HomeMy WebLinkAboutC13-072 HCPF Purchase OrderHIPAA BUSINESS ASSOCIATE ADDENDUM
This Business Associate Addendum (“Addendum”)is part of the Contract between the
State of Colorado,Department of Health Care Policy and financing and the Contractor.For
purposes of this Addendum,the State is referred to as “Department”,“Covered Entity”or “CE”
and the Contractor is referred to as “Associate”.Unless the context clearly requires a distinction
between the Contract document and this Addendum,all references herein to “the Contract”or
“this Contract”include this Addendum.
RECITALS
A.CE wishes to disclose certain information to Associate pursuant to the terms of the
Contract,some of which may constitute Protected Health Information (“PHI”)(defined
below).
B.CE and Associate intend to protect the privacy and provide for the security of PHI
disclosed to Associate pursuant to this Contract in compliance with the Health Insurance
Portability and Accountability Act of 1996,42 U.S.C.§1320d —1320d-$(“HIPAA”)as
amended by the American Recovery and Reinvestment Act of 2009 (“ARRA”)/HITECH
Act (P.L.111-005),and its implementing regulations promulgated by the U.S.
Department of Health and Human Services,45 C.f.R.Parts 160,162 and 164 (the
“Privacy Rule”)and other applicable laws,as amended.
C.As part of the HIPAA regulations,the Privacy Rule requires CE to enter into a contract
containing specific requirements with Associate prior to disclosure of PHI,as set forth in,
but not limited to,Title 45,Sections 160.103,164.502(e)and 164.504(e)of the Code of
federal Regulations (“C.F.R.”)and contained in this Addendum.
The parties agree as follows:
1.Definitions.
a.Except as otherwise defined herein,capitalized terms in this Addendum shall have
the definitions set forth in the HIPAA Privacy Rule at 45 C.F.R.Parts 160,162 and 164,as
amended.In the event of any conflict between the mandatory provisions of the Privacy Rule and
the provisions of this Contract,the Privacy Rule shall control.Where the provisions of this
Contract differ from those mandated by the Privacy Rule,but are nonetheless permitted by the
Privacy Rule,the provisions of this Contract shall control.
b.“Protected Health Information”or “PHI”means any information,whether oral or
recorded in any form or medium:(i)that relates to the past,present or future physical or mental
condition of an individual;the provision of health care to an individual;or the past,present or
future payment for the provision of health care to an individual;and (ii)that identifies the
individual or with respect to which there is a reasonable basis to believe the information can be
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used to identify the individual,and shall have the meaning given to such term under the Privacy
Rule,including,but no limited to,45 C.f.R.Section 164.501.
c.“Protected Information”shall mean PHI provided by CE to Associate or created
or received by Associate on CE’s behalf.To the extent Associate is a covered entity under
HIPAA and creates or obtains its own PHI for treatment,payment and health care operations,
Protected Information under this Contract does not include any PHI created or obtained by
Associate as a covered entity and Associate shall follow its own policies and procedures for
accounting,access and amendment of Associate’s PHI.
2.Obligations of Associate.
a.Permitted Uses.Associate shall not use Protected Information except for the
purpose of performing Associate’s obligations under this Contract and as permitted under this
Addendum.Further,Associate shall not use Protected Information in any manner that would
constitute a violation of the Privacy Rule if so used by CE,except that Associate may use
Protected Information:(i)for the proper management and administration of Associate;(ii)to
carry out the legal responsibilities of Associate;or (iii)for Data Aggregation purposes for the
Health Care Operations of CE.Additional provisions,if any,governing permitted uses of
Protected Information are set forth in Attachment A to this Addendum.Associate accepts full
responsibility for any penalties incurred as a result of Associate’s breach of the Privacy Rule.
b.Permitted Disclosures.Associate shall not disclose Protected Information in any
manner that would constitute a violation of the Privacy Rule if disclosed by CE,except that
Associate may disclose Protected Information:(i)in a manner permitted pursuant to this
Contract;(ii)for the proper management and administration of Associate;(iii)as required by
law;(iv)for Data Aggregation purposes for the Health Care Operations of CE;or (v)to report
violations of law to appropriate federal or state authorities,consistent with 45 C.f.R.Section
164.502(j)(1).To the extent that Associate discloses Protected Information to a third party,
Associate must obtain,prior to making any such disclosure:(i)reasonable assurances from such
third party that such Protected Information will be held confidential as provided pursuant to this
Addendum and only disclosed as required by law or for the purposes for which it was disclosed
to such third party;and (ii)an agreement from such third party to notify Associate within two
business days of any breaches of confidentiality of the Protected Infonnation,to the extent it has
obtained knowledge of such breach.Additional provisions,if any,governing permitted
disclosures of Protected Infonnation are set forth in Attachment A.
c.Appropriate Safeguards.Associate shall implement appropriate safeguards as are
necessary to prevent the use or disclosure of Protected Information other than as permitted by
this Contract.Associate shall comply with the requirements of the Security Rules,164.308,
164.310,164.312,and 164.316.Associate shall maintain a comprehensive written infonriation
privacy and security program that includes administrative,technical and physical safeguards
appropriate to the size and complexity of the Associate’s operations and the nature and scope of
its activities.
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d.Reporting of Improper Use or Disclosure.Associate shall report to CE in writing
any use or disclosure of Protected Inforn-iation other than as provided for by this Contract within
five (5)business days of becoming aware of such use or disclosure.
e.Associate’s Agents.If Associate uses one or more subcontractors or agents to
provide services under the Contract,and such subcontractors or agents receive or have access to
Protected Infonnation,each subcontractor or agent shall sign an agreement with Associate
containing substantially the same provisions as this Addendum and further identifying CE as a
third party beneficiary with rights of enforcement and indemnification from such subcontractors
or agents in the event of any violation of such subcontractor or agent agreement.Associate shall
implement and maintain sanctions against agents and subcontractors that violate such restrictions
and conditions shall mitigate the effects of any such violation.
f.Access to Protected Information.Associate shall make Protected Information
maintained by Associate or its agents or subcontractors in Designated Record Sets available to
CE for inspection and copying within ten (10)business days of a request by CE to enable CE to
fulfill its obligations to permit individual access to PHI under the Privacy Rule,including,but
not limited to,45 C.F.R.Section 164.524.
g.Amendment of PHI.Within ten (10)business days of receipt of a request from
CE for an amendment of Protected Information or a record about an individual contained in a
Designated Record Set,Associate or its agents or subcontractors shall make such Protected
Information available to CE for amendment and incorporate any such amendment to enable CE
to fulfill its obligations with respect to requests by individuals to amend their PHI under the
Privacy Rule,including,but not limited to,45 C.F.R.Section 164.526.If any individual requests
an amendment of Protected Information directly from Associate or its agents or subcontractors,
Associate must notify CE in writing within five (5)business days of receipt of the request.Any
denial of amendment of Protected Information maintained by Associate or its agents or
subcontractors shall be the responsibility of CE.
h.Accounting Rights.Within ten (10)business days of notice by CE of a request
for an accounting of disclosures of Protected Infonriation,Associate and its agents or
subcontractors shall make available to CE the information required to provide an accounting of
disclosures to enable CE to fulfill its obligations under the Privacy Rule,including,but not
limited to,45 C.f.R.Section 164.528.As set forth in,and as limited by,45 C.f.R.Section
164.52$,Associate shall not provide an accounting to CE of disclosures:(i)to carry out
treatment,payment or health care operations,as set forth in 45 C.f.R.Section 164.506;(ii)to
individuals of Protected Information about them as set forth in 45 C.f.R.Section 164.502;(iii)
pursuant to an authorization as provided in 45 C.F.R.Section 164.508;(iv)to persons involved
in the individual’s care or other notification purposes as set forth in 45 C.f.R.Section 164.510;
(v)for national security or intelligence purposes as set forth in 45 C.f.R.Section 164.5 l2(k)(2);
(vi)to correctional institutions or law enforcement officials as set fort in 45 C.F.R.Section
164.5 12(k)(5);(vii)incident to a use or disclosure otherwise permitted by the Privacy Rule;(viii)
as part of a limited data set under 45 C.F.R.Section 164.514(e);or (ix)disclosures prior to April
14,2003.Associate agrees to implement a process that allows for an accounting to be collected
and maintained by Associate and its agents or subcontractors for at least six (6)years prior to the
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request,but not before the compliance date of the Privacy Rule.At a minimum,such
information shall include:(1)the date of disclosure:(ii)the name of the entity or person who
received Protected Information and,if known,the address of the entity or person;(iii)a brief
description of Protected Information disclosed;and (Iv)a brief statement of purpose of the
disclosure that reasonably informs the individual of the basis for the disclosure,or a copy of the
individual’s authorization,or a copy of the written request for disclosure.In the event that the
request for an accounting is delivered directly to Associate or its agents or subcontractors,
Associate shall within five (5)business days of the receipt of the request forward it to CE in
writing.It shall be CE’s responsibility to prepare and deliver any such accounting requested.
Associate shall not disclose any Protected Information except as set forth in Section 2(b)of this
Addendum.
i.Governmental Access to Records.Associate shall make its internal practices,
books and records relating to the use and disclosure of Protected Information available to the
Secretary of the U.S.Department of Health and Human Services (the “Secretary”),in a time and
manner designated by the Secretary,for purposes of determining CE’s compliance with the
Privacy Rule.Associate shall provide to CE a copy of any Protected Information that Associate
provides to the Secretary concurrently with providing such Protected Information to the
Secretary.
j.Minimum Necessary.Associate (and its agents or subcontractors)shall only
request,use and disclose the minimum amount of Protected Information necessary to accomplish
the purpose of the request,use or disclosure,in accordance with the Minimum Necessary
requirements of the Privacy Rule including,but not limited to,45 C.F.R.Sections 164.502(b)
and 164.514(d).
k.Data Ownership.Associate ackuowledges that Associate has no ownership rights
with respect to the Protected Information.
1.Retention of Protected Information.Except upon termination of the Contract as
provided in Section 4(d)of this Addendum,Associate and its agents or subcontractors shall
retain all Protected Information throughout the term of this Contract and shall continue to
maintain the infonnation required under Section 2(h)of this Addendum for a period of six (6)
years.
m.Associate’s Insurance.Associate shall maintain casualty and liability insurance to
cover loss of PHI data and claims based upon alleged violations of privacy rights through
improper use or disclosure of PHI.All such policies shall meet or exceed the minimum
insurance requirements of the Contract (e.g.,occurrence basis,combined single dollar limits,
annual aggregate dollar limits,additional insured status and notice of cancellation).
n.Notification of Breach.During the term of this Contract,Associate shall notify
CE within two (2)business days of any suspected or actual breach of security,intrusion or
unauthorized use or disclosure of PHI and/or any actual or suspected use or disclosure of data in
violation of any applicable federal or state laws or regulations.Such notice shall include the
identification of each individual whose unsecured PHI has been,or is reasonably believed to
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have been accessed,acquired or disclosed during the breach.Associate shall take (i)prompt
corrective action to cure any such deficiencies and (ii)any action pertaining to such unauthorized
disclosure required by applicable federal and state laws and regulations.
o.Audits,Inspections and Enforcement.Within ten (10)business days of a written
request by CE,Associate and its agents or subcontractors shall allow CE to conduct a reasonable
inspection of the facilities,systems,books,records,agreements,policies and procedures relating
to the use or disclosure of Protected Information pursuant to this Addendum for the purpose of
determining whether Associate has complied with this Addendum;provided,however,that:(i)
Associate and CE shall mutually agree in advance upon the scope,timing and location of such an
inspection;(ii)CE shall protect the confidentiality of all confidential and proprietary information
of Associate to which CE has access during the course of such inspection;and (iii)CE shall
execute a nondisclosure agreement,upon tenns mutually agreed upon by the parties,if requested
by Associate.The fact that CE inspects,or fails to inspect,or has the right to inspect,
Associate’s facilities,systems,books,records,agreements,policies and procedures does not
relieve Associate of its responsibility to comply with this Addendum,nor does CE’s (i)failure to
detect or (ii)detection,but failure to notify Associate or require Associate’s remediation of any
unsatisfactory practices,constitute acceptance of such practice or a waiver of CE’s enforcement
rights under the Contract.
p.Safeguards During Transmission.Associate shall be responsible for using
appropriate safeguards to maintain and ensure the confidentiality,privacy and security of
Protected Information transmitted to CE pursuant to the Contract,in accordance with the
standards and requirements of the Privacy Rule,until such Protected Information is received by
CE,and in accordance with any specifications set forth in Attachment A.
q.Restrictions and Confidential Communications.Within ten (10)business days of
notice by CE of a restriction upon uses or disclosures or request for confidential communications
pursuant to 45 C.F.R.Section 164.522,Associate will restrict the use or disclosure of an
individual’s Protected Information,provided Associate has agreed to such a restriction.
Associate will not respond directly to an individual’s requests to restrict the use or disclosure of
Protected Information or to send all communication of Protected Information to an alternate
address.Associate will refer such requests to the CE so that the CE can coordinate and prepare a
timely response to the requesting individual and provide direction to Associate.
3.Obligations of CE.
a.Safeguards During Transmission.CE shall be responsible for using appropriate
safeguards to maintain and ensure the confidentiality,privacy and security of PHI transmitted to
Associate pursuant to this Contract,in accordance with the standards and requirements of the
Privacy Rule,until such PHI is received by Associate,and in accordance with any specifications
set forth in Attachment A.
b.Notice of Changes.CE shall provide Associate with a copy of its notice of
privacy practices produced in accordance with 45 C.f.R.Section 164.520,as well as any
subsequent changes or limitation(s)to such notice,to the extent such changes or limitation(s)
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may effect Associate’s use or disclosure of Protected Information.CE shall provide Associate
with any changes in,or revocation of permission to use or disclose Protected Information,to the
extent it may affect Associate’s permitted use or disclosure of PHI.CE shall notify Associate of
any restriction on the use or disclosure of Protected Information that CE has agreed to in
accordance with 45 C.f.R.Section 164.522.CE may effectuate any and all such notices of non-
private information via posting on CE’s web site.Associate shall review CE’s designated web
site for notice of changes to CE’s HIPAA privacy policies and practices on the last day of each
calendar quarter.
4.Termination.
a.Material Breach.In addition to any other provisions in the Contract regarding
breach,a breach by Associate of any provision of this Addendum,as determined by CE,shall
constitute a material breach of this Contract and shall provide grounds for immediate termination
of this Contract by CE pursuant to the provisions of the Contract covering termination for cause,
if any.If the Contract contains no express provisions regarding termination for cause,the
following terms and conditions shall apply:
(I)Default.If Associate refuses or fails to timely perform any of the
l)rovisions of this Contract,CE may notify Associate in writing of the non-performance,and if
not promptly corrected within the time specified,CE may terminate this Contract.Associate
shall continue performance of this Contract to the extent it is not terminated and shall be liable
for excess costs incurred in procuring similar goods or services elsewhere.
(2)Associate’s Duties.Notwithstanding termination of this Contract,and
subject to any directions from CE,Associate shall take timely,reasonable and necessary action
to protect and preserve property in the possession of Associate in which CE has an interest.
(3)Compensation.Payment for completed supplies delivered and accepted
by CE shall be at the Contract price.In the event of a material breach under paragraph 4(a),CE
may withhold amounts due Associate as CE deems necessary to protect CE against loss from
third party claims of improper use or disclosure and to reimburse CE for the excess costs
incurred in procuring similar goods and services elsewhere.
(4)ElToneous Termination for Default.If afier such termination it is
determined,for any reason,that Associate was not in default,or that Associate’s actionlinaction
was excusable,such termination shall be treated as a termination for the public interest,and the
rights and obligations of the parties shall be the same as if this Contract had been terminated for
the public interest,as described in this Contract.
b.Reasonable Steps to Cure Breach.If CE knows of a pattern of activity or practice
of Associate that constitutes a material breach or violation of the Associate’s obligations under
the provisions of this Addendum or another arrangement and does not terminate this Contract
pursuant to Section 4(a),then CE shall take reasonable steps to cure such breach or end such
violation,as applicable.If CE’s efforts to cure such breach or end such violation are
unsuccessful,CE shall either (i)terminate the Contract,if feasible or (ii)if termination of this
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Contract is not feasible,CE shall report Associate’s breach or violation to the Secretary of the
Department of Health and Human Services.
c.Judicial or Administrative Proceedings.Either party may terminate the Contract,
effective immediately,if (i)the other party is named as a defendant in a criminal proceeding for
a violation of HIPAA,the HIPAA Regulations or other security or privacy laws or (ii)a finding
or stipulation that the other party has violated any standard or requirement of HIPAA,the
HIPAA Regulations or other security or privacy laws is made in any administrative or civil
proceeding in which the party has been joined.
d.Effect of Termination.
(1)Except as provided in paragraph (2)of this subsection,upon termination
of this Contract,for any reason,Associate shall return or destroy all Protected Information that
Associate or its agents or subcontractors still maintain in any form,and shall retain no copies of
such Protected Information that Associate or its agents or subcontractors still maintain in any
form,and shall retain no copies of such Protected information.If Associate elects to destroy the
PHI,Associate shall certify in writing to CE that such PHI has been destroyed.
(2)If Associate believes that returning or destroying the Protected
Infonnation is not feasible,Associate shall promptly provide CE notice of the conditions making
return or destruction infeasible.Upon mutual agreement of CE and Associate that return or
destruction of Protected Information is infeasible,Associate shall continue to extend the
protections of Sections 2(a),2(b).2(c),2(d)and 2(e)of this Addendum to such information,and
shall limit further use of such PHI to those purposes that make the return or destruction of such
PHI infeasible.
5.Injunctive Relief.CE shall have the right to injunctive and other equitable and legal
relief against Associate or any of its agents or subcontractors in the event of any use or
disclosure of Protected Information in violation of this Contract or applicable law.
6.No Waiver of Immunity.No term or condition of this Contract shall be construed or
interpreted as a waiver,express or implied,of any of the immunities,rights,benefits,protection,
or other provisions of the Colorado Governmental Immunity Act,CRS 24-10-100 et seq.or the
federal Tort Claims Act,2$U.S.C.2671 et seq.as applicable,as now in effect or hereafier
amended.
7.Limitation of Liability.Any limitation of Associate’s liability in the Contract shall be
inapplicable to the terms and conditions of this Addendum.
8.Disclaimer.CE makes no warranty or representation that compliance by Associate with
this Contract,HIPAA or HIPAA Regulations will be adequate or satisfactory for Associate’s
own purposes.Associate is solely responsible for all decisions made by Associate regarding the
safeguarding of PHI.
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9.Certification.To the extent that CE determines an examination is necessary in order to
comply with CE’s legal obligations pursuant to HIPAA relating to certification of its security
practices,CE or its authorized agents or contractors may,at CE’s expense,examine Associate’s
facilities,systems,procedures and records as may be necessary for such agents or contractors to
certify to CE the extent to which Associate’s security safeguards comply with HIPAA,the
HIPAA Regulations or this Addendum.
10.Amendment.
a.Amendment to Comply with Law.The parties acknowledge that state and federal
laws relating to data security and privacy are rapidly evolving and that amendment of this
Addendum may re required to provide for procedures to ensure compliance with such
developments.The Parties specifically agree to take such action as is necessary to implement the
standards and requirements of HIPAA,the Privacy Rule,the final HIPAA Security Regulations
at 68 Fed.Reg.8334 (Feb 20,2003),45 C.F.R.§164.3 14 and other applicable laws relating to
the security or privacy of PHI.The parties understand and agree that CE must receive
satisfactory written assurance from Associate that Associate will adequately safeguard all
Protected Information.Upon the request of either party,the other party agrees to promptly enter
into negotiations concerning the terms of an amendment to this Addendum embodying written
assurances consistent with the standards and requirements of HIPAA,the Privacy Rule or other
applicable laws.CE may terminate this Contract upon thirty (30)days written notice in the event
(i)Associate does not promptly enter into negotiations to amend this Contract when requested by
CE pursuant to this Section or (ii)Associate does not enter into an amendment to this Contract
providing assurances regarding the safeguarding of PHI that CE,in its sole discretion,deems
sufficient to satisfy the standards and requirements of HIPAA and the Privacy Rule.
b.Amendment of Attachment A.Attachment A may be modified or amended by
mutual agreement of the parties in writing from time to time without formal amendment of this
Addendum.
11.Assistance in Litigation or Administrative Proceedings.Associate shall make itself,and
any subcontractors,employees or agents assisting Associate in the performance of its obligations
under the Contract,available to CE,at no cost to CE,up to a maximum of thirty (30)hours,to
testify as witnesses,or otherwise,in the event of litigation or administrative proceedings being
commenced against CE,its directors,officers or employees based upon a claimed violation of
HIPAA,the Privacy Rule or other laws relating to security and privacy or PHI,except where
Associate or its subcontractor,employee or agent is a named adverse party.
12.No Third Party Beneficiaries.Nothing express or implied in this Contract is intended to
confer,nor shall anything herein confer,upon any person other than CE,Associate and their
respective successors or assigns,any rights,remedies,obligations or liabilities whatsoever.
13.Interpretation and Order of Precedence.The provisions of this Addendum shall prevail
over any provisions in the Contract that may conflict or appear inconsistent with any provision in
this Addendum.Together,the Contract and This Addendum shall be interpreted as broadly as
necessary to implement and comply with HIPAA and the Privacy Rule.The parties agree that
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any ambiguity in this Contract shall be resolved in favor of a meaning that complies and is
consistent with HIPAA and the Privacy Rule.This Contract supersedes and replaces any
previous separately executed HIPAA addendum between the parties.
14.Survival of Certain Contract Terms.Notwithstanding anything herein to the contrary,
Associate’s obligations under Section 4(d)(“Effect of Termination”)and Section 12 (“No Third
Party Beneficiaries”)shall survive termination of this Contract and shall be enforceable by CE as
provided herein in the event of such failure to perform or comply by the Associate.This
Addendum shall remain in effect during the term of the Contract including any extensions.
15.Signature
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Persons signing for Contractor hereby swear and affirm that they are authorized to act on
Contractor’s behalf and acknowledge that the State is relying on their representations to
that effect.7,E
Contractor Legal Name:
Signature of Authorized
Officer or Agent:
Typed or Printed Name of
Authorized Officer or Agent:
Title of Authorized Officer or
Agent:
Date:
—,--I I:
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ATTACHMENT A
This Attachment sets forth additional terms to the HIPAA Business Associate
Addendum,which is part of the Contract between the State of Colorado,Department of Health
Care Policy and Financing and the Contractor and is effective as of the date of the Purchase
Order (the “Attachment Effective Date”).This Attachment may be amended from time to time
as provided in Section 10(b)of the Addendum.
1.Additional Permitted Uses.In addition to those purposes set forth in Section 2(a)of the
Addendum,Associate may use Protected Information as follows:
No additional permitted uses.
2.Additional Permitted Disclosures.In addition to those purposes set forth in Section 2(b)
of the Addendum,Associate may disclose Protected Information as follows:
No additional permitted disclosures.
3.Subcontractor(s).The parties acknowledge that the following subcontractors or agents of
Associate shall receive Protected Information in the course of assisting Associate in the
performance of its obligations under this Contract:
No additional permitted disclosures.
4.Receipt.Associate’s receipt of Protected Infonriation pursuant to this Contract shall be
deemed to occur as follows and Associate’s obligations under the Addendum shall commence
with respect to such PHI upon such receipt:
Upon receipt of PHI from the Department.
5.Additional Restrictions on Use of Data.CE is a Business Associate of certain other
Covered Entities and,pursuant to such obligations of CE,Associate shall comply with the
following restrictions on the use and disclosure of Protected Information:
No additional permitted uses.
6.Additional Terms.
No additional terms.
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PURCHASE ORDER TERMS AND CONDITIONS
1.OfferlAcceptance.If this purchase order (“PD”)refers
to vendors bid or proposal,this PD is an ACCEPTANCE
of vendor’s OFFER TO SELL in accordance with the
terms and conditions of the “solicitation”identified in
vendor’s bid or proposal.The solicitation includes an
RFP,lFB,or any other form of order by buyer.If a bid or
proposal is not referenced,this P0 is an OFFER TO BUY,
subject to vendor’s acceptance,demonstrated by
vendor’s performance or written acceptance of this PD.
Any COUNTER-OFFER TO SELL automatically
CANCELS this P0,unless a change order is issued by
buyer accepting a counter-offer.This P0 shall supersede
and control over any vendor form(s)or part(s)thereof
included in or attached to any bid,proposal,offer,
acknowledgment,or otherwise,in the event of
inconsistencies or contradictions,regardless of any
statement to the contrary in such form(s)or parts thereof.
2.Safety Information.All chemicals,equipment and
materials proposed and/or used in the performance of this
P0 shall conform to the requirements of the Occupational
Safety and Health Act of 1970.Vendor shall furnish all
Material Safety Data Sheets (MSDS)for any regulated
chemicals,equipment or hazardous materials at the time
of delivery.
3.Changes.Vendor shall furnish products and/or
services strictly in accordance with the specifications and
price set forth for each item.This P0 shall not be
modified,superseded or otherwise altered,except in
writing signed by purchasing agent and accepted by
vendor.Each shipment received or service performed
shall comply with the terms of this P0,notwithstanding
invoice terms or acts of vendor to the contrary,unless this
PD has been modified,superseded or otherwise altered
in accordance with this section.
4.Delivery.Unless otherwise specified in the solicitation
or this P0,delivery shall be FOB destination.Buyer is
relying on the promised delivery date,installation,and/or
service performance set forth in vendor’s bid or proposal
as material and basic to buyer’s acceptance.If vendor
fails to deliver or perform as and when promised,buyer,in
its sole discretion,may cancel its order,or any part
thereof,without prejudice to its other rights,return all or
part of any shipment so made,and charge vendor with
any loss or expense sustained as a result of such failure
to deliver or perform as promised.Time is of the essence.
5.Intellectual Property.Any software,research,reports,
studies,data,photographs,negatives or other
documents,drawings or materials (collectively
“materials”)delivered by vendor in performance of its
obligations under this P0 shall be the exclusive property
of buyer.Ownership rights shall include,but not be limited
to,the right to copy,publish,display,transfer,prepare
derivative works,or otherwise use the materials.Vendor
shall comply with all applicable Cyber Security Policies of
the State of Colorado (the “State”),or buyer,as
applicable,and all confidentiality and non-disclosure
Issued by the Office of the State Controller
agreements,security controls,and reporting
requirements.
6.Quality.Buyer shall be the sole judge in determining
“equals”with regard to quality,price and performance.All
products delivered shall be newly manufactured and the
current model,unless otherwise specified.
7.Warranties.All provisions and remedies of the
Colorado Uniform Commercial Code,CRS,Title 4
(“CUCC”),relating to implied and/or express warranties
are incorporated herein,in addition to any warranties
contained in this P0 or the specifications.
8.Inspection and Acceptance.Final acceptance is
contingent upon completion of all applicable inspection
procedures.If products or services fail to meet any
inspection requirements,buyer may exercise all of its
rights,including those provided in the CUCC.Buyer shall
have the right to inspect services provided under this P0
at all reasonable times and places.“Services”as used in
this section includes services performed or tangible
material produced or delivered in the performance of
services.tf any of the services do not conform to PD
requirements,buyer may require vendor to perform the
services again in conformity with P0 requirements,
without additional payment.When defects in the quality or
quantity of service cannot be corrected by re
performance,buyer may (a)require vendor to take
necessary action to ensure that future performance
conforms to P0 requirements and fb)equitably reduce
the payment due vendor to reflect the reduced value of
the services performed.These remedies do not limit the
remedies otherwise available in this P0,at law,or in
equity.
9.Cash Discount.The cash discount period will start
from the later of the date of receipt of acceptable invoice,
or from date of receipt of acceptable products/services at
the specified destination by an authorized buyer
representative.
10.Taxes.Buyer and the State are exempt from all
federal excise taxes under Chapter 32 of the Internal
Revenue Code [No.84-730123K]and from all State and
local government sales and use taxes [CRS,Title 39,
Article 26,Parts I and II].Such exemptions apply when
materials are purchased for the benefit of State,except
that in certain political subdivisions (e.g.,City of Denver)
vendor may be required to pay sales or use taxes even
though the ultimate product or service is provided to
buyer.Buyer shall not reimburse such sales or use taxes.
11.Payment.Buyer shall pay vendor for all amounts due
within 45 days after receipt of products or services and a
correct notice of amount due.Interest on the unpaid
balance shall begin to accrue on the 46th day at the rate
set forth in CRS §24-30-202(24)until paid in full.Interest
shall not accrue if a good faith dispute exists as to buyer’s
obligation to pay all or a portion of the amount due.
Vendor shall invoice buyer separately for interest on
delinquent amounts due,referencing the delinquent
Date Issued:7/1/74
Rule 2-2 Page 1 of 3 Date Revised:1/1/09
PURCHASE ORDER TERMS AND CONDITIONS
payment,number of day’s interest to be paid,and
applicable interest rate.
12.Vendor Offset.[Not Applicable to Inter
governmental POs]Under CR3 §24-30-202.4 (3.5),the
State Controller may withhold payment under the State’s
vendor offset intercept system for debts owed to State
agencies for:(a)unpaid child support debts or arrearages;
(b)unpaid balances of tax,accrued interest,or other
charges specified in CRS §39-21-101,etseq.;fc)unpaid
loans due to the Student Loan Division of the Department
of Higher Education;fd)amounts required to be paid to
the Unemployment Compensation Fund:and (e)other
unpaid debts owing to the State as a result of final agency
determination or judicial action.
13.Assignment and Successors.Vendor shall not
assign rights or delegate duties under this PD,or
subcontract any part of the performance required under
this P0,without the express,written consent of buyer.
This PD shall inure to the benefit of and be binding upon
vendor and buyer and their respective successors and
assigns.Assignment of accounts receivable may be made
only upon written notice furnished to buyer.
14.Indemnification.If any article sold or delivered under
this P0 is covered by a patent,copyright,trademark,or
application therefore,vendor shall indemnify and hold
harmless buyer from any and all loss,liability,cost,
expenses and legal fees incurred on account of any
claims,tegal actions or judgments arising out of
manufacture,sale or use of such article in violation or
infringement of rights under such patent,copyright,
trademark or application.If this PC is for services,vendor
shall indemnify,save,and hold harmless buyer,its
employees and agents,against any and all claims,
damages,liability and court awards including costs,
expenses,and attorney fees and related expenses,
incurred as a result of any act or omission by vendor,or
its employees,agents,subcontractors or assignees,
arising out of or in connection with performance of
services under this P0.
15.Independent Contractor.Vendor shall perform its
duties hereunder as an independent contractor and not as
an employee.Neither vendor nor any agent or employee
of vendor shall be deemed to be an agent or employee of
buyer.Vendor and its employees and agents are not
entitled to unemployment insurance or workers
compensation benefits through buyer and buyer shall not
pay for or otherwise provide such coverage for vendor or
any of its agents or employees.Unemployment insurance
benefits will be available to vendor and its employees and
agents only if coverage is made available by vendor or a
third party.Vendor shall pay when due all applicable
employment,income,and local head taxes incurred
pursuant to this PC.Vendor shall not have authorization,
express or implied,to bind buyer to any agreement,
liability or understanding,except as expressly set forth
herein.Vendor shall (a)provide and keep in force
workers’compensation and unemployment compensation
Issued by the Office of the State Controller
insurance in the amounts required by law,(b)provide
proof thereof when requested by buyer,and (c)be solely
responsible for its acts and those of its employees and
agents.
16.Communication.All communication concerning
administration of this P0,prepared by vendor for buyer’s
use,shall be furnished solely to purchasing agent.
17.Compliance.Vendor shall strictly comply with all
applicable federal and state laws,rules,and regulations in
effect or hereafter established,including,without
limitation,laws applicable to discrimination and unfair
employment practices.
18.Insurance.Vendor shall obtain,and maintain,at all
times during the term of this PD,insurance as specified in
the solicitation,and provide proof of such coverage as
requested by purchasing agent.
19.Termination Prior to Shipment.If vendor has not
accepted this P0 in writing,buyer may cancel this P0 by
written or oral notice to vendor prior to shipment of goods
or commencement of services.
20.Termination for Cause.(a)If vendor refuses or fails
to timely and properly perform any of its obligations under
this PC with such diligence as will ensure its completion
within the time specified herein,buyer may notify vendor
in writing of non-performance and,if not corrected by
vendor within the time specified in the notice,terminate
vendor’s right to proceed with the PC or such part thereof
as to which there has been delay or a failure.Vendor shall
continue performance of this PD to the extent not
terminated and be liable for excess costs incurred by
buyer in procuring similar goods or services elsewhere.
Payment for completed services performed and accepted
shall be at the price set forth in this P0.(b)Buyer may
withhold amounts due to vendor as buyer deems
necessary to reimburse buyer for excess costs incurred in
curing,completing or procuring similar goods and
services,(c)If after rejection,revocation,or other
termination of vendor’s right to proceed under the CUCC
or this clause,buyer determines for any reason that
vendor was not in default or the delay was excusable,the
rights and obligations of buyer and vendor shall be the
same as if the notice of termination had been issued
pursuant to termination under §21.
21.Termination in Public Interest.Buyer is entering into
this PC for the purpose of carrying out the public policy of
the State,as determined by its Governor,General
Assembly,and Courts.If this P0 ceases to further the
public policy of the State,buyer,in its sole discretion,may
terminate this PD in whole or in part and such termination
shall not be deemed to be a breach of buyer’s obligations
hereunder.This section shall not apply to a termination for
vendor’s breach,which shall be governed by §20.Buyer
shall give written notice of termination to vendor
specifying the part of the PC terminated and when
termination becomes effective.Upon receipt of notice of
termination,vendor shall not incur further obligations
except as necessary to mitigate costs of performance.For
Date Issued:711/74
Rule 2-2 Page 2 of 3 Date Revised:1/1/09
PURCHASE ORDER TERMS AND CONDITIONS
services or specially manufactured goods,buyer shall pay
a)reasonable settlement expenses,(b)the P0 price or
rate for supplies and services delivered and accepted,Cc)
reasonabte costs of performance on unaccepted supplies
and services,and (U)a reasonable profit for the
unaccepted work.For existing goods,buyer shall pay (e)
reasonable settlement expenses,(f)the PC price for
goods delivered and accepted,(g)reasonable costs
incurred in preparation for delivery of the undelivered
goods,and (Ii)a reasonable profit for the preparatory
work.Buyer’s termination liability under this section shall
not exceed the total PD price plus a reasonable cost for
settlement expenses.Vendor shall submit a termination
proposal and reasonable supporting documentation,and
cost and pricing data as required by CRS §24-106-101,
upon request of buyer.
22.P0 Approval.This PC shall not be valid unless it is
executed by purchasing agent.Buyer shall not be
responsible or liable for products or services delivered or
performed prior to proper execution hereof.
23.Fund Availability.Financial obligations of buyer
payable after the current fiscal year are contingent upon
funds for that purpose being appropriated,budgeted and
otherwise made available.If this PC is funded in whole or
in part with federal funds,this PD is subject to and
contingent upon the continuing availability of federal funds
for the purposes hereof.Buyer represents that it has set
aside sufficient funds to make payment for goods
delivered in a single installment,in accordance with the
terms of this PC.
24.Choice of Law.State laws,rules and regulations
shall be applied in the interpretation,execution,and
enforcement of this P0.The CUCC shall govern this P0
in the case of goods unless otherwise agreed in this P0.
Any provision included or incorporated herein by
reference which conflicts with such laws,rules,and
regulations is null and void.Any provision incorporated
herein by reference which purports to negate this or any
other provision in this PC in whole or in part shall not be
valid or enforceable or available in any action at law,
whether by way of complaint,defense,or otherwise,
Untess otherwise specified in the solicitation or this PC,
venue for any judicial or administrative action arising out
of or in connection with this PC shall be in Denver,
Colorado.Vendor shall exhaust administrative remedies
in CRS §24-109-106,prior to commencing any judicial
action against buyer.
25.Public Contracts for Services.[Not Applicable to
offer,issuance,or sale of securities,investment
advisory services,fund management services,
sponsored projects,intergovernmental POs,or
information technology services or products and
services]Vendor certifies,warrants,and agrees that it
does not knowingly employ or contract with an illegal alien
who will perform work under this P0 and will confirm the
employment eligibility of all employees who are newly
hired for employment in the United States to
Issued by the Office of the State Controller
Rule 2-2
under this P0,through participation in the E-Verify
Program or the Department program established pursuant
to CRS §8-1 7.5-1 02(5)(c),Vendor shall not knowingly
employ or contract with an illegal alien to perform work
under this P0 or enter into a contract or P0 with a
subcontractor that fails to certify to vendor that the
subcontractor shall not knowingly employ or contract with
an illegal alien to perform work under this PD.Vendor
shall (a)not use [-Verify Program or Department program
procedures to undertake pre-employment screening of job
applicants during performance of this PC,(b)notify
subcontractor and buyer within three days if vendor has
actual knowledge that subcontractor is employing or
contracting with an illegal alien for work under this P0,(c)
terminate the subcontract if subcontractor does not stop
employing or contracting with the illegal alien within three
days of receiving notice,and (U)comply with reasonable
requests made in the course of an investigation,
undertaken pursuant to CRS §8-17.5-102(5),by the
Colorado Department of Labor and Employment.If vendor
participates in the Department program,vendor shall
deliver to the buyer a written,notarized affirmation that
vendor has examined the legal work status of such
employee,and shall comply with all of the other
requirements of the Department program.tf vendor fails to
comply with any requirement of this provision or CRS §8-
17.5-101 et seq.,buyer may terminate this P0 for breach
and,if so terminated,vendor shall be liable for damages.
26.Public Contracts with Natural Persons.Vendor,if a
natural person eighteen (18)years of age or older,hereby
swears and affirms under penalty of perjury that he or she
(a)is a citizen or otherwise lawfully present in the United
States pursuant to federal law,(b)shall comply with the
provisions of CR5 §24-76.5-101 et seq.,and (c)has
produced a form of identification required by CRS §24-
76.5-1 03 prior to the date vendor delivers goods or begins
performing services under terms of the PC.
Date Issued:7/1/74
Date Revised:1/1/09Page3of3
STATEMENT OF WORK
1.0 PROJECT OVERVIEW
1.1 The Colorado Department of Health Care Policy and financing (the Department)is
contracting with Eagle County Health and Human Services (the Contractor)to provide
outreach to eligible but not enrolled (EBNE)for the family Medicaid and the Child
Health Plan Plus (CHP+)programs and outreach and administrative case management for
the eligible children and youth aged 20 and under and all pregnant women enrolled in
Medicaid and CHP+.
2.0 BACKGROUND
2.1 The Department is the single State Agency charged with the operation of the Early and
Periodic Screening,Diagnosis and Treatment (EPSDT)program in Colorado.EPSDT is
contained within Title XIX of the Social Security Act,Section 1905.EPSDT covers a
wide variety of services,including those that are listed in the state plan as well as those
that are medically necessary for the health of the child.The Department operates the
EPSDT program for children 20 and under as well as all pregnant women who are
eligible for Medicaid.By statute and operation,EPSDT is an entitlement program since it
is contained within Medicaid itself.
2.2 The Department is also the State Agency charged with the administration of the
Children’s Basic Health Plan (CBHP)marketed as CHP+.CBHP was enacted through
C.R.S.§25.5-8-101,through C.R.S.§25.5-8-113 et seq.CHP+is a health care coverage
program for children in families with incomes equal to or below 250%of the federal
poverty level.The CHP+program,by statute and operation,is a non-entitlement,
commercial-coverage health plan with largely privatized administration.Public/private
collaboration and cooperation are hallmarks of CHP+.
2.3 Healthy Communities combines the best aspects of the EPSDT Outreach and
Administrative Case Management program and the CHP+outreach program into one
program to better meet the needs of clients.
3.0 TERM OF PROJECT
3.1 The Contractor shall begin work upon acceptance of this purchase order.All work
pursuant to this statement of work and purchase order shall be completed no later than
June 30,2013,with a final Report due no later than July 15,2013.
4.0 DEFINITIONS
4.1 “Assist”means certified by the Department to assist potentially eligible clients in
completing the application,verifying documents (Certified Application Assistance Site
(CAAS),Presumptive Eligibility (PE)site,Medical Assistance (MA)site and/or county
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 1 of 10
department of social/human services)and submitting the completed application for
eligibility determination to a MA site or county department of social/human services.
4.2 “Refer”means not certified by the Department to assist potentially eligible clients in
completing the application and verifying documents,but knowledgeable about the
existence of and locations for CAAS,PE site,MA site,county department of
social/human services or the Colorado Program Eligibility Application Kit Colorado
PEAK)web site.
5.0 GENERAL REQUIREMENTS
5.1 The Contractor shall perform all work in accordance with all applicable Federal and State
statutes,regulations and rules,as now and hereafter amended,and the requirements
described within this Statement of Work and the purchase order.
5.2 The Contractor shall work closely and collaboratively with the Department,discuss
suggestions or issues as they occur and incorporate suggestions or guidance from the
Department while performing the work described within this Statement of Work and the
purchase order.
5.3 The Contractor shall coordinate and prioritize all work to ensure that all deliverables and
deadlines are met.
5.4 The Contractor shall employ an internal quality control process to ensure that all
deliverables are complete,accurate,easy to understand,and of high quality.The
Contractor shall provide deliverables that,at a minimum,are responsive to the specific
requirements,organized into a logical order,contain no spelling or grammatical errors,
formatted uniformly,and contain accurate information and correct calculations.The
Contractor shall retain all work papers generated for reference through the duration of the
project and project acceptance.The Contractor shall participate in the review and
revision process,until the Department provides written acceptance of the deliverable.
5.5 The Contractor shall provide copies of any supporting documentation to the Department
upon request of the Department and without charge.
5.6 The Contractor shall respond to all telephone calls and e-mail inquiries from the
Department within one (1)business day.
5.7 The Contractor shall provide electronic deliverables using Microsoft 2007 software.
5.8 PROJECT PERSONNEL
5.8.1 KEY PERSONNEL
5.8.1.1 The Contractor shall provide Key Personnel as specified.The Contractor must
identify all Key Personnel to the Department within thirty (30)days of the
effective date of this contract,including those who are not directly employed by
the Contractor.
5.8.1.2 The Department reserves the right to approve or disapprove all of the Key
Personnel assigned to this contract.In the event that a Key Personnel resigns or is
tenninated,the Contractor shall provide the Department with immediate notice of
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 2 of 10
the vacancy,the reason(s)for the vacancy and an action plan for filling the Key
Personnel position.A Key Personnel position shall not be vacant for more than
sixty (60)consecutive days.The Contractor may not fill vacant Key Personnel
positions with other existing personnel without approval by the Department.It is
the responsibility of the Contractor to cover the Key Personnel’s position during
leaves of absence.
5.8.1.3 The Contractor shall immediately notify the Department if any Key Personnel
cease to be assigned to this contract.Provided there is a good-faith reason for the
change,if Contractor wishes to replace Key Personnel,Contractor shall notify the
Department and seek its approval.Such approval is at the Department’s sole
discretion.Such notice shall specify why the change is necessary,who the
proposed replacement is,what their qualifications are and when the change would
take effect.Anytime Key Personnel cease to be assigned to this contract,the
Department,in its sole discretion,may direct Contractor to suspend work until
such time as their replacements are approved.All notices sent under this
subsection shall be sent in accordance with the Notices and Representatives
provisions of this contract.
5.8.1.4 The Key Personnel titles identified for this contract are as follows:
5.8.1.4.1 Contract Manager.
5.8.1.4.1.1 Contractor’s performance hereunder shall be under the direct supervision
of the Contract Manager,an employee or agent of Contractor,who is
hereby designated as the responsible party for the completion of the
Statement of Work for this contract.
5.8.1.4.2 Program Supervisor.
5.8.1.4.3 family Health Coordinator(s).
5.8.2 OTHER PERSONNEL
5.8.2.1 The Contractor shall provide Other Personnel who have previous experience in
providing quality work on projects of similar scope and size.
6.0 CONTRACTOR RESPONSIBILITIES
6.1 The Contractor shall serve Eagle County and provide Early and Periodic Screening,
Diagnosis and Treatment (EPSDT)services listed at 42 U.S.C.§1396(a)(43)and
1396d(2)(4)(B)and 10 C.C.R.2505-10.8.280,and to provide CHP+services listed at 42
CfR §457.90 through 42 CfR §457.110 and 42 CfR §457.340.
6.2 The Contractor shall demonstrate knowledge of standards and usage of the following
documents or websites:
6.2.1 Applications for Medicaid.
6.2.2 Colorado PEAK (colorado.gov/benefits).
6.2.3 Medicaid Medical Homes for Children Program (MedicalHomeColorado.org).
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 3 of 10
6.2.4 Peregrine Data Management (MedicalQuest.com).
6.2.5 Colorado Department of Health Care Policy and Financing including but not limited
to:
6.2.5.1 Medicaid Provider Services.
6.2.5.2 Provider bulletins.
6.2.5.3 Billing manuals.
6.2.5.4 Location of applications as well as the lists of locations of PE and CAAS sites.
6.2.5.5 Program fact sheets.
6,2.5.6 Medicaid co-pay information.
6.2.5.7 Behavioral Health infonriation.
6.2.5.8 CHP+program information (cchp.org).
6.2.6 Colorado Department of Public Health and Enviromiient including but not limited to:
6.2.6.1 Immunizations.
6.2.6.1 .1 VFC and Infant Immunization programs.
6.2.6.1.2 Colorado Immunization Information System (CIIS).
6.2.6.2 Health Care Program for Children with Special Needs (HCP).
6.2.6.3 Women,Infants,and Children (WIC).
6.2.6.4 Health Statistics.
6.2.7 Colorado Health Foundation (coloradohealth.org).
6.2.8 El Colorado (eicolorado.org).
6.2.9 Colorado Child Healthcare Access Program (CCHAP.org).
6.2.10 Centers for Medicare and Medicaid,EPSDT 416 reporting (CMS.gov).
6.2.11 Colorado Head Start (coloheadstart.org).
6.3 The Contractor shall conduct outreach to EBNE families to that includes,but is not
limited to,all of the following:
6.3.1 Generate awareness of all available programs.
6.3.2 Encourage families to apply for medical assistance.
6.3.3 Educate families on the availability of application assistance and PE sites or assist the
family with the application before referring them to an assistance site or submitting
the application from your site.
6.3.4 Provide applicants with education on the enrollment process and Medicaid and CHP+
benefits to increase their knowledge of and encourage enrollment in Medicaid and
CHP+.
6.3.5 Assist ERNE children and pregnant women with the application process.
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 4 of 10
6.3.6 Assist applicants in accessing and accessing PEAK for eligibility self-screening.
6.3.7 Refer EBNE children and pregnant women to a CAAS,PE site,MA site,county
department of social/human services or PEAK for the purpose of facilitated
enrollment in Medicaid and CHP+.
6.3.8 Educate parents and families on the other services and benefits available within the
community,including medical and non-medical programs.
6.4 The Contractor shall:
6.4.1 Participate in four (4)community activities per month.
6.4.2 follow-up with at least 25%of the EBNEs as to the outcome of the outreach.If the
family did not submit an application,inquire as to the reasons for non-submission of
an application and encourage the family to apply for coverage.Information regarding
this follow-up shall be contained in the monthly reporting for the EBNE families seen
during the previous three months.
6.4.3 Perform outreach to eligible families and pregnant women to provide “system
navigation”services that complement the health care services provided by Medicaid
and CHP+providers.The Contractor shall perform all services described in this
section in accordance with all applicable federal and state regulations and policies.
6.4.4 Provide information to families and pregnant women on available managed care
options to parents and families and refer them appropriately.
6.4.5 Provide referrals.If enrolled in CHP+,the referral shall be to the State Managed
Care Administrative Services Organization (ASO)contractor.If enrolled in
Medicaid,the referral shall be to the Colorado Medicaid Enrollment Broker to
facilitate their choice of providers;or Network (SMCN)or applicable MCO for
enrollment information.
6.4.6 Assist parents and families in selecting a managed care plan,Primary Care Provider
(PCP),ObstetricianlGynecologist (OB/GYN)or certified Medical Home and offer
clarification of the role of the PCP.
6.4.7 Assist parents and families to understand the need for timely and appropriate
appointments according to the Colorado Periodicity Schedule.
6.4.8 Assist parents and families in obtaining appointments with providers in appropriate
settings.
6.4.9 Educate parents and families on the financial responsibilities of Medicaid and/or
CHP+.
6.4.10 Assist parents and families with billing issues.
6.4.11 Assist the client in reporting the birth of a newborn.
6.4.12 facilitate parent and family access to medical home providers and resources available
in their community.
6.4.13 Educate parents and families on the other services and benefits available within the
community that they may be eligible for,including medical and non-medical
programs.
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 5 of 10
6.4.14 Assist parents and families with access to PEAK to determine whether they may be
eligible for public health insurance programs and if they are existing clients to check
their benefits.
6.4.15 The Contractor shall work with local community partners who provide medical and
non-medical programs and services that are not covered by Medicaid or CHP+.
6.4.16 The Contractor shall have family Health Coordinators conduct outreach and training
to community partners to ensure that families have accurate information and access to
needed community resources with an emphasis on:
6.4.16.1 Training community partners to understand the Department’s basic eligibility
guidelines and program rules and regulations to ensure appropriate client referrals
to providers for medical services.
6.4.16.2 Assisting community partners to identify additional resources and programs and
ensure that families have access to these programs.
6.4.16.3 Communicating the availability of family Health Coordinators as a resource to
any of the following:
6.4.16.3.1 Community partners.
6.4.16.3.2 Providers.
6.4.16.3.3 Child protection.
6.4.16.3.4 foster care.
6.4.16.3.5 Public health.
6.4.16.3.6 Schools.
6.4.16.3.7 All other interested parties.
6.4.16.4 Share lists of current providers who are accepting new clients,including office
hours and ages accepted to ensure current and proper referrals utilizing data from
the Department.
6.4.16.5 Assist community partners to engage families who appear eligible in one-on-one
discussions at health fairs and other health events regarding the financial and
health benefits of participation in Medicaid and CHP+,how to apply for these
programs and the benefits of the programs.
7.0 REPORTING
7.1 The Contractor shall submit reports to the Department according to the following
schedule:
STATUS REPORTING
REPORT DUE DATE CHANGE IN WORK PLAN
RESULTING IN CHANGE TN
:SERVICES
Monthly By the tenth (10th)If change has occurred,impact
Reports business day of each month must be reported in monthly report.
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page 6 of 10
for the prior month’s
performance results.
final Report No later than July 15,2013 If change has occurred,impact
must be reported in final report.
Ad hoc As requested by the
Report(s)Department
7.2 MONTHLY REPORT
7.2.1 The Contractor shall create an electronic spreadsheet which captures all required
information for the monthly report.
7.2.2 The Contractor shall provide a monthly report in an electronic spreadsheet format as
specified by the Department.All reports shall include the status and outcomes of
activities performed by a Family Health Coordinator,including all of the following:
7.2.2.1 Contacts with EBNE clients,including the following data elements in an
electronic spreadsheet format:
7.2.2.1.1 Social Security number,last name,first name,middle initial and date of birth
(DOB);
7.2.2.1.2 Notation that the Contractor assisted the client with the application process;
7.2.2.1 .3 Notation that the Contractor referred the client to an appropriate eligibility
site;
7.2.2.1.4 Contacts with enrolled clients,including whether the contact was:
7.2.2.1.4.1 Face-to-face.
7.2.2.1.4.2 Telephone.
7.2.2.1.4.3 Letter.
7.2.2.1.4.4 Through other social marketing or electronic means.
7.2.2.2 Contacts with Medicaid providers,CHP+providers,community resources and
community partners.
7.2.2.3 Clients assisted in obtaining or making follow-up appointments with providers in
appropriate settings.
7.2.2.4 Clients assisted in reporting the birth of their newborn.
7.2.2.5 Appropriate referrals (appropriate means a referral,which meets the family’s
specific needs for community resources)made to specific providers and
community partners.
7.2.2.6 Families who established access through a medical home provider.
7.2.2.7 Requests for assistance from specific providers and community partners as well as
completed tasks related to the requests.
7.2.2.8 Referrals received from specific providers and community partners.
7.2.2.9 “Lessons learned”and “best practices”experienced while working in provider
offices.
Attachment A to Purchase Order #XX-UHA-XXX12XXXXXX Page7oflO
7.2.2.10 Details of any significant monthly change in the Contractor’s operations that
could cause a change in capacity to meet the requirements in the Statement of
Work.
7.2.3 The Contractor shall implement any Department-approved changes to the
Contractor’s reports in subsequent months.
7.3 FINAL REPORT
7.3.1 The Contractor shall submit a final report summarizing successes and challenges of
the program over the contract period.The Contractor shall submit final report to the
Department by July 15,2013 for the prior contract year.The Contractor shall provide
the Department with an executive summary of the contract year’s activities and
outcomes,trends and results.
7,4 AD HOC REPORTS
7.4.1 Ad Hoc reports are defined as reports that the Department may require the Contractor
to generate on an as-needed basis.When the Department requests information that is
not part of usual business processes,the Contractor shall coordinate with the
Department to confirm its understanding of the request,identify the best method for
response and respond fully by providing such report within thirty (30)days of the
Department’s request.
8.0 PERFORMANCE STANDARDS
8.1 The Contractor shall demonstrate progress in performing outreach to EBNE families as
measured by the enrollment of the family in the appropriate medical assistance program.
8.2 The Contractor shall demonstrate increased physical,oral health and mental health
utilization in their service area(s)for EPSDT children as measured by the EPSDT 416
and other billing reports.
8.3 The Contractor shall demonstrate completion of at least four (4)training and outreach
activities a month,listing the attendees and a reason for training.
8.4 The Contractor shall ensure the community partners have knowledge of Family Health
Coordinators and the community partners’interactions with the family Health
Coordinator have resulted in clients making the appropriate appointment.
8.5 A survey administered by the Department will verify whether the Contractor has met the
established goal of eighty percent (80%)of the community partners having knowledge of
Family Health Coordinators and whether the community partners’interactions with the
Family Health Coordinator have resulted in clients making the appropriate appointment.
9.0 COMPENSATION
9.1 The total amount of funding for this fixed price purchase order for all work to be
performed pursuant to this Statement of Work is $13,000.00.This total amount of
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finding will be the sole compensation to the Contractor for the services and/or
deliverables provided.
9.2 The Contractor shall submit an invoice monthly based on the Contractor’s actual
expenditures for the period specified.
9.3 All invoices shall reference the Contract by the contract routing number which appears
on the first page of the Contract.Invoices shall be based upon the costs of the work and
services performed during the term of this Contract;and,shall be supplemented or
accompanied by supporting data and subcontractor invoices,if any,covering the work
shown on the invoice.Indirect costs shall not exceed five percent (5%)of the contract
Maximum Amount for the contract year.The total of the invoices submitted by the
Contractor for the specified period shall not exceed the contract Maximum Amount.
10.0 DEPARTMENT RESPONSIBILITIES
10.1 The Department will:
10.1.1 Provide education and training for the Contractor on Family Medicaid and CHP+
eligibility requirements,enrollment procedures and benefits.
10.1.2 Provide training for the Contractor to become a CAAS or PE site,if requested.
10.1.3 Provide the Contractor with necessary Managed Care Organizations (MCO)contacts,
MCO client referral procedures and health plan information.
10.1.4 Provide the Contractor with a template to use for submittal of invoices.
10.1.5 Conduct a baseline survey at the completion of the Contract on client satisfaction to
determine how the client’s interaction with the Family Health Coordinators assisted
them in accessing health care services and give the results to the Contractor.
10.1.6 Conduct a baseline survey at the completion of the Contract on provider satisfaction
to determine how the provider’s interaction with the family Health Coordinators
assisted them in serving their clients.
10.1.7 Provide the Contractor with the necessary program procedures and documents
required to provide education and training to community partners.
10.1.8 Provide feedback on areas where the Contractor’s training process needs
improvement.
10.1 .9 Conduct a baseline survey at the completion of the Contract of community partners
on their knowledge of the family Health Coordinators and the community partners’
assessment of the family Health Coordinator’s effectiveness in providing accurate
and timely assistance and the results given to the Contractor.
10.1.10 Be responsive to e-mail,telephone calls or messages and will be available for
meetings with the Contractor for this project.
10.1.11 Provide Departmental review,comments,and guidance in response to the
Contractor’s concerns or questions related to this project.
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10.1.12 Submit payment to the Contractor upon the Department’s review and acceptance of
deliverables and invoicing received from the Contractor.
11.0 HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT
(HIPAA).
11 .1 Federal law and regulations governing the privacy of certain health insurance requires a
business associate contract between the Department and the contractor.45 C.F.R.§
164.504(e).Attached hereto and incorporated herein by reference and agreed to by the
parties is a HIPAA Business Associate Addendum for HIPAA compliance.Terms of the
Addendum shall be considered binding upon the execution of this contract and shall
remain in effect during the term of the contract including any extensions.
Statement of Work Approved by:
Eagle County Man,g
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