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HomeMy WebLinkAboutC14-299 Health Care Policy & Financing AmendmentContract Routing Number 15-68444 CONTRACT AMENDMENT NO. 1 Original Contract Routing Number 14-56561, CMS 1. PARTIES This Amendment to the above -referenced Original Contract (hereinafter called the "Contract") is entered into by and between Eagle County Department of Social and Human Services, P.O. Box 850 Eagle, CO 81631, (hereinafter called "Contractor"), and the STATE OF COLORADO, acting by and through the Department of Health Care Policy and Financing, 1570 Grant Street, Denver, Colorado 80203 (hereinafter called "Department" or "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.") The Department 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 Contract for Healthy Communities Outreach and Case Management. The purpose of this Amendment is to modify the Statement of Work. 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 Contract, and the Contract and all prior amendments thereto, if any, remain in full force and effect except as specifically modified herein. 6. MODIFICATIONS The Contract and all prior amendments thereto, if any, are modified as follows: A. Section 4, Definitions, Subsection B, Exhibits and other Attachments, is hereby deleted in its entirety and replaced with the following: B. Exhibits and Other Attachments. The following documents are attached hereto and incorporated by reference herein: HIPAA Business Associate Addendum Exhibit A, Statement of Work Exhibit B, Sample Option Letter B. Section 19, General Provisions, Subsection I, Order of Precedence, is hereby deleted in its entirety and replaced with the following: Page 1 of 3 o0-1 I. Order of Precedence The provisions of this Contract shall govern the relationship of the State and Contractor. In the event of conflicts or inconsistencies between this Contract and its exhibits and attachments, including, but not limited to, those provided by Contractor, such conflicts or inconsistencies shall be resolved by reference to the documents in the following order of priority: i. Colorado Special Provisions ii. HIPAA Business Associate Addendum iii. The provisions of the main body of this Contract iv. Exhibit A, Statement of Work V. Exhibit B, Sample Option Letter C. Exhibit A, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit Al, Statement of Work, attached hereto and incorporated by reference into the Contract. All references within the Contract to Exhibit A shall be deemed to reference Al. D. Exhibit C, Customer Relationship Management Procedures, is hereby deleted in its entirety. 7. START DATE This Amendment shall take effect on its Effective Date. 8. ORDER OF PRECEDENCE Except for the Special Provisions and the HIPAA Business Associates Addendum, in the event of any conflict, inconsistency, variance, or contradiction between the provisions of this Amendment and any of the provisions of the Contract, the provisions of this Amendment shall in all respects supersede, govern, and control. The most recent version of the Special Provisions incorporated into the Contract or any amendment shall always control other provisions in the Contract or any amendments. 9. AVAILABLE FUNDS Financial obligations of the state payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted, or otherwise made available to the Department by the federal government, state government and/or grantor. REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK Page 2 of 3 Contract Routing Number 15-68444 THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's behalf and acknowledge that the State is relying on their representations to that effect. CONTRACTOR: Eagle County Department of Social and Human Services By:,jW 0By: Signature o Authorized Officer Date: �' 6 (� 4 Date: `�AkA T, R-/-A1-C� Printed Name of Authorized Officer V [ LL C,K.(� 4tca-\ By: Printed Title of Authorized Officer Date: STATE OF COLORADO: John W. Hickenlooper, Governor Susan E. Birch, MBA, BSN, RN Executive Director Department of Health Care Policy and Financing LEGAL REVIEW: John W. Suthers, Attorney General ALL CONTRACTS REOUIRE APPROVAL BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. an Date: STATE CONTROLLER: Robert Jaros, CPA, MBA, JD Department of Health Care Policy and Financing Page 3 of 3 EXHIBIT Al STATEMENT OF WORK SECTION 1.0 ACRONYMS, ABBREVIATIONS AND OTHER TERMINOLOGY 1.1. Acronyms, abbreviations and other terminology are defined at their first occurrence in this Statement of Work. The following list is provided to assist the reader in understanding acronyms, abbreviations and terminology used throughout this document. 1.1.1. 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 department of social/human services) and submitting the completed application for eligibility determination to a MA site or county department of social/human services. 1.1.2. Client means any person who is eligible for EPSDT Medicaid, a pregnant woman on Medicaid or any person on the Child Health Plan Plus (CHP+)program. 1.1.3. Community Partner means any individual or organization who may provide additional services or general assistance to Clients. 1.1.4. EBNE means eligible but not enrolled. 1.1.5. Provider means any entity that submits claims under Colorado Medical Assistance Programs for services rendered. 1.1.6. Refer means to offer to a Client or his/her representative the contact information for an individual or list of Community Partners and/or Providers in order to help meet the Client's individual needs. SECTION 2.0 CONTRACTOR'S GENERAL REQUIREMENTS 2.1. The Contractor may be privy to internal policy discussions, contractual issues, price negotiations, confidential medical information, Department financial information, and advance knowledge of legislation. In addition to all other confidentiality requirements of the Contract, the Contractor shall also consider and treat any such information as confidential and shall only disclose it in accordance with the terms of the Contract. 2.2. The Contractor shall work cooperatively with key Department staff and, if applicable, the staff of other Department contractors or other State agencies to ensure the completion of the Work. The Department may, in its sole discretion, use other contractors to perform activities related to the Work that are not contained in the Contract or to perform any of the Department's responsibilities. In the event of a conflict between the Contractor and any other Department contractor, the Department will resolve the conflict and the Contractor shall abide by the resolution provided by the Department. 2.3. The Contractor shall inform the Department on current trends and issues in the healthcare marketplace and provide information on new technologies in use that may impact the Contractor's responsibilities under this Contract. 2.4. Stated Performance Standards Page 1 of 9 2.4.1. Any section within this Statement of Work headed with or including the term "PERFORMANCE STANDARD" is intended to highlight a performance standard contained in this Statement of Work. The sections with this heading is not intended to expand or limit the requirements or responsibilities related to any performance standard. 2.5. Communication Requirements 2.5.1. Communication with the Department 2.5.1.1. The Contractor shall enable all Contractor staff to exchange documents and electronic files with the Department staff in formats compatible with the Department's systems. The Department currently uses Microsoft Office 2013 and/or Microsoft Office 365 for PC. If the Contractor uses a compatible program that is not the system used by the Department, then the Contractor shall ensure that all documents or files delivered to the Department are completely transferrable and reviewable, without error, on the Department's systems. 2.5.2. Communication with Clients, Providers and Other Entities 2.5.2.1. The Department will provide policies and procedures that include, but are not limited to, all of the following: 2.5.2.1.1. A description of how the Contractor will communicate to Clients any changes to the services those Clients will receive or how those Clients will receive the services. 2.5.2.1.2. A description of the communication methods, including things such as email lists, newsletters and other methods, the Contractor will use to communicate with Providers and Subcontractors. 2.5.2.1.3. The specific means of immediate communication with Clients and a method for accelerating the internal approval and communication process to address urgent communications or crisis situations. 2.5.2.1.4. A general plan for how the Contractor will address communication deficiencies or crisis situations, including how the Contractor will increase staff, contact hours or other steps the Contractor will take if existing communication methods for Clients or Providers are insufficient. 2.5.2.1.5. A requirement for the listing of the following individuals within the Contractor's organization, that includes cell phone numbers and email addresses: 2.5.2.1.5.1. An individual who is authorized to speak on the record regarding the Work, the Contract or any issues that arise that are related to the Work. 2.5.2.1.5.2. An individual who is responsible for any website or marketing related to the Work. 2.5.2.1.5.3. Back-up communication staff that can respond in the event that the other individuals listed are unavailable. 2.5.2.2. The Contractor shall deliver the Communication Plan to the Department for review and approval. Page 2 of 9 2.5.2.3. The Department shall review its policies and procedures on an annual basis and determine if any changes are required to account for any changes in the Work, in the Department's processes and procedures or in the Contractor's processes and procedures. 2.5.2.4. The Contractor shall not engage in any non -routine communication with any Client, any Provider, the media or the public without the prior written consent of the Department. 2.6. Performance Reviews 2.6.1. The Department may conduct performance reviews or evaluations of the Contractor in relation to the Work performed under the Contract. 2.6.2. The Department may work with the Contractor in the completion of any performance reviews or evaluations or the Department may complete any or all performance reviews or evaluations independently, at the Department's sole discretion. 2.6.3. The Contractor shall provide all information necessary for the Department to complete all performance reviews or evaluations, as determined by the Department, upon the Department's request. The Contractor shall provide this information regardless of whether the Department decides to work with the Contractor on any aspect of the performance review or evaluation. 2.6.4. The Department may conduct these performance reviews or evaluations at any point during the term of the Contract, or after termination of the Contract for any reason. 2.6.5. The Department may make the results of any performance reviews or evaluations available to the public, or may publicly post the results of any performance reviews or evaluations. 2.7. Renewal Options 2.7.1. The Department may, within its sole discretion, choose to not exercise any renewal option in the Contract for any reason. If the Department chooses to not exercise an option, it may reprocure the performance of the Work in its sole discretion. 2.8. Department System Access 2.8.1. In the event that the Contractor requires access to any Department computer system to complete the Work, the Contractor shall have and maintain all hardware, software and interfaces necessary to access the system without requiring any modification to the Department's system. The Contractor shall follow all Department policies, processes and procedures necessary to gain access to the Department's systems. 2.9. The Contractor shall fully cooperate with the scheduling of and participation in an annual site visit by Department designee as well as any follow up meetings deemed necessary by the Department to address specific issues requiring corrective action. 2.10. The Contractor shall have at least one member of its staff attend, in person, via conference call and/or web conferencing when available, at least 90 percent of all regular Healthy Communities Family Health Coordinator monthly meetings; and, in the same manner, attend all annual Healthy Communities statewide meetings, trainings or retreats. Page 3 of 9 2.11. The Contractor shall notify the Department within one (1) business day when any employee or subcontractor leaves employment and within ten (10) business days of hiring a new employee. 2.11.1. The Contractor shall ensure all provisions of this contract will be carried out during such employment/subcontractor gaps or transitions and shall secure replacements within sixty (60) days. 2.12. Other Personnel Responsibilities 2.12.1. The Contractor shall use its discretion to determine the number of Other Personnel necessary to perform the Work in accordance with the requirements of the Contract. In the event that the Department has determined that Contractor has not provided sufficient Other Personnel to perform the Work in accordance with the requirements of the Contract, the Contractor shall provide all additional Other Personnel necessary to perform the Work in accordance with the requirements of the Contract at no additional cost to the Department. 2.12.2. The Contractor shall ensure that all Other Personnel have sufficient training and experience to complete all portions of the Work assigned to them. The Contractor shall provide all necessary training to its Other Personnel, except for Department -provided training specifically described in the Contract. 2.12.3. The Contractor may subcontract to complete a portion of the Work required by the Contract. The conditions for using a Subcontractor or Subcontractors are as follows: 2.12.3.1. The Contractor shall provide the organizational name of each Subcontractor and all items to be worked on by each Subcontractor to the Department. 2.12.3.1.1. DELIVERABLE: Name of each Subcontractor and items on which each Subcontractor will work 2.12.3.1.2. DUE: The later of thirty (30) days prior to the Subcontractor beginning work or the Effective Date 2.12.3.1.3. The Contractor shall obtain prior consent and written approval for any use of ' Subcontractor(s). SECTION 3.0 PROJECT REQUIREMENTS 3.1. The Contractor shall work collaboratively with its Regional Care Collaborative Organization (RCCO) in providing outreach, case management and care coordination to clients. 3.1.1. The contractor shall meet with its RCCO to facilitate such collaborations a minimum of two (2) times per contact year. 3.2. Client Outreach and Program Education Page 4 of 9 3.2.1. The Contractor shall conduct a minimum of four (4) outreach activities per month to actively generate awareness and provide education to women and children currently enrolled in the Healthy Communities Program and those who are eligible for the Healthy Community Program, but are not enrolled (EBNE). The outreach activities shall, at a minimum, include information describing available programs and eligibility requirements on all of the following: 3.2.1.1. Medical assistance programs other than Medicaid and Child Health Plan Plus (CHP+). 3.2.1.2. Supplemental food programs for women, infants, and children. 3.2.1.3. Family Health Coordinators as a resource. 3.2.1.4. The Contractor shall assist clients in finding or accessing appropriate community resources and ensure families have access to the abovementioned programs. 3.3. The Contractor shall work to increase the number of well child and oral health visits as counted on the Centers for Medicare and Medicaid Services Early and Periodic Screening, Diagnostic, and Treatment (CMS EPSDT) 416 report to eighty percent (80%) for all ages under twenty one (2 1) and eligible for Medicaid. 3.3.1.1. The contactor shall work to increase physical health visits by three percent (3%) over the previous CMS 416 report. 3.3.2. The Contractor shall work to increase oral health visits by ten percent (10%) over five (5) years. 3.3.3. The Contractor shall use the 2010 CMS EPSDT 416 report as the baseline for the abovementioned oral health increase. 3.4. Community Outreach and Program Education 3.4.1. The Contractor shall educate the client regarding the availability of services offered by the Healthy Communities Program. 3.4.2. The Contractor shall assist Community Partners in understanding the Medicaid and CHP+ medical assistance programs, program benefits, and program administration. 3.4.3. The Contractor shall plan, manage, and coordinate collaborative efforts and/or activities with Community Partners to ensure better service delivery and education to the populations served. 3.4.4. The Contractor shall attend relevant meetings, conferences, and other channels of collaboration in conjunction with Community Partners at no additional cost to the Department. 3.5. Provider Outreach and Program Education 3.5.1. The Contractor shall educate providers on all services provided by or available through Healthy Communities Program. 3.5.2. The Contractor shall educate and assist providers with services covered by Medicaid and CHP+. 3.5.3. The Contractor shall educate the providers on all of the following: 3.5.3.1. The importance of the well care periodicity schedule. Page 5 of 9 3.5.3.2. Federal mandates that eighty percent (80%) of children under age twenty one (21) receive one (1) well child visit per year. 3.5.3.3. The importance of oral health and that a referral to a dentist should be given by age one (1). 3.5.4. The Contractor shall refer providers to the appropriate local department of human or social services, the Department, and/or community resource(s) as necessary. 3.5.5. The Contractor shall assist providers with missed appointment follow-up as requested. 3.6. Case Management and Program Navigation 3.6.1. The Contractor shall assist all EBNEs and clients enrolled in the Healthy Communities Program with the overall program navigation of the Medicaid and/or CHP+ programs. 3.6.2. The Contractor shall assist EBNEs with the application process, which includes all of the following: 3.6.2.1. Assisting the EBNEs with a paper Medicaid application or the Colorado Program Eligibility and Application Kit (PEAK). 3.6.2.2. Providing on site Presumptive Eligibility (PE) determinations for those who may qualify. 3.6.2.3. Providing an appropriate referral, when necessary, to another application assistance site, including, but not limited to a local department of human or social services, a Presumptive Eligibility (PE) site, a Certified Application Assistant Site (CAAS), or a Medicaid Assistance (MA) site. 3.6.2.4. The Contractor shall perform the following tasks for all individuals who qualify for the Healthy Communities Program: 3.6.2.5. Follow-up with pregnant women, children, families, and EBNEs regarding the status of their application as requested by the client. 3.6.2.6. Provide Healthy Communities Program clients with a list of appropriate Medicaid and CHP+ providers and referrals when appropriate. 3.6.2.7. Provide appointment assistance as requested by Medicaid eligible clients. 3.6.2.8. Provide referrals for medical and non-medical programs to Healthy Communities Program clients and their family members as requested by the client. 3.6.2.9. Provide missed appointment follow up as requested by physical, oral and mental health providers. 3.6.2.10. Provide follow-up assistance to clients who have not received services within six (6) months and/or annually for services defined in the Colorado Periodicity Schedule or by the CHP+ oral health periodicity schedule. 3.6.2.11. Assist in resolving any issues or concerns regarding enrollment into Medicaid or CHP+ and/or eligibility issues, including, but not limited to, facilitating contact with CHP+ contractors. Page 6 of 9 3.6.2.12. Assist clients with scheduling appointments and Non -Emergent Medical Transportation (NEMT) needs through the Medicaid Transportation Broker or local department of human or social services. 3.6.2.13. Assist clients with billing issues and/or any additional questions and issues regarding program benefits and/or navigation. 3.7. Client Relationship Management Database 3.7.1. The Contractor shall provide all employees' access for the program to use the Healthy Communities Client Relationship Management Database as required. 3.7.2. The Contractor shall assure that all local information needed to assist clients, such as providers, community resources, etc. are added to the Healthy Communities Client Relationship Management Database as they relate to the Healthy Communities Program in a timely manner to assure lists are available for use by clients and community partners as needed. 3.7.3. The Contractor shall assure that staff are computer literate and able to use the Healthy Communities Client Relationship Management Database to its full potential. 3.8. Reporting 3.8.1. The Contractor shall utilize the Healthy Communities Client Relationship Management Database to provide reporting. 3.8.2. The Contractor shall submit a detailed Budget Report to the Department within sixty (60) days of the issuance or renewal of a contract with the Department. At a minimum, the Budget Report shall include all anticipated program related expenses for employee(s) and operating expenses for the entire contractual period. 3.8.2.1. DELIVERABLE: Budget Report. 3.8.2.2. DUE: Within sixty (60) days of the issuance or renewal of a contract with the Department. 3.8.3. The Contractor shall assure the Healthy Communities Client Relationship Management Database is up to date by the 10th of the month following the reporting month. The Department will pull reports for monthly contacts, referrals, and outreach activities after the 10th and before the 15th of the month to meet the monthly reporting requirements. 3.8.4. By the 10th day of each month, the Contractor shall submit a Monthly Narrative Status Report summarizing the activity of the previous month including noteworthy accomplishments, project status, challenges or barriers to program efforts, and collaborations with community or other agency partners. 3.8.4.1. DELIVERABLE: Monthly Narrative Status Report. 3.8.4.2. DUE: By the 10th day of each month 3.8.5. The Contractor shall submit all requests for extensions of the deadline in section 3.8.5 (above) to the Department in writing no later than the 5th of the month. 3.8.6. The Contractor shall submit a Final Report to the Department utilizing reporting and information from the Healthy Communities Client Relationship Management Database. Page 7 of 9 3.8.6.1. The Final Report shall include, at a minimum, all of the following: 3:8.6.1.1. An analysis of any successes and challenges faced by the Contractor, based on their individual program and location, related to the Healthy Communities program during the contracted period; 3.8.6.1.2. An analysis of the contract year's activities, outcomes, trends, and results; 3.8.6.1.3. An analysis of their ability to meet CMS EPSDT requirements for well child, oral health, and lead testing; 3.8.6.1.4. An analysis of their ability to meet the oral, health periodicity schedule for CHP+ eligible children. 3.8.6.1.5. The Contractor shall provide Ad Hoc Reports as requested by the Department. 3.8.6.1.6. When an Ad Hoc Report is requested, the Contractor shall coordinate with the Department to confirm its understanding of the request and identify the best method for response. 3.8.6.1.7. The Contractor shall provide all ad hoc reports within thirty (30) days of the Department's request at no additional cost to the Department. 3.8.6.2. DELIVERABLE: Final Report. 3.8.6.3. DUE: Thirty (30) days after the contract expires, renews or is terminated. 3.9. Client Communications 3.9.1. The Contractor will use email and letter templates stored in the Healthy Communities Client Relationship Management Database for all written client communications unless otherwise inappropriate to use them. SECTION 4.0 TRAINING 4.1 The Department will provide training to Contractor as needed at the Departments discretion, to include: 4.1.1. Training on the Healthy Communities Client Relationship Management Database and access to the system for all of the Contractor's current employees working with the Healthy Communities Program in a timely manner. 4.1.2. Training on the Healthy Communities Client Relationship Management Database and access to the system for any new employee hired by the Contractor working with the Healthy Communities Program within ten (10) business days of being notified of the new hire. 4.1.3. Providing site visits as needed for quality assurance and training. SECTION 5.0 PAYMENT 5.1. The Contractor shall submit an invoice monthly based on the Contractor's actual expenditures for the period specified. All invoices shall be submitted using the Contract Reimbursement Statement Form in form and format provided by the Department. Page 8 of 9 5.2. All invoices shall reference the Contract by the Contract routing number that appears on the first page of the Contract. Invoice shall be based upon the cost of the Work performed during the term of this Contract, and, shall be supplemented or accompanied by supporting data and subcontractor invoices, upon request, covering the Work shown on the invoice. 5.3. Indirect costs shall not exceed five percent (5%) of the Contract Maximum Amount for the Contract year. 5.4. Supervision shall be defined as work performed by any employee or subcontractor who is not a regular contributor to the Healthy Communities Program as evidenced by their work recorded (or lack thereof) in the Healthy Communities Client Relations Management Database. 5.5. Supervision expenses are limited to five percent (5%) of the Contract Maximum Amount for the Contract year. 5.6. The total of the invoice submitted by the Contractor for all periods during a Contract year shall not exceed the Contract maximum amount for that year. Page 9 of 9 Date: I Original Contract Routing No. Option Letter No. 1 Contract Routing No. 119/2014 14-56561, GMS 1 15-70735 1) OPTIONS: Choose all applicable options listed in §I and in §2 and delete the rest. Option to renew only (for an additional ternt). 2) REQUIRED PROVISIONS: In accordance with the Contract between the State of Colorado, Department of Health Care Policy and Financing, and Eagle County Department of Social and Human Services, the State hereby exercises its option for an additional term beginning July 1, 2014 and ending on June 30, 2015. The maximum amount payable under the Contract is increased by $26,000.00 to a new total including all previous amendments, option letters, etc. for all State Fiscal Years of $52,000.00 as consideration for services ordered under the Contract. The table in Section 7 is hereby deleted in its entirety and replaced with the following: State Fiscal Year 2013-14 $26,000.00 State Fiscal Year 2014-15 $26,000.00 Total for all State Fiscal Years $52,000.00 3) EFFECTIVE DATE: The effective date of this Option Letter is upon approval of the State Controller or July 1, 2014, whichever is later. STATE OF COLORADO John W. Hickenlooper, GOVERNOR De ment of Halth Care Policyand Financing By: E. Birch, MBA, BSN, R ,f Executive Director ODS ✓�'7 Date: ALL CONTRACTS REOUIItE APPROVAL BY THE STATE CONTROLLER CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or services provided hereunder. STAT ONTRC Robe : By: TVA Departmen I are o Date: Page 1 of 1 Financing