HomeMy WebLinkAboutbocc.con.327.2016 A C tW)
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
NTRACT
OF PITKIN COUNTY, COLORADO
0 14
APPROVING AN INTERGOVERNMENTAL AGREEMENT WITH HEALTH CARE
POLICY AND FINANCING FOR THE COUNTY MEDICAID INCENTIVE
it PROGRAM
fro RESOLUTION NO. or of 2016
1. C.R.S. 25.5-1-101 et.seq. and 10 CCR 2505-10 et.seq. and funds have been
budgeted, appropriated and otherwise made available and a sufficient
unencumbered balance therof remains available for payment. Required approvals,
clearance and coordination have been accomplished from and with appropriate
agencies.
2. C.R.S 29-1-201 et seq provides that governments may cooperate with one another
to provide any function, service or facility lawfully authorized to each by contract
specifying the purposes,power,rights, obligations and responsibilities, financial
and otherwise, of the contracting parties; and
3. Pitkin County Board of County Commissioners acknowledge the value of meeting
state Medicaid performance standards related to Medicaid eligibility and
cooperation with other Medicaid related entities in an effort to provide the highest
quality service to its constituents.
4. Pitkin County Board of County Commissioners desire to enter into this
Intergovernmental Agreement with Health Care Policy and Financing in order to
receive financial incentives for meeting the agreed upon Medicaid performance
standards.
NOW, THEREFORE,BE IT RESOLVED by the Board of County Commissioners of
Pitkin County, Colorado that: : Pitkin County is authorized to enter into an
Intergovernmental Agreement with Health Care Policy and Financing in substantially
the same form satisfactory to the County Attorney; and authorizes the Chair or the
Director of Health and Human Services to sign the agreement on behalf of the County
and further, authorization for the Director of Health and Human Services to sign all
future amendments to this intergovernmental agreement with approval of such by the
county manager.
INTRODUCED,READ AND ADOPTED AS AN EMERGENCY RESOLUTION ON
THE `f DAY OF iptc-e-- 2016 AN - SET FOR CONFIRMATORY
PUBLIC HEARING ON THE 0- DAY OF , 2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND TITLE AND SHORT
SUMMARY OF THE EMERGENCX RESOLUTION P BLISHED IN THE ASPEN.
TIMES WEEKLY ON THE 9L DAY OF />>2 , 2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE
RESOLUTION POSTED ON THE OFFICIAL PITKIN COUNTY WEBSITE
www.pitkincounty:com ON THE q14-' DAY OF (JO 2016.
CON FI MED AT A CONFIRMATORY PUBLIC HEARING ON THE V AA-eDAY
OF 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY,AFTER CONFIRMATORY
PUBIC HEARING, IN THE ASPEN TIMES WEEKLY ON THE _ )AY OF
, 2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN COUNTY
WEBSITE www.pitkincounty.corn ON THE 23 -DAY OF I/ tee 2016
ATTE : BOARD OF COUNTY COMMISSIONERS
BY / r L
BY: ]I1 �� / //L 1 '
Jean- to Jones ,: . . el E. Ric ards, Chai
Dep y County Clerk
Date: ia
gSf
APPROVED AS TO FORM: MANAGER APPROVAL
John Ely, Co . • tto -y on Peck, County Manager
2
CONTRACT# y'�-�6/`
Department of Health Care Policy and Financing
Agreement Routing Number 2015CMIP097A1
AGREEMENT AMENDMENT NO. 1
Original Agreement Routing Number 2015CMIP097
1. PARTIES
This Amendment to the above-referenced Original. Agreement (hereinafter called the
"Agreement") is entered into by and between the Department of Health Care Policy and
Financing, 1570 Grant Street, Denver, CO 80203 (hereinafter called "HCPF" or the
"Department"), and the Pitkin County(hereinafter called"Contractor"),who may collectively be
called the "Parties" and individually a "Party", both of which are agencies of the STATE OF
COLORADO,hereinafter called the"State".
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date"). HCPF shall not
be liable to pay or reimburse Contractor for any performance hereunder, including, but not
limited to, costs or expenses incurred, or be bound by any provision hereof prior to the Effective
Date.
3. FACTUAL RECITALS •
The Parties entered into the Agreement. to create incentives ,for counties that achieve certain
incentive performance standards related to Medicaid eligibility and cooperation with other
Medicaid related entities. The purpose of this Amendment is to add exhibits and update the
incentives.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained.herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
CT
This Amendment is incorporated by reference into the Agreement, and the Agreement and all
prior amendments thereto, if any,remain in full force,and effect except as specifically modified
herein.
6. MODIFICATIONS •
The Agreement and all prior amendments thereto,if any, are modified as follows:
A. Section 4,Definitions, Subsection B is hereby deleted in its entirety and replaced with the
following:
B. Exhibits and other Attachments. The following documents are attached hereto and
incorporated by reference herein:
BJPAA Business Associate Addendum
Exhibit A, Statement of Work
Exhibit B,Rates
Exhibit C,Sample Option Letter
Exhibit D, Small,Medium, and Large County List
C. Exhibit A, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A-1, Statement of Work, attached hereto and incorporated by reference into the
Agreement. All references within the Agreement to Exhibit A, shall be deemed to
reference to Exhibit A-1.
D. Exhibit B, Rates, Section 1.2., SFY 2015-16 Incentive Payment Table, is hereby deleted
in its entirety and replaced with the following:
1.2. SFY 2015-16 Incentive Payment Table
Incentive Payment Name Payment Amount
Court Settlement Timeliness Incentive Payment $2,481.71
Collaboration.Incentive Payment $930.64
Application Backlog Incentive Payment $1,240.88
Training Incentive Payment $930.64
MEQIP Reporting Incentive Payment $620.42
Total Maximum Available for $6,204.29
all Incentive Payments
E. Exhibit B, Rates, Section 2.2., SFY 2015-16 Pool Maximum County Share Table, is
hereby deleted in its entirety and replaced with the following:
2.2. SFY 2015-16 Pool Maximum County Share Table
Payment Pool Maximum Distribution Amount
Total Maximum Available for Pool $2,068.10
Distributions
F. Exhibit D, Small, Medium and Large County List, is hereby attached hereto and
incorporated herein.
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE •
Execpt for the HIPAA Business Associates Addendum, in the event of any conflict,
inconsistency, variance, or contradiction between the provisions of this Amendment and any of
Page 2 of 13
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the provisions of the Agreement, the provisions of this Amendment shall in all respects
supersede,govern,and control.
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 HCPF by the
federal government, state government and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
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Page 3 of 13
Amendment Routing Number 2015CMIP097A1
THE PARTIES HERETO HAVE EXECUTED THIS INTERAGENCY AGREEMENT
Persons signing for Parties hereby swear and affirm that they are authorized to act on behalf of
their respective Party and acknowledge that the other Party is relying on their representations to
that effect.
STATE OF COLORADO •
John W.Hickenlooper,Governor
•
Pitkin County Department of Health Care Policy and
'.ancing
By: CkAre.A.4 F, I IrZ • 40
Name of authorized signer By: • — 40
Title Susan E.Birch,MBA,BSN,RN
..b r vk 0 O C-C Executive Director
Date: Laf 27—,20 /5
Date: Ult. I 1
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ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
TATE CONTROLLER
4terCPA,MBA,JD
By: (06/11.4--
Department of Health Care Poliand Financing •
Date: / i /ioT(�T
Page5 of 13
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EXHIBIT A-1,STATEMENT OF WORK
1. TERMINOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms,
abbreviations and terminology used throughout this document.
1.1.1. Applicant—An individual for whom the Contractor is performing a Determination.
1.1.2. Behavioral Health Organisation (BHO) - An orgrni7ation that arranges for enrolled
Clients to get medically, necessary behavioral health services. For a list of BHOs,
please see the County Incentive Program Guide.
1.1.3. Backlogged Determination—Any Untimely Determination that is not yet complete.
1.1.4. Client—An individual who is eligible for the Colorado Medical Assistance Program.
1.1.5. Determination —The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program.
1.1.6. Reporting Period—The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.6.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end
on December 31 of that SFY.
1.1.6.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and
end on June 30 of that SPY.
1.1.7. Redetermination—A Determination as defined under 10 C.C.R.2505-8.100.3.P.
1.1.8. State Fiscal Year (SPY) — The period beginning July 1 of each calendar year and
ending on June.30 of the following calendar year.
1.1.9. Timely Determination/Redetermination—Any Determination/Redetermination that is
completed within the timeliness requirements set forth in 10 C.C.R.2505-8.100.3.D.
1.1.10. Untimely Determination/Redetermination—Any Determination/Redetermination that
is not completed within the timeliness requirements set forth in 10 C.C.R. 2505-
8.100.3.D.
1.1.11. Small,Medium and Large County—The size of the county is determined by the case-
and workload of Medical Assistance.enrollment; for a list of how all counties are
classified for the purposes of this contract,see Exhibit D.
1.1.12. County Incentives Program Guide — A supplemental document, provided by the
Department to each County, that defines the expectations of the Department for the
county incentive program. This includes lists of collaboration partners, required
forms and other relevant materials.
2. COUNTY DETERMINATIONS •
2.1. The Contractor shall perform all Medicaid related work within the Contractor's county,
required under C.R.S. §25.5-1-101 et seq. The Department and the Contractor share the
costs of this work performed by the Contractor as defined in those statutes and this
Contract shall not impact the allocated amount of that cost sharing.
3. PERFORMANCE INCENTIVE PROGRAM
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Page 6 of 13
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3.1. The Contractor may earn an incentive payment to reimburse it for a portion of its cost
sharing as described in this Section 3.
3.2. Court Settlement Timeliness Incentive Standard
3.2.1. The Contractor may earn a Court Settlement Timeliness Incentive Payment for each
Reporting Period in which at least ninety-five percent (95%) of all Determinations
and Redeterminations completed were Timely Determinations/Redeterminations.
3.2.1.1. To determine the timeliness percent for this standard, the Department shall total
up all Timely Determinations and Redeterminations the Contractor completed
within the Reporting Period and divide that by the total number of Determinations
and Redeterminations the Contractor completed during that Reporting Period.
The Department shall round these calculated percentages to two (2) decimal
places. The Contractor shall be paid for each Reporting Period it meets the
incentive standards after the end of the fiscal year in which the work was
performed.
3.2.1.2. In the event that the Contractor processes a total of two hundred and forty (240)
or fewer Determinations and two hundred and forty (240) or fewer
Redeterminations per month, the Contractor shall be deemed to have met this
performance standard so long as they had eighteen (18) or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
3.2.1.3. The Department will not include any Untimely Determinations/Redeterminations
in its calculation of this performance standard if the Department has approved that
Untimely Detenriination/Redetermination as being-untimely because of unusual .
circumstances. Determinations/Redeterminations may .be delayed for unusual
circumstances as described in 10 C.C.R.2505-8.100.3.D(d).
3.2.1.3.1. The Contractor shall submit documentation With the semi-annual report to
request the Department's approval of that Determination as being untimely
because of unusual circumstances. The-Contractor..shall use the exemption
request forms in the County Incentives Program Guide for documentation.
When sending the form back to the Department,the Contractor shall name the
electronic file using the following naming mechanism "County
Name_Timeliness Exemption RequestDate"with the date being the end of the
reporting period in which the exemption is filed.
3:2.1.3.2. The Department may. approve . or reject any. request for Untimely
Determination exemption and may limit the. total number of exempted
Untimely Determinations.. .
3.2.2. The Department will :determine the Contractor's compliance with the Court
Settlement Timeliness Incentive Standard during each Reporting Period utilizing data
from the monthly Court Reports. Instructions for the Contractor to look up cases
• included in the court reports are in the County Incentives Program Guide.
3.3. Collaboration.Incentive Standard
3.3.1. The Contractor may earn a Collaboration Incentive Payment for each Reporting
Period in which it has hosted or attended Collaboration meetings with the partners
described below.
Page 7 of 13
3.3.1.1. The Contractor shall host or attend at least one (1) meeting with at least three (3)
of the following during each calendar quarter:
3'3.1.1.1. Each Behavioral Health Organization (BHO) that serves Clients in the
Contractor's County. See list of BHOs in the County Incentives Program
Guide.
3.3.1.1.2. Each Local Public Health Agency (LPHA) that serves Clients in the
Contractor's County.
3.3.1.1.3. Each Medical Assistance Site (MA Site) that serves Clients in the
Contractor's County. See list of MA Sites in the County Incentives Program
Guide.
3.3.1.1.4. Each Regional Care Collaborative Organization(RCCO)that serves Clients in
the Contractor's County. See list of RCCOs in the County Incentives Program
Guide.
3.3.1.1.5. Regional Connect For Health Colorado Partners(C4).
3.3.1.1.6. Hospitals and Clinics that serve Clients in the Contractor's County.
3.3.1.1.7. Federally Qualified Health Clinic (FQHC) that serves Clients in the
Contractor's County..'
3.3.1.1.8. Private Practice Providers such as Medical, Dental or Behavioral Health that
serve Clients in the Contractor's County.
3.3.1.1.9. Community Mental Health Centers (CMHC) that serve Clients in the
Contractor's County. See list of CMHCs in the County Incentives Program
Guide.
3.3.1.1.10. Long-term Care Facilities that serve Clients in the Contractor's County.
3.3.1.1.11. Single Entry Point (SEP) Agencies that serve Clients in the Contractor's
County. See list of SEPs in the County Incentives Program Guide.
3.3.1.1.12. County Sheriff/Local Law Enforcement that serves Clients in the Contractor's
County.
3.3.1.1.13. Ute Mountain Ute Tribe.
3.3.1.1.14. Southern Ute Indian Tribe.
3.3.1.2. The Contractor may combine any or all of the meetings in this Section 3.3 to meet
the Collaboration Incentive Standard and does not need to have individual
meetings with each of the entities listed in section 3.3.1.1.
3.3.1.3. The Contractor may also host any or all of the meetings in this Section 3.3 in
collaboration with other counties, but in the event that it does combine any
meeting with another county or other counties, the Contractor shall provide at
least one(1)representative to attend that meeting.
3.3.1.4. The Contractor shall develop the meeting agenda for each meeting it hosts.
3.3.1.4.1. The agenda shall include the following topics:
3.3.1.4.1.1. Recognition of the roles and responsibilities for each of the partners.
Page 8 of 13
3.3.1.4.1.2. Cultivating collaboration and the coordination of services among all of the
partner agencies.
3.3.1.4.1.3. Establishing two (2) to three (3) goals that the partners would like to
accomplish over the next year to improve clients' access to care.
3.3.1.4.2. In the event that the Contractor hosts a meeting in collaboration with another
county or other counties, then the Contractor may develop the agenda in
collaboration with those other counties.
3.3.1.5. The Contractor shall take meeting minutes and compile a list of attendees for each
meeting it hosts. In the event that the Contractor hosts a meeting in collaboration
with another county or other counties,then the Contractor may create the meeting
minutes and list of attendees in collaboration with those other counties.
3.3.1.5.1. The Contractor shall document its compliance with the Collaboration
Incentive Standard by submitting the Collaboration Incentivetemplate, see the
County Incentives Program Guide,providing the Department with the meeting
agenda, meeting minutes and list of attendees for each meeting it hosted,
either individually or collaboratively with other counties and the two (2) to
three(3) goals as described in 33.1.4.1.3. The Department will determine the
Contractor's compliance with the Collaboration Incentive Standard based on
the submission of the meeting agendas,meeting minutes and list of attendees
for all meetings during the Reporting Period. The Contractor shall..use the
Collaboration Incentive Template found in the County Incentives Program
Guide to organize the documentation. When sending the Collaboration
Template back to the Department,the Contractor shall name the electronic file
using the following naming mechanism "County Name.Collabortion
Incentive.Date" with the date being the end of the reporting period in which
the exemption is filed.
3.4. Application Backlog Incentive Standard
3.4.1. The Contractor may earn an Application Backlog Incentive Payment for each
Reporting Period in which the Application Backlog for new applications and
redeterminations is within the limits described in the following table:
3.4.1.1. County Backlog Table
County Size • Limit
New Applications �tii ;uSr Pul[ izt7 F' ',L_fl{c�Y �
i e.';a-rrtuJr ,tsF"o,!:1 - LargeraT:•.-�+.,ca x.r,.t..,,,'5.'..,..vY >:n•c,.C.lr<l..100
:5.. w•f z�to-7^...
Tw�`r'r'.,wiwa.� z� y7�u'✓ � tft Fi ,�1 k�7ke Medium < 15
�,75'F'r�na k y`SI A'�49,4 til Yrj�n[-' x;k n
kr yf r��4 + ,r rf t Sth ill <5
•
Redeterminations
•
n,6;-u�.._.b.l,-.„,•Z r.`µ,l�ic.n� nY u•_4k s [..k•,.,r ;.;. j�s r Nf..F.+. uy4ns:ySticr
<300
' t,lAwb 8r4,1Large
t `-*• [A,4* 4'r y A- SIF 4� 1 Medium <30
%'7doDg •�h5t,x fik .fir I 1 d IJ.. 1 - .:
Small <10
Page 9of13
3.4.1.2. The Department will not include any Backlogged Determination in its calculation
of this performance standard if the Department has approved that Determination
as being backlogged because of unusual circumstances.
3.4.1.2.1. The Contractor shall submit documentation with the semi-annual report to
request the Department's approval of that Determination as being in backlog
because of unusual circumstances. The Contractor shall use the exemption
request forms in the County Incentives Program Guide for documentation.
When sending the form back to the Department,the Contractor shall name the
electronic 'file using the following naming mechanism "County
Name.Backlog.Exemption Request.Date" with the date being the end of the
reporting period in which the exemption is filed.
3.4.1.2.2. The Department may approve or reject any request for Backlogged
Determination exemption and may limit the total number of exempted
Backlogged Determinations.
3.5. Training Incentive Standard
3.5.1. The Contractor may earn the Training Incentive Payment for each Reporting Period
as long as at least seventy five percent (75%) of its medical eligibility full time
equivalents (FTE) staff complete nine (9)hours of training. The required amount of
training can be spread throughout both reporting periods, as long as the required
amount is met at the conclusion of the second reporting period. Eligible trainings
shall include:
3.5.1.1. Medical eligibility training through the Health Care and Economic Security Staff
Development Center (SDC), County trainers who are certified through the SDC
and Department training.
3.5.1.2. When the Department launches its new Learning Management System(LMS),the
Contractor will have the option to access and track online training in addition to
the SDC's curriculum.
3.5.2. Statewide,regional or local training may qualify to meet the Training Incentive. The
Contractor shall seek approval for training developed by sources other than the SDC,
Department .or SDC certified county trainers in advance of submitting the
documentation for the Training Incentive.
3.5.2.1. The Contractor shall provide agendas, training content and proof of participation
through sign-in sheets or printed reports, such as those available through the
SDC's LMS.
3.6. MEQIP Reporting Incentive
3.6.1. ' The Contractor may earn a Medicaid Eligibility Quality Improvement Plan(MEQIP)
Reporting Incentive for each Reporting Period in which all quarterly reports and the
annual review plan are submitted by the specified due date below.If the due date falls
on a non-working day then the Contractor shall submit the report on the first working
day after the due date.
MEQIP Quarterly Report Reporting Period 'Due Date*
Quarter 1 Report a :, • ,. . . ,
Quarter 2 Report 'Octotier;�'>NC7V, 6er:• °December `! February 1st;
Page 10 of 13
Revised Annual Plans
Quarter 3 Report YJa nary;Febryuary&;March°{„ tilla 1st r
Quarter 4 Report �Y°��sxa 'a �f. ���� ��_ if
3.7. Quarterly Reporting
3.7.1. The Contractor shall create a Semi-Annual Incentive Report for each Reporting
Period that includes all of the following for the Reporting Period:
3.7.1.1. The meeting agendas, meeting.minutes, lists of attendees and goals to document
its compliance With the Collaboration Incentive Standard.
3'.7.1.2. Any Untimely Determination exemption forms for the Reporting Period.
3.7.1.3. Any Backlogged Determination exemption forms for the Reporting Period.
3.7.1.4. All Training Reports for the Reporting Period. •
3.7.2. The Contractor shall submit the Semi-Annual Incentive Report to the Department.
3.7.2.1. DELIVERABLE: Semi-Annual Incentive Report
3.7.2.2. DUE: January 5th for the first reporting period ending December 31st and July 5th
for the second reporting period ending June 30th
4. COMPENSATION
4.1. Compensation
4.1.1. Incentive Payment •
4.1.1.1. The Department shall pay the Contractor an Incentive Payment for each incentive
standard it meets during the applicable Reporting Period as follows:
4.1.1.1.1. The Department shall pay-the Contractor a Court Settlement Timeliness
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that incentive.
4.1.1.1.2. The Department,shall pay the Contractor a Collaboration Incentive Payment
• as shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
4.1.1.1.3. The Department shall pay the Contractor a MEQIP Incentive Payment as
shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
4.1.1.1.4. The Department shall pay the Contractor an Application Backlog Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that incentive.
4:1.1.1.5. The Department shall pay the Contractor.a Training Incentive Payment as
shown in Exhibit B for each Reporting Period that the'Contractor meets the
requirements for that incentive.
4.1.2. Remaining Funds Incentive Pool Payment
4.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
Page 11 of 13
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4.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
4.1.2.1.1.1. The total amount of all base incentive payments allocated to any counties
that selected to not participate in the County Medicaid Eligibility
•
Determination Incentive Program for that SFY.
4.1.2.1.1.2. Each of the base incentive payments that were not earned by a county
during a Reporting Period in that SFY.
4.1.2.1.2. In the event that the Remaining Funds Incentive Pool is zero dollars ($0.00)
for any SFY, the Contractor shall not receive a Remaining Funds Incentive
Pool Payment for that SFY.
4.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
4.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive.Pool based on the dollar amount of incentives met during that SFY.
4.1.2.2.2. Based on the proportion of total incentive funds that the Contractor is eligible
to be paid in each SFY, the Contractor shall receive the same proportion of
funds from the Remaining Funds Incentive Pool.
4.1.2.2.3. The Contractor's payment of funds from the Remaining Funds Incentive Pool
shall never exceed the county's share of Medicaid expenditure, as specified in
4.2.2.
4.1.2.3. To carry out the Work under this Contract, the Contractor.shall comply with the
County Incentive Program Guide.
4.2. Payment Procedures
4.2.1. The Contractor shall receive an incentive allocation for each of the Reporting Periods
within ninety days (90) days following the end of the fiscal year in which the work
was performed. This allocation will reflect the maximum the contractor can earn for
each incentive type per Reporting Period.
4.2.2. Actual incentive payment maximums are dependent on the county share of Medicaid
expenditure. In no event shall Contractor be paid more than the Contractor's county
share of Medicaid expenditure in any Reporting Period.
4.2.3. The Department may add any unearned funds fronk the first Reporting Period into to
the second Reportiing Period allocation for any SPY.
4.2.3.1. The Contractor shall receive the incentive payment through the County Financial
Management System(CFMS).
4.2.4. The Department may use any unearned second Reporting Period incentive payments
during the county administration'close out process. .
4.2.4.1. In the event that the Contractor believes that the calculation or determination of
any payment is incorrect, the Contractor shall notify the Department of the error
within thirty (30) days of receipt' of the payment or notification of the
determination of the payment, as appropriate.. The Department will review the
information presented by the Contractor and may make changes based on this
review. The determination or calculation that results from the Department's
review shall be final. No .disputed payment shall be due until after the
Department has concluded its review.
Page 12 of 13
EXHIBIT D,SMALL,MEDIUM AND LARGE COUNTY LIST
The below categorizes counties as small,medium and large for purposes of qualification of
exemptions for timeliness and/or backlog incentives.
•
Small
Archuleta Grand Phillips
Baca Gunnison Pitkin.
Bent Hinsdale Rio Blanco
Cheyenne Jackson Routt
Clear Creek Kiowa San Juan
Costilla Kit Carson San Miguel
Crowley Lake Sedgwick
Custer • Lincoln Summit
Dolores Mineral Washington
Elbert Garay Yuma
• Gilpin Park
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Medium
Alamosa Garfield Morgan
Broomfield Huerfano • Otero
Chaffee La Plata • Prowers
Conejos Las Animas Rio Grande
Delta Logan Saguache
Douglas Moffat Teller
Eagle Montezuma
Fremont - Montrose •
•
Large
Aciam,
Arapahoe
Boulder
Denver
El.Paso
Jefferson
Lorimer •
Mesa
Pueblo
Weld
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Page 13 of 13
i—(FOEIV :0
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Department of Health Care Policy and Financing
Agreement Routing Number 2015CMIP097A2
AGREEMENT AMENDMENT NO.2
Original Agreement Routing Number 2015CMIP097A2
1. PARTIES
This Amendment to the above-referenced Original Agreement (hereinafter called .the
"Agreement") is entered into by and between 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."), and the Pitkin County (hereinafter
called"Contractor").
2. EFFECTIVE DATE AND ENFORCEABILITY
This Amendment shall not be effective or enforceable until it is approved and signed by the
Colorado State Controller or designee (hereinafter called the "Effective Date"). HCPF shall not
be liable to pay or reimburse for any performance hereunder, including, but not limited to, costs
or expenses incurred, or be bound by any provision hereof prior to the Effective Date.
3. FACTUAL RECITALS
The Parties entered into the Agreement to create incentives for counties that achieve certain
incentive performance standards related to Medicaid eligibility and cooperation with other
Medicaid related entities. The purpose of this Amendment is to add exhibits and update the
Incentives Standards.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. • LIMITS OF EFFECT
This Amendment is incorporated by reference into the Agreement, and the Agreement and all
prior amendments thereto, if any, remain in full force and effect except as specifically modified
herein.
6. MODIFICATIONS
The Agreement and ali prior amendments thereto, if any, are modified as follows:
A. Section 5, Term, Subsection A, Initial Term, is hereby deleted in its entirety and replaced
with the following:
A. Initial Term
The Parties' respective performances under this Contract shall commence on the later
of the Effective Date or January 1, 2015. This Contract shall expire June 30, 2017,
unless sooner terminated or further extended as specified elsewhere herein.
B. Section 7, Payments to Contractor, Subsection A, Maximum Amount, is hereby deleted
in its entirety and replaced with the following:
A. Maximum Amount
The maximum amount payable under this Contract to Contractor by the Department
is shown in the following table, as determined by the Department from available
funds. Payments to the Contractor are limited to the unpaid obligated balance of the
Contract at the rates set forth in.Exhibit B. The maximum amount payable by.the
Department to the Contractor is:
State Fiscal Year 2014-15 $7,198.99
State Fiscal Year 2015-16 $8,272.38
.State Fiscal Year 2016-17 $7,546.25
Total for All State Fiscal Years $23,017.62
C. Section 4, Definitions, Subsection B 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-2, Statement of Work
Exhibit B, Rates
Exhibit C, Sample Option Letter
Exhibit D, List of CDHS programs for Training Incentive
Exhibit E. Small, Medium, Large County List
A. Exhibit A, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A-2, Statement of Work, attached hereto and incorporated by reference into the
Agreement. All references within the Agreement to Exhibit A or Exhibit A-1, shall be
deemed to reference to Exhibit A-2.
B. Exhibit B, Rates, Section 1.3., SFY 2016-17 Incentive Payment Table, is hereby added as
follows:
1.3. SFY 20 I6-17 Incentive Payment Table
/Incentive Payment Name % of Funding Payment Amount
Court Settlement Timeliness Incentive 25% $1.414.92
Payment
Collaboration Incentive Payment 20% $1.131.94
Page 2 of 16
Application Backlog Incentive Payment 25% $1.414.92
Training Incentive Payment 15% $848.95
MEQIP Incentive Payment 15% $848.95
Total Maximum S5,659.69
Available for all
Incentive Payments
C. Exhibit B, Rates, Section 2.3., SFY 2016-17 Pool Maximum County Share Table, is
hereby added as follows:
2.3. SFY 2016-17 Pool Maximum County Share Table
Pool Name Pool Maximum Distribution
Amount
Total Maximum Available for 51,886.56
all Pool Distributions
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
Execpt for the HIPAA Business Associates Addendum, in the event of any conflict,
inconsistency, variance, or contradiction between the provisions of this Amendment and any of
the provisions of the Agreement, the provisions of this Amendment shall in all respects
supersede, govern, and control.
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 HCPF by the
federal government, state government and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 3 of 16
Amendment Routing Number 2015CM1P097A2
THE PARTIES HERETO HAVE EXECUTED THIS INTERAGENCY AGREEMENT
Persons signing for Parties hereby swear and affirm that they are authorized to act on behalf of
their respective Party and acknowledge that the other Party is relying on their representations to
that effect.
STATE OF COLORADO
John W. Hickenlooper, Governor
Pitkin County Department of Health Care Policy and
(( Financing
By: N �
Name of ahorized signer y:
Title Susan E. Birch, MBA, BSN. RN
Executive Director
Date: (e)(2-4 I %
Date: n n \
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
S TE ROLLER
aros,CPA, MBA,JD
By: (alifk /
Department o Healt Care P•licy and.Financing
Date:
Page 4 of 16
EXHIBIT A-2,STATEMENT OF WORK
1. TERMINOLOGY
1.1. The following list is provided to assist the reader in understanding acronyms,
abbreviations and terminology used throughout this document.
1.1.1. Applicant—An individual for whom the Contractor is performing a Determination.
1.1.2. Behavioral Health Organization (BHO) - An organization that arranges for enrolled
Clients to get medically necessary behavioral health services. For a list of BHOs,
please see the County Incentive Program Guide.
1.1.3. Backlogged Determination —Any Untimely Determination that was not completed by
the timeliness requirements as set in Section 1.1.11.
1.1.4. Backlogged Redetermination -- Any Untimely Redetermination that was not
completed by the timeliness requirements as set in Section 1.1.12.
1.1.5. Client—An individual who is eligible for the Colorado Medical Assistance Program.
1.1.6. Colorado Benefits Management System (CBMS) -- the State's eligibility
determination system
1.1.7. Determination --The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program based on information submitted on a new application.
1.1.8. Reporting Period—The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.8.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end
on December 31 of that SFY.
1.1.8.2. The Second Reporting Period fora SFY shall begin on January I of that SFY and
end on June 30 of that SFY.
1.1.9. Redetermination—A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.10. State Fiscal Year (SFY) — The period beginning July 1 of each calendar year and
ending on June 30 of the following calendar year.
1.1.11. Timely Determination — Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.12. Timely Redetermination -- Any Redetermination that is completed by the last day of
the month prior to the month in which the client's new annual enrollment period
begins.
1.1.13. Untimely Determination — Any Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.14. Untimely Redetermination * Any Redetermination that is not completed by the last
day of the month prior to the month in which the client's new annual enrollment
period begins. This is based on the CBMS RRR Due Date.
1.1.15. Small, Medium and Large County—The size of the county is determined by the case-
and workload of Medical Assistance enrollment
•
Page 5 of 16
1.1.16. County Incentives Program Guide -- A supplemental document, provided by the
Department to each Contractor, that defines the expectations of the Department for
the County Incentives Program. This includes lists of collaboration partners, required
forms and other relevant materials.
1.1.17. COGNOSIDecision Support System 01 (DSS01) — the Department's data reporting
systems that use information from the Colorado. Benefits Management System
(CBMS).
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid related workwithin the Contractor's county,
required under C.R.S. §25.5-1-101 el. seq. The Department and the Contractor share the
costs of this work performed by the Contractor as defined in those statutes and this
Contract shall not impact the allocated amount of that cost sharing.
2.2. To determine whether the Contractor met any or all of the Incentive Standards when
completing determinations and redeterminations within the Contractor's county, the
Department will utilize the COGNOS/DSSO1 systems to pull the following reports:
2.2.1. Weekly Timeliness
2.2.2. Detailed Timely Processing of Medical Applicant Determinations/Redeterminations
2.2.3. Mass Update Case Error Details .
2.2.4. Non-MAGI Redeterminations Due
2.2.5. Redeterminations Due for Self-employment and individuals without a Social Security
Number
2.2.6. Verifications Due
2.3. The above list is not all-inclusive and the Department may add additional reports,from
the COGNOS/DSSOI systems to determine whether the Contractor met any or all of the
Incentive Standards.
2.4. The date the data or reports will be pulled from the COGNOS/DSS01 systems will be
defined in each applicable Incentive Standard.
2.5. The Department will communicate to the Contractor, through various pre-existing
methods, when new reports are available that may be utilized in determining whether the
Contractor met any or all of the Incentive Standards.
3. PERFORMANCE INCENTIVE PROGRAM
3.1. The Contractor may earn an incentive payment to reimburse it for a portion of its cost
sharing as described in Section 3.
3.1.1. To fulfill the requirements in Exhibit A-2 Statement of Work and earn an incentive
payment, the Contractor shall utilize and comply with the County Incentive Program
Guide.
3.2. Court Settlement Timeliness Incentive Standard
3.2.1. The Contractor may earn a Court Settlement Timeliness Incentive Payment for each
Reporting Period in which at least ninety-five percent (95%) of all Determinations
and Redeterminations completed were Timely Determinations/Redeterminations.
Page 6 of 16.
3.2.1.1. To determine the timeliness percent for this standard, the Department shall total
up all Timely Determinations and Redeterminations the Contractor completed
within the Reporting Period and divide that by the:total number of Determinations
and Redeterminations the Contractor completed during that Reporting Period.
The Department shall round these calculated percentages to two (2) decimal
places. The Contractor shall be paid for each Reporting Period it meets the
incentive standards after the end of the fiscal year in which the work was
performed.
3.2.1.2. The calculation for the Court Settlement Timeliness Incentive Standard will be
Timely Determinations plus (+) Timely Redeterminations divided by (/) All
Determinations plus (+) All Redeterminations completed during that Reporting
Period.
3.2.1.3. In the event that the Contractor processes a total of two-hundred and forty (240)
or fewer Determinations and two-hundred and forty (240) or fewer
Redeterminations per month, the Contractor shall be deemed to have met this
performance standard so long as they had eighteen (18) or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
3.2.1.4. The Department will not include any Untimely Determinations/Redeterminations
in its calculation of this performance standard if the Department has approved that
Untimely Determination/Redetermination as being untimely because of unusual
circumstances as specified in Section 4, Exemptions.
3.2.1.4.1. The Contractor shall submit documentation with the semi-annual report to
request the Department's approval of that Determination as being untimely
because of unusual circumstances. The Contractor shall use the exemption
request form in the County Incentives Program Guide for documentation.
The Department will determine the Contractor's compliance with the Court
Settlement Timeliness Incentive Standard during each Reporting Period utilizing data
from the monthly Court Reports. Instructions for the Contractor to look up cases
included in the court reports are in the County Incentives Program Guide.
3.2.2.1. Data and reports for the Court Settlement Timeliness Incentive Standard will be
pulled the first working day after the end of each Reporting Period.
3.3. Collaboration Incentive Standard
3.3.1. The Contractor may earn a Collaboration Incentive Payment for each Reporting
Period in which it hosted or attended Collaboration meetings with the partners
described below.
3.3.1.1. The Contractor shall host or attend at least one (1) meeting with at least three (3)
of the following during each calendar quarter:
3.3.1.1.1. Each Behavioral Health Organization (BHO) that serves Clients in the
Contractor's County. See list of BHOs in the County Incentives Program
Guide.
3.3.1.1.2. Each Local Public Health Agency (LPHA) that serves, Clients in the
Contractor's County.
Page 7 of 16
3.3.1.1.3. Each Medical Assistance Site (MA Site) that serves Clients in the
Contractor's County. See list of MA Sites in the County Incentives Program
Guide.
3.3.1,1.4. Each Regional Care Collaborative Organization (RCCO) that serves Clients in
the Contractor's County. See list of RCCOs in the County Incentives Program
Guide.
3.3.1.1.5. Regional Connect For Health Colorado Partners(C4).
3.3.1.1.6. Hospitals and Clinics that serve Clients in the Contractor's County.
3.3.1.1.7. Federally Qualified Health Clinic (FQHC) that serves Clients in the
Contractor's County.
3.3.1.1.8. Private Practice Providers such as Medical, Dental or Behavioral Health that
serve Clients in the Contractor's County.
3.3.1.1.9. Community Mental Health Centers (CMHC) that serve Clients in the
Contractor's County. See list of CMHCs in the County Incentives Program
Guide.
3.3.1.I.10. Long-term Care Facilities that serve Clients in the Contractor's County.
3.3.1.1.11. Single Entry Point (SEP) Agencies that serve Clients in the Contractor's
County. See list of SEPs in the County Incentives Program Guide.
3.3.1.1.12. Community Centered Boards (CCB). See list of CCBs in County Incentives
Program Guide.
3.3.1.I.13. County Sheriff/Local Law Enforcement that serves Clients in the Contractor's
County.
3.3.1.1.14. Ute Mountain Ute Tribe.
3.3.1.1.15. Southern Ute Indian Tribe.
3.3.1.2. The Contractor may combine any or all of the meetings in this Section 3.3 to meet
the Collaboration Incentive Standard and does not need to have individual
meetings with each of the entities listed in Section 3.3.1.1.
3.3.1.3. The Contractor may also host any or all of the meetings in Section 3.3 in
collaboration with other counties, but in the event that it does combine any
meeting with another county or other counties, the Contractor shall provide at
least one(1) representative to attend that meeting.
3.3.1.4. The Contractor shall develop the meeting agenda for each meeting it hosts.
3.3.1.4.1. The agenda shall include the following topics:
3.3.1.4.1.1. Recognition of the roles and responsibilities for each of the partners.
3.3.1.4.1.2. Cultivating collaboration and the coordination of services among all of the
partner agencies.
3.3.1.4.1.3. Establishing two (2) to three (3) goals that the partners would like to
accomplish over the nest year to improve clients' access to care.
Page 8 of 16
3.3.1.4.2. In the event that the Contractor hosts a meeting in collaboration with another
county or other counties, then the Contractor may develop the agenda in
collaboration with those other counties.
3.3.1.5. The Contractor shall take meeting minutes and compile a list of attendees for each
meeting it hosts. In the event that the Contractor hosts a meeting in collaboration
with another county or other counties, then the Contractor may create the meeting
minutes and list of attendees in collaboration with those other counties.
3.3.1.5.1. The Contractor shall document its compliance with the Collaboration
Incentive Standard by submitting the Collaboration Incentive template, see the
County Incentives Program Guide, providing the Department with the meeting
agenda, meeting minutes and list of attendees for each meeting it hosted,
either individually or collaboratively with other counties and the two (2) to
three (3) goals as described in Section 3.3.1.4.1.3. The Department will
determine the Contractor's compliance with the Collaboration Incentive
Standard based on the submission of the meeting agendas, meeting minutes
and list of attendees for all meetings during the Reporting Period. The
Contractor shall use the Collaboration Incentive Template found in the County
Incentives Program Guide to organize the documentation.
3.4. Application Backlog Incentive Standard
3.4.1. The Contractor may earn an Application Backlog Incentive Payment for each
Reporting Period in which the Application Backlog for new applications and
redeterminations is within the limits described in the following table:
3.4.1.1. County Backlog Table
County Size Limit
New Applications
Large < 100
Medium < 15
Small 5 5
Redeterminations
Large <360
Medium 536
Small 15512
3.4.1.2. The Department will not include any Backlogged Determination in its calculation
of this performance standard if the Department has approved that Determination
as being backlogged because of unusual circumstances.
3.4.1.2.1. The Contractor shall submit documentation with the semi-annual report to
request the Department's approval of that Determination as being backlogged
because of unusual circumstances. The Contractor shall use the exemption
request form in the County Incentives Program Guide for documentation.
Page 9 of 16
3.4.1.2.2. The Department may approve or reject any request for Backlogged
Determination exemption and may limit the total number of exempted
Backlogged Determinations.
3.4.1.3. The Department will utilize data and reports from the COGNOS/DSS01 systems
as specified in Section 2.2 to conclude whether the Contractor's Determinations
and Redeterminations are within the limits as set in Section 3.4.1.1.
3.4.1.3.1. Data and reports for the Application Backlog Incentive Standard will be
pulled the first working day after the end of each Reporting Period.
3.4.1.3.2. A Determination or Redetermination will be considered backlogged for the
First Reporting Period if the due date for the Determination or
Redetermination is on or before December 31 and the Determination or
Redetermination was not completed on or before the due date.
3.4.1.3.3. A Determination or Redeterminatidn will be considered backlogged for the
Second Reporting Period if the due date for the Determination or
Redetermination is on or before June 30 and the Determination or
Redetermination was not completed on or before the due date.
3.5. Training Incentive Standard
3.5.1. The Contractor may earn the Training Incentive Payment for each Reporting Period
as long as at least seventy five percent (75°Oo) of its medical assistance eligibility
technicians and supervisors complete the designated number of hours based on the
number of programs with which the technician or supervisor works. This will be
based on the eligibility technician or supervisor having the adequate security profile
in CBMS as described in Section 3.5.1.4.
3.5.1.1. The medical assistance eligibility technician will be responsible for nine (9)hours
of training in the contractual period if the technician has the security profile to
only authorize medical assistance.
3.5.1.2. The medical assistance eligibility technician will be responsible for six (6) hours
of training in the contractual period if the technician has the security profile to
authorize medical assistance plus one (1)additional program from Exhibit D.
3.5.1.3. The medical assistance eligibility technician will be responsible for three (3)
hours of training in the contractual period if the technician has the security profile
to authorize medical assistance plus two (2) or more additional programs from
Exhibit D.
3.5.1.4, The types of CBMS access user roles subject to the Training Incentive Standard
include Management and Eligibility Enrollment Specialist(EES).
3.5.2. The required amount of training can be spread throughout both Reporting Periods, as
long as the required amount is met at the conclusion of the Second Reporting Period.
Eligible trainings not requiring pre-approval shall include:
3.5.2.1. Medical eligibility training through the Health Care and Economic Security Staff
Development Center (SDC), county trainers who are certified through the SDC
and Department training.
Page 10 of 16
3.5.2.2. The Contractor shall log all eligible training hours in the Department's Learning
Management System (LMS). Only training hours: logged in the LMS system will
count towards the Training Incentive.
3.5.3. Statewide, regional or local training may qualify to meet the Training Incentive. The
Contractor shall seek approval for training developed by sources other than the SDC,
Department or SDC certified county trainers in advance of submitting the
documentation for the Training Incentive.
3.5.3.1. The Contractor shall log the training hours in the Department's LMS for trainings
not offered through the SDC, the Department, or an SDC certified trainer and
submit the content below.
3.5.3.1.1. The Contractor shall provide agendas, training content and proof of
participation when logging trainings not offered through the SDC, the
Department,or an SDC certified trainer.
3.6. Medicaid Eligibility Quality,Improvement Plan (MEQIP) Incentive Standard
3.6.1. The Contractor may earn a MEQIP Incentive for each Reporting Period the
Contractor meets all of the requirements as laid out in Section 3.6.1.
3.6.1.1. The accurate authorizations of the Contractor's Determinations and
Redeterminations, as measured by the Contractor's quarterly MEQIP reporting,
must be greater than or equal to ninety percent(90%).
3.6.1.2. In the event the Contractor completes ten (10) or less MEQIP case reviews for
any given quarterly report, then the accurate authorizations of the Contractor's
Determinations and Redeterminations must be greater than or equal to seventy
percent(70%).
3.6.1.3. The Contractor shall submit all quarterly reports and the annual review plan by
the specified due date below. If the due date falls on a non-working day then the
Contractor shall submit the report on the first working day after the due date.
MEQIP Quarterly Report Reporting Period Due Date*
Quarter 1 Report July,August&September :_F. November 1st_.
Quarter 2 Report October,November&December February 1st
Revised Annual Plans July 1st June 30th, March 31st
Quarter 3 Report. January,February&March May 1st
Quarter 4 Report April,.0.41 11 • August1st
._ V..
3.6.1.4. The quarterly reports and the annual review plan submitted by the Contractor
must be deemed complete per the requirements as specified in the MEQIP Manual
or as specified by the MEQIP program manager. For those quarterly reports and
the annual review plan deemed incomplete per the MEQIP Manual and/or MEQIP
program manager, it shall be deemed that the Contractor did not follow the
requirements for the timely submission of the quarterly reports and the annual
review plan as specified in 3.6.1.3.
3.6.2. The Contractor's quarterly MEQIP reporting submissions are subject, at any time and
without prior notification, to re-review and audit by the Department to ensure
accuracy of the Contractor's results.
Page 11 of 16
3.6.2.1. If the re-review or audit of the Contractor's MEQIP reporting finds inaccuracies
on cases re-reviewed or audited, the Contractor will be required to submit a
Corrective Action Plan (CAP) within 30 days of notification of the inaccuracies.
The Contractor shall address the inaccuracies found in the re-review or audit in
the Corrective Action Plan by detailing training, process, or business
improvements to be made.
3.7. Semi-Annual Reporting
3.7.1. The Contractor shall create a Semi-Annual Incentive Report for each Reporting
Period that includes all of the following for the Reporting Period:
3.7.1.1. The meeting agendas, meeting minutes, lists of attendees and goals including the
Collaboration Template to document its compliance with the Collaboration
Incentive Standard.
3.7.1.2. Any Court Settlement Timeliness Incentive Standard and Application Backlog
Incentive Standard exemption forms for the Reporting Period.
3.7.1.3. All Training Reports for the Reporting Period.
3.7.2. The Contractor shall submit the Semi-Annual Incentive Report to the Department.
3.7.2.1. DELIVERABLE: Semi-Annual Incentive Report
3.7.2.2. DUE: January 5th for the First Reporting Period ending December 31st and July
5th for the Second Reporting Period ending June 30th
4. EXEMPTIONS
4.1. If a Determination or Redetermination is delayed for unusual circumstances as defined
under 10 C.C.R. 2505-8.100.3.D (d), the Contractor is eligible to submit an exemption
form.
4.1.1. The Department will not include any Untimely Determinations/Redeterminations in
its calculation of the Court Settlement Timeliness Incentive Standard and/or the
Application Backlog Incentive Standard if the Department has approved that
Untimely Determination/Redetermination as being untimely because of unusual
circumstances as specified in 4.1.
4.1.2. The Contractor shall be responsible for submitting one (1) exemption form that
details each of the cases for which the Contractor is requesting an exemption.
4.1.3. The Contractor shall provide adequate information on the exemption form for the
Department to quantify personnel issues if the Contractor requests an exemption due
to staff vacancies,staff training,or other personnel issues.
4.2. The Department may approve or reject any request for Untimely
Determination/Redetermination exemptions and may limit the total number of exempted
Untimely Determinations/Redeterminations for both the Court Settlement Timeliness
Incentive Standard and Application Backlog Incentive Standard.
4.2.1. The Department will deny exemption requests that do not meet timeliness definition
set forth in 10 C.C.R. 2505-8.100.3.D (d) and Section 1.1.12 due to the fault of the
Contractor and/or any exemption requests based on the following:
Page 12 of 16
4.2.1.1. Failure of the Contractor to timely act on a Determination or Redetermination
which resulted in a failure to meet the timeliness requirements in Sections 1.1.11
and 1.1.12.
4.2.1.2. Failure of the Contractor to act on client verification that was submitted timely
which was requested for a Determination or Redetermination.
4.2.1.3. Failure of the Contractor to manually authorize a Determination or
Redetermination with a mass update exception.
4.2.1.4. Failure of the Contractor to manually authorize a Redetermination when the auto
re-enrollment or Ex Parte processes were not successful.
4.2.1.5. Failure of the Contractor to pull any and all applicable COGNOS reports for the
purposes of fulfilling Exhibit A-2, Statement of Work.
4.2.2. The reasons for denial of an exemption as stated in Section 4.2.1 are not all-inclusive
and the Department reserves the right to deny any exemption for reasons not stated in
Section 4.
4.2 2.1. Prior to denying an exemption for reasons beyond those stated in Section 4.2.1,
the Department may, at its discretion, request further information from the
Contractor to determine whether the request for exemption meets the exemption
standards as stated in Section 4, Exemptions.
5. COMPENSATION
5.1. Compensation
5.1.1. Incentive Payment
5.1.1.1. The Department shall pay the Contractor an Incentive Payment for each incentive
standard it meets during the applicable Reporting Period as follows:
5.1.1.1.1. The Department shall pay the Contractor a Court Settlement Timeliness
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that incentive.
5.1.1.1.2. The Department shall pay the Contractor a Collaboration Incentive Payment
• as shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
5.1.1.1.3. The Department shall pay the Contractor a MEQIP Incentive Payment as
shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
5.1.1.1.4. The Department shall pay the Contractor an Application Backlog Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that incentive.
5.1.1.1.5. The Department shall pay the Contractor a Training Incentive Payment as
shown in Exhibit B for each Reporting Period that the Contractor meets the
requirements for that incentive.
5.1.2. Remaining Funds Incentive Pool Payment
5.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
5.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
Page 13 of 16
5.1.2.1.1.1. The total amount of all base incentive payments allocated to any counties
that selected to not participate in the County Medicaid Eligibility
Determination Incentive Program for that SFY.
5.1.2.1.1.2. Each of the base incentive payments that were not earned by the
Contractor during a Reporting Period in that SFY.
5.1.2.1.2. In the event that the Remaining Funds Incentive Pool is zero dollars ($0.00)
' for any SFY, the Contractor shall not receive a Remaining Funds Incentive
Pool Payment for that SFY.
5.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
5.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amount of incentives met during that SFY.
5.1.2.2.2. Based on the proportion of total incentive funds that the Contractor is eligible
to be paid in each SFY, the Contractor shall receive the same proportion of
funds from the Remaining Funds Incentive Pool.
5.1.2.2.3. The Contractor's payment of funds from the Remaining Funds Incentive Pool
shall never exceed the county's share of Medicaid expenditure, as specified in
Section 4.2.2.
5.2. Payment Procedures
5.2.1. The Contractor shall receive an incentive allocation for each of the Reporting Periods
within ninety days (90) days following the end of the fiscal year in which the work
was performed. This allocation will reflect the maximum the contractor can earn for
each incentive type per Reporting Period.
5.2.2. Actual incentive payment maximums are dependent on the county share of Medicaid
expenditure. In no event shall the Contractor be paid more than the Contractor's
county share of Medicaid expenditure in any Reporting Period.
5.2.3. The Department may add any unearned funds from the First Reporting Period into to
the Second Reporting Period allocation for any SFY.
5.2.3.1. The Contractor shall receive the incentive payment through the County Financial
Management System (CEMS).
5.2.4. The Department may use any unearned Second Reporting Period incentive payments
during the county administration close out process.
5.2.4.1. In the event that the Contractor believes that the calculation or determination of
any payment is incorrect, the Contractor shall notify the Department of the error
within thirty (30) days of receipt of the payment or notification of the
determination of the payment, as appropriate. The Department will review the
information presented by the Contractor and may make changes based on this
review. The determination or calculation that results from the Department's
review shall be final. No disputed payment shall be due until after the
Department has concluded its review.
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EXHIBIT D, LIST OF COLORADO DEPARTMENT OF HUMAN SERVICES (CDHS)
PROGRAMS FOR TRAINING INCENTIVE
The below list provides a list of eligible CDHS programs that will assist the Contractor in
determining how many training hours are required based on the number of programs each
eligibility technician and/or supervisor works.
1. Supplemental Nutrition Assistance Program (SNAP)
a. Also known as Food Assistance/Food Stamps
2. Temporary Assistance to Needy Families
a. Also known as Colorado Works
3. Adult Financial
4. Child Welfare
5. Child Support Services
6. Adult Protective Services
7. Low Income Energy Assistance Program
a. Also known as LEAP
8. Colorado Child Care Assistance Program
a. Also known as CCAP
9. Employment First
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EXHIBIT E,SMALL, MEDIUM AND LARGE COUNTY LIST
The below categorizes counties as small, medium and large for purposes of qualification of
exemptions for timeliness and/or backlog incentives.
Small
Archuleta Grand Phillips
Baca Gunnison Pitkin
Bent Hinsdale Rio Blanco
Cheyenne Jackson Routt
Clear Creek Kiowa San Juan
Costilla Kit Carson San Miguel
Crowley Lake Sedgwick
Custer Lincoln Summit
Dolores Mineral Washington
Elbert Ouray Yuma
Gilpin Park
Medium
Alamosa Garfield Morgan
Broomfield Huerfano Otero
Chaffee La Plata Prowers
Conejos Las Animas Rio Grande
Delta Logan Saguache
• Douglas Moffat Teller
Eagle Montezuma
Fremont Montrose
Large
Adams
Arapahoe
Boulder
Denver
El Paso
Jefferson
Larimer
Mesa
Pueblo
Weld
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