HomeMy WebLinkAboutC15-439 Medicaid IGADepartment of Health Care Policy and Financing
Agreement Routing Number 20 I 5CMIP037AI
AGREEMENT AMENDMENT NO. 1
Original Agreement Routing Number 20 I 5CMIP03 7
I. PANTIES
This Amendment to the above-referenced Original Agreement (hereinafter called the
"Agreement") is entered into by and between the Department of Health Care Policy and
Financing, 1570 Grant Street, Denver, CO 80203 (hereinafter called '.HCPF" or the
"Department"), and the Eagle County (hereinafter called "Contractor"), who may collectively be
called the "Parties" and individually a "Part5/", both of which are agencies of the STATE OF
COLORADO, hereinafter called the "State".
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date"). HCPF shall not
be liable to pay or reimburse Contractor for any performance hereunder, including, but not
limited to, costs or expenses incurred, or be bound by any provision hereof prior to the Effective
Date.
3. FACTUAL RECITALS
The Parties entered into the Agreement to create incentives for counties that achieve certain
incentive performance standards related to Medicaid eligibility and cooperation with other
Medicaid related entities. The purpose of this Amendment is to add exhibits and update the
incentives.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
This Amendment is incorporated by reference into the Agreement, and the Agreement and all
prior amendments thereto, if any, remain in full force and effect except as specifically modified
herein.
6. MODIFICATIONS
The Agreement and all prior amendments thereto, if any, are modified as follows:
A. Section 4, Definitions, Subsection B is hereby deleted in its entirety and replaced with the
following:
Eagle County Commissioners' OfficeC15-439
B. Exhibits and other Attachments. The following documents are attached hereto qnd
incorporated by reference herein:
[l{
Exhibit A, Statement of lVork
Exhibit B, Rates
Exhibit C, Sample Option Letter
Exhibit D, Small, Medium, and Large County List
C. Exhibit A, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A-1, Statement of W'ork, attached hereto and incorporated by reference into the
Agreement. All references within the Agreement to Exhibit A, shall be deemed to
refsrence to Exhibit A-1.
D. Exhibit B, Rates, Section 1.2., SFY 2015-16 Incentive Pay:rent Table, is hereby deleted
in its entirety and replaced with the following:
1.2. SFY 2015-16 Incentive Pavment Table
lncentive Parment Name Pavment Amount
Court Settlement Timeliness Incentive Payment $r0.743.34
Collaboration Incentive Pavment $4.028.75
Annlication Backlos Incentive Pavment s5.371.68
Trainine Incentive Payment $4.028.75
MEOIP Renortins Incentive Pavment $2.685.83
Total Maximum Available for
all Incentive Pavments
$26,858.35
E. Exhibit B, Rates, Section 2.2., SFY 2015-16 Pool Maximum Conqty Share Table, is
hereby deleted in its entirety and replaced with the following:
2.2. SFY 2015-16 Pool Maximum County Share Table
Payment Pool Maximum Distribution Amount
Total Maximum Available for Pool
Distributions
s8.952.79
F. E*ibit D, Small, Medium and Large County List, is hereby attached hereto and
incorporated herein.
7. START I}ATE
This Amendment shall take Effect on its Effective Date.
8. ORDER OF PRECEDENCE
Execpt for the HIPAA Business Associates Addendum, in the event of any conflict,
inconsistency, variance, or contradiction between the provisions of this Amendment and any of
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the provisions of the Agreement, the provisions of this Amendment shall in all respects
supersede, govem, and control.
9. AVAILABLE FUNDS
Financial obligations of the state payable after the current fiscal year are contingent upon frrnds
for that purpose being appropriated, budgeted, or otherwise made available to HCPF by the
federal government, state government and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
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Amendment Routing Number 20 I 5CMIP037AI
THE PARTIES TIERETO HAVE EXECUTED THIS INTERAGENCY AGREEMENT
Persons signing for Parties hereby swear and affirm that they are authorized to act on behalf of
their respective Party and acknowledge that the other Party is relying on their representations to
that effect.
STATE OF COLORADO
John W. Hickenlooper, Govemor
E. Birch, hrlBA, BSN,
Date:
Bz*sZFyau,/
o^,", - l\f gftg .
ALL.AGREEMENTS REOUIRE APPROVAL BY TiIE STATE CONTROLLER
Our",W
of authorized signer
Jaros, CPA, MBA, JD
th Care Policy and Financing
Page 5 of 13
EXHIBIT A-1, STATEMENT OF WORK
r. TENMtrNOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms,
abbreviations and terminology used throughout this document.
I . I .l . Applicant * An individual for whom the Contractor is performing a Determination.
L1.2. Behavioral Health Organization (BHO) - An organization that arranges for enrolled
Clients to get medically necessary behavioral heal1h servicEs. For a list of BHOs,
please see the County Incentive Program Guide.
L1.3. Backlogged Determination* Any Untimely Determination that is not yet complete.
1.1.4. Client* An individual who is eligible for the Colorado Medical Assistance Program.
1.1.5. Determination * The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program.
1 . L6. Reporting Period * The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.6.1. The First Reporting Period for a SFY shalt begin on July I of that SFY and end
on December 31 of that SFY.
1.1.6.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and
end on June 30 of that SFY.
1.1.7 . Redetermination * A Determination as defined under l0 C.C,R. 2505-8.100.3.P.
1.1.8. State Fiscal Year (SFY)* The pedod beginning July 1 of each calendar year and
ending on June 30 of the following calendar year.
I .1.9. Timely Deteardnation/Redet6nnination * Any Determination/Redetermination that is
completed within the timeliness requirements set forth in 10 C.C.R.2505-8.100.3.D.
l.l.l0. Untimely Determination/ Redetermination * Any DeterminatiorlRedetermination that
is not completed within the timeliness requirements set forth in 10 C.C.R. 2505-
8.100.3.D.
1.1.11. Small, Medium and Large County*The size of the county is deterrrined by the case-
and workload of Medical Assistance enrollment; for a list of how all counties are
classified for the purposes of this contract, see Exhibit D.
l.l.l2. County Incentives Program Guide * A supplemental document, provided by the
Department to each County, that defines the expectations of the Department for the
county incentive program. This includes lists of collaboration partners, required
forms and other relevant materials.
2. COUNTY DETERMINATIONS
2,1.. The Contractor shall perfonn all Medicaid related work within the Contractor's county,
required under C.R.S. $25.5-l-101 et. seq. The Deparbnent and the Contractor share the
costs of this work performed by the Contractor as delined in those statutes and this
Contract shall not impact the allocated amount of that cost sharing.
3. PES.FORMAI{CE INCENTIV* PROGRAM
Page 6 of l3
3.1. The Contractor may earn an incentive payment to reimburse it for a portion of its cost
sharing as described in this Section 3.
3.2. Court Settlement Timeliness Incentive Standard
3.2.1. The Contractor may eam a Court Settlement Timeliness Incentive Payment for each
Reporting Period in which at least ninety-five percent (95%) of all Determinations
and Redeterminations completed were Timely Determinations/Redeterminations.
3.2.1,1. To determine the timeliness percent for this standard, the Department shall total
up all Timely Determinations and Redeterminations the Contractor completed
within the Reporting Period and divide that by the total number of Determinations
and Redeterminations the Contractor completed during that Reporting Period.
The Department shall round these calculated percentages to two (2) decimal
places. The Contractor shall be paid for each Reporting Period it meets the
incentive standards after the end of the fiscal vear in which the work was
performed.
3.2.1.2. In the event that the Contractor processes a total of fwo-hundred and forty (2a0)
or fewer Determinations and two-hundred and forfy (240) or fewer
Redeterminations per rnonth, the Contractor shall be deemed to have met this
performance standard so long as they had eighteen (18) or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
3.2.1.3. The Department will not include any Untimely Determinations/Redeterminations
in its calculation of this performance standard if the Department has approved that
Untimely Determination/Redetermination as being untimely because of unusual
circumstances. DeterminationslRedeterminations may be delayed for unusual
circumstances as described in I 0 C.C.R. 2505-8. 100.3.D(d).
3.2.1.3.t.The Contractor shall submit documentation with the semi-annual report to
request the Department's approval of that Determination as being untimely
because of unusual circumstances. The Contractor shall use the exemption
request forms in the County Incentives Program Guide for documentation.
When sending the form back to the Department, the Contractor shall name the
electronic file using the following naming mechanism "County
Name.Timeliness Exemption Request.Date" with the date being the end of the
reporting period in which the exemption is filed.
The Department may approve or reject any request for Untimely
Determination exemption and may limit the total number of exempted
Untimely Determinations.
3.2.2. The Department will determine the Contractor's compliance with the Court
Seftlement Timeliness Incentive Standard during each Reporting Period utilizing data
from the monthly Court Reports. Instructions for thE Contractor to look up cases
included in the court reports are in the County Incentives Program Cuide.
3.3. Collaborationlncentive Standard
3.3.1. The Contractor may eam a Collaboration Incentive Payment for each Reporting
Period in which it has hosted or attended Collaboration meetings with the partners
described below.
3.2.1.3.2.
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3.3.1.1.
3.3.1.1.1.
The Contractor shall host or attend at least one (l) meeting with at least three (3)
of the following during each calendar quarter:
Each Behavioral Healih Organization (BHO) that serves Clients in the
Contractor's County, See list of BHOs in the County Incentives Program
Guide.
Each Local Public Health Agency (LPHA) that serves Clients in the
Contractor's County.
Each Medical Assistance Site (MA Site) that s€rves Clients in the
Contractor's County. See list of MA Sites in the County Incentives Program
GuidE.
Each Regional Care Collaborative Organization (RCCO) that serves Clients in
the Contractor's County. See list of RCCOs in the County lncentives Program
Guide.
Regional Connect For Health Colorado Partners (C4).
Fiospitals and Clinics that serve Clients in the Contractor's County.
Federally Qualified Health Clinic (FQHC) that serves Clients in the
Contractor's County.
Private Practice Providers such as Medical, Dental or Behavioral Health that
serve Clients in the Contractor's County.
Community Mental Health Centers (CMHC) that serve Clients in the
Contractor's County. See list of CMHCs in the County Incentives Program
Guide.
Long-tetrn Care Facilities that serve Clients in the Contractor's County.
Single Entry Point (SEP) Agencies that serve Clients in the Contractor's
County. See list of SEPs in the County Incentives Program Guide.
County Sherif?Local Law Enforcement that serves Clients in the Contractor's
County.
Ute Mountain Ute Tribe.
Southern Ute Indian Tribe.
The Contractor may combine any or all of the meetings in this Section 3.3 to meet
the Collaboration Incentive Standard and does not need to have individual
meetings with each of the entities listed in section 3.3.1.1.
The Contractor may also host any or all of the meetings in this Section 3.3 in
collaboration with other counties, but in the event that it does combine any
meeting with another coun$r or other counties, the Contractor shall provide at
least one (l) representative to attend that meeting.
The Contractor shall develop the meeting agenda for each meeting it hosts.
The agenda shall include the following topics:
Recognition of the roles and responsibilities for each of the partners.
3.3.1.r.2.
3.3.1.1.3.
3.3.1.1.4.
3.3.1.l.5.
3.3.1.1.6.
3.3.1.1.7.
3.3.1.1.8.
3.3.1.1.9.
3.3.1.1. t0.
3.3.1.1.11.
3.3.1.1.12.
3.3.1.1.13.
3.3.1.1.14.
3.3.t.2.
3.3.1.3.
3.3.1.4.
3.3.1.4.1.
3.3"1.4.1.1.
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Cultivating collaboration and the coordination of services among all of the
partner agencies.
Establishing two (2) to three (3) goals that the partners would like to
accomplish over the next year to improve clients' access to care.
3.3.1.4.2. In the event that the Contractor hosts a meeting in collaboration with another
county or other counties, then the Contractor may develop the agenda in
collaboration with those other counties.
3.3.1.s.The Contractor shall take meeting minutes and compile a list of attendees for each
meeting it hosts. In the event that the Contractor hosts a meeting in collaboration
with another county or other counties, then the Contractor may create the meeting
minutes and list of attendees in collaboration with those other counties.
The Contractor shall document its compliance with the Collaboration
Incentive Standard by submitting the Collaboration Incentive template, see the
County Incentives Program Guide, providing the Department with the meeting
agenda, meeting minutes and list of attendees for each meeting it hosted,
either individually or collaboratively with other counties and the nvo (2) ta
three (3) goals as described in 3.3.1 .4.1.3. The Department will determine the
Contractor's compliance with the Collaboration Incentive Standard based on
the submission of the meeting agendas, meeting minutes and list of attendees
for all meetings during the Reporting Period. The Contractor shall use the
Collaboration Incentive Template found in the.County Incentives Program
Guide to organize the documentation. When sending the Collaboration
Template back to the Department, the Contractor shall name the electronic file
using the following naming mechanism "County Name.Collabortion
Incentive.Date" with the date being the end of the reporting period in which
the exemption is filed.
3.3.1.5.1.
3.4. Application Backlog Incentive Standard
3.4.t.
3.3.1.4.1.2.
3.3.1.4.1.3.
3.4.1.1 .
The Contractor may earn an Application Backlog Incentive Payment for each
Reporting Period in which the Application Backlog for new applications and
redeterminations is within the limits described in the following table:
County Backlog Table
New Applications
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3.4.1.2.2.
3.4.1.2. The Departrnent will not include any Backlogged Detemination in its calculation
of this performance standard if the Department has approved that Determination
as being backlogged because ofunusual circumstances.
3.4.1.2.r.The Contractor shall submit documentation with the ssni-annual report to
request the Departnrent's approval of that Determination as being in backlog
because of unusual circumstances. The Conkactor shall use the exemption
request forms in the County Incentives Program Guide for documentation.
When sending the form back to the Department, &e Conhactor shall name the
electronic file using the following naming mechanism "Coun!/
Name.Sacklog.Exemption Request.Date" with the date being the end of the
reporting period in which the exemption is filed.
The Department may approve or reject any request for Backlogged
Determination exemption and may limit the total number of exempted
Backlogged Determinations.
3.5. Training Incentive Standard
3.5.1. The Contractor may esm the Training Incentive Palrment for each Reporting Period
as long as at least seventy five percent (7596) of its medical eligibility firll time
equivalents (FTE) staff cornplete nine (9) hours of training. The required amount of
training can be spread throughout both reporting periods, as long as the required
amount is met at the conclusio:r of the second reporting period. Eligible trainings
shall include:
3.5.1.1. Medical eligibility training through the Health Care and Economic Security Staff
Development Center (SDC), County trainers who are certified through the SDC
and Department training.
3.5.1.2. When the Deparfrnent launches its new Learning Management System (LMS), the
Contractor will have the option to access and track online training in addition to
the SDC's curriculum.
3.5.2. Statewide, regional or local training may qualifu to meet the Training Incentive. The
Contractor shall seek approval for training developed by sources other than the SDC,
Department or SDC certified county trainers in advance of submitting the
documentation for the Training Incentive.
3.5.2.1. The Contractor shall provide agendas, training content and proof of participation
tbrough sign-in sheets or printed reports, such as those available tluough the
SDC's LMS.
3.6. MEQIP Reporting Incentive
3.6.1. The Contractor may earn a Medicaid Eligibility Quality Improvement Plan (MEQIP)
Reporting Incentive for each Reporting Period in which all quarterly reports and the
annual review plan are submitted by the specified due date below. If the due date falls
on a non-working day then the Contractor shall submit the report on the first working
dav after the due date.
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3.7.
3.7.t.
3.7.r.1.
3.7.1.2.
3.7.1.3.
3.7.1.4.
3.7.2.
3.7.2.1.
3.7.2.2.
4.t.1.r.4.
4.1 .1.1.5.
Quarterly Reporting
The Contractor shall create a Semi-Annual Ineentive Report for each Reporting
Period that includes all of the following for the Reporting Period:
The meeting agendas, meeting minutes, lists of attendees and goals to document
its compliance with the Collaboration Incentive Standard.
Any Untimely Determination exemption forms for the Reporting Period.
Any Backlogged Determination exemption forms for the Reporting Period.
All Training Reports for the Reporting Period.
The Contractor shall submit the Semi-Annual Incentive Report to the Department.
DELMRABLE: Semi-Annual Incentive Report
DUE: January 5s for the first reporting period ending December 3lst and July 5ft
for the second reporting period ending June 30h
4. COMPENSATION
4.1. Compensation
4. Ll. Incentive Payment
4.1.1.1. The Department shall pay the Contractor an Incentive Payment for each incentive
standard it meets during the applicable Reporting Period as follows:
4.1.1.l.t.The Department shall pay the Contractor a Court Settlement Timeliness
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that incentive.
The Department shall pay the Contractor a Collaboration Incentive Payment
as shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
The Department shall pay the Contractor a MEQIP Incentive Payment as
shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
The Department shall pay the Contractor an Application Backlog Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that incentive.
The Department shall pay the Contractor a Training Incentive Payment as
shown in Exhibit B for each Reporting Period that the Contractor meets the
4.t.t.1.2.
4.1.1.1.3.
requirements for that incentive.
4.1.2. Remaining Funds Incentive Pool Payment
4.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
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4.t.2,1.t.
4.1.2.1.1.1.
4.t.2.1.t.2.
4.t.2.t.2.
4.t.2.2.
4.1.2.2.t.
4.1.2.2.2.
4.1.2.2.3.
4.1.2.3.
The Remaining Funds Incentive Pool shall include the following:
The total amount of all base incentive payments allocated to any counties
that selected to not participate in the County Medicaid Eligibility
Determination Incentive Program for that SFY.
Each of the base incentive payments that were not earned by a county
during a Reporting Period in tbat SFY.
ln the event that the Remaining Funds Incentive Pool is zero dollars ($0.00)
for any SFY, the Contractor shall not receive a Remaining Funds Incentive
Pool Payment for that SFY.
The Remaining Funds Incentive Pool will be paid as follows:
The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amou$t of incentives met during that SFY.
Based on the proportion of total incentive funds that the Contractor is eligible
to be paid in each SFY, the Contractor shall receive the same proportion of
funds from the Remaining Funds Incentive Pool.
The Contractor's payment of funds from the Remaining Funds, Incentive Pool
shall never exceed the county's share of Medicaid expenditure, as specified in
4.2.2.
To carry out the Work under this Contract, the Contractor shall comply with the
County Incentive Program Guide.
4.2. PaymentProcedures
4.2-1. The Contractor shall receive an incentive allocation for each of the Reporting Periods
within ninety days (90) days following the end of the fiscal year in which the work
was performed. This allocation will reflect the maximum the contractor catr earn for
each incentive type per Reporting Period.
4.2.2. Actual incentive payment maximums are dependent on the county share of Medicaid
expenditure. In no event shall Contractor be paid more tban the Connactor's county
share of Medicaid expendi*re in any Reporting Period.
4.2.3. The Department may add any uneamed funds from the first Reporting Period into to
the second Reporting Period allocation for any SFY.
The Contractor shall receive the incentive payment through the County Financial
Management System (CFMS).
4.2.3.1.
4.2.4. The Department may use any uneamed second Reporting Period incentive payments
during the county administration close out process.
4.2.4.t.In the event that the Contractor believes that the calculation or determination of
any payment is incorrect, the Contractor shall notiff the Department of the error
within thirly (30) days of receipt of the payment or notification of the
determination of the pa)rment, as appropriate. The Department will review the
information presented by the Contractor and may make changes based on this
review. The determination or calculation that results from the Department's
review shall be final- No disputed payment shall be due until after the
Department has concluded its review.
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EXHIBIT D, SMALL, MEDIUM AND LARGE COUNTY LIST
The below categorizes counties as small, medium and large for purposes of qualification of
exemptions for timeliness and/or backlog incentives.
Small
Archuleta
Baca
Bent
Cheyenne
Clear Creek
Costilla
Crowley
Custer
Dolores
Elbert
Gilpin
Medium
Alamosa
Broomfield
Chaffee
Conejos
Delta
Douglas
Eagle
Fremont
Large
Adams
Arapahoe
Boulder
Denver
El Paso
Jefferson
Larimer
Mesa
Pueblo
Weld
Grand
Gunnison
Hinsdale
Jackson
Kiowa
Kit Carson
Lake
Lincoln
Mineral
Ouray
Park
Garlield
Huerfano
La Plata
Las Animas
Logan
Moffat
Montezuma
Montrose
Phillips
Pitkin
Rio Blanco
Routt
San Juan
San Miguel
Sedgwick
Summit
Washington
Yuma
Morgan
Otero
Prowers
Rio Grande
Saguache
Teller
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