before the date due, per the instructions provided by Connect for Health Colorado, following C4HCO's guidelines and formats. Upon receipt, review, and approval of Grantee reports, C4HCO shall issue grant payments. 8. Grant Monitoring and Evaluation: A. The Grantee agrees to attend meetings, participate in site visits, and give reports on progress and accomplishments to the Board of Directors of C4HCO, C4HCO staff and advisors, and other grantees as requested by C4HCO. 3 • B. The Grantee agrees to participate in an evaluation of C4HCO's grants program, including assisting with any data collection and information gathering, such as participation in surveys, site visits, meetings, and interviews with evaluators. C. The Grantee agrees to provide quarterly reports with information including but not limited to characteristics of the population served, numbers served, and outreach and enrollment strategies and outcomes. D. The Grantee agrees to produce all documents and reporting required for monitoring of Federal grant sub -recipients, as determined and directed by C4HCO. E. The Grantee agrees to comply with the Federal rules and requirements related to C4HCO's grant including but not limited to circulars A-87, A-122, and A-133, issued by the United States Office of Management and Budget, as applicable. If Grantee receives funds in excess of $500,000 in the Grantee's fiscal year, Grantee will be subject to a federal A-133 Audit. Grantee is responsible for notifying C4HCO in the event that grant funds will exceed the $500,000 threshold for the Grantee fiscal year. 9. Financial Reporting Requirements: A. On a monthly basis, beginning on August 15, 2013, for reimbursement the Grantee shall provide to C4HCO an itemized statement of expenditures, and documentation of expenses showing how the funds were expended for the preceding month. For prospective disbursement of funds, requests must be submitted by the 15th of the month preceding the month for which funding is requested and documentation of expenditures must be provided on the 15th of the month following the month for which funding was disbursed. B. The Grantee must provide C4HCO with any audited financial statements including qualified/unqualified opinion with comments for any year in which C4HCO Grant funds are received. C. When Grantee identifies a problem or barrier to meeting project timelines or deliverables, Grantee shall notify C4HCO immediately. Notification shall include specific strategies to deal with or overcome the problem or barrier and shall include any required revisions to the timeline, budget or deliverables. Upon approval by C4HCO, the proposed revisions shall be incorporated as an update to Grantee's work plan for its project. Until approval by C4HCO of any proposed revisions to the grant agreement or timeline currently in operation, the Grantee shall be responsible for completing all timeline requirements and objectives, as provided in that agreement, in a timely fashion. 4 D. Continued funding for an awarded project is contingent on the Grantee meeting the goals and objectives stated in the approved original or revised timeline and budget. 10. Failure to perform and corrective action: If it is apparent that the Grantee is failing to meet its obligations under this Agreement, Connect for Health Colorado will provide notice of the identified failure to the Grantee, an opportunity to establish a corrective action plan approved by Connect for Health Colorado, and at least thirty (30) days to cure. Failure to cure will result in suspension or cancellation of unpaid disbursements. 11. Reversion of Grant: Connect for Health Colorado may suspend or cancel unpaid disbursements if Grantee becomes unable to carry out the purposes of the Grant or ceases to be an appropriate means for accomplishing the purposes of the Grant based on, by way of non-exclusive example, the Grantee's insolvency, receivership, bankruptcy, assignment for the benefit of creditors, or cessation of business on a regular basis. In any such case, the Grantee shall, at a minimum, within thirty days after written request by C4HCO, repay the portions of the Grant received but not disbursed, and all portions of the Grant, which although disbursed, are within the Grantee's control. 12. Non -Discrimination: The Grantee may not discriminate against any employee or applicant for employment because of race, color, religion, sex, national origin, sexual orientation, or any other characteristic forbidden as a basis for discrimination by applicable laws, and certifies that its Constitution or by-laws contains a non-discrimination clause consistent with all applicable law. 13. Title VI and ADA Compliance. Pursuant to 45 CFR 155.210(5), the Grantee and its Health Coverage Guides shall at all times provide information in a culturally and linguistically appropriate manner in compliance with Title VI of the Civil Rights Act of 1964 and shall ensure accessibility and usability for individuals with disabilities in accordance with the Americans with Disabilities Act of 1990, Section 504 of the Rehabilitation Act and 45 CFR 155.205(c). 14. Collusion or Other Offenses: A. Neither the Grantee, nor any of its officers or directors, has engaged in collusion with respect to the grantee's application for the Grant or this Agreement or has been convicted of bribery, attempted bribery, or conspiracy to bribe under the laws of any state or of the United States; B. The Grantee has not employed or retained any person, partnership, corporation, or other entity, other than a bona fide employee or agent working for the Grantee, to solicit or secure the Grant or this 9 Agreement, and the Grantee has not paid or agreed to pay any such entity any fee or other consideration contingent on the making of the Grant or this Agreement: C. The Grantee, if incorporated, is registered or qualified in accordance with the Colorado Secretary of State's Office, and is in good standing, has filed all required annual reports and filing fees with all applicable State, County, and/or other local governmental jurisdictional bodies; D. No money has been paid to or promised to be paid to any legislative agent, attorney, or lobbyist for any services rendered in securing the passage of legislation establishing or appropriating funds for the Grant; E. Neither the Grantee, nor any of its officers or directors, nor any person substantially involved in the contracting or fundraising activities of the Grantee, is currently suspended or debarred from contracting with the State or any other public entity; and F. Neither the Grantee, nor any of its officers, directors, employees nor any other person substantially involved in the contracting or fundraising activities of the Grantee is currently on the "List of Excluded Individuals/Entities (LEIS) maintained by the Office of Inspector General of the United States Department of Health and Human Services. 15. Conflict of Interest A. Grantee affirms that Grantee and all of its employees are not any of the prohibited entities and will not engage in any of the prohibited conduct specified in the Conflict of Interest Policy, Attachment 3. B. Grantee will remain free of conflicts during the term of this Agreement. Grantee agrees that if an actual or potential conflict of interest arises after the date of this Agreement, the Grantee shall immediately make a full disclosure in writing to Connect for Health Colorado of all relevant facts and circumstances. This disclosure shall include a description of actions which the Grantee has taken and proposes to take to avoid, mitigate, or neutralize the actual or potential conflict of interest. If the contract has been awarded and performance of the contract has begun, the Grantee shall continue performance until notified by Connect for Health Colorado per the terms articulated in the Grant Agreement of any further action to be taken. 16. Conduct, Roles and Responsibilities A. Grantee agrees to ensure that the employees and volunteers under its supervision pursuant to this Agreement will adhere to requirements as set forth at 45 CFR § 155.210 (e) and the role as defined in the Funding Opportunity Announcement. 9 B. Grantee will ensure that employees and volunteers under its supervision pursuant to this Agreement will not represent or conduct themselves in such a way that violates State of Colorado law governing the licensing and appointment of insurance producers, C.R.S. 10-2-401 et. seq. 17. General Reauirements: A. The Grantee shall comply with the terms and conditions of the Connect for Health Colorado Assistance Network, as set forth in the Connect for Health Colorado Assistance Network Funding Opportunity, the Grantee's application including any subsequently submitted revised Scope of Work as set forth and incorporated by reference as Attachment #1, and the terms of this Agreement. B. The Grantee shall conduct background investigations of its employees and volunteers performing work related to this Agreement. C. Grantee understands and acknowledges that under 45 CFR 92.34, the Department of Health & Human Services (HHS) retains a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or otherwise use and authorize others to use, for Federal Government purposes, the copyright in any work developed under a Federal grant, or a subgrant or subcontract, and in any rights to a copyright purchased with grant support. D. The Grantee shall comply with C4HCO's privacy and security standards as set forth and incorporated by reference in Attachment 3 of the Agreement. D. The laws of Colorado shall govern the interpretation and enforcement of this Agreement. Any claim, action, suit or proceeding relating to this Agreement shall be brought in the applicable State or Federal courts for the City and County of Denver, Colorado. E. The Grantee may not sell, transfer, or otherwise assign any of its obligations under this Agreement, or its rights, title, or interest in this Agreement, without the prior written consent of C4HCO. This Agreement shall bind any respective successors and assigns of the parties. F. No amendment to this Agreement is binding unless it is in writing and signed by both parties. G. The following items are incorporated by reference and made a part of this Agreement. Attachment 1: Grantee's Application and Budget Worksheet submitted in response to Connect for Health Assistance Network Funding Opportunity Announcement, including any subsequently submitted revised Scope of Work and revised Budget. 7 Attachment 2: Privacy and Security Standards Attachment 3: Conflict of Interest Disclosure and Statement 18 Non-availability of Funds: If third parties fail to make expected funds available (including funds which may be received from the federal government) for the continued performance for any fiscal period of C4HCO operations, this Agreement shall be canceled automatically as of the beginning of the fiscal year for which funds were not appropriated or otherwise made available; provided, however, that this will not affect either C4HCO's rights or the Grantee's rights under any termination clause in this Agreement. The effect of termination of the Agreement hereunder will be to discharge both the Grantee and the C4HCO from future performance of the Agreement, but not from their rights and obligations existing at the time of termination. C4HCO shall notify the Grantee as soon as it has knowledge that funds may not be available for the continuation of this Agreement 19. Acceptance of Terms and Conditions: This document shall be signed by an individual legally authorized to execute contracts on behalf of the Grantee, signifying agreement to comply with all the terms and conditions specified above. The above terms and conditions of the grant are hereby accepted and agreed to as of the date specified: For: Colo d ealt nefit Exchange By: Date: 9#1/040 43 For: COUNTY OF EAGLE, STATE OF COLORADO, By an Through Its BOARD OF COUNTY COMMISSIONERS By: Sara J. Fisher, Ch irman Date: elI�1 8 Attachment 1 Grantee's Application ezCOLORADO HEALTH BENEFIT E X C H A N G E CONNECT FOR HEALTH ASSISTANCE NETWORK APPLICATION for FUNDING Instructions: Please complete all fields of this application. If a question does not apply, please indicate by typing "NA". For applicants who are applying as a partnership or coalition, please select one organization to be the contact and fiscal agent, and please be specific in your responses about which organization is performing which activity or role. All applications must be typed and must not exceed 25 pages (not including attachments). Please PDF applications and attachments as one document and submit by email to grants(&cohbe.org. Applications are due no later than April 8th 2013 Al 5:00 PM. Contact Information If several organizations are applying as a partnership or coalition, please select one organization to serve as the fiscal agent and contact. Organization Name: Eagle County Health & Human Services Organization Administrative Address: PO Box 660 City, County, State, Zip: Eagle, Eagle County, CO 81631 Phone Number: 970-328-8840 Fax Number: SSS -848-8828 Web Address: www.eaglecounty.us/HHS Primary Contact: Kathleen Lyons Title: Economic Services Director Primary Contact Phone: 970-328-8841 Primary Contact Email: kathleen.lyons@eaglecounty.us Is your organization applying for funding? X Yes ❑ No FEIN: 084024447 Is your organization a non-profit? ❑ Yes X No If not, please describe your organization's tax status. Selected organizations will be asked to provide W9. Local Government Fiscal Officer Name (if different from primary contact): Rita Woods Fiscal Officer Phone: 970-328-8817 Fiscal Officer Email: rita.woods@eaglecounty.us Application for (select all that apply): Regional Assistance HUB: ❑ Yes ❑ No Assistance Site: X Yes ❑ No Assistance Site with SHOP specialty: X Yes 17 No Organizational Backel:ound 1. Please describe the organization's history and mission. The West Mountain Region Health Assistance Network (WMRHAN) includes Eagle County Health and Human Services (ECHHS), Pitkin County Health and Human Services (PCHHS), Community Health Services, Inc. (CHS), Garfield County Public Health (GCPF), Garfield County Human Services (GCHS), and Mountain Family Health Centers (MFHC), a Federally -Qualified Health Center with clinical sites in all three counties. Eagle County will be the lead agency and fiscal agent for the Network. WMRHAN is an operational committee of the West Mountan Region Health Care Coalition (WMRHCC), a larger ad hoc group formed three years ago to identify service gaps for the medically -indigent in primary care, dental, and mental health and to plan for the implementation of the Affordable Care Act. The Coalition convenes quarterly meetings of regional HHS departments and public health agencies, hospitals, Colorado West Regional Mental Health, and private human service non -profits providing safety net services in the region. All three counties are located within an area of the state known as the Rural Resort Region, and have a long history of collaboration to address the unique demographics of our populations, seasonal economies, and geographic challenges due to large size and mountainous terrain. The role of geography cannot be understated; EI Jebel is in Eagle County along the Roaring Fork River, but separated by a mountain range. The region experienced shared significant challenges over the past decade with the doubling of the Hispanic population and rapid growth of methane gas drilling operations. The onset of the recession in 2008, which had devastating consequences for hospitality, construction, and oil and gas businesses in the region, further motivated the counties to strengthen and expand our partnerships to better serve residents by enhancing communications, searching for economies of scale, and co -developing opportunities that are conducive to bridging county lines. For example, the counties contract with one another for certain services for Public Assistance, Child Support, Child Welfare, Adult Protection, and Prenatal Services. Other partnerships include Emergency Preparedness and the Tobacco Education, Prevention and Cessation program. MFHC has played a prime clinical role in many of these collaborative efforts; for example, screening over 4,500 persons in the three country region for cardiovascular disease from 2009 to 2011. Further, each of the counties has played critical roles in the expansion of MFHC, making it the fastest growing rural health center in Colorado and creating an efficient system of primary care for a large number of medically - indigent and uninsured residents. WMRHAN shares a mission to promote the health and well-being of all residents in the region to ensure healthy children and families and a productive workforce. As such, we are motivated and organized to maximize the COBHE initiative. 2. Please describe the type of work your organization performs and the services provided. Our Public Health and Human Service agencies provide a broad range of social and medical services, including senior services, disease prevention and control, family planning, immunizations, child support services, child services such as foster care, services for the disabled and blind, Single Point of Entry for Long Term Care, Women, Infants and Children (WIC) nutrition program, Veteran's Services, and public assistance programs, e.g., cash, food, shelter, medical, energy and emergency services. MFHC provides comprehensive primary care, including internal medicine, integrated behavioral health, and dental services. 3. Describe any experience the organization has with recognizing health coverage needs, or assistance with applications for health coverage, or outreach and education. All WMRHAN agencies have extensive experience in identifying and addressing health needs through studies, needs assessments, and extensive participation in every major safety net health inititative in the state, including tobacco cessation, disease prevention and screening, as well as direct services delivery, such as prenatal care and immunizations. In collaboration with other members of the regional coalition, we address all aspects of health, including access to healthcare, nutrition, safety, environmental health, mental health and substance abuse. As the safety net agencies in our region, we are responsible for eligibility determination and enrollment for residents in Medicaid, Food Assistance, TANF, and other financial assistance programs, such as the Colorado Indigent Care Program and WIC. We have established relationships with local businesses, churches, schools, and other non-profit human services agencies with which our staffs work daily to disseminate information or convene communites of interest, e.g., senior citizens, mono -lingual Spanish speakers, emergency assistance providers. 4. Please describe the populations the organization currently serves (for example: families with school -aged children, young adults, low-income families, businesses or entrepreneurs, individuals with limited English proficiency, people with a particular diagnosis or disability, people of faith, uninsured individuals, small employers or workers of a particular industry, etc.). Please describe how many customers the organization currently serves and in what geographic area. WMRHCC agencies serve a large cross-section of the working poor, children, disabled persons and seniors in the region. ECHHS serves 3,460 Medicaid clients (2,718 20 years of age (YOA) or under and 742 21 YOA or older) and over 700 individuals through CHP+. In addition ECHHS serves approximately 700 low-income households with food assistance benefits, 150 with cash assistance benefits, and more than 1750 individuals per month with direct public health services such as immunizations, family planning, WIC and Nurse Family Partnership program. GCHS serves 7,663 Medicaid clients (5,203 20 YOA or under and 2,460 21 YOA or older) and 1,342 individuals through CHP+. In addition GCHS serves approximately 2,324 low-income households with food assistance benefits and 309 with cash assistance benefits. GCPH serves more than 1850 individuals per month with direct public health services such as immunizations, prenatal case management, WIC, blood pressure screening and health education. PCHHS serves 416 Medicaid clients (256 20 YOA or under and 160 21 YOA or older) and 97 individuals through CHP+. In addition PCHHS serves approximately 150 low- income households with food assistance benefits and 50 with cash assistance benefits. CHS serves 200 individuals per month with direct public health services such as family planning, WIC, immunizations, women's health screenings and HIV and STD testing. MFHC serves 9,375 patients from all three counties; 41% are 19 YOA or younger and 590A are 20 YOA or older. Note that 52% are uninsured. These data reflect persons receiving direct services and do not include a large number of residents whom benefit from various outreach and education activities. 5. Please describe the geographic area you serve. If your organization is statewide, please describe all the areas where you have a presence and the type of presence. The members of WMRHAN serve Eagle, Garfield, and Pitkin Counties, which have a total population of 125,743 residents dispersed over 5,620 square miles of mountainous terrain. The major industries are tourism, hospitality, and methane gas drilling. The major population centers are clustered in valleys along the north -south axis of 1-70 between Vail and Parachute and the east -west axis of Highway 82 between Glenwood Springs and Aspen. 6. Is the organization a health plan? ❑ Yes X No 7. Is the organization a subsidiary of a health plan? ❑ Yes X No 8. Is the organization a member of a health plan association? ❑ Yes X No 9. Does the organization receive any type of funding from a health plan? ❑ Yes X No a. If yes, please describe. Include the types of services funded by health plans and whether or not funding is received for enrollment into health insurance. N/A 10. Describe how you currently collaborate with other organizations or service providers to provide service to your clients, to enhance service delivery, increase capacity, facilitate information sharing, or to provider referrals. WMRHAN agencies employ staff whose job it is to match clients to services available in the region. But beyond these core service activities to individual clients, the individual coalition members all have notable broad-based community involvement projects. For example, the Garfield County LiveWell coalition is developing a public/private intiative to address the availability of nutritious food, opportunities to exercise safely, e.g., bike paths separated from automobile traffic for children to ride to school. Likewise, Eagle County has established a Healthy Communities Coalition that is working to address areas such as school/youth wellness, food policy, healthy aging, built environment and includes a workplace wellness program underway with area businesses. Eagle and Pitkin Counties established and lead the regional Coalition of Emergency Assistance Providers (LEAP) to create a seamless network of emergency assistance services which maximizes available resources. All three have worked closely with MFHC to secure financial commitments from area hospitals to help support access to primary care for the uninsured. Similarly, all of us are involved in the Roaring Fork Mid -Valley Coalition working with non-profit service providers to match services to population centers and needs, and expand and promote the 211 information and referral service to facilitate residents' access to services. 4 11. Please describe your organizational leadership and management structure. Eagle County is a government entity which is guided by the Eagle County Board of Commissioners, composed of three elected members. The policies of the Board are carried out by the County Manager. All departments heads, including the Director of Health and Human Services, report to the County Manager. The HHS Economic Services Director, who will supervise the project, reports to the HHS Assistant Executive Director. Eagle County will assume fiscal and management responsibility for the project. WMRHAN Advisory Committee will act in an advisory capacity to the Eagle County HHS Economic Services Director to oversee the successful execution of the network assistance project. The WMRHAN Advisory Committee includes the Eagle County HHS Economic Services Director, Eagle County HHS Assistant Executive Director, Eagle County Public Health Director, the Pikin County HHS Director, the Pitkin County Public Health Director, the Garfield County Public Health Director, the Garfield County Human Services Director and MFHC Executive Director. The Organizational Chart in Attachment 6 includes Eagle County Health & Human Services, Eagle County Economic Services and WMRHAN. Mal If $ * • ! II ® It Scope of Work 1. Describe how participating in the Connect for Health Assistance Network as an Assistance Site or Regional Hub fits within the mission of your organization. WMRHAN shares a mission to promote the health and well being of all residents In the region to ensure healthy children and families and a productive workforce. Affordable insurance removes a major obstacle to the working poor in our region. While the census -estimated povery rate is low for this region of the state (12%), costs of living are much higher, for example, the annual self-sufficiency standard in Eagle County for one adult and one preschooler is 374% of the Federal Poverty Level ($54,994), compared to the Colorado average of 251% FPL ($47,448). This is a major reason the Rural Resort Region has one of the highest rates of uninsurance in the state. In addition, the high cost of living disproportinately affects Hispanic/Latino households, whose reported median income is half that of non - Hispanic households in the region. 2. Describe how the organization plans to conduct outreach and education to raise awareness of the Exchange and new opportunities for coverage. Include activities such as presentations, attendance at health fairs, or making print materials and advertising available. WMRHAN will use a variety of means to provide outreach and public education that helps inform our communities about new opportunities for accessing health care coverage, and assistance paying for health coverage, including: 1) Presentations and/or booths at back to school nights, health fairs, and health screening events in which HHS agencies and MFHC participates throughout the region. 2) Presentations to civic and business organizations, church groups, Colorado Mounain College campuses, and at individual businesses. 3) Public service announcements on the local radio stations and in print media. 4) Articles in various newsletters published and distributed by partner organizations. 5) Websites for the three county organizations and MFHC will each contain a page dedicated to WMRHAN with a schedule of events and educational sessions, link to COHSE, and contact information for the nearest HCGs. 6) Business networking events focused on Connect for Health Colorado in each county. 7) Work site presentations for small businesses, as requested. Residents who are eligible for Medicaid and Exchange subsidies will look to HHS departments for assistance accessing these programs. As the region's trusted safety net providers, WMRHAN agencies are in daily contact, both in our offices and in the field, with the populations targeted by COHBE. On a typical day, agency staff are giving presentations or delivering services throughout the three counties. The non-WMRHAN field staff from our departments will also be trained in basic health network assistance information and make sure appropriate audiences receive brochures and contact information, thus augmenting the efforts of the WMRHAN staff. WMRHAN will coordinate activities with the major Chambers of Commerce in the region to promote the exchange and SHOP; note the letters of support in the Attachments. I Describe how your organization plans to conduct day to day in person assistance activities with individuals, families, small employers and employees. Include descriptions of activities like how appointments will be made, if the organization plans to be mobile, and whether the organization plans to execute enrollment events. Potential individual customers will call a central number in Eagle or send an email to a centralized email address to obtain general information and schedule an appointment at any WMRHAN assistance location. Walk-in customers will be accommodated at HHS and MFHC locations as schedules allow, although scheduling an appointment will be strongly encouraged. WMRHAN is already exploring the feasibility of providing an online scheduling capability through Eagle County whereby customers could view the schedules at network assistance locations. SHOP activities will follow a sequence in which mobile SHOP -trained Health Coverage Guides (HCGs) support small employers and their employees with education and information about SHOP, assist employers with understanding contribution strategies and setting up plans, then will be available to assist employees, at the site of employment or other Assistance Network location, in enrollment and determining eligibility for subsidy support. 'Enrollment events will be scheduled, but details are not available at the time of this submission. 4. Describe the target populations the organization plans to serve with public education and in person assistance, whether adding Health Coverage Guide services will increase the volume of customers served, how the organization plans to reach those populations and respond to the increased workload (if applicable). WMRHAN will focus our efforts on three populations: (1) Medicaid eligible, (2) Uninsured individuals under 400% Federal Poverty Level (ages 0 — 64), and (3) small employers and their employees. (Note: Data sources appear at the end of this section.) Individuals and families who currently purchase insurance on their own will also be served if they request assistance and capacity is available. Community education events will target these populations but be open to the general public. Medicaid Population - WMRHAN will provide information and enrollment services to a total of 8,654 children and adults who are potentially eligible for Medicaid from Oct. 1, 2013 to Oct. 14, 2014. This projection is based on the data in the table below, showing the total target population for expansion for Medicaid in all three counties. The estimate includes those Newly Eligible for Medicaid in 2014. It assumes a 90% penetration rate. Note: This chart shows individuals. To determine the HCG hours needed to provide enrollment services to this population, a household size of 2.5 members was applied the Parents + Kids 0-18 category and the Adult category was calculated as individuals. Subsidy/Premium Tax Credit Eligible Uninsured — WMRHAN will assist 3,470 subsidy/premium tax credit eligible uninsured persons with information and enrollment services during the 1St Enrollment Period (Oct. 1, 2013 - Mar. 31, 2014). This forecast assumes a 25% market penetration rate and average household size of 2.5 persons as shown in the chart below. An additional 3,470 subsidy eligible uninsured persons will receive assistance during the 2nd Enrollment Period (Oct. 13, 2014 — Dec. 7, 2014). Further, during the Non -Open Enrollment Period (April 1, 2014 — Oct. 12, 2014) an estimated 1,388 persons will receive enrollment assistance due to life changes, e.g., divorce. It is also anticipated that 50% of the subsidy/premium tax credit population that enrolled during the 1St open enrollment period will return during the 2"d open enrollment period for assistance with renewal. Uninsured individuals (0-64) under 400% FPL less New Eligible for Medicaid from above Individuals Eagle 5821 Garfield 6489 Eagle Garfield I Pitkin Newly Eligible for Medicaid in 2014 Parents + Kids 0-18 2004 2329 716 Adults* 2288 2003 275 Total by County 4292 4332 991 Total for Region 9615 Subsidy/Premium Tax Credit Eligible Uninsured — WMRHAN will assist 3,470 subsidy/premium tax credit eligible uninsured persons with information and enrollment services during the 1St Enrollment Period (Oct. 1, 2013 - Mar. 31, 2014). This forecast assumes a 25% market penetration rate and average household size of 2.5 persons as shown in the chart below. An additional 3,470 subsidy eligible uninsured persons will receive assistance during the 2nd Enrollment Period (Oct. 13, 2014 — Dec. 7, 2014). Further, during the Non -Open Enrollment Period (April 1, 2014 — Oct. 12, 2014) an estimated 1,388 persons will receive enrollment assistance due to life changes, e.g., divorce. It is also anticipated that 50% of the subsidy/premium tax credit population that enrolled during the 1St open enrollment period will return during the 2"d open enrollment period for assistance with renewal. Uninsured individuals (0-64) under 400% FPL less New Eligible for Medicaid from above Individuals Eagle 5821 Garfield 6489 Pitkin 1 1573 Combined Total by Region 1 13,883 Small Businesses — WMRHAN SHOP guides will assist 1,100 small businesses with 2 to 50 employees. This forecast assumes 20% penetration rate, based on data in the chart below, which includes all businesses with 5 to 49 FTE, plus 25% of small business with 1 to 4 FTE. Eagle 2,283 Garfield 2,004 Pitkin 1,302 Total 5,589 Data Sources: Newly Eligible for Medicaid and Under 400% FPL (2010 Small Area Health Insurance Estimates, US Census Bureau) Small Employers with 1 to 49 FTE (Colorado LMI Gateway website) 5. Please estimate how many customers does your organization plan to serve with Health Coverage Guide services in a month (include current and new customers) and in which geographic areas? If the organization plans on specializing in SHOP, please include the number of small employers planned to be served in a month. WMRHAN HCGs will assist an average of 1,132 individuals per month starting in October 2013. These will be distributed approximately 43% in Eagle, 46% in Garfield, and 11% in Pitkin. Lead HCGs will assist an average of 73 small businesses per month, distributed as described above. These will be distributed approximately 41% in Eagle, 36% in Garfield, and 23% in Pitkin. 6. Describe how the organization will ensure information and services are provided in a fair, accurate, and impartial manner and why the organization feels it is important. This will be accomplished in four ways: l) Including the requirement in the job description to deliver the information in such manner, 2) Re-emphasize this requirement in all trainings, meetings, and performance reviews, 3) Periodic random participation/supervision by the MWRHAN Manager of Client -HCG encounters, and 4) the Support Specialist will administer a standard, short questionnaire via phone to persons who have been in contact with HGCs to measure customer satisfaction, including that they are receiving "fair, accurate, and impartial' information. ECHHS and WMRHAN partners believe that individuals and families are the experts in knowing what is best for their situation and that the role of the HCG is to provide comprehensive information and assistance in enrollment. 8 7. How does the organization currently ensure it provides culturally and linguistically appropriate services? All the agencies in the coalition have had training in the provision of culturally and linguistically appropriate services and currently provide services in that manner. Most materials and presentations are available in both English and Spanish. Many presentations are also provided in Spanish -only format for mono -lingual Spanish residents; for example, MFHC hosts the American Diabetes Association's "Por to Familia" program to teach self-management skills to Spanish speaking -only patients. S. Describe the languages other than English spoken by staff. The majority of line staff in all coalition agencies are bilingual English -Spanish. If awarded the grant, some of the HCG positions hired will include staff who are bilingual English - Spanish. There are provisions in the proposed budget to pay for translation services for sign language or via phone for other languages other than English or Spanish, as needed. 9. Describe the additional services the organization provides that complement the delivery of Health Coverage Guide Services. Please include the potential impact of these complementary services and the potential number of clients benefitting from the complementary services. See selection criteria chart for examples. As stated in the first section of this grant, HHS agencies provide a broad range of social and medical services, including senior services, disease prevention and control, family planning, immunizations, child support services, child services such as foster care, services for the disabled and blind, Single Point of Entry for Long Term Care, Women, Infants and Children (WIC) nutrition program, Veteran's Services, and public assistance programs, e.g., cash, food, shelter, medical, energy and emergency services. MFHC provides comprehensive primary care, including internal medicine, integrated behavioral health, and dental services. MFHC deals extensively with various private insurance programs and routinely assists patients with benefits issues. All our agencies offer assistance applying for assistance programs, education and health care literacy, mobile navigator services, and telephone support. 10. If applying for Assistance Site with SHOP specialty please answer this question. Otherwise, please type N/A. Describe the organization's current work providing assistance to small businesses and the self-employed. Please describe the organization's plan for also serving the employees of those employers. WMRHAN members work on a daily basis with local employers and employees. For instance, Eagle County works with the Vail Valley Partnership, the area's Chamber of Commerce, to conduct worksite wellness programs. During the past six years, MFHC collaborated with an number of businesses in the region to emplolyees for cardiovascular disease. Mobile SHOP outreach staff will be available for presentations and individual enrollment sessions at places of employment (when privacy and internet access is available). 11. Describe the organization's experience with providing quality oversight of programs, feedback to stakeholders, and reporting. 9 Every agency in the WMRHAN presently reports to numerous boards of county commissioners, boards of directors, state and federal agencies, and private foundations, such as The Colorado Health Foundation. In recent years, reporting and accountability requirements have steadily increased as budgets have tightened. All state and federal programs now incorporate quality expectations and performance targets, e.g., rates of Immunizations for 2 year olds. Human service programs are required to perform county level auditing to assure the quality of the work within those programs. All members of WMRHAN measure their performance against annual quantified goals, and have considerable experience in collecting, consolidating and reporting information online or through printed forms and reports. StafHne 1. Please describe how the organization will staff Health Coverage Guides. Will the organization use current or new staff? How many current and new full time equivalent (FTE) Health Coverage Guides will the organization employ (or supervise if using volunteers)? Where will each Health Coverage Guide be located? Our staffing plan for Health Coverage Guides (HCGs) is based on two assumptions: 1) Most enrollments will occur as households of an average of 2.5 persons, and 2) 90 minutes will be required for 65% of the assistance sessions that will be with English speakers and 120 minutes for 35% of sessions with Spanish -only speakers. The FTE requirement was calculated based on man-hours calculated, the forecast number needing services and language mix of customers. Based on the above, WMRHAN will hire 16 new FTE staff, including 3 Lead Health Coverage Guides with SHOP and individual market skills, and 8 Health Coverage Guides (HCGs) focused on the individual market, 1 Manager, 1 Supervisor and 1 Program Support technician and 2 Medicaid eligibility technicians. In addition,1 short term (30 -day) temporary human resource specialist will be hired. The HCGs will be based in the following locations and will travel throughout the region, as needed to ensure a broad reach: Eagle County: HHS offices in Eagle and EI Jebel (covering Vail, Avon, Edwards, Eagle, Gypsum, EI Jebel, Basalt, Snowmass and Aspen) Garfield County: HHS offices in Glenwood Springs and Rifle (covering Glenwood Springs, Rifle, Carbondale, Parachute, New Castle and Silt) In addition, an HCG will be on-site daily at MFHC clinics in Glenwood Springs, Rifle, Basalt and Edwards. 2. Describe the organization's. recruitment and retention practices. If the organization is hiring new staff or engaging new volunteers to serve as Health Coverage Guides, describe the organizational approach and timing to recruiting and hiring staff or volunteers. 10 Eagle County will hire and supervise all WMRHAN employees except 1 Medicaid Eligibility technician who will be hired and supervised by Garfield County Human Services. Eagle County provides a salary/wage that is competitive in both the public and private sectors, along with an excellent benefit package, a robust wellness program and flexible work arrangements to retain its employees. These effective retention strategies have kept the overall turnover rate for at a low 7% for the past three years. Preliminary job descriptions and salary levels have already been developed in the preparation of the budget for this grant request. Upon notice of grant award, the job opportunities will immediately be posted in all three counties, both online and in print media. The top priority will be to hire the WMRHAN Manager so this person can take the lead in hiring the HCGs. The goal is to get all the hiring completed by July so the HCG regional team could focus on training and outreach from July through September 2013. 3. Describe the organization's plan for supervision and oversight of Health Coverage Guides. Include the title of the supervisor or manager, the other duties the person is responsible for within the organization, and the approximate portion of the supervisor's time that is anticipated. A newly -hired WMRHAN Manager, based at Eagle County HHS, will oversee activities and report to the Eagle County Economic Services Director. The Manager will hire and oversee the activities of the HCGs in all three counties, interface with COBHE and other pertinent agencies, develop and implement a quality assurance plan, ensure adherence with program requirements and budget, and coordinate and conduct community education activities. The Manager will be assisted by a Supervisor and Program Support Specialist. The Supervisor will supervise 2 Lead HCGs and 6 HCGs located in EI Jebel, Glenwood Springs and Rifle. The Program Support Specialist will be responsible for customer service, scheduling, report preparation, and logistical and marketing support to community education efforts. Each county will have a Lead Health Guide, expert in both the individual and SHOP markets, who will be located in the respective HHS office. Detailed duties for the non -Health Coverage Guide positions can be found on the Personnel tab within the Budget Worksheet. 4. Describe the # of and titles of other staff expected to be used to support the work of Health Coverage Guides and the approximate FTE's associated with their support. Please also describe the other duties these persons serve. Support positions include 1 FTE Manager, 1 FTE Supervisor, and 1 FTE Program Support Technician. These positions do not have other duties outside those of the WMRHAN. S. Does the organization currently require a background check of employees or volunteers? If not, will the organization agree to facilitate background checks for employees or volunteers working with COHBE system access? Yes, all are subject to background checks. 11 6. Please describe how the organization will ensure employed or volunteer Health Coverage Guides can meet certification requirements. All members of WMRHAN routinely recruit and supervise employees who must competently navigate complex eligibility and financial assistance programs. To accomplish this, employees are carefully selected and receive extensive training. Project management will ensure that all HCGs attend Hub and other trainings, which will be a requirement in the job description. 7. Does the organization have a nondiscrimination and inclusion policy? X Yes ❑ No If yes, please describe, or include a copy as an attachment. If no, please explain. This is a requirement of any agency receiving state or federal funding, as do all the agencies in the WMRHAN. 8. How will the organization support Health Coverage Guides to provide appropriate referrals for customers who have grievances, complaints, or with additional needs outside the scope of the organization. Please describe any similar referral services the organization currently provides. HCGs will be trained to determine the appropriate referral based on the nature of the grievance. If the issue involves billing, claims, and benefits, the person will be directed to the insurance carrier. HCGs will also be able to identify complaints that can best be addressed by the Department of Insurance, and will provide instructions how to contact it. If the grievance pertains to a breach of confidentiality or inappropriate employee behavior, the grievance falls within the purview of the Eagle County HHS Standards of Conduct. In such cases, the grievance first goes to the WMRHAN Project Manager for resolution. If that is not satisfactory, the grievance will then go to the Economic Services Director for further consideration. Employees who violate the Standards of Conduct are subject to disciplinary measures and termination. Facilities 9. Does the organization have a Privacy and Security polity? X Yes ❑ No a. If yes, please describe. All WMRHAN agencies have policies regarding client confidentiality, building securing, and information technology firewalls to prevent unauthorized access to records, per various state and federal regulations. All ECHHS staff are required to sign a Confidentiality Agreement annually. 10. Describe how the organization plans to comply with federal and state privacy standards including controlling access to sensitive information, record storage and destruction, monitoring of employees and vendors, and how incidents of breech in privacy is reported. Please name who within the organization is responsible for privacy and their title, or the name of the vendor contact if contracted. All WMRHAN agencies routinely handle sensitive personal health and financial information and conduct their activities under strict HIPAA rules and regulations. Any possible breach of 12 M confidentiality will be reported to Jennifer Ludwig, Eagle County Public Health Director and HIPAA Compliance Officer at 970-328-8819. 11. Please describe the days of the weeks and the hours that your organization plans on having Health Coverage Guide service in each geographic location. As described in Question #1 under "Staffing," fulltime HCGs will be based at HHS offices and will be mobile and stationary, depending on demand, and be located at HHS offices in Eagle, Aspen, Glenwood Springs, and Rifle. This distribution will be modified, if needed, based on customer demand within the region. HGC will be assigned to each MFHC site in Glenwood Springs (Garfield), Rifle (Garfield), Edwards (Eagle) and Basalt (Pitkin/Eagle). HGCs work normal office hours from 8 am to 5 pm. However, some HGCs will work flex hours based on whether they are stationed all day in a particular location or attending a special activity, e.g., health fair, after church gathering, back to school night. 12. Describe the spaces your organization plans to use to meet with individuals in person. Is the space accessible under the Americans with Disabilities Act? If not, how do you plan to provide reasonable accommodation to meet with people who cannot access your facility? All offices are in ADA compliant facilities. The HCGs will be located with other eligibility and enrollment staff where there is ready access to phones, printers, document shredders, facsimilies, and high speed internet connectivity. They will be in cubicles with soundproof walls where clients will meet at a desk across from the HGC. 13. Does this space currently have access to computer, high speed internet, scanning, phones service, and printing? If not, what is the time frame anticipated for the organization implementing these capabilities? Yes, all fixed sites have all these capabilities because they will be housed in government and/or clinic sites with well developed infrastructures that address all these requirements. The availability of these services at mobile locations will vary. However, all HCGs will be equipped with WiFi enabled laptops, cel phones and secure broadband service. 14. Do you have the ability to respond to telephone and email inquiries within 1 business day and to set up appointments for in person meetings? X Yes ❑ No a. If no, please describe how the organization plans to respond to inquiries by phone and email, and requests for appointments. 15. Describe how the organization is located in a place that is accessible for the target population it plans to serve. All the HCG locations are in public buildings conveniently located on main roads in high traffic 13 areas that are well known and frequented by the local population and served by public transportation systems. Regional Hubs If applying for a Regional Assistance Hub please answer the following questions. Otherwise, type N/A. 1. Please define the region you propose to serve and how you will ensure reach to organizations in that area. N/A 2. Describe the organization's experience with convening community partners for education, resource sharing, networking, support, or outreach coordination. N/A 3. Describe the organization's plan for convening health coverage guides for COHBE trainings and other networking or support activities. N/A 4. Describe the organization's plan for coordinating outreach and public education opportunities in the region. N/A Additional Information This is an opportunity to provide any additional information you would like to submit for consideration. 8 ❑ Attachment 1: 2 Letters of reference from clients or partner organizations ❑ Attachment 2: Completed Budget Worksheet ❑ Attachment 3: Most recent annual audited financial statement ❑Attachment 4: Most recent prepared interim financial statement ❑Attachment 5: Organizational operational budget for upcoming year excluding Assistance Network activity or funding ❑Attachment 6: Organizational Chart showing existing organization and structure if funded ❑ Attachment 7: Memorandum of Understanding if applying as partnership or coalition ❑ Attachment 8: Optional Attachments 14 (U <v V) 0 C OJ C O m N .E m O 3 0 N 3 'O C O E 3 C O1 m E i.+ H W 0) fn N m 00 00 00 O m M M lC M � co N N Ln In o w M O N 00 rl M � O O N N 03 (A C1 In N N N N N N X C 00 00 O O O O O O Go 06 to to to to to t0 N N N O 4 VM! tMl1 N C m d "-L N N C4 C4 r4 C4 CN _� C1 C► C1 C1 C1 o 0 v T 0 0 0 o o 0 i°- V1. t m v 01v °1v 01v °1v W m d v W m m CA Gl o 00 0 0 0 0 N X H O 00 00 00 00 00 00 00 00 F C a E C. 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O O O N to tD O 00 O 00 L1 O w A Lf N C Lf O a0 -4 r -I M O DO r 1 O 1" L1 N I� DO aQ U e -I r401 M ri r -I' a-1 rs- N 00 N 00 O u aJ -c C'p f° o O 41 tko EA m m c Or �� Nw i O H C Y u 41 a/ C m X 4- a° am+w L, aJ uA O H a 0M w 3 U o O tw O C m 41 Oa m C c ip c !_^ O C 0 2 _ m H CL O V 7 pp Y 'c w aJ N O U m m m 00 m a` m Lai H C7 w Fa- 0 c a m c H Y N V O it C C O cu a CL 4,Q A Ln al a! U N C m E m o m U N N E E w F- n O i F- N ,n O W 'O pp x v� M O u O U N vOi C tw w LL •� m O aJ z N m— Q X (D a1 a1 L Y d m 00 am+ N 3 = i R `6 J 3 QQ m u c0 uVi a c7 N 0 O I- CONN ECT.HEALTH"vr COLORADO Connect for Health Colorado Connect for Health Assistance Network Funding Opportunity Request for Application Revision Eagle County Health & Human Services May 24th, 2013 Submission Due Date June 10th, 2013 3773 Cherry Creek N. Dr. • suite 1015 • Denver, C080209. 720-496-2530 • connectforhealthco.com Instructions................................................................................................................................................................. 3 New Information about the Connect for Health Assistance Network ............................................... 3 Termof the Grant................................................................................................................................................ 4 Performance Based Metrics and Evaluation............................................................................................4 Scopeof Work.......................................................................................................................................................4 HealthCoverage Guide FTE............................................................................................................................. 5 Administrative SuRport/Reception and Supervision FTE................................................................. 6 HubPersonnel.......................................................................................................................................................6 OtherPersonnel Costs.......................................................................................................................................6 Travel......................................................................................................................................................................... 6 Supplies.................................................................................................................................................................... 6 OtherExpenses..................................................................................................................................................... 7 Indirect..................................................................................................................................................................... 8 Contractual............................................................................................................................................................. 8 NotAllowed............................................................................................................................................................ 8 Revisionof Scope of Work.................................................................................................................................... 8 Revisionof Budget............................................................................................................................................... 11 2 The purpose of this Request for Application Revision is to provide Connect for Health Colorado an opportunity to balance its geographic needs and funding approach for implementing the Assistance Network after having undergone two levels of application review and detailed budget analysis. Application revisions will allow Connect for Health Colorado to work with applicants to modify scopes of work and budgets to fit within our parameters. The Request for Application Revision is also intended to provide applicants an opportunity to refine their approach to the Assistance Network based on the new information provided by Connect for Health Colorado, the needs of the organization, and other factors. The Request for Application Revision is divided into 4 sections. The first section requests information Connect for Health Colorado will use to prepare a grant agreement. The second section is new information applied to all Applicants. The third section includes a request for revisions to the Applicant's proposed scope of work. The last section is a request for revisions to the Applicant's proposed budget. Responses must be submitted to grants@connectforhealthco.com and must be submitted on this form with the attached budget worksheet no later than June 10th, 2013. The budget worksheet does include formulas. It is the responsibility of the applicant to make sure all formulas remain intact. Please e-mail us with technology issues or other concerns as soon as they are identified to grants Pconnectforheatlhco.com or call 720-496-2536. Grant Agreement Information To prepare grant agreements, please respond to the questions below: 1. Name of Authorized Signatory: Jon Stavney 2. Title of Authorized Signatory: Chairman, Eagle County Board of County Commissioners 3. Legal form of (lead) Entity (ie tribal/gov't, corp, partnership, non-profit): Government New Information about the Connect for Health Assistance Network Connect for Health Colorado was fortunate to receive over 70 applications from community organizations willing to provide education and in person assistance to individuals, families, and small businesses throughout the state of Colorado. The availability of a variety of locations and skilled organizations to serve the diverse needs of Coloradans will be an asset to Connect for Health Colorado. However, due to budget considerations Connect for Health Colorado is not able to fund the majority of proposals at the level of funding requested by applicants. Because of significant variations in the way that applicants approached their goals and budgets, and some advancement in Connect for Health Colorado's organizational approach to outreach and evaluation, we are providing clarified definitions of services that can be paid for through the Assistance Network Funding Opportunity and asking that applicants modify their goals and budget requests accordingly. These definitions will allow Connect for Health Colorado to further standardize the approach to using available funding and reporting, while allowing individual applicants to retain creativity and flexibility in their approach to service. Term of the Grant Connect for Health Colorado is requesting all applicants be prepared for an 18 month grant term, July 1, 2013 -December 31, 2014. Please email grants@connectforhealthco.com or call 720-496-2545 for exceptions. Performance Based Metrics and Evaluation In addition to funding initially awarded through the revised application, Connect for Health Colorado intends to create a mechanism under which we will allocate incentive payments to organizations that demonstrate high performance. Incentive payments will only be awarded after the initial open enrollment period, provided adequate funding is available to Connect for Health Colorado. Performance metrics used to evaluate organizations are still in development and are anticipated to use goals relative to all organizations while giving consideration to the differences in geographic regions and population characteristics. Connect for Health Colorado will use a variety of methods to conduct ongoing evaluation of Assistance Sites including system reports, reports from Assistance Sites, site visits, and surveys. This evaluation will help target additional training and support to organizations in the Network and help identify best practices to inform future program development. Organizations that do not demonstrate progress towards goals will be given an opportunity to revise their strategy and goals. Consistent failure to progress towards goals could result in loss of funding prior to the second enrollment period, October 15th -December 7th 2014. Scope of Work The Assistance Network is expected to provide outreach, education, and in person assistance with affordability program applications and enrollment in health coverage. In person assistance is expected to be primarily education for pre or post enrollment, and assistance with online application submission, account management, and online health plan enrollment. 4 We ask that applicants take this opportunity to re-evaluate the number of applicants you propose to serve through outreach activities and in person assistance appointments. Please consider some of the following factors as appropriate for your organization: • Contributions of all partners participating in the application. • The number of the applicant's current clients who are likely eligible to purchase health coverage in Connect for Health Colorado and/or who are eligible for premium tax credits (133-400% of the federal poverty level). • The possibility of customer participation in available outreach and in person assistance activities given the availability of other customer service channels like the customer service center, brokers, the possibility of completing applications online without assistance, and the possibility of completely forgoing coverage. Connect for Health Colorado used as a reference the following report by Price Waterhouse Coopers, http://www.pwc.com/us/en/health- industries/publications/change-the-channel.jhtml#media-feature-2 • Variations in customer needs during and outside enrollment periods. • Target audiences for health coverage through Connect for Health Colorado include the uninsured, people without access to employer based coverage, people who currently purchase coverage in the individual market, and small businesses. • Audiences not likely to apply for health coverage through Connect for Health Colorado include people eligible for insurance through an employer or eligible for public health programs. • While assisting individuals with affordability program applications, it is acknowledged that some customers will discover they are eligible for Medicaid or CHP+. Outreach and in person assistance with a 'no wrong door' approach is expected. While developing staffing plans and numbers served, please take into consideration possible needs for flexibility to meet varying demands for outreach and in person assistance throughout the term of the grant. Health Coverage uis e FTE Connect for Health Colorado assumes that Health Coverage Guide (HCG) FTE time will be spent providing both in person assistance and outreach activities in a balanced approach method such that outreach leads to and drives application assistance and enrollment. Whether focusing on outreach or enrollment, all HCGs will receive the same training. One HCG FTE is assumed to equal 40 hours per week for a total of 3120 hours in 18 months. Reductions or increases in what Connect for Health Colorado can fund for HCG FTE per applicant reflect the total available funding, proportionate to the population and uninsured in a given geographic area, as well as the general target audience characteristics described by the applicant. Administrative Suppo / peep i n and Supervision FT Connect for Health Colorado assumes that dedicated administrative and reception support will be necessary for some applicants. The allowance for this support is to provide phone, email, reporting, scheduling, ordering, reception, and similar assistance to customers and HCGs. There is also the assumption that dedicated and skilled supervision is required for Health Coverage Guides and associated administrative support/reception staff. No more than 0.2 FTE per each HCG FTE will be allowed for administrative and supervision. Please specify in the budget narrative whether supervisory staff will split time as a HCG providing direct service or only provide oversight for direct service staff. Hub Personnel At least one FTE will be allowed for each Hub to facilitate their goals. Applicants including plans for providing trainers or training support should specify how this resource will be used throughout the grant term within their staffing plan. Please include narrative description of which costs are Hub costs if also serving as an Assistance Site. Please specify whether or not Hub staff will also provide HCG services as needed. Other Personnel Costs So that funding can be focused on in person assistance and education, only the above personnel responsible for direct delivery of education and in person assistance can be funded through the direct personnel allowance. Any other personnel cost must be considered indirect expenses and subject to the 10% indirect expense limitation. No funding from Connect for Health Colorado, direct or indirect, can be used for personnel who are lobbyists. "Urav l Funding is available to help offset the costs of travel directly related to providing outreach and in-person assistance, or other activities directly associated with services that support the Assistance Network, such as supplemental training. This is particularly important for applicants who are serving large geographic areas in rural and frontier areas of the state. Supervisory travel is expected to be minimal. Travel for initial training will be reimbursed outside this funding opportunity so do not include those costs in travel estimates. Connect for Health Colorado requests that applicants use the most direct and efficient means of travel to meet goals including traveling together, combining trips, and centralizing activities where it makes sense. Metro area applicants should be reasonable in their travel requests and use locations easily accessible to customers with the least cost for travel. Travel for joint program goals, for instance mobile clinics, should be allocated appropriately. upplit"m Mobile and reliable technology equipment will be essential to effective outreach and in person assistance. The technology needs to support these activities are a high speed internet connection, mobile computer device (such as thin client or laptop) with access to a full internet browser, and possibly mobile printer with scanning function, and accessories like keyboard, carrying case, locking device etc. Communication devices that are dedicated to the program like cell phones and mobile internet devices are also allowed as supplies. G Applicants are expected to keep each new technology and communication set up below $2000. Office furniture items such as desks and chairs can only be allowed when unavailable from existing office resources. Connect for Health Colorado does not anticipate the need for file storage furniture as the application and enrollment process is primarily in person and online. Printing by Assistance Sites is expected to be minimal and should not require direct cost of office machinery. General office supplies (examples: printer toner, pens, paper, sticky notes of all sizes, staples, file folders) will be allowed in the budget as one line item and limited to no more than $540/FTE/grant term. Other Expenses Connect for Health Colorado is conducting a broadcast media campaign throughout the state in English and Spanish that includes television, radio, and print. For this reason the allowance for advertising costs to Assistance Sites is expected to be minimal and primarily used for local print advertising of services and events. There will be an opportunity to work directly with Connect for Health Colorado for art file templates to be used with local print vendors. Connect for Health Colorado will also work directly with Assistance Sites to centralize social media advertising at no cost to the Assistance Sites. Connect for Health Colorado will be using a print on demand vendor for ordering brochures and flyers, with the opportunity for some customization, at no cost to Assistance Sites. For this reason, brochure development and printing is not expected to be included in Assistance Site budgets. Interpretation services for customers with hearing impairment or for non-English speakers will be available through Connect for Health Colorado at no cost to Assistance Sites. Only applicants with access to interpretation services at a lower cost than $0.95/minute for language interpretation services and $3.35/minute for video ASL interpretation will be allowed interpretation costs. Connect for Health Colorado recognizes that applicants currently use a wide variety of software for scheduling and reporting. Unfortunately, funding cannot be allowed to purchase improvements to existing programs unless the cost is minimal. Low cost subscription services for virtual meeting and synchronized scheduling can be supported. Connect for Health Colorado will provide reporting functions to Assistance Sites at no cost. In addition to device costs listed in supplies, cell phone service costs and mobile internet service costs can be considered for funding in the other area, but if used for other programs, should be allocated proportionally. Indirect. Costs expected to be allocated proportionately to indirect expenses include personnel such as management, human resources, finance, executive leadership, IT, auditors, and 7 maintenance. Insurance, rent, utilities, and communications systems like servers can be included in indirect costs and should be allocated. Rent allocation should be based on total organization square footage divided by FTE. Indirect expenses can be no more than 10% of the total of the Personnel, Supplies and Other categories. Contractual Partner contracts for categories described above as HCG personnel, Admin/Supervisory, associated travel, supplies, other, and indirect will be allowed to enhance outreach, education, and in person assistance. Legal contracts related directly to implementing Assistance Network activities can also be included at a maximum of $5,000. Not. Allowed Food, direct rent, policy or political activity, travel for initial training, consultants, incentives, and recruitment fees cannot be allowed through this grant. Revision of Scope of Work Eagle County Health & Human Services Connect for Health Colorado is pleased to offer Eagle County Health and Human Services $750,000 to provide Health Coverage Guide services in Eagle, Garfield and Pitkin counties. The reduced budget offer reflects our need to balance requests with our available resources while trying to recognize the higher costs of providing services in mountain and resort communities. We would like to work with you to use the new budget worksheet to submit a final budget. Please respond to the below prompts to describe your final work plan: 1. How many Health Coverage Guide FTE will be staffed within each geographic region (for instance a location, city, county, or mobile region) Eagle County Health & Human Services (ECHHS), as the lead and fiscal agentfor the West Mountain Regional Health Assistance Network (WMRHAN), will employ 4 full- time Health Coverage Guides who will be bi-lingual (English/Spanish). Each guide will be mobile, having a primary location with an assigned coverage area. Each guide will have 2 to 3 designated service locations with regularly scheduled appointments and will be available on an as requested and as available basis to work in other community sites/events within the coverage area. The locations will be: ➢ Eagle (Eagle County) - the HCG housed in Eagle at ECHHS will have a coverage area encompassing the 1-70 corridorfrom Vail to Dotsero as well as outlying areas of Redcliff on Hwy 24 and communities along the Colorado River Road such as McCoy and Bond. Designated service locations currently identified are ECHHS facilities in Eagle and Avon and Mountain Family Health Center in Edwards (when opened). Other locations being considered are Vail Valley Medical Center in Vail and Colorado West Regional Mental Health Centers in Eagle and Vail. ➢ Glenwood Springs (Garfield County) - the HCG housed in Glenwood Springs at Garfield County Human Services will have a coverage area encompassing the Hwy 82 corridor from Glenwood to Carbondale (including the Town of Carbondale) as well as communities along the 1-70 corridor west of Glenwood Springs to New Castle. Designated service locations currently identified are Garfield County Human Services, Mountain Family Health Center and Valley View Hospital, all in Glenwood Springs. Another location being considered on a rotating basis is Colorado West Regional Mental Health Center in Glenwood Springs. ➢ Rifle (Garfield County) - the HCG housed in Rifle at Garfield County Human Services will have a coverage area encompassing the I-70 corridor from New Castle to Parachute. Designated service locations currently identified are Garfield County Human Services, Mountain Family Health Center and Grand River Hospital, all in Rifle. Another location being considered on a rotating basis is Colorado West Regional Mental Health Center in Rifle. ➢ El Jebel (Western Eagle County & Pitkin County) - the HCG housed in El Jebel at ECHHS will have a coverage area encompassing the Hwy 82 corridor from Carbondale to Aspen. Designated service locations currently identified are ECHHS in El Jebel, Mountain Family Health Center in Basalt and Pitkin County Health & Human Services in Aspen. Another location being considered is Aspen Valley Hospital in Aspen In addition, the Health Assistance Network Manager, based in Eagle, will serve as HCG for approximately. 60 FTE. This position, across the entire 3 county region, will fill in as needed for the 4 primary HCGs, provide services to community partner locations as requested, provide coverage of "overflow" if the need in a particular area is higher than anticipated, and conduct outreach and public education presentations/events. All HCGs will provide individual market as well as SHOP services. 2. Please describe how the proposed Health Coverage Guide FTE would be staffed within each geographic region listed, and for each contracted partner. If the organization(s) will provide in kind FTE, please separate that number here and describe how that staff would be used in each geographic region. 4.0 FTE Health Coverage Guides, the 1.0 FTE Health Assistance Network Manager (including .60 HCG FTE) and a.40 FTE Program Support Technician will be new hires for ECHHS. These positions will be geographically located as outlined in #1 above and on the attached organizational chart. The Program Support position will be located in Eagle at ECHHS. There are no contracted partners or in-kind FTE. 3. Please describe how the proposed Health Coverage Guide FTE will be used to provide outreach and in person assistance. Please include plans for staff activities throughout the term of the grant that reflects balancing outreach and in person assistance as well as the possibility of seasonal changes in staff levels. Outreach and education that helps inform our communities about new opportunities for accessing health care coverage and assistance paying for health coverage will include: ➢ Centralized webpage that can be accessed through the three county organizations and Mountain Family Health Center websites. ➢ Presentations and/or booths at back -to -school nights, health fairs and health screening events throughout the region. ➢ Presentations to civic and business organizations, church groups, Colorado Mountain College campuses and at individual businesses. ➢ Public service announcements on the local radio stations and in print media. ➢ Articles in various newsletters published and distributed by partner organizations. ➢ Business networking events focused on Connect for Health Colorado and SHOP services in partnership with the local Chamber of Commerce in each county. ➢ Work site presentations for small businesses as requested. ➢ Provide basic health assistance network information training to community partners including outreach materials and contact information to ensure community partners are able to connect their customers with health assistance network services The Health Assistance Network Manager will be responsible for coordinating outreach and public education. A focus on outreach will occur during the months ofAugust, September and early October 2013. Each HCG FTE (total 4.56 FTE) will be responsible for both outreach/education activities and providing in-person assistance. During open enrollment periods, the proposed in-person assistance schedule for each HCG allows approximately 6-8 hours per week to be in the community, either attending a community event, presenting to communitygroups or connecting with community partners to identify events, presentation opportunities or scheduling and planning such events/presentations. During non -open enrollment periods, time available for outreach will be increased. In person assistance will be provided from October 2013 through December 2014 in several ways: ➢ Face-to-face scheduled appointments at designated service locations (and walk-in appointments as the schedule allows). ➢ Face-to-face scheduled appointments at various community partner locations (and walk-in appointments as the schedule allows). ➢ Face-to-face appointments at various community events. ➢ Face-to-face appointments as scheduled with small businesses at the business site or other location. These appointments will support small employers in understanding contribution strategies and setting up plans and to assist employees in enrollment and eligibility determination for subsidy support. ➢ Each HCG will have a published phone number within their coverage area to respond to phone inquiries and to schedule appointments. ➢ Web -based appointment scheduling system that can be accessed by customers through a centralized website ➢ Centralized email address to provide general information and schedule an appointment. 10 4. In the below form, please use reasonable scope of work definitions above to estimate your goals: In Person Assistance: based on funded HCG FTE, estimate number of unique encounters (new customer served or new issue for existing customer) July 1, 2013 -March 31, 2014: 2,000 April 1, 2014 -September 30, 2014: 1,875 October 15, 2014 -Dec 31, 2014: 750 Total estimated unique in person appointments: 4,625 *Note: these numbers include individuals, households (with an estimated average of 2.5 members per household) and small businesses. In Person Assistance: If providing in kind HCG FTE, based on all available HCG, estimate number of unique encounters (new customer served or new issue for existing customer) July 1, 2013 -March 31, 2014: N/A April 1, 2014 -September 30, 2014: N/A October 15, 2014 -Dec 31, 2014: N/A Total estimated unique in person appointments: N/A Outreach/Education: estimate number of people reached through direct contact outreach/education strategies (direct staff interaction with customer in group or event setting, for instances number of attendees at presentations or number of people interacting at event) July 1, 2013 -March 31, 2014: 3,500 April 1, 2014 -September 30, 2014: 3,500 October 15, 2014 -Dec 31, 2014: 500 Total estimated direct outreach contacts: 7,500 Revision of Budget Eagle County Health & Human Services Maximum Budget Amount: $750,000.00 On the form attached to the Application Revision email, please provide information about how you will use your available budget. 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H Z axi F E X 21 Attachment 2 Privacy and Security Standards Grantee shall: (a) Not use or disclose C4HCO information other than as permitted or required by the Agreement or as required by law; (b) Use appropriate safeguards, and comply with or exceed C4HCO supplied policies and guidance with respect to C4HCO information, to prevent use or disclosure of information other than as provided for by the Agreement; (c) Report to C4HCO any use or disclosure of C4HCO information not provided for by the Agreement of which it becomes aware, including breaches of unsecured C4HCO information, and any security incident of which it becomes aware; (d) If applicable, ensure that any subcontractors that create, receive, maintain, or transmit C4HCO information on behalf of the Grantee agree to the same restrictions, conditions, and requirements that apply to the f Partnerl with respect to such information; (e) Maintain and make available the information regarding accounting of disclosures; and (f) Make its internal practices, books, and records available to C4HCO for purposes of determining compliance with the C4HCO Polices and Guidance. 6 Attachment 3 Conflict of Interest Policy Connect for Health Assistance Network: Conflict of Interest Framework for Assistance Sites and Health Coverage Guides Revised May 2013 It is Connect for Health Colorado's intent that the Connect for Health Assistance Network Program provides Exchange customers with impartial, high quality, community based education and information, and in-person assistance. In order to assure the delivery of high quality services, to minimize or eliminate the existence of conflicts of interest and ensure the integrity of the program Connect for Health Colorado will' 1. Monitor for potential conflicts of interest during the Assistance Site and Regional Hub selection process and throughout the term of engagement with the Assistance Site or Regional Hub. 2. Provide robust initial and ongoing training that includes instruction on providing impartial education and in person assistance with customer selection of a qualified health plan. 3. Require from Assistance Sites, Regional Hubs and Health Coverage Guides disclosures of affiliations that may present a direct or indirect conflict of interest. 4. Monitor Health Coverage Guide enrollment practices through use of reporting in Connect for Health Colorado's system. 5. Monitor Health Coverage Guide conduct through feedback tools on Connect for Health Colorado's website and through use of qualitative and quantitative evaluation tools like secret shopping. 6. Actively solicit customer satisfaction feedback on their experience working with Health Coverage Guides. 7. As circumstances command where a conflict of interest arises, require mitigation, revocation of certification, or termination of the grant. 1. Prohibition on conduct 1.1. As required by 45 CFR 155.210 (d) a Navigator [Health Coverage Guide] or Navigator entity [Assistance Site or Regional Hub] must not: 1.1.1.Be a health insurance issuer or issuer of stop loss insurance 1.1.2.Be a subsidiary of a health insurance issuer or issuer of stop loss insurance 1.1.3.Be an association that includes members of, or lobbies on behalf of, the insurance industry; or 1.1.4.Receive any consideration directly or indirectly from any health insurance issuer or issuer of stop loss insurance in connection with the enrollment of any individuals or employees in a QHP [qualified health plan] or non-QHP [qualified health plan].' 1 The comments in the final federal regulations state, ""consideration," as used in § 155.210(d)(4) of the final rule, should be interpreted to both mean financial compensation—including monetary or in-kind of any type, including grants—as well as any other type of influence a health insurance issuer could use, including but not limited to things such as gifts and free travel, which may result in steering individuals to particular QHPs offered in the Exchange or plans outside of the Exchange."" Patient Protection and Affordable Care Act; Establishment of Exchanges and Qualified Health Plans; Exchange Standards for Employers; Final Rule and Interim Final Rule," Federal Register 77:59 (March 27, 2012) 18333. Connect for Health Colorado thus interprets the words "indirect 1.2. A Health Coverage Guide, Assistance Site or Regional Hub must not: 1.2.1. Be a provider entity (including, but not limited to, hospitals, clinics, and physician practices) that is directly owned by, a subsidiary of, or exclusively contracts with, a single insurer or its subsidiaries, except in cases where the provider can demonstrate that due to geography or other factors, there are significant limitations on available insurers with whom to contract. 1.3. Receive any consideration directly or indirectly from any health insurance producer in connection with the enrollment of any individuals or employees in a QHP [qualified health plan] or non-QHP [qualified health plan]. 2. Health Coverage Guide conflict of interest 2.1. A Health Coverage Guide shall not allow any philosophical, professional or personal financial or non-financial interests to influence or appear to influence the ability of the Health Coverage Guide to perform his/her duties impartially. 2.2. Health Coverage Guides shall disclose to Connect for Health Colorado and to customers personal and professional financial and non-financial interests that may present a conflict of interest. 2.3. Health Coverage Guides shall attest that they are not a prohibited entity or employed by a prohibited entity as described in Paragraph 1. 2.4. 2.4.1.Health Coverage Guides shall not receive direct or indirect consideration from any health insurance issuer in connection with enrollment of individuals or employees. 2.5. Health Coverage Guides shall not charge for their services. 2.6. Health Coverage Guides shall provide to customers impartial information about all plans for which customers are eligible and shall not allow personal or professional interests to influence the customers' decisions. In an effort to maintain impartiality in providing assistance: 2.6.1.Health Coverage Guides must not in any way solicit or persuade customers to enroll in any specific health insurance plan. 2.6.2.Health Coverage Guides must not in any way solicit or persuade customers to switch from one health insurance issuer to another. 2.6.3.Health Coverage Guides must not in any way persuade or compel customers to select a particular provider, but may assist a customer in locating or selecting a provider. 2.6.4.Health Coverage Guides must not in any way solicit or persuade customers to engage a particular agent or broker, but may assist a customer in locating or selecting a broker. 2.7. Health Coverage Guides shall not use their role as a Health Coverage Guide for lead generation or profit. 2.8. Health Coverage Guides shall adhere to Connect for Health Colorado monitoring and evaluation requirements. 3. Assistance Site and Regional Hub conflict of interest 3.1. An Assistance Site or Regional Hub shall not allow any philosophical, financial or non-financial interests or affiliations to influence or appear to influence the ability of the Assistance Site to impartially deliver Health Coverage Guide services or assure that the Health Coverage Guides consideration" to mean in-kind compensation and other types of influence as stated above. Connect for Health Colorado further interprets this provision to say that Health Coverage Guides and Assistance Sites cannot receive compensation (cash or in-kind) for enrollment. 12 4 employed, contracted or otherwise supervised by the Assistance Site are able to impartially perform their duties as Health Coverage Guides. 3.2. Assistance Sites and Regional Hubs shall disclose to Connect for Health Colorado and to Connect for Health Colorado customers all philosophical, financial and non-financial interests or affiliations that may present a conflict of interest, including professional relationships between the entity and any health insurance issuer. 3.3. Assistance Sites and Regional Hubs shall not be any of the prohibited entities described in Paragraph 1. 3.3.1. Assistance Sites and Regional Hubs shall disclose to Connect for Health Colorado and customers all relationships with prohibited entities as described in paragraph 1. 3.3.2.Assistance Sites and Regional Hubs receiving any cash or in-kind compensation from health insurance issuers shall disclose to Connect for Health Colorado and customers the nature of the compensation, what the compensation is intended to support, and from whom it is received. 3.4. Assistance Sites and Regional Hubs shall not direct or permit Health Coverage Guides to solicit or persuade customers to enroll in any specific health insurance plan, switch from one carrier to another, or select a particular provider. 3.5. Assistance Sites and Regional Hubs shall not charge for Health Coverage Guide services or otherwise utilize the Assistance Program, or their association with the Assistance Program for lead generation or profit. 3.6. Assistance Sites and Regional Hubs shall not utilize interests or affiliations for purposes of soliciting or persuading customers to enroll in a specific health insurance plan, switch from one plan to another, or to select a particular provider. 3.7. Assistance Sites and Regional Hubs shall monitor Health Coverage Guides they employ, contract with or otherwise supervise for fair and impartial performance of Health Coverage Guide duties. 3.8. Assistance Sites and Regional Hubs shall adhere to Connect for Health Colorado monitoring and reporting requirements. 13