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N RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
cr4 OF PITKIN COUNTY, COLORADO
n APPROVING AN INTERGOVERNMENTAL AGREEMENT WITH HEALTH CARE
p POLICY AND FINANCING FOR THE COUNTY MEDICAID INCENTIVE
PROGRAM
rx c v? RESOLUTION NO. OW 2016
1. C.R.S. . t. and 10 CCR 2505-10 et.seq. and funds have been
budgeted25, appropr5-1-101 eiated seq.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.
INTROD,U ED,READ ANDOPTED AS AN EMERGENCY RESOLUTION ON
THE 71""' DAY OF DA(-c- 2016 AN SET FOR CONFIRMATORY
PUBLIC HEARING ON THE 0- DAY OF pt,--e.._ ,2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND TITLE AND SHORT
SUMMARY OF THE EMERGENCX RESOLUTION P LISHED IN THE ASPEN
TIMES WEEKLY ON THE Q DAY OF UIXLe- ,2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE
RESOLUTION POSTED ON THE OFFICIAL PITK1�1 COUNTY WEBSITE
www.pitkincounty.com ON THE Q `- DAY OF do;c.c._ 2016.
CONFI ED AT A CONFIRMATORY PUBLIC HEARING ON THE ' DAY
OF ( ULtL 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY,AFTER CONFIRMJTORY
PUBIC HEARING, IN THE ASPEN TIMES WEEKLY ON THE _ )AY OF
t,'yt,. _ ,2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICL L PITKIN COUNTY
WEBSITE www.pitkincounty.com ON THE 13 -DAY OF //ticc..� 2016
ATTE : BOARD OF COUNTY COMMISSIONERS
C�
By•l �i 14 Li/ By: iIl i i a 0 ,moi
Jean, e Jones 1-1 E. Ric ards, Cha' ,,OF
Dep, y County Clerk
Date: "M-
APPROVED AS TO FORM: MANAGER APPROVAL
John Ely, Co • • •tto -y on Peck, ounty Manager
2
Department of Health Care Policy and Financing
Agreement Routing Number 2015CMIP097A5
AGREEMENT AMENDMENT NO.5
Original Agreement Routing Number 2015CMIP097A5
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 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').The Department
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 performance-related benchmarks for county
departments ofhuman/social services that achieve certain Performance Incentive Standards related
to determining and redetermining Medicaid eligibility, those populations currently enrolled in
Medicaid and cooperation with other Medicaid-related entities. The purpose of this Amendment
is to add exhibits and update the Performance 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.
b. 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:
Exhibit A-5,Statement of Work
Page 1 of 4
Exhibit C,Small,Medium,Large County List
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 I $8,272.38
State Fiscal Year 2016-17 I $7,546.25
State Fiscal Year 2017-18 ) $8,395.04
,State Fiscal Year 2018-19 I $9,081.30
State Fiscal Year 2019-20 I $12,217.58
Total for All State Fiscal Years I $52,711.54
C. Exhibit A-4,Statement of Work,is hereby deleted in its entirety and replaced with Exhibit
A-5,Statement of Work,attached hereto and incorporated by reference into the Agreement.
All references within the Agreement to Exhibit A,Exhibit A-1, Exhibit A-2, Exhibit A-3
or Exhibit A-4 shall be deemed to reference to Exhibit A-5.
D. Exhibit B,Rates,Section 1.4.,SFY 2019-20 Incentives Payment Table,is hereby added as
follows:
1.4. SFY 2019-20 Incentives Payment Table
Incentive Payment Name %of Funding Payment Amount
Eligibility Performance Incentive 15% 1
$3,217.04
Payment
Exceptional Eligibility Performance I 5% 1
$459.58
Incentive Payment
Training Performance Incentive Payment 20% 1 $1,838.31
Cybersecurity Performance Incentive 30% � $2,757.46
Payment
Food Security Performance Incentive 100/' 1 $919.15
Payment
Total Maximum Available for allI $9,191.55
Incentive Payments 1
E. Exhibit B, Rates, Section 2.4., State Fiscal Year(SFY)2019-20 Pool Maximum County
Share Table,is hereby added as follows:
Page 2 of 4
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 Healty0re Policy and
�. n g
V -C"(= 0,- kirn Bimestefer J
Executive Director
Date: /
Date:—
t !
ALL AGREEMENTS REOUIRE APPROVAL BY THE STATE CONTROLLER
STATE CONTROLLER
Rob a BA,JD
17
By: A,
Departmen of lth re Policy and Financing
Date:
Page 4 of 4
2.4.SFY 2019-20 Pool Maximum County Share Table
Pool Name Pool Maximum Distribution
Amount
Total Maximum Available for all Pool I $3,026.031
Distributions
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
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 the Department by
the federal government,the Colorado General Assembly and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 3 of 4
EXHIBIT A-5,STATEMENT OF WORK
1. TERMINOLOGY
i
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. Backlogged Determination--Any Untimely Determination that was not completed by
the timeliness requirements as set in Section 1.1.11.
1.1.3. Backlogged Redetermination—Any Untimely Redetermination that was not completed
by the timeliness requirements as set in Section 1.1.12.
1.1.4. COGNOS/Decision Support System 01 (DSS01) — the Department's data reporting
systems that use information from the Colorado Benefits Management System
(CBMS).
1.1.5. Colorado Benefits Management System(CBMS)—the State's eligibility determination
system.
1.1.6. Colorado Department of Human Services (CDHS) — The Colorado Department of
Human Services connects Coloradans to assistance, resources and support for living
independently in the state.CDHS is the state agency responsible for the administration
of the Supplemental Nutrition Assistance Program.
1.1.7. Colorado Information Security Policies (CISP) - Colorado Information Security
Policies promulgated by the Chief Information Security Officer in the Governor's
Office of Information Technology pursuant to§§24-37.5-401,et seq.,C.R.S.
1.1.8. Colorado interChange(interChange)--the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data
related to those payments.
1.1.9. County Administration website -- the Department's public-facing website where
contract documentation is kept for the County Incentives Program
(httn://www.colorado.izov/hcDf/county-admin).
1.1.10. County Financial Management System (CFMS) -- the accounting system utilized by
the Contractor to record expenditures against county administration funding for
Colorado's Medical Assistance Program. The system is also used to issue Performance
Incentive Payments to eligible Contractors.
1.1.11. County Incentives Program — program that provides specific funding to county
departments of human/social services for meeting Medicaid-related Performance
Incentive Standards in their counties. Also referenced as Performance Incentive
Standard Program throughout this Agreement.
1.1.12. Determination—The act of using CBMS to determine if an Applicant is eligible for the
Colorado Medical Assistance Program based on information submitted on a new
application,a redetermination or a change in member circumstance.
Page 1 of 17
1.1.13, Disenroll or Disenrollment — The act of processing a change in circumstance that
affects a member's eligibility and makes them ineligible for coverage within Health
First Colorado or Child Health Plan Plus.
1.1.14. Governor's Office of Information Technology (OIT) — The office created by and
described in§§24-37.5.101,et seq.C.R.S. OTT is the Information Technology Service
Provider for Consolidated State Agencies.
1.1.15. HCPF Memo Series - The Department's policy, operational and informational
communications that are utilized to provide contract clarifications, provide data and
operational guidance and share information pertaining to the County Incentives
Program.
1.1.16. Health First Colorado —the member-facing name for Colorado's Medical Assistance
Program.
1.1.17. Home and Community-Based Services (HCBS) - HCBS waiver programs provide
additional benefits and services to eligible populations in addition to the standard
benefit package offered to all members.
1.1.18. Information Technology Service Provider(ITSP)-- A Service Provider that provides
information technology services to the Contractor. The ITSP may be an internal
department,a third-party vendor or OIT.
1.1.19. Learning Management System (LMS)— the system utilized by the Health Care and
Economic Security Staff Development Center to track course registration,completions
and other training-related documentation for Medical Assistance training.
1.1.20. Long Term Care (LTC) - Long-Term Care is a Medical Assistance program that
provides nursing-home care, home-health care, personal or adult day care for
individuals aged at least 65 years or with a chronic or disabling condition.
1.1.21. Long Term Services and Supports(LTSS)--for the purposes of this Agreement,LTSS
refers to determinations and redeterminations made for LTC,HCBS and PACE.
1.1.22. Member—An individual who is eligible for the Colorado Medical Assistance Program.
Also known as a client,
1.1.23. Program for the All-Inclusive Care for the Elderly (PACE) -- Program provides
comprehensive medical and social support services to certain frail individuals 55 years
of age and over. The goal of PACE is to keep individuals in their homes and
communities through comprehensive care coordination.
1.1.24. Reporting Period—The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.24.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.24.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and
end on June 30 of that SFY.
1.1.25. Redetermination—A Determination as defined under 10 C.C.R.2505-8.100.3.P.
1.1.26. State Fiscal Year(SFY)—The period beginning July I of each calendar year and ending
on June 30 of the following calendar year.
Page 2 of 17
1.1.27. Status Report — a communication to the Contractor that details which Performance
Incentive Standards were met for each Reporting Period.
1.1.28. Supplemental Nutrition Assistance Program — This program exists to safeguard the
health and well-being of low income,financially eligible households by providing food
assistance benefits redeemable for food items at authorized retailers.Counties conduct
eligibility determination based on state/federal rules and guidelines. An additional
component of the program is SNAP Outreach. Colorado partners with four agencies:
Benefits Data Trust, Benefits in Action, Care and Share Food Bank for Southern
Colorado, Hunger Free Colorado for outreach services. These agencies work to
simplify the SNAP application process,providing both over-the-phone and in-person
application assistance throughout the state.
1.1.29. Timely Determination — Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R.2505-8.100.3.D.
1.1.30. Timely Disenrollment—Processing a change in a member's circumstance and making
a determination within fifteen(15)calendar days.
1.1.31. Timely Redetermination--Any Redetermination that is completed by the last day of
the month prior to the month in which the member's new annual enrollment period
begins.
1.1.32. Untimely Determination — Any Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R.2505-8.100.3.D.
1.1.33, Untimely Redetermination—Any Redetermination that is not completed by the last day
of the month prior to the month in which the member's new annual enrollment period
begins. This is based on the CBMS RRR Due Date.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility-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. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
3.1.1. To determine whether the Contractor met any or all the Performance Incentives
Standards when completing determinations and redeterminations within the
Contractor's county,the Department will utilize the COGNOS/DSSO1 systems to pull
data tracking and reports that track the Contractor's compliance with certain
Performance Incentive Standards.
3.1.2. To determine whether the Contractor met any or all the Performance Incentives
Standards when working with Medicaid populations within the Contractor's county,
the Department may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive and the Department will,at its discretion,
utilize additional data and reports from the COGNOS/DSS01, interChange, and/or
Page 3 of 17
other systems to determine whether the Contractor met any or all the Performance
Incentives Standards.
3.1.4. The date the data or reports will be pulled from the COGNOS/DSSOI, interChange,
and/or other systems will be defined in each applicable Performance Incentive
Standard.
3.1.5. The Contractor should utilize policy,operational and informational guidance provided
in this Exhibit and through the HCPF Memo Series for each Performance Incentive
Standard to assist with implementing the Performance Incentives Standard and pulling
applicable data and reports to determine the Contractor's compliance with any or all
the Performance Incentives Standards.
3.2. Communications Utilized to Determine Compliance
3.2.1. To fulfill the requirements in Exhibit A-5 Statement of Work and earn a Performance
Incentive Payment, the Contractor shall utilize and comply with guidance issued
through the HCPF Memo Series.
3.2.2. The Contractor will utilize the HCPF Memo Series to find any forms, templates,
program contacts or additional information needed to operationalize the Incentives
Performance Standard Program referenced throughout this Agreement.
3.2.3. If additional guidance or contract clarification is needed,the Department may release
additional guidance to the Contractor through the HCPF Memo Series.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor may earn Performance Incentive Payments to reimburse it for a portion of
its cost sharing as described in Section 2.
4.2. Eligibility Performance Incentive Standard
4.2.1. The Contractor may earn an Eligibility Performance Incentive Payment for each
Reporting Period in which the Contractor meets at least three (3) out of the four(4)
following benchmarks; Timeliness of Determinations and Redeterminations,
Timeliness of LTSS Determinations and Redeterminations, Backlogged
Determinations and Redeterminations and Timeliness of Case Maintenance and
Disenrollment as found in section 4.2.
4.2.1.1. Timeliness of Determinations and Redeterminations
4.2.1.1.1. The Contractor shall complete at least ninety-five percent (95%) of all
Determinations and Redeterminations as Timely Determinations and Timely
Redeterminations.
4.2.1.1.2. The Department will total all Timely Determinations and Timely
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 to determine the timeliness
percent. The Department will round these calculated percentages to two (2)
decimal places.
4.2.1.1.3. Determining Compliance with the Timeliness of Determinations and
Redeterminations
Page 4 of 17
4.2.1.1.3.1. The Department will utilize the MA County Incentives Timeliness Report
— Summary and MA County Incentives Timeliness Report -- Detail to
determine compliance with timeliness benchmark of the Eligibility
Timeliness and Backlog Performance Incentive Standard.
4.2.1.1.3.2. The MA County Incentives Timeliness Report—Summary and MA County
Incentives Timeliness Report—Detail will be pulled the second Monday
after the end of each Reporting Period to determine the Contractor's
performance over the entire six-month Reporting Period.
4.2.1.2. Backlogged Determinations and Redeterminations
4.2.1.2.1. The Contractor's Backlogged Determinations average and Backlogged
Redeterminations average at the end of each Reporting Period shall be within
the limits described in the following table:
4.2.1.2.2. County Backlog Table
County Size Limit
New Applications I
f Large 1 :5 75
Medium 1 5 10
Small 1 :5 3
Redeterminations
I Large 1 :5280
Medium I <28
Small 1510
4.2.1.2.3. To determine the Backlogged Determinations average, the Department will
total the Backlogged Determinations of each month of the Reporting Period and
divide by the number of months in the Reporting Period.
4.2.1.2.3.1. The MA County Incentives Backlog Report— Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Contractor's amount of Backlogged Determinations for each month of each
Reporting Period.
4.2.1.2.3.2. The MA County Incentives Backlog Report— Summary and MA County
Incentives Backlog Report— Detail will be pulled on the second working
day of each month.
4.2.1.2.4. To determine the Backlogged Redeterminations average,the Department will
total the Backlogged Redeterminations of each month of the Reporting Period
and divide by the number of months in the Reporting Period.
4.2.1.2.4.1. The MA County Incentives Backlog Report—Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Page 5 of 17
i
Contractor's amount of Backlogged Redeterminations for each month of
each Reporting Period.
4.2.1.2.4.2. The MA County Incentives Backlog Report—Summary and MA County
Incentives Backlog Report —Detail will be pulled on the second working
day of each month.
4.2.1.2.4.3. The Department will round both the Backlogged Determinations average
and Backlogged Redeterminations average to the nearest whole number.
4.2.1.2.5. When a Determination or Redetermination is Considered Backlogged
4.2.1.2.5.1. 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.
4.2.1.2.5.2. A Determination or Redetermination 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.
4.2.1.3. Timeliness of LTSS Determinations and Redeterminations
4.2.1.3.1. The Contractor shall complete at least ninety-five percent (95%) of all LTC,
HCBS, and PACE Determinations and Redeterminations as Timely
Determinations and Timely Redeterminations.
4.2.1.3.1.1. The Department will total all Timely Determinations and Timely
Redeterminations for LTC, HCBS, and PACE the Contractor completed
within the Reporting Period and divide that by the total number of LTC,
HCBS, and PACE Determinations and Redeterminations the Contractor
completed during that Reporting Period to determine the timeliness percent.
The Department will round these calculated percentages to two(2)decimal
places.
4.2.1.3.1.2. Determining Compliance with the Timeliness of LTSS Determinations and
Redeterminations
4.2.1.3.1.2.1. The Department will utilize the MA County Incentives LTSS
Timeliness Report — Summary and MA County Incentives LTSS
Timeliness Report—Detail to determine compliance with the timeliness
benchmarks of the LTSS Performance Incentive Standard.
4.2.1.3.1.2.2. The MA County Incentives LTSS Timeliness Report— Summary and
MA County Incentives LTSS Timeliness Report—Detail will be pulled
the second Monday after the end of each Reporting Period.
4.2.1.4. Timeliness of Case Maintenance and Disenrollment
4.2.1.4.1. The Contractor shall process changes in a member's circumstance within fifteen
(15) calendar days and shall complete eighty-five percent (85%) of the
Contractor's disenrollments within fifteen(15)calendar days.
4.2.1.4.1.1. Processing and Timeframes for a Member's Change in Circumstances
Page 6 of 17
4.2.1.4.1.1.1. The Contractor shall process all member and partner agency-reported
change in circumstances within fifteen(15)calendar days.
4.2.1.4.1.1.2. The fifteen (15) calendar day clock begins on the date the member's
change in circumstance is reported to the Contractor and ends on the
date the eligibility determination based on the change is authorized in
CBMS.
4.2.1.4.1.1.3. The fifteen(15)calendar day benchmark applies to changes reported by
a member, by a partner agency such as the Single Entry Point or
Community Centered Board or external agencies such as nursing
facilities.
4.2.1.4.1.1.4. The Contractor- shall not pre-screen changes in circumstances to
determine if the change results in a disenrollment. The Contractor shall
process the change in circumstance by entering the information into
CBMS within fifteen(15)calendar days.
4.2.1.4.1.1.5. The Contractor shall follow existing policy and operational guidance for
entering information relating to a change in circumstances into CBMS.
4.2.1.4.1.1.5.1. The calculation for Timely Disenrollments is based on data entry
into CBMS. The Contractor shall ensure that information is
correctly entered into CBMS, including the date the change in
circumstance was reported, to ensure the Timely Disenrollment
calculation is accurate.
4.2.1.4.1.2. Timely Disenrollments
4.2.1.4.1.2.1. The Contractor will disenroll all members where a change in
circumstance has resulted in ineligibility within fifteen (15) calendar
days.
4.2.1.4.1.3. Determining Compliance for Timely Disenrollments
4.2.1.4.1.3.1. The Department will utilize the MA Disenrollment Processing Times
Report to determine the Contractor's compliance with the Timely
Disenrollment percentage.
4.2.1.4.1.3.2. The MA Disenrollment Processing Times Report will be pulled the
second Monday of the first month after the end of each Reporting
Period.
4.2.1.4.1.3.3. To determine the Contractor's percentage of timely disenrollments,the
Department will take the total number of timely disenrollments over
each Reporting Period and divide that by the total number of
disenrollments completed. The Department will round the number to
two decimal places.
4.2.2. Small County and Sample Size Exceptions
4.2.2.1.1. If 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 the timeliness percentage of
the Eligibility Performance Incentive Standard so long as they had eighteen(18)
Page 7 of 17
or fewer Untimely Determinations/Redeterminations during that Reporting
Period.
4.2.2.1.2. If the Contractor processes a total of ten(10)or fewer LTSS Determinations
and twenty (20) or fewer LTSS Redeterminations per Reporting Period, the
Contractor shall be deemed to have met the LTSS timeliness percentage
benchmark for the Eligibility Performance Incentive Standard so long as they
had six (6) or fewer Untimely LTSS Determinations and Untimely LTSS
Redeterminations during that Reporting Period.
4.2.2.1.3. If the Contractor processes a total of eight(8)or fewer disenrollments during
any given month, the Contractor shall be deemed to have met the Timely
Disenrollment percentage benchmark for the Eligibility Performance Incentive
Standard so long as they had at least sixty percent(60%)of disenrollments as
Timely Disenrollments.
4.2.2.1.4. There are no Small County or Sample Size Exceptions for backlogged
Determinations and Redeterminations.
4.2.3. Exemptions for Unusual Circumstances .
4.2.3.1. The Contractor may request an exemption for unusual circumstances for failure to
meet the Timeliness of Determinations and Redeterminations benchmark as
described in section 4.2.1.1, failure to meet Backlogged Determinations and
Redeterminations benchmark as described in section 4.2.1.2 or failure to meet the
Timeliness of LTSS Determinations and Redeterminations benchmark as described
in section 4.2.1.3.
4.2.3.1.1. The Contractor is not eligible to request an exemption for unusual
circumstances for failure to meet the Timeliness of Case Maintenance and
Disenrollment benchmark as described in section 4.2.1.4.
4.2.3.2. The exemption process for unusual circumstances is described in section 6,
Exemptions.
4.2.4. BENCHMARK: Three(3)out of the following four(4): 95%timeliness average over
each Reporting Period for determinations and redeterminations as described in section
4.2.1.1; backlogged determination and redetermination averages over each Reporting
Period below limit based on county size as described in section 4.2.1.2.;95%timeliness
average over each Reporting Period for LTSS determinations and redeterminations as
described in section 4.2.1.3.; eighty-five percent (85%) of disenrollments completed
within fifteen(15)calendar days as described in section 4.2.1.4.
4.3. Exceptional Eligibility Performance Incentive Standard
4.3.1. The Contractor may earn an Exceptional Eligibility Performance Incentive Payment
for each Reporting Period in which the Contractor meets all four (4) of following
benchmarks: Timeliness of Determinations and Redeterminations,Timeliness of LTSS
Determinations and Redeterminations, Backlogged Determinations and
Redetenninations and Timeliness of Case Maintenance and Disenrollment as found in
section 4.2.
4.3.2. BENCHMARK: Four (4) out of the following four(4): 95.00%timeliness average
over each Reporting Period for determinations and redeterminations as described in
Page 8 of 17
section 4.2.1.1; backlogged determination and redetermination averages over each
Reporting Period below limit based on county size as described in section 4.2.1.2.;
95.00%timeliness average over each Reporting Period for LTSS determinations and
redeterminations as described in section 4.2.1.3.; eighty-five percent (85.00%) of
disenrollments completed within fifteen (15) calendar days as described in section
4.2.1.4.
4.4. Training Performance Incentive Standard
4.4.1. The Contractor may earn the Training Performance Incentive Payment for each
Reporting Period if at least seventy five percent (75%) of its eligibility technicians
and/or supervisors complete the required number of training hours as described in
section 4.4. The Contractor's staff that are subject to the Training Performance
Incentive Standard requirement is described in section 4.4.1.1.
4.4.1.1. Staff Subject to Training Performance Incentive Standard and Training Hours
Requirement
4.4.1.1.1. The eligibility technician and/or supervisor will be responsible for eight (8)
hours of training in the contractual period if the eligibility technician and/or
supervisor has the security profile to authorize Medical Assistance as described
in section 4.4.1.1.4.
4.4.1.1.2. The eight (8) hours of training shall be completed from the list of approved
trainings provided by the Department. The list of approved trainings will be
provided to the Contractor at implementation and will be posted on the
Department's County Administration website.
4.4.1.1.3. Trainings from the Approved Training List can be trained by the Staff
Development Center(SDC) or an SDC-certified trainer using SDC-approved
materials.
4.4.1.1.4. Management and Eligibility Enrollment Specialist (EES) CBMS access users
are subject to the Training Performance Incentive Standard.
4.4.1.2. Training Completion Timeframes and Previously Completed Trainings
4.4.1.2.1. The required amount of training can be completed during the First and Second
Reporting Periods, if the required amount is met by the conclusion of the
Second Reporting Period.
4.4.1.2.2. The Contractor's staff may re-take a previously completed course and be
granted credit so long as the course was not originally taken within the current
fiscal year.
4.4.1.2.2.1. Courses re-taken from a previous fiscal year shall be tracked per the
requirements in section 4.4.1.3.2.
4.4.1.3. Determining Compliance with the Training Performance Incentive Standard
4.4.1.3.1. 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 Performance Incentive Standard.
4.4.1.3.1.1. Only eligible trainings as found on the list of approved trainings should be
logged in LMS via the Add External Training feature.
Page 9 of 17
4.4.1.3.1.2. Trainings added via Add External Training that are not included on the list
of approved trainings will be rejected.
4.4.1.3.1.3. External Training requests must match the amount of training hours offered
as described on the list of approved trainings. External Training requests
that request more hours than described on the list of approved trainings will
be denied.
4.4.1.3.2. Courses re-taken shall be manually added into the LMS by utilizing the Add
External Training feature.
4.4.1.3.2.1. If a course has not yet been completed in the LMS, then the Contractor's
staff shall register for the course through the standard course registration
process and not request approval via Add External Training feature.
4.4.1.3.3. To determine compliance with the required number of training hours, the
Department will request data on users with security profiles listed in section
4.4.2.3. A cross-comparison with the security profiles data pull and LMS
completion reports will determine if the Contractor complied with the seventy
five percent (75%) requirement for the Training Performance Incentive
Standard.
4.4.2. BENCHMARK: 75%of eligibility technicians and supervisors with security profiles
listed in section 4.4.2.3 complete eight (8) hours of training from the Approved
Training List within the contract period as described in section 4.4.1.
4.5. Cybersecurity Performance Incentive Standard
4.5.1. The Contractor may earn a Cybersecurity Performance Incentive Payment for each
Reporting Period in which the Contractor submits the required deliverables relating to
cybersecurity standards and remediation plans for the Colorado Information Security
Policies(CISP)as described in section 4.5.
4.5.2. First Reporting Period Deliverable
4.5.2.1. No later than the semi-annual reporting due date for the First Reporting Period,the
Contractor shall submit to the Department a signed Memorandum of Understanding
(MOU)or similar document,created collaboratively between the Department and
the Contractor,regarding compliance with the CISPs,data privacy and/or sharing
or other cybersecurity standards to be addressed.
4.5.2.1.1. The Contractor shall ensure that the cybersecurity agreement is implemented in
the Contractor's county within a reasonable timeframe. Implementation may
or may not depend on compliance with the CISPs and the Contractor's
Remediation Plan for the CISPs,as described in section 4.5,will also consider
the cybersecurity agreement mentioned in section 4.5.2.1.
4.5.3. Second Reporting Period Deliverable
4.5.3.1. No later than the semi-annual reporting due date for the Second Reporting Period,
the Contractor shall review whether its IT systems and other data privacy and
protection safeguards comply with the CISPs. If the Contractor is not in
compliance, the Contractor shall create and submit a Remediation Plan. The
Remediation Plan will address areas of non-compliance and set a timeline to gain
compliance.
Page 10 of 17
4.5.3.1.1. In instances where the Contractor's ITSP is OIT, OIT shall be responsible for
CISP compliance only for those CISPs which OIT manages on behalf of the
Contractor.
4.5.3.1.1.1. The Contractor shall not be responsible for compliance with the CISPs for
any policies which are the responsibility of OIT or the State.
4.5.3.1.2. Full compliance with the CISPs does not need to be met by the semi-annual due
date for the Second Reporting Period; rather, the Contractor, through the
Remediation Plan,shall create a reasonable timeframe for which it would gain
CISP compliance,considering workload,funding and other factors.
45.4. DELIVERABLES: Signed cybersecurity MOU submitted no later than the semi-
annual due date for the First Reporting Period;completed Remediation Plan submitted
no later than the semi-annual due date for the Second Reporting Period.
4.6. Food Security Performance Incentive Standard
4.6.1. The Contractor may earn a Food Security Performance Incentive Payment for both
Reporting Periods in which the Contractor meets its specified benchmark relating to
the percentage of Health First Colorado members who have a corresponding enrollment
in the SNAP as described in section 4.6.
4.6.1.1. Percentage of Health First Colorado members with enrollment in SNAP
4.6.1.1.1. The Contractor shall increase the percentage of Health First Colorado members
with enrollment in SNAP. The percentage increase and the overall Food
Security benchmark will be mutually agreed-upon by the Department and
CDHS. The benchmark will be communicated to the Contractor through the
HCPF Memo Series.
4.6.1.1.2. Determining Compliance with the Food Security benchmark
4.6.1.1.2.1. The Department will total the number of Health First Colorado members
with SNAP enrollment and divide that by the total number of all Health
First Colorado members in the Contractor's county.
4.6.1.1.2.2. The Department and CDHS will utilize a cross-systems data pull to
determine compliance with the benchmark of the Food Security
Performance Incentive Standard.
4.6.1.1.2.2.1. The numerator and denominator of the benchmark will exclude any
relevant populations(e.g.IPV,E&T sanctions)as mutually determined
by the Department and CDHS. The populations excluded will be
communicated through the HCPF Memo Series.
4.6.1.1.3. The Contractor has the option to document its efforts to meet the Food Security
benchmark through an outreach plan or similar written documentation. The
written documentation is not required to be submitted to the Department as a
contract deliverable.
4.6.2. BENCHMARK: Enrollment benchmark of Medicaid members who have a
corresponding enrollment in SNAP in section 4.6. Enrollment benchmark will be
communicated through the HCPF Memo Series.
5. SEMI-ANNUAL REPORTING
Page 11 of 17
5.1.1. The Contractor shall submit documentation to the Department to verify the
Contractor's compliance with each Performance Incentive Standard and will submit
such documentation on a semi-annual basis.
5.1.1.1. For the First Reporting Period, the Contractor will submit the following
documentation:
Any Eligibility Performance Incentive Standard exemption forms for the
Reporting Period,if the Contractor failed to meet specified benchmarks.
Any Cybersecurity Performance Incentive Standard Memorandums of
Understanding (MOU), Remediation Plans or other documents listed as
deliverables under this agreement.
DUE DATE: January 5,2020
5.1.1.2. For the Second Reporting Period, the Contractor will submit the following
documentation:
5.1.1.2.1. Any Eligibility Performance Incentive Standard exemption forms for the
Reporting Period,if the Contractor failed to meet specified benchmarks.
5.1.1.2.2. Any Cybersecurity Performance Incentive Standard Memorandums of
Understanding (MOU), Remediation Plans or other documents listed as
deliverables under this agreement.
5.1.1.2.3. DUE DATE:July 5,2020
6. EXEMPTIONS
6.1. Exemptions for Unusual Circumstances for the Eligibility Performance Incentive Standard
and the Exceptional Eligibility Performance Incentive Standard
6.1.1. 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.
6.1.1.1. The Department will not include any Untimely Detenninations/Redetertninations
in its calculation of the Eligibility Performance Incentive Standard if the
Department has approved that Untimely Determination/Redetermination as being
untimely because of unusual circumstances as specified in section 6.1.1.
6.1.1.2. 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.
6.1.1.3. 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.
6.1.1.3.1. Exemption requests based on staff vacancies and trainings,personnel or other
related issues will only be considered in exceptional circumstances. The
Department reserves the right to deny exemption requests
6.1.2. The Department may approve or reject any request for Untimely
Detertnination/Redetermination exemptions and may limit the total number of
exempted Untimely Determinations/Redeterminations for the Eligibility Performance
Incentive Standard.
Page 12 of 17
6.1.2.1. 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:
6.1.2.1.1. 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.
6.1.2.1.2. Failure of the Contractor to act on client verification that was submitted timely
which was requested for a Determination or Redetermination.
6.1.2.1.3. Failure of the Contractor to manually authorize a Determination or
Redetermination with a mass update exception.
6.1.2.1.4. Failure of the Contractor to manually authorize a Redetermination when the
auto re-enrollment or Ex Parte processes were not successful.
6.1.2.1.5. Failure of the Contractor to pull all applicable COGNOS reports for the
purposes of fulfilling Exhibit A-5,Statement of Work.
6.1.2.2. The reasons for denial of an exemption as stated in section 6 are not all-inclusive
and the Department reserves the right to deny any exemption for reasons not stated
in section 6.
6.1.2.2.1. Prior to denying an exemption for reasons beyond those stated in section 6,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 6,Exemptions.
6.1.2.3. The Department may approve or reject any request for exemption due to unusual
circumstances and may limit the total number of exemption requests.
6.2. Exemptions for Unusual Circumstances for Performance Incentive Standards other than
the Eligibility Performance Incentive Standard
6.2.1. Exemptions for unusual circumstances will not be considered for any Performance
Incentive Standard listed under section 6.2.1.
6.2.1.1. Training Performance Incentive Standard
6.2.1.2. Cybersecurity Performance Incentive Standard
6.2.1.3. Food Security Performance Incentive Standard
6.2.2. The Contractor's performance and compliance with the Performance Incentive
Standards listed under section 6.2.1 will be deemed final, as determined by the
Department, and Performance Incentive Payments made without the opportunity to
submit an exemption for unusual circumstances.
7. NOTIFICATIONS
7.1. After each Reporting Period,the Contractor will be provided a Status Report that details
which Incentive Performance Standards were met.
7.1.1. The Contractor's Reporting Period Status Report will only detail which Incentive
Performance Standards were met for the Reporting Period in question. Funding
amounts will not be provided until the conclusion of the fiscal year.
Page 13 of 17
7.1.2. If the Contractor has more than one Reporting Period in the fiscal year to meet any
Incentive Performance Standards,the Reporting Period Status Report will not include
the Contractor's performance in those Performance Standards.
7.2. After the conclusion of the fiscal year,the Department will provide the Contractor a final
Status Report that details which Performance Incentive Standards were met and how much
Performance Incentive Payments were earned by the Contractor.
7.2.1. The final Status Report cannot be disputed; if the Contractor disagreed with the
Department's determination of compliance with any Performance Incentive Standard,
the Contractor shall have disputed that result based on the Reporting Period Status
Report.
7.3. Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor's
compliance with the Performance Incentives Standards.
7.4. Status Reports for each Reporting Period will be sent within ten(10) calendar days after
the Semi-Annual Reporting due date for each Reporting Period as found in Section 5,Semi-
Annual Reporting.The date on which the Status Report for each Reporting Period is sent
to the Contractor will be considered the Status Report Date.
7.4.1. If unusual circumstances have delayed the Contractor's Reporting Period or final Status
Reports,the Department will inform the Contractor of the delay and an anticipated date
of resolution.
7.5. The final Status Report will be sent upon the Department's determination of final
Performance Incentive Payment amounts.
7.6. The Contractor will have the opportunity to dispute the Status Report results as defined in
section 7,Dispute Resolution.
8. DISPUTE RESOLUTION
8.1. Opportunity and Timeframe for Dispute Resolution
8.1.1. In the event the Contractor disagrees with the findings of the official notification as
found in section 7,Notifications,the Contractor will have the opportunity to dispute
the Reporting Period Status Report for the Reporting Period in question.
8.1.1.1.1. The final Status Report cannot be disputed per section 7.2.1.
8.1.1.2. The Contractor will have ten (10) calendar days from the Status Report Date to
review each Reporting Period Status Report and dispute the results.
8.1.1.3. If the Contractor fails to dispute the Reporting Period Status Report within ten(10)
calendar days from the Status Report Date,the Status Report results will be deemed
final. No further disputes will be allowed, and compensation will be made per
section 9 based on the results of the non-disputed Status Report.
8.2. Allowable Disputes
8.2.1. The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
Page 14 of 17
8.2.1.1. The Contractor submitted documentation that was required for a Performance
Incentive Standard, so long as the Contractor has proof that the required
documentation was submitted on or before the contractually-required due date.
8.2.1.2. The Contractor requests a re-review of the Contractor's submitted documentation
that was used to determine compliance with any Performance Incentive Standard.
8.2.1.3. The Contractor has available data, such as systems reports or other tracking
methodologies,that conflicts with the Department's available data that will utilized
to determine compliance with a Performance Incentive Standard.
8.2.1.3.1. The Contractor will be responsible for providing all necessary and relevant data
available to the Department in order to determine if the Contractor's data truly
conflicts with the Department's data.
8.2.1.3.2. The Department will make the final determination when a conflict of data
occurs and will make Performance Incentive Standard Payments based on its
final determination.
8.2.2. The Department reserves the right to add additional allowable dispute reasons
throughout the fiscal year based on additional information made available from the
Department and/or Contractor. These additional allowable dispute reasons will be
considered on a case-by-case basis,and the Department's determination of additional
allowable dispute reasons are final and not subject to the Dispute Resolution process
as outlined in section 8.
8.3. Nonallowable Disputes
8.3.1. The Contractor will not be allowed to dispute the results of the Status Report based on
the following reasons;
8.3.1.1. The Contractor failed to meet contractually-specified requirements relating to the
content of submission of deliverables and the timely submission of deliverables.
8.3.1.2. The Contractor failed to meet contractually-specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3. The Contractor's failure to review and utilize County Incentives Program
documentation, including policy, informational, and operational guidance issued
through the HCPF Memo Series, that resulted in the Contractor failing to meet
performance benchmarks and deliverables relating to any Incentive Performance
Standard..
8.3.1.4. The Department's final determination of the Contractor's exemption request{s}for
the Eligibility Performance Incentive Standard.
8.3.1.5. Any exemption requests for unusual circumstances for other Performance Incentive
Standards other than those listed in 8.3.1.4.
8.3.2. The Department reserves the right to deny a Contractor's dispute based on any reason
not included under section 8.3.1. The Department's determination is final and is not
subject to dispute or appeal.
9. COMPENSATION
9.1. Compensation
Page 15 of 17
9.1.1. Performance Incentive Payment
9.1.1.1. The Department shall pay the Contractor,after the end of the fiscal year in which
the work was performed,a Performance Incentive Payment for each Performance
Incentive Standard it meets during the applicable Reporting Period as follows:
9.1.1.1.1. The Department shall pay the Contractor an Eligibility Performance Standard
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.1.1.2. The Department shall pay the Contractor a Training Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.1.1.3. The Department shall pay the Contractor a Cybersecurity Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.4. The Department shall pay the Contractor a Food Security Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.2. Remaining Funds Incentive Pool Payment
9.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
9.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.l.l. The total amount of all base Performance Incentive Payments allocated to
any Contractor that selected to not participate in the Performance Incentive
Standards Program for that SFY.
9.1.2.1.1.2. Each of the base Performance Incentive Payments from the Training
Performance Incentive Standard,the Cybersecurity Performance Incentive
Standard and the Food Security Performance Incentive Standard that were
not earned by the Contractor during a Reporting Period in that SFY.
9.1.2.1.1.2.1. The Contractor shall be eligible for Remaining Funds Incentive Pool
payments for the Eligibility Performance Incentive Standard only if the
Contractor was in compliance with the Exceptional Eligibility
Performance Incentive Standard.
9.1.2.1.2. If 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.
9.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
9.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amount of Incentives met during that SFY.
9.1.2.2.2. 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.
Page 16 of 17
9.1.2.2.3. 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 2,County Determinations.
9.2. Payment Procedures
9.2.1. The Contractor shall receive Performance Incentive Payments for each Reporting
Period within ninety days(90)days following the end of the fiscal year in which the
Performance Incentive benchmarks were met.This allocation will reflect the maximum
the Contractor can earn for each Performance Incentive Standard per Reporting Period.
9.2.1.1. If the Contractor's county administration line item is over-expended during the
county administration closeout process,Settlement Accounting and the Department
may utilize the Contractor's earned Performance Incentive Payments during the
closeout process.
9.2.2. Actual Performance Incentive Payment maximums are dependent on the Contractor's
share of Medicaid county administration expenditure. In no event shall the Contractor
be paid more than the Contractor's county share of Medicaid county administration
expenditure in any Reporting Period.
9.2.3. The Department may add any unearned funds from the First Reporting Period into to
the Second Reporting Period allocation for any SFY.
9.2.3.1. The Contractor shall be paid the Performance Incentive Payments through the
County Financial Management System(CFMS).
9.2.4. The Department may use any unearned Second Reporting Period Incentive
Performance Payments during the county administration close out process.
Page 17 of 17
EXHIBIT C. 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 1 Grand Phillips
Baca Gunnison Pitkin
Bent Hinsdale Rio Blanco
Cheyenne Jackson Routt
Clear Creek Kiowa San Juan
Castilla 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
CONTRACT
RESOLUTION OF THE BOARD OF COUNTY COMMISSIONERS
OF PITKIN COUNTY,COLORADO
APPROVING AN INTERGOVERNMENTAL AGREEMENT WITH HEALTH CARE
POLICY AND FINANCING FOR THE COUNTY MEDICAID INCENTIVE
PROGRAM
RESOLUTION NO. OW 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. CKS 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 Medicai' - tan rds related to Medicaid eligibility and
cooperation provide the highest
quality servi
4. Pitkin Coun into this
Intergovern nancing in order to
receive fina caid performance
standards.
NOW,THEREF Commissioners of
Pitkin County,C ter into an
Intergovernmen#t ing in substantially
the same farm sa ;f' the Chair or the
Director of Heal ehalf of the County
and further,auth ervices to sign all
future amend val of such by the
county manager
INTRODU ED,READ ANDADOPTED AS AN EMERGENCY RESOLUTION ON
THE DAY OF rflljt-4- 2016 AN SET FOR CONFIRMATORY
PUBLIC HEARING ON THE QDAY O'. -2016.
NOTICE OF CONFIRMATORY'PUBLIC HEARING AND TITLE AND SHORT
SUMMARY OF THE EMERGENCY RESOLUTION PPBLISHED IN THE ASPEN
TIMES WEEKLY ON T14E Q DAY OF e--alt mac— ,2016.
NOTICE OF CONFIRMATORY PUBLIC HEARING AND THE FULL TEXT OF THE
RESOLUTION POSTED ON THE OFFICIAL PITKIN`` COUNTY WEBSITE
wwwmitkincountv:com ON THE DAY OF lfUta�_ 2016.
CONFI ED AT A CONFIRMATORY PUBLIC HEARING ON THE DAY
OF (14t-c 2016.
PUBLISHED BY TITLE AND SHORT SUMMARY,AFTER CONFIRM4TORY
PUBIC HEARING,IN THE ASPEN TIMES WEEKLY ON THE 7AY OF
2016.
POSTED BY TITLE AND SHORT SUMMARY ON THE OFFICIAL PITKIN COUNTY
WEBSITE www.nitkincountv.com ON THE PQDAY Of e. . 2016
ATTE BOARD OF COUNTY COMMISSIONERS
By By: -
Jean a Jones R=h E.Ric ands,Cha'
Dep(Ay County Clerk '(^. i
Date: !0
APPROVED AS TO FORM: MANAGER APPROVAL
Ak
John Ely,Co tt y �on P�cock,
unty Manager
2
Date: Original Contract No. Option Letter No.3 Contract No.
May 28,2419 201 SCMIP097 2015CMIP097OL3
1) OPTIONS:
a.Option to renew only(for an additional term).
2) REQUIRED PROVISIONS:
In accordance with Section 7.E of the Original Contract between the State of Colorado,Department of Health
Care Policy and Financing, and Pitkin County, the State hereby exercises its option for an additional term
beginning July 1, 2019 and ending on June 30, 2020 and for an increase in the amount of services under the
Agreement at the rates as specified in Exhibit B.
3) EFFECTIVE DATE:
The effective date of this Option Letter is upon approval of the State Controller or July 1,2019,whichever is later.
STATE OF COLORADO
Jared S.Polis VERNOR
Department of eal h ar olicy and Financing
By:
Kim llimestefer t
Executive Director v C,
Date: ( - -�' 1
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.
STATE CONTROLLER
Robert arAMBA,JD
By: l
Department of l&hItl4 are Policy nd Financing
Date:
Page 1 of I
t
CONTRACT .�j� "262�
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 shsll not
be liable to pay or reimburse Contractor for any performance hereunder, including, but not
limited to, costs or expenses incurred, or be bound by any provision hereof prior to the Effective
Date.
3. FACTUAL RECITALS
The Parties entered into the Agreement to create incentives for counties that achieve certain
incentive performance standards related to Medicaid eligibility and cooperation with other
Medicaid related entities. The purpose of this Amendment is to add exhibits and update the
incentives.
4. CONSIDERATION
The Parties acknowledge that the mutual promises and covenants contained herein and other
good and valuable consideration are sufficient and adequate to support this Amendment.
5. LIMITS OF EFFECT
This Amendment is incorporated by reference into the Agreement, and the Agreement and all
prior amendments thereto, if any, remain in full force and effect except as specifically modified
herein.
6. MODIFICATIONS
The Agreement and all prior amendments thereto, if any, are modified as follows:
A. Section 4, Definitions, Subsection B is hereby deleted in its entirety and replaced with the
following:
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,Rates
Exhibit C, Sample Option Letter
Exhibit D, Small,Medinrn, 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., SPY 2015-16 Pool Maximum County Share Table, is
hereby deleted in its entirety and replaced with the following:
2.2. SPY 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
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 13
Amendment Routing Number 2015CM[P097A1
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: tr c F- egiV
Name of authorized signer By:
Title Susan E.Birch,MBA,BSN,RN
c c a..:r w.cu, S3 in CC Executive Director
Date: GU/2-5-12--0 !S
Date: RI Cs 1 ! '(
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
SATE CONTROLLER
: .e A,MBA,JD
By: (a41,4---
Department •f Health Care Poand Financing
/iO7(Date: /!
Page 5 of 13
EX.IIIBIT 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 Organi7ation (BHO) - An organi7ation 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 SFY.
1.1.7. Redetermination—A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.8. State Fiscal Year (SFY) — The period beginning July 1 of each calendar year and
ending on June 30 of the following calendar year.
1.1.9. 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
Page 6 of 13
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
3.2A. 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 Detenninations/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 Deterniination/Redetermination as being.untimely because of unusual
circ»mstances. 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 Request.Date"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 Orgaui7ation(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 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 3.3.1.4.1.3. The Department will determine the
Contractor's compliance with the Collaboration Incentive Standard based on
the submission of the meeting agendas, meeting minutes and list of attendees
for all meetings during the Reporting Period. The Contractor shall use the
Collaboration Incentive Template found in the County Incentives Program
Guide to organize the documentation. When sending the Collaboration
Template back to the Department,the Contractor shall name the electronic file
using the following naming mechanism "County Name.Collabortion
Incentive.Date" with the date being the end of the reporting period in which
the exemption is filed.
3.4. 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 ` `� , ww„rlts �
5,,•t , 1TIP a{ 5
•
4r;
,..,,.c
;IP -r;4t. 2,'w 4 4 Large < 100
% _ _ �^ f> Medium < 15
1 R
". Small <5
Redeterminations ; S � fi �.
.f,.. i. � J f'' r:...i hyyr m{ ^' o4..,d;,t-,s4
t���A wh iC i Yy y`hx 4 0 Large <300
1 '11 49' �VZ'/1�1 � d� �S
� M 3 , ro t . Medium <30
���ti y21�a'tF�t
t
} �rcct1 :i 3 t dF Y ' a 4 J3 E� 'u J <10
{,a Small
k`t = 1! A miq'i t +�2`r
Page 9 of 13
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 .
Quarter 2 Report ;OcoberiY, Nov'em; &i wecemb -;;Yir Febru. arc;..:,......
1st
Page 10 of 13
Revised Annual Plans a oast s� t- fit-l_ e P.D11J
Quarter 3 Report ,;January, February&Much 'May 1st y
Quarter 4 Report *:(11,-,,alit411.1—
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.
17.1.2. 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
•
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 from the first Reporting Period into to
the second Reporting Period allocation for any SFY.
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 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
Page 13 of 13
•
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 all 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 I, 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
1 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-I, 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 2016-17 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% $1,414.93
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 2015CMIP097A2
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: (7 ‘,A., �� U< C-c)
Name of a horized signer
Title Susan E. Birch. MBA, BSN. RN
Executive Director
Date: ((:)(
Date:
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
S TE e ROLLER
• - aros,CPA, MBA,JD
By: _ 6€11.r14
Department o Healt Care Policy 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 1 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. COGNOS:`Decision Support System 01 (DSSOI) 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 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.
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/DSSOI 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/DSSOI 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.
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.
3.2.2.1. 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.
3.3.1.1.14. 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 next 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
Redeterminations
Large _<360
Medium ; <_36
Small 512
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/DSS0I 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%) 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
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 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,May&June August 1st
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 3I st 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 (I) 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 (CFMS).
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.
Page 14 of 16
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
Page 15 of 16
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
Page 16 of 16
_l
CONTRACT#'YS V‘°4t ;i;;
APPROVED BY
RESOLUTION Department of Health Care Policy and Financing
#n Agreement Routing Number 2015CMIP097A2
AGREEMENT AMENDMENT NO.2
Original Agreement Routing Number 20I5CMIP097A2
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 all 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 I, 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-I, 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 2016-17 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 $5,659.69
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 $1,886.56
all Pool Distributions
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
Except 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 2015CMIP097A2
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
Financin
By:
Name of authorized signer co Lly: 0 C ,
Title Susan E. Birch, MBA, BSN, RN
Executive Director
Date: (0
1 2-4- I I ‘e.i
Date: l �� I
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
S TE ROLLER
airr�os,, CPA, MBA,JD
o7l
Department HealaarrePPlilicy and Financing
Date:____
Page 4 of 16
EXHIBIT A-2,STATEMENT OF WORK
I. 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 (RHO) - 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 1 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
Page5 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. COGNOS/Decision 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 work within 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/DSSOI 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/DSSOI 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.
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.
3.2.2.1. 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 (I) 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.
3.3.1.1.10. 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. Community Centered Boards(CCB). See list of CCBs in County Incentives
Program Guide.
3.3.1.1.13. 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 33 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 next year to improve clients' access to care.
Page8 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
Redeterminations
Large <_360
Medium <36
Small <12
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 Redetermination 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%) 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(I)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 l0 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'
Quarttr 1 Report u _.. .
'July,.ABust&September November 1st
Quarter 2 Report October,November&December February 1st
Revised annual Plans July 1st-June 30tH March31st
Qujrter 3 Re port January,February&March May 1st
Quarter 4 Report April,May&June August 1st
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 3I st and July
5'h for the Second Reporting Period ending June 30i11
4. EXEMPTIONS
4.1. If a Determination or Redetermination is delayed for unusual circumstances as defined
under 10 C.C.R. 2505-8.I00.3.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 or 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.
5.1.1.12. 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(CFMS).
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.
Page 14 of 16
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.
I. 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
S. Colorado Child Care Assistance Program
a. Also known as CCAP
9. Employment First
Page 15 of 16
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 Oumy 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
Larve
Adams
Arapahoe
Boulder
Denver
El Paso
Jefferson
Larimer
Mesa
Pueblo
Weld
Page 16 of 16
APPROVED BY eUNTRACT # ���
RESOLUTION
# Dyl __
Department of Health Care Policy and Financing
Agreement Routing Number 2015CMIP097A3
AGREEMENT AMENDMENT NO.3
Original Agreement Routing Number 2015CMIP097A3
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"). The Department
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 performance-related benchmarks for county
departments of human/social services that achieve certain Incentive Performance Standards related
to determining and redetermining Medicaid eligibility, those populations currently enrolled in
Medicaid and cooperation with other Medicaid-related entities. The purpose of this Amendment
is to add exhibits and update the Incentives Performance 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 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 arc attached hereto and
incorporated by reference herein:
Exhibit A-3,Statement of Work
Exhibit B, Rates
Exhibit C, Sample Option Letter
Exhibit D, List of CDHS programs for Training Performance Incentive
Exhibit E, Small, Medium, Large County List
Exhibit F, List of Mandatory Trainings for Training Performance Incentive
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
State Fiscal Year 2017-18 $8,395.04
Total for All State Fiscal Years $31,412.66
C. Section 10, Confidential Information, Subsection B, Health Insurance Portability &
Accountability Act of 1996 ("HIPAA"), Paragraph ii, Business Associate Contract is
hereby deleted in its entirety.
D. Section 16,Notices and Representatives is hereby deleted in its entirety and replaced with
the following.
16. NOTICES AND REPRESENTATIVES
Each individual identified below is the principal representative of the designating
Party All notices required to be given hereunder shall be hand delivered with
receipt required or sent by certified or registered mail to such Party's principal
representative at the address set forth below. In addition to,but not in lieu of, a
hard-copy notice,notice also may be sent by e-mail to the e-mail addresses, if
any, set forth below. Either Party may from time to time designate by written
notice substitute addresses or persons to whom such notices shall be sent.Unless
otherwise provided herein,all notices shall be effective upon receipt.
For the State: Joshua Montoya
Department of Health Care Policy and Financing
1570 Grant Street
Denver,CO 80203
Joshua.Montoya@hcpf.state.co.us
Page 2 of 19
For the Contractor: The Contractor shall provide the Department with
the name and address of its principal representative.
In the event that the Contractor does not provide
this information to the Department,all notices
required to be given hereunder shall be delivered to
the attention of the Contractor's director of human
services or director of social services,at the general
address on file with the Department.
E. Section 19, General Provisions, Subsection I, Order of Precedence, Paragraph ii, HIPAA
Business Associate Addendum is hereby deleted in its entirety.
F. Attachment A, HIPAA Business Associate Addendum, is hereby deleted in its entirely.
G. Exhibit A-2, Statement of Work, is hereby deleted in its entirety and replaced with Exhibit
A-3,Statement of Work,attached hereto and incorporated by reference into the Agreement.
AM references within the Agreement to Exhibit A, Exhibit A-I, or Exhibit A-2 shall be
deemed to reference to Exhibit A-3.
H. Exhibit B, Rates, Section 1.3.,SFY 2017-18 Incentives Payment Table, is hereby added as
follows:
1.3. SFY 2017-18 Incentives Payment Table
Incentive Payment Name %of Funding Payment Amount
Eligibility Timeliness and Backlog 35% $2,203.70
Performance Incentive Payment
Collaboration Performance Incentive 20% $1,259.26
Payment
Long Term Services and Supports 10% $629.63
(LTSS)Performance Incentive Payment
Training Performance Incentive 15% $944.44
Child Welfare Performance Incentive 20% $1,259.26
Payment
Total Maximum $6,296.28
Available for all
Incentive Payments
I. Exhibit B,Rates,Section 2.3.,SFY 2017-18 Pool Maximum County Share Table,is hereby
added as follows:
2.3. SFY 2017-18 Pool Maximum County Share Table
Pool Name Pool Maximum Distribution
Amount
Total Maximum Available for $2,098.76
all Pool Distributions
Page 3 of 19
7. START DATE
This Amendment shall take effect on its Effective Date.
N. ORDER OF PRECEDENCE
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 4 of 19
Amendment Routing Number 2015CMIP097A3
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: y\ aG�L \SU ? /
Susan E. Birch, MBA, BSN, RN
ExecutiveDirector
Date O I —7 1 j
t / Date: _ 1
ALL AGREEMENTS REQUIRE APPROVAL BY THE STATE CONTROLLER
ST E CONT. LER
' ••-` . : ns, CPA, MBA, JD
By: ■1 4 . 4.4 4
vs Department of Health Care PoliMind Fin 'macciiinngg/INSSERT-Name of Agency or IHE
Date:---1`
Page5 of 19
EXHIBIT A-3,STATEMENT OF WORK
1. TERMINOLOGY
I.I. The following list is provided to assist the reader in understanding acronyms,abbreviations
and terminology used throughout this document.
1.1.1. Accountable Care Collaborative (ACC) - the Department's program for care
coordination and cost containment for Medicaid members in all sixty-four (64) of
Colorado's counties.
1 12. Applicant -An individual for whom the Contractor is performing a Determination
1.1.3. 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.
1.1.4. Backlogged Determination -Any Untimely Determination that was not completed by
the timeliness requirements as set in Section 1.1.11.
1.1.5. Backlogged Redetermination -Any Untimely Redetermination that was not completed
by the timeliness requirements as set in Section 1.1.12.
1.1.6. COGNOS/Decision Support System 01 (DSS01) - the Department's data reporting
systems that use information from the Colorado Benefits Management System
(CBMS).
1.1.7. Colorado Benefits Management System(CB MS)-the State's eligibility determination
system.
1.1.8. Colorado interChange (interChange) -the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data
related to those payments.
1.1.9. 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 supporting documentation for the Child
Welfare Incentive and Training Incentive,Collaboration Incentive partner information,
required forms and templates and other relevant materials.
1.1.10. Determination - The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program based on information submitted on a new application.
1.1.11. DSSI -A two-way communication form between the financial eligibility worker and
the case management agency that can include the ULTC 100 2 certification and the
financial eligibility determination.
1.1.12. Member-An individual who is eligible for the Colorado Medical Assistance Program;
also known as a client.
1.1.13. Regional Care Collaborative Organization (RCCO) - contracted entities of the
Department that are responsible for carrying out the goals of the Accountable Care
Collaborative.
1.1.14. Reporting Period -The period of time for each performance standard used to measure
whether the Contractor met that standard.
Page 6 of 19
1.1.14 1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.14.2. The Second Reporting Period for a SFY shall begin on January I of that SFY and
end on June 30 of that SFY.
1.1.15. Redetermination—A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.16. Small, Medium and Large County—The size of the county is determined by the case-
and workload of Medical Assistance enrollment.
1.1.17. State Fiscal Year(SFY)—The period beginning July I of each calendar year and ending
on June 30 of the following calendar year.
1.1.18. Timely Determination — Any Determination that is completed within the timeliness
requirements set forth in 10 C C R.2505-8.100.3.D.
1.1.19. 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.
1.1.20. Untimely Determination — Any Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.21. 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.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility-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. SYSTEMS USED TO DETERMINE COMPLIANCE WITH INCENTIVES
PERFORMANCE STANDARDS
3.1. To determine whether the Contractor met any or all of the Incentives Performance
Standards when completing determinations and redeterminations within the Contractor's
county, the Department will utilize the COGNOS/DSS01 systems to pull the following
reports:
3 1.1 Weekly Timeliness.
3 1.2. Detailed Timely Processing of Medical Applicant Determinations/Redeterminations
3.1.3. Mass Update Case Error Details.
3.1.4. Non-MAGI Redeterminations Due.
3 1.5. Redeterminations Due for Self-employment and individuals without a Social Security
Number.
3.1.6. Verifications Due.
3.2. To determine whether the Contractor met any or all of the Incentives Performance
Standards when working with Medicaid populations within the Contractor's county, the
Department may utilize data from the Colorado interChange system.
Page 7 of 19
3.3 The above list of systems and reports is not all-inclusive and the Department will, at its
discretion, utilize additional data and reports from the COGNOS/DSSOI, interChange,
and/or other systems to determine whether the Contractor met any or all of the Incentives
Performance Standards.
3.4. The date the data or reports will be pulled from the COGNOS/DSSOI, interchange, or
other systems will be defined in each applicable Incentives Performance Standard.
3 5 The Contractor shall utilize Section 3, Determining Compliance with Incentives
Performance Standards,and information in the County Incentives Program Guide,to assist
with pulling applicable data and reports to determine the Contractor's compliance with any
or all of the Incentives Performance Standards.
4. INCENTIVES PERFORMANCE STANDARD PROGRAM
4.1. The Contractor may earn an incentive payment to reimburse it for a portion of its cost
sharing as described in Section 3.
4.1.1. To fulfill the requirements in Exhibit A-3 Statement of Work and earn an incentive
payment, the Contractor shall utilize and comply with the County Incentives Program
Guide.
4.1.1.1. The Contractor shall utilize the County Incentives Program Guide to find any
forms, templates, program contacts or additional information needed to
operationalize the Incentives Performance Standard Program referenced
throughout this Agreement.
4 2. Eligibility Timeliness and Backlog Performance Incentive Standard
4.2.1. The Contractor may earn an Eligibility Timeliness and Backlog Performance Incentive
Payment for each Reporting Period in which the Contractor:
4.2.1.1. Completes at least ninety-five percent (95%) of all Determinations and
Redeterminations as Timely Determinations and Timely Redeterminations and,
4.2.1.2. The Backlogged Determinations average and Backlogged Redeterminations
average at the end of each Reporting Period is within the limits described in the
following table:
4.2.1.2.1. County Backlog Table
County Size Limit
New Applications
Large <_ 100
Medium <_ 15
Small <5
Redeterminations
Large 960
Medium <_36
Small <12
Page 8 of 19
4 2 1.3. To determine the Backlogged Determinations average, the Department will total
the Backlogged Determinations of each month of the Reporting Period and divide
by the number of months in the Reporting Period.
4.2.1.3.1. The Court Order Based Timeliness Report's Weekly Backlog by County Report
of the first week of each month will be used to determine the Contractor's
amount of Backlogged Determinations.
4.2.1.4. To determine the Backlogged Redeterminations average,the Department will total
the Backlogged Redeterminations of each month of the Reporting Period and divide
by the number of months in the Reporting Period.
4.2 1.4.1. The Court Order Based Timeliness Report's Weekly Backlog by County Report
of the first week of each month will be used to determine the Contractor's
number of Backlogged Redeterminations.
4.2.1.5. The Department will round both the Backlogged Determinations average and
Backlogged Redeterminations average to a whole number.
4.2.1.6. To determine the timeliness percent for this Performance Standard,the Department
shall total up all Timely Determinations and Timely 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.
4.2 1 7. If 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 the timeliness percentage of this
performance standard so long as they had eighteen (18) or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
4.2.1.8 The Department will not include any Untimely Determinations/Untimely
Redeterminations and/or Backlogged Determinations/Backlogged
Redeterminations in its calculation of this Performance Standard if the Department
has approved those Untimely Determinations/Untimely Redeterminations and/or
Backlogged Determinations/Redeterminations as being untimely and/or
backlogged because of unusual circumstances as specified in Section 4,
Exemptions.
4.2.1.8.1. The Contractor shall submit documentation with the semi-annual report to
request the Department's approval of that Determination or Redetermination as
being untimely and/or backlogged because of unusual circumstances. The
Contractor shall use the exemption request form in the County Incentives
Program Guide for documentation.
4.2.1.8.2. The Department may approve or reject any request for exemption due to
unusual circumstances and may limit the total number of exemption requests.
4.2.1.9. The Department will determine the Contractor's compliance with the Eligibility
Timeliness and Backlog Performance Incentive Standard during each Reporting
Period as specified in Section 3, Determining Compliance with Performance
Incentive Standards.
Page 9 of 19
4.2.1.9.1. Timeliness data and reports for the Eligibility Timeliness and Backlog
Performance Incentive will be pulled the first working day after the end of each
Reporting Period
4.2.1.9.2. Backlog data and reports for the Eligibility Timeliness and Backlog
Performance Incentive will be pulled the first working Monday of each month
over the entire Reporting Period
4.2.1.10. 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.
4.2.1.11. A Determination or Redetermination 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.
43. Collaboration Performance Incentive Standard
4 3.1 The Contractor may earn a Collaboration Performance Incentive Payment for each
Reporting Period in which it hosted or attended at least one of the types of
Collaboration meetings listed below:
4.3.1.1. Collaborative Case Conferences -The Contractor will invite the below partner, at
minimum,to participate in at least seventy five percent(75%)of foster care youth
Collaborative Case Conferences and following the below requirements:
4.3.1.1.1. A representative from the county's Regional Care Collaborative Organization
(RCCO).
4.3.1.32. Foster care youth are mandatory populations. The Contractor may include
additional child welfare cases, but additional cases will not be included in the
seventy five percent (75%) performance benchmark as specified in Section
4.3.1.1.
4.3.1.1.2.1. The county will provide a template by the semi-annual report due date for
each Reporting Period, found in the County Incentives Program Guide,
attesting to compliance with the seventy five percent (75%) performance
benchmark listed in Section 4.3.1.1.2.
4.3.1.1.2.1.1. The template is subject to audit and any findings that indicate
performance was below the seventy five percent (75%) performance
benchmark will make the Contractor ineligible for a Collaboration
Performance Incentive Payment for the Reporting Period.
4.3.1.1.3. The county and the RCCO must meet at least once per Reporting Period to
establish and evaluate RCCO Collaborative Case Conference participation.
4 3.1.1.3.1. Documentation of the Contractor and RCCO evaluation of Collaborative
Case Conference participation shall be through meeting minutes, agendas,
and sign in sheets attached to the Collaboration Template submitted by the
semi-annual report due date for each Reporting Period.
4.3.1.1.4. If the Contractor has no foster care youth cases to meet the requirements in
4.3.1.1,the Contractor will be deemed to have met the requirements of 4.3.1.1
Page 10 of 19
if the Contractor and Partners meet the requirements of the Alternative
Collaboration listed in 4.3.1,4 and the General Requirements for the
Collaboration Performance Incentive Standard listed in 4.3.1.5.
4.3.1.2. LTSS Collaboration—the Contractor will convene with the below partners at least
once per calendar quarter to resolve Long Term Care,Home and Community Based
Services (HCBS) and other cases that require additional action beyond a financial
eligibility determination.
4.3.1.21. At least one Long Term Care Facility that serves Members from the
Contractor's county.
4 3 1.2.2. Single Entry Point (SEP) Agency that serves Members in the Contractor's
county.
4.3.1.2.3. Community Centered Board (CCB) Agency that serves Members in the
Contractor's county.
4.3.1.2.4. The Contractor may include additional partners beyond the mandatory three(3)
partners from those listed in Sections 4.3.1.2.1 through 4.3.1,2.3.
4.3.1.2.5. Documentation of the LTSS Collaboration shall be through meeting minutes,
agendas, and sign in sheets attached to the Collaboration Template submitted
by the semi-annual report due dates for each Reporting Period.
4.3.1.2 6. In the event the Contractor selects the LTSS Collaboration option but has no
complex cases to resolve with the partners mentioned in 4.3.1.2.1 through
4.3.1.2 4, the Contractor will be deemed to have met the requirements of the
LTSS Collaboration so long as the Contractor and Partners meet the
requirements of the Alternative Collaboration listed in 4.3.1.4 and the General
Requirements for the Collaboration Performance Incentive Standard listed in
4.3.1.5.
4.3.1.3. RCCO/BHO Collaboration — the county will convene with the below partners at
least once per calendar quarter to better understand the roles and functions of each
partner and improve the relationship between partners to advance two (2) to three
(3) mutually agreed upon goals:
4.3.1.3.1. The RCCO that serves Members in the Contractor's county.
4.3.1.3.2 The BHO that serves Members in the Contractor's county.
4.3.1.3.3. The Contractor may include additional partners beyond the mandatory two (2)
listed in Sections 4.3.1 3.1 through 4.3.1.3.2.
4.3.1.3.4. Documentation of the RCCO/BHO Collaboration shall be through meeting
minutes, agendas, and sign in sheets attached to the Collaboration Template
submitted by the semi-annual report due dates of each Reporting Period.
4.3.1.4. Alternative Collaboration —the county has the option to convene at least once per
calendar quarter,with at least three(3)of the below partners, while advancing two
(2)to three(3)mutually agreed upon goals:
4.3.1.4.1. BHO that serves Members in the Contractor's County.
4.3.1.4.2. Local Public Health Agency (LPHA) that serves Members in the Contractor's
County.
Page 11 of 19
4.3.1.4.3. Medical Assistance Site (MA Site) that serves Members in the Contractor's
County.
4.3.1.4.4. RCCO that serves Members in the Contractor's County.
4 3.1.4.5. Regional Connect for Health Colorado Partners
4.3.1.4.6. Hospitals and Clinics that serve Members in the Contractor's County.
4 3.1.4.7. Federally Qualified Health Clinic (FQHC) that serves Members in the
Contractor's County
4.3.1.4.8. Private Practice Providers such as Medical, Dental or Behavioral Health that
serve Members in the Contractor's County.
4 3 1.4.9. Community Mental Health Centers (CMHC) that serve Members in the
Contractor's County.
4.3.1.4.10. Long-term Care Facilities that serve Members in the Contractor's County.
4.3 1.4.11. Single Entry Point (SEP) Agencies that serve Members in the Contractor's
County.
4.3.1.4.12. Community Centered Boards (CCB) that serve Members in the Contractor's
County.
4.3.1.4.13. County Sheriff/Local Law Enforcement that serves Members in the
Contractor's County.
4.3.1.4.14 Ute Mountain Ute Tribe.
4.3.1.4.15. Southern Ute Indian Tribe.
4.3.1.4.16. If the Contractor chooses the Alternative Collaboration option, the Contractor
must request pre-approval from the Department and provide supporting
documentation prior to the Alternative Collaboration being eligible for a
Collaboration Performance Incentive Payment.
4.3.1.4.16.1. The Department reserves the right to deny any request for pre-approval of
an Alternative Collaboration.
4.3.1.4 17 Documentation of the Alternative Collaboration shall be through meeting
minutes, agendas, and sign in sheets attached to the Collaboration Template
submitted by the semi-annual report due dates of each Reporting Period.
4.3.1.5. General Requirements for the Collaboration Performance Incentive Standard
4.3.1.5.1. The Contractor may host any or all of the meetings in Sections 4 3 1.2, 4.3.1.3
or 4.3.1.4 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 (I) representative to attend that meeting.
4.3.1.5.2. The Contractor shall develop the meeting agenda for each meeting it hosts,
based on the meeting and collaboration type.
4.3.1.5.2.1. If the Contractor is convening either the RCCO/BHO Collaboration or the
Alternative Collaboration, the agenda shall include the following topics:
4.3 1.5.2.1.1. Recognition of the roles and responsibilities for each of the partners.
Page 12 of 19
4 3.1.5.2.1.2. Cultivating collaboration and the coordination of services among all of
the partner agencies.
4.3.1.5.2.1.3. Establishing two (2) to three (3) goals that the partners would like to
accomplish over the next year to improve clients' access to care.
43.1.5.3. 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.
4.3.1.5.4. 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.
4.4. Training Performance Incentive Standard
4.4.1. The Contractor may earn the Training Performance Incentive Payment for each
Reporting Period if at least seventy five percent (75%) of its eligibility technicians
and/or supervisors complete the designated number of hours based on the number of
programs the eligibility technician and/or supervisor works with. This will be based
on the eligibility technician and/or supervisor having the adequate security profile in
CBMS as described in Section 4.4.1.3.
4.4.1.1. The medical assistance eligibility technician and/or supervisor will be responsible
for twelve(12)hours of training in the contractual period if the eligibility technician
and/or supervisor has the security profile to only authorize Medical Assistance.
4.4.1.1.1. Eight (8) hours of training must be completed from the Mandatory Courses
listed in Exhibit C as trained by an SDC-certified trainer using SDC-approved
materials.
4.4.1.1.2. An additional four(4)hours of training can be completed through other courses
offered by the Health Care and Economic Security Staff Development Center
(SDC), SDC-certified county trainers or the Department. Other trainings must
be pre-approved, per the process and timelines stated in the County Incentives
Program Guide.
4.4.1.1.3. National, statewide,regional or local training may qualify to meet the Training
Performance Incentive Standard 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
Performance Incentive Standard.
4.4.1.1.4. The Contractor shall provide agendas and training content when requesting pre-
approval for trainings not offered by the SDC, the Department, or an SDC-
certified trainer.
4.4.1.2. The eligibility technician and/or supervisor will be responsible for eight(8) hours
of training in the contractual period if the eligibility technician and/or supervisor
has the security profile to authorize Medical Assistance plus one (I) or more
programs from Exhibit D.
Page 13 of 19
4.4.1 2.1. The eight (8)hours of training can be completed from the Mandatory Courses
listed in Exhibit C as trained by an SDC-certified trainer using SDC-approved
materials.
4.4.1.3. Management and Eligibility Enrollment Specialist (EES) CBMS access users are
subject to the Training Performance Incentive Standard.
4.4.2 The required amount of training can be completed during the First and Second
Reporting Periods, if the required amount is met by the conclusion of the Second
Reporting Period.
4.4.3. 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 Performance Incentive Standard.
4.5. Child Welfare Performance Incentive Standard
4.5.1. The Contractor may earn a Child Welfare Performance Incentive Payment in each
Reporting Period in which the Contractor:
4.5.1.1 Maintains enrollment, for each Reporting Period, in the Accountable Care
Collaborative (ACC) for foster care youth at or above the level specified for the
Contractor in the County Incentives Program Guide.
4.5.1.1.1. Enrollment levels in the ACC for foster care youth will be measured on the first
working day after the end of each Reporting Period.
4.5.1 1.2. The Contractor shall not actively disenroll foster care youth from the ACC.
4.5.1.1.3. The Contractor is encouraged to enroll foster care youth into the ACC to
4.5.1.2. Ensures an application for Medicaid State Plan benefits is entered in CBMS within
ten (10) business days of closure of TRAILS Medicaid benefits for a certain
percentage of all foster care youth TRAILS Medicaid closures. The Contractor's
percentage benchmark is in the County Incentives Program Guide.
4.5.1.2.1. If a new application for Medicaid State Plan benefits is unnecessary because
the foster care youth's guardian is currently receiving Medical Assistance, the
Contractor shall ensure that the request for Medical Assistance is entered in
CBMS within ten (10) business days of the foster care youth's TRAILS
Medicaid closure.
4.5.1.2.2. The Contractor will provide the Department,no later than the Second Reporting
Period due date,a written process and/or procedure that details the Contractor's
internal workflow to ensure an application and/or request for Medicaid State
Plan benefits is entered in CBMS within ten (10) business days of closure of
TRAILS Medicaid for foster care youth.
4.5.1.3. The Contractor must meet the requirements in both Sections 4.5.1.1 and 4.5.1.2 to
earn a Child Welfare Performance Incentive Payment for the Reporting Period.
4.5.1.4. The Contractor shall ensure foster care youth have only have one Medicaid case,
either State Plan Medicaid through CBMS or TRAILS Medicaid,open at one time.
4.5.1.5. The Contractor shall be exempt for cases where the foster care youth and/or
guardian opts-out of Medical Assistance, enrollment in the ACC, or otherwise
elects to not participate in any of the performance measures listed in Section 4.5.
Page 14 of 19
Foster care youth and/or guardians who opt-out will be removed from the
Department's calculation used to determine if the Contractor meets the
requirements in Section 4.5.
4.5.1.6. If further clarity and/or guidance is needed to implement the Child Welfare
Performance Incentive but is not found in this Amendment or in the County
Incentives Program Guide,the Department will work with the Contractor to provide
additional direction The Department's decision in these cases is final and not
subject to appeal.
4.6. LTSS Performance Incentive
4.6.1. The Contractor may earn a LTSS Performance Incentive Payment for the Second
Reporting Period if the Contractor:
4.6.1.1. Completes at least eighty-five percent(85%)of all Long Term Care Determinations
and Redeterminations as Timely Determinations and Timely Redeterminations.
4.6.1.1.1. The LTSS Performance Incentive shall follow the same requirements as the
Eligibility Timeliness and Backlog Performance Incentive as found only in
Sections 4.2.1.4,4.2.1.5,4.2.1.6,4 2.1.6.1,4.2.1.6.2,4.2.1.7 and 4.2.1.7.1.
4.6.1.2. Utilizes the Department approved DSSI form to communicate with Single Entry
Points and/or Community Centered Boards for at least ninety-five percent (95%)
of functional determinations.
4.6.1.2.1 Compliance with the DSSI requirement shall be determined by a random
sample of functional determination cases for the Second Reporting Period..
4.6.1.2.2. If the Contractor utilizes electronic communications and/or workflows and not
the paper DSSI form,the Contractor may continue its current process if the data
fields found on the DSSI are added to the Contractor's electronic
communications and/or workflows.
4.6.1.3 The Contractor must meet the requirements in both Section 4.6.1.1 and 4.6.1.2 to
earn a LTSS Performance Incentive Payment.
4.6.1.4. If further clarity and/or guidance is needed to implement the LTSS Performance
Incentive but is not found in this Amendment or in the County Incentives Program
Guide, the Department will work with the Contractor to provide additional
direction. The Department's decision in these cases is final and not subject to
appeal.
4.7. Semi-Annual Reporting
4.7.1 The Contractor shall create a Semi-Annual Incentive Report for each Reporting Period
that includes all of the following for the Reporting Period:
4.7.1.1. The meeting agendas, meeting minutes, lists of attendees and goals including the
Collaboration Template to document its compliance with the Collaboration
Incentive Standard.
4.7 1.2. Any Eligibility Timeliness and Backlog Incentive Standard exemption forms for
the Reporting Period.
4.7.1.3. The Training Performance Incentive Standard Template for both Reporting
Periods. The Template is due on the Second Reporting Period due date.
Page 15 of 19
4.7.2. The Contractor shall submit the Semi-Annual Incentive Report to the Department.
4.7.2.1. DELIVERABLE: Semi-Annual Incentive Report
4.7.2.2. DUE:January 5'h for the First Reporting Period ending December 31st and July 5"'
for the Second Reporting Period ending June 30'h
5. EXEMPTIONS
5.1. 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.
5.1.1. The Department will not include any Untimely Determinations/Redeterminations in its
calculation of the Eligibility Timeliness and Backlog Performance Incentive Standard
if the Department has approved that Untimely Determination/Redetermination as being
untimely because of unusual circumstances as specified in 4.1.
5.1 2. The Contractor shall be responsible for submitting one(I)exemption form that details
each of the cases for which the Contractor is requesting an exemption
5.1.3. 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
5.2. 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 the Eligibility Timeliness and Backlog
Performance Incentive Standard.
5.2.1. 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:
5.2.1.1. 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.
5.2 12. Failure of the Contractor to act on client verification that was submitted timely
which was requested for a Determination or Redetermination.
5.2.1.3. Failure of the Contractor to manually authorize a Determination or Redetermination
with a mass update exception
5.2.1.4. Failure of the Contractor to manually authorize a Redetermination when the auto
re-enrollment or Ex Parte processes were not successful.
5.2.1.5. Failure of the Contractor to pull any and all applicable COONOS reports for the
purposes of fulfilling Exhibit A-3,Statement of Work.
5.2.2. The reasons for denial of an exemption as stated in Section 5.2.1 are not all-inclusive
and the Department reserves the right to deny any exemption for reasons not stated in
Section 4.
5.2.2.1. Prior to denying an exemption for reasons beyond those stated in Section 5.2.1,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 5, Exemptions.
Page 16 of 19
6. COMPENSATION
6.1. Compensation
6.1.1. Incentive Payment
6.1.1 I The Department shall pay the Contractor, after the end of the fiscal year in which
the work was performed,an Performance Incentive Payment for each Performance
Incentive Standard it meets during the applicable Reporting Period as follows:
6.1.1.1.1. The Department shall pay the Contractor an Eligibility Timeliness and Backlog
Performance Standard Payment as shown in Exhibit B for each Reporting
Period that the Contractor meets the requirements for that Performance
Incentive Standard.
6.1.1.1.2. The Department shall pay the Contractor a Collaboration Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
6.1.1.1.3. The Department shall pay the Contractor a LTSS Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
6.1.1.1.4. The Department shall pay the Contractor a Child Welfare Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
6.1.1.1.5. The Department shall pay the Contractor a Training Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
6.1.2. Remaining Funds Incentive Pool Payment
6.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
6.1.2 11. The Remaining Funds Incentive Pool shall include the following:
6.1.2.1.1.1. The total amount of all base incentive payments allocated to any Contractor
that selected to not participate in the Incentives Performance Standard
Program for that SFY.
6.1 2.1.1 2. Each of the base incentive payments that were not earned by the Contractor
during a Reporting Period in that SFY.
6.1.2.1.2. 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.
6 1.22. The Remaining Funds Incentive Pool will be paid as follows:
6.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amount of incentives met during that SFY.
6.1.2.2.2. 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.
Page 17 of 19
6.1.2.2.3. 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 2,County Determinations.
6.2. Payment Procedures
6.2 I. 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
Performance Incentive Standard per Reporting Period.
6.2.2 Actual Performance Incentive Payment maximums arc dependent on the Contractor's
share of Medicaid county administration expenditure. In no event shall the Contractor
be paid more than the Contractor's county share of Medicaid county administration
expenditure in any Reporting Period.
6.2 3. The Department may add any unearned funds from the First Reporting Period into to
the Second Reporting Period allocation for any SFY.
6.2.3.1. The Contractor shall receive the Incentive Performance Payments through the
County Financial Management System(CFMS).
6.2.4. The Department may use any unearned Second Reporting Period Incentive
Performance Payments during the county administration close out process.
6.2.4.1. 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 18 of 19
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
I Supplemental Nutrition Assistance Program (SNAP)
2. Temporary Assistance to Needy Families(TANF)
3. Adult Financial
4. Child Welfare
5. Child Support Services
6. Adult Protective Services
7. Low Income Energy Assistance Program(LEAP)
8. Colorado Child Care Assistance Program(CCAP)
9. Employment First
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 Roult
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
Larne
Adams
Arapahoe
Boulder
Denver
El Paso
Jefferson
Larimer
Mesa
Pueblo
Weld
EXHIBIT F,LIST OF MANDATORY TRAININGS FOR TRAINING PERFORMANCE
INCENTIVE
For the Training Performance Incentive Standard,the Contractor shall select from the list below
of Mandatory Trainings in order to meet the required number of training hours and qualify for a
Training Performance Incentive Payment:
I. Redetermination, Recertification and Reassessment(RRR) Web-based Training
2. Income Training
3. Reasonable Compatibility
4. Buy-In Training
5. Building Foundations for Medical Assistance Programs for eligibility technicians and/or
supervisors gaining CBMS access.
6. Any additional trainings the Department may add. The Department shall communicate to
the Contractor if additional trainings are added that qualify for the Training Performance
Incentive
APPROVED BY
CONTRACT RESOLUTION
�1.
qq # 'i t/( .. G
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# 9 7 3^ 0/ Department of Health Care Policy and Financing
Agreement Routing Number 2015CM1P097A4
AGREEMENT AMENDMENT NO.4
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 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 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"). The Department
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 performance-related benchmarks for county
departments of human/social services that achieve certain Performance Incentive Standards related
to determining and redetermining Medicaid eligibility, those populations currently enrolled in
Medicaid and cooperation with other Medicaid-related entities. The purpose of this Amendment
is to add exhibits and update the Performance 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 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:
Exhibit A-4, Statement of Work
Exhibit B,Rates
Exhibit C, Small,Medium, Large County List
B. 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, 2019,
unless sooner terminated or further extended as specified elsewhere herein.
C. 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
State Fiscal Year 2017-18 $8,395.04
State Fiscal Year 2018-19 $9,081.30
Total for All State Fiscal Years $40,493.96
D. Exhibit A-3,Statement of Work,is hereby deleted in its entirety and replaced with Exhibit
A-4,Statement of Work,attached hereto and incorporated by reference into the Agreement.
All references within the Agreement to Exhibit A, Exhibit A-1, Exhibit A-2 or Exhibit A-
3 shall be deemed to reference to Exhibit A-4.
E. Exhibit B,Rates, Section 1.4., SFY 2018-19 Incentives Payment Table,is hereby added as
follows:
1.4. SFY 2018-19 Incentives Payment Table
Incentive Payment Name Vs of Funding Payment Amount
Eligibility Timeliness and Backlog 30% $2,043.29
Performance Incentive Payment _
Case Maintenance Performance Incentive 15% $1,021.65
Payment
Long Term Services and Supports 15% $1,021.65
(LTSS)Performance Incentive Payment
Page 2 of 24
Training Performance Incentive 15% $1,021.65
Child Welfare Performance Incentive 15% $1,021.65
Payment
Improved Member Correspondence 10% $681.10
Performance Incentive Payment
Total Maximum $6,810.97
Available for all
Incentive Payments
F. Exhibit B,Rates,Section 2.4.,SFY 2018-19 Pool Maximum County Share Table,is hereby
added as follows:
2.4. SFY 2018-19 Pool Maximum County Share Table
Pool Name Pool Maximum Distribution
Amount
Total Maximum Available for $2,270.33
all Pool Distributions
7. START DATE
This Amendment shall take effect on its Effective Date.
8. ORDER OF PRECEDENCE
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 the Department by
the federal government, state government and/or grantor.
REMAINDER OF THIS PAGE INTENTIONALLY LEFT BLANK
Page 3 of 24
Amendment Routing Number 2015CMIP097A4
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
nFi .r ing
By: cJv�s2vy:
Cim Bimestefkc
014 ✓ Cavi Executive Director
Date: 1.‘,1 `I t I 1 p Date: (0l2�`�
ALL AGREEMENTS REOUIRE APPROVAL BY THE STATE CONTROLLER
ATE CONTROLLER
aros, CPA,MBA, JD
By: _IAA LL
Deparhn-of Health are Po .cy and Financing
Date:
Page 5 of 25
EXHIBIT A-4,STATEMENT OF WORK
1. TERMINOLOGY
1.I. The following list is provided to assist the reader in understanding acronyms,abbreviations
and terminology used throughout this document,
1.1.1. Accountable Care Collaborative (ACC) the Department's program for care
coordination and cost containment for Medicaid members in Colorado's 64 counties.
1,1.2. Applicant-An individual for whom the Contractor is performing a Determination.
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. COGNOS/Decision Support System 01 (DSS0I) - the Department's data reporting
systems that use information from the Colorado Benefits Management System
(CBMS).
1.1.6. Colorado Benefits Management System(CBMS)-the State's eligibility determination
system.
1.1,7. Colorado interChange (interChange) - the State's claims payment system and related
subsystems that utilize eligibility information from CBMS to pay providers for medical
and/or other claims. The system and related subsystems also collects and analyzes data
related to those payments.
1,1.8. County Administration website the Department's public-facing website where
contract documentation is kept for the County Incentives Program
(httn://www.colorado.gov/hcpf/county-admin).
1.1.9. Determination - The act of determining if an Applicant is eligible for the Colorado
Medical Assistance Program based on information submitted on a new application.
1.1.10. Disenrollment - The act of processing a change in circumstance that affect's a
member's eligibility and makes them ineligible for coverage within Health First
Colorado or Child Health Plan Plus.
1.1.11. Health First Colorado -the member-facing name for Colorado's Medical Assistance
Program.
1.1.12. Home and Community-Based Services (HCBS) - HCBS waiver programs provide
additional benefits and services to eligible populations in addition to the standard
benefit package offered to all members.
1.1.13. Long Term Care (LTC) - Long-Term Care is a Medical Assistance program that
provides nursing-home care, home-health care, personal or adult day care for
individuals aged at least 65 years or with a chronic or disabling condition.
1.1.14. Member-An individual who is eligible for the Colorado Medical Assistance Program.
Also known as a client.
1.1.15. Memo Series - The Department's policy, operational, and informational
communications that are utilized to provide contract clarifications, provide data and
Page 6 of 25
operational guidance, and share information pertaining to the County Incentives
Program.
1.1.16. Program for the All-Inclusive Care for the Elderly (PACE) - Program provides
comprehensive medical and social support services to certain frail individuals 55 years
of age and over. The goal of PACE is to keep individuals in their homes and
communities through comprehensive care coordination.
1.1.17. Regional Accountable Entity (RAE) - contracted entities of the Department that are
responsible for carrying out the goals of the Accountable Care Collaborative by
providing physical and behavioral care coordination and wrap-around supports for
members.
1.1.18. Reporting Period- The period of time for each performance standard used to measure
whether the Contractor met that standard.
1.1.18.1. The First Reporting Period for a SFY shall begin on July 1 of that SFY and end on
December 31 of that SFY.
1.1.18.2. The Second Reporting Period for a SFY shall begin on January 1 of that SFY and
end on June 30 of that SFY.
1.1.19. Redetermination-A Determination as defined under 10 C.C.R. 2505-8.100.3.P.
1.1.20. State Fiscal Year(SFY)-The period beginning July 1 of each calendar year and ending
on June 30 of the following calendar year.
1.1.21. Status Report - a communication to the Contractor that details which Performance
Incentive Standards were met for the Reporting Period in question.
1.1.22. Timely Determination - Any Determination that is completed within the timeliness
requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.23. Timely Disenrollment-Processing a change in a member's circumstance and making
a determination within fifteen(15)calendar days.
1.1.24. Timely Redetermination - Any Redetermination that is completed by the last day of
the month prior to the month in which the member's new annual enrollment period
begins.
1.1.25. Untimely Determination - Any Determination that is not completed within the
timeliness requirements set forth in 10 C.C.R. 2505-8.100.3.D.
1.1.26. Untimely Redetermination-Any Redetermination that is not completed by the last day
of the month prior to the month in which the member's new annual enrollment period
begins. This is based on the CBMS RRR Due Date.
2. COUNTY DETERMINATIONS
2.1. The Contractor shall perform all Medicaid eligibility-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. SYSTEMS USED TO DETERMINE COMPLIANCE WITH PERFORMANCE
INCENTIVES STANDARDS
3.1. Systems Utilized to Determine Compliance
Page 7 of 25
3.1.1. To determine whether the Contractor met any or all the Incentives Performance
Standards when completing determinations and redeterminations within the
Contractor's county, the Department will utilize the COGNOS/DSS01 systems to pull
data tracking and reports that track the Contractor's compliance with certain
Performance Incentive Standards.
3.1.2. To determine whether the Contractor met any or all the Incentives Performance
Standards when working with Medicaid populations within the Contractor's county,
the Department may utilize data from the Colorado interChange system.
3.1.3. The above list of systems is not all-inclusive and the Department will, at its discretion,
utilize additional data and reports from the COGNOS/DSSO I, interChange, and/or
other systems to determine whether the Contractor met any or all the Incentives
Perfonnance Standards.
3.1.4. The date the data or reports will be pulled from the COGNOS/DSS01, interChange,
and/or other systems will be defined in each applicable Incentives Performance
Standard.
3.1.5. The Contractor should utilize the information provided for each Performance Incentive
Standard and information issued through the Memo Series in the County Incentives
Program Guide, to assist with pulling applicable data and reports to determine the
Contractor's compliance with any or all the Performance Incentives Standards.
3.2. Communications Utilized to Determine Compliance
3.2.1. To fulfill the requirements in Exhibit A-4 Statement of Work and earn a Performance
Incentive Payment, the Contractor shall utilize and comply with guidance issued
through the HCPF Memo Series.
3.2.2. The Contractor will utilize the HCPF Memo Series to find any forms, templates,
program contacts, or additional information needed to operationalize the Incentives
Performance Standard Program referenced throughout this Agreement.
3.2.3. In the event that additional guidance or contract clarification is needed,the Department
may release additional guidance to the Contractor through the HCPF Memo Series.
4. PERFORMANCE INCENTIVES STANDARD PROGRAM
4.1. The Contractor may earn Performance Incentive Payments to reimburse it for a portion of
its cost sharing as described in Section 2.
4.2. Eligibility Timeliness and Backlog Performance Incentive Standard
4.2.1. The Contractor may earn an Eligibility Timeliness and Backlog Performance Incentive
Payment for each Reporting Period in which the Contractor meets timeliness and
backlog requirements as found in section 4.2.
4.2.1.1. Timeliness of Determinations and Redetermrnations
4.2.1.1.1. The Contractor shall complete at least ninety-five percent (95%) of all
Determinations and Redeterminations as Timely Determinations and Timely
Redeterminations.
4.2.1.1.2. The Department will total all Timely Determinations and Timely
Redeterminations the Contractor completed within the Reporting Period and
divide that by the total number of Determinations and Redeterminations the
Page 8 of 25
Contractor completed during that Reporting Period to determine the timeliness
percent. The Department will round these calculated percentages to two (2)
decimal places.
4.2.1.1.3. Determining Compliance with the Timeliness of Determinations and
Redeterminations
4.2.1.1.3.1. The Department will utilize the MA County Incentives Timeliness Report
- Summary and MA County Incentives Timeliness Report - Detail to
determine compliance with timeliness benchmark of the Eligibility
Timeliness and Backlog Performance Incentive Standard.
4.2.1.1.3.2. The MA County Incentives Timeliness Report-Summary and MA County
Incentives Timeliness Report- Detail will be pulled the first working day
after the end of each Reporting Period to determine the Contractor's
performance over the entire six-month Reporting Period.
4.2.1.2. Backlogged Determinations and Redeterminations
4.2.1.2.1. The Contractor's Backlogged Determinations average and Backlogged
Redeterminations average at the end of each Reporting Period shall be within
the limits described in the following table:
4.2.1.2.2. County Backlog Table
County Size Limit
New Applications
Large <75
Medium < 10
Small <3
Redeterminations
Large <280
Medium <28
Small <10
4.2.1.2.3. To determine the Backlogged Determinations average, the Department will
total the Backlogged Determinations of each month of the Reporting Period and
divide by the number of months in the Reporting Period.
4.2.1.2.3.1. The MA County Incentives Backlog Report- Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Contractor's amount of Backlogged Determinations for each month of each
Reporting Period.
4.2.1.2.3.2. The MA County Incentives Backlog Report- Summary and MA County
Incentives Backlog Report-Detail will be pulled on the first working day
of each month.
Page 9 of 25
4.2.1.2.4. To determine the Backlogged Redetenninations average, the Department will
total the Backlogged Redeterminations of each month of the Reporting Period
and divide by the number of months in the Reporting Period.
4.2.1.2.4.1. The MA County Incentives Backlog Report - Summary and MA County
Incentives Backlog Report - Detail will be used to determine the
Contractor's amount of Backlogged Redeterminations for each month of
each Reporting Period.
4.2.1.2.4.2. The MA County Incentives Backlog Report - Summary and MA County
Incentives Backlog Report - Detail will be pulled on the first working day
of each month.
4.2.1.2.4.3. The Department will round both the Backlogged Determinations average
and Backlogged Redeterminations average to a whole number.
4.2.1.25. When a Determination or Redetermination is Considered Backlogged
4.2.1.2.5.1. 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.
4.2.1.2.5.2. A Determination or Redetermination 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.
4.2.1.3. Small County Exemption
4.2.1.3.1. If 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 the timeliness percentage of
this performance standard so long as they had eighteen(18)or fewer Untimely
Determinations/Redeterminations during that Reporting Period.
4.2.1.3.2. There is no Small County Exemption for backlogged Determinations and
Redeterminations.
4.2.2. Exemptions for Unusual Circumstances
4.2.2.1. The Contractor may request an exemption for unusual circumstances for failure to
meet the timeliness benchmark as described in section 4.2.1.1 or failure to meet
backlog benchmark as described in section 4.2,1.2.
4.2.2.2. The exemption process for unusual circumstances is described in section 6,
Exemptions,
4.2.3. BENCHMARK; 95.00% timeliness average over each Reporting Period for
determinations and redeterminations as described in section 4.2.1.1; backlogged
determination and redetermination averages over each Reporting Period below limit
based on county size as described in section 4.2.1.2.
4.3. Child Welfare Performance Incentive Standard
4.3.1. The Contractor may earn a Child Welfare Performance Incentive Payment for each
Reporting Period in which it hosted or attended quarterly collaboration meetings with
Page 10 of 25
all required partners and submits the required documentation as listed in sections
4.3.1.1,4.3.1.2 and 4.3.1.3.
4.3.1.1. Quarterly Meetings and Data Collection
4.3.1.1.1. The Contractor will host or convene collaboration meetings at least once each
calendar quarter with the required partners listed in section 4.3.1.2. and ensure
documentation requirements are met per section 4.3.1.3.
4.3.1.1.2. The Contractor may host any or all meetings in collaboration with other
counties, but if it does combine any meeting with another county or other
counties,the Contractor shall provide at least one(1)representative from child
welfare staff and one (1) representative from eligibility staff to attend that
meeting.
4.3.1.1.3. The Contractor may use existing collaboration meetings or combine other
meetings to meet the quarterly collaboration meeting requirement so long as all
required partners listed in section 4.3.1.2 are invited and present,except for the
RAE,DYS or CMP representatives per section 4.3.1.2.2.
4.3.1.2. Required and Optional Partners for the Child Welfare Performance Incentive
Standard
4.3.1.2.1. Required partners for the Child Welfare Performance Incentive Payment
include a representative from the Regional Accountable Entity (RAE), a
representative from the Contractor's child welfare staff, a representative from
the Division of Youth Services (DYS), a representative from the Collaborative
Management Program (CMP), and a representative from the Contractor's
eligibility staff.
4.3.1.2.2. All required partners shall be invited to participate to the quarterly collaboration
meetings. If a representative from the DYS,CMP,or RAE is not able to attend,
the Contractor shall provide documentation from the required partner that the
representative was not able to attend.
4.3.1.2.3. If the Contractor does not have a DYS facility or representative in their county
and/or region, the Contractor can invite a local correctional representative in
place of the DYS representative.
4.3.1.2.4. The Contractor may,at its discretion,invite additional partners such as Healthy
Communities, Family Resource Centers, Dependency & Neglect System
Reform(DANCR)and Multisystemic Therapy(MST).
4.3.1.3. Documentation Requirements for the Child Welfare Performance Incentive
Standard
4.3.1.3.1. The Contractor shall develop the meeting agenda for each meeting it hosts.
4.3.1.3.1.1. If 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.
4.3.1.3.2. The Contractor shall take meeting minutes and compile a list of attendees for
each meeting it hosts. The list of attendees shall clearly identify which agency
the attendee is representing.
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4.3.1.3.2.1. If the Contractor hosts a meeting in collaboration with another county or
other counties, the Contractor may create the meeting minutes and list of
attendees in collaboration with those other counties.
4.3.2. DELIVERABLE: Agenda, Meeting Minutes, Attendee List, and Child Welfare
Incentive Template for quarterly collaboration meetings submitted by January 5,2019
for the First Reporting Period and July 5, 2019 for the Second Reporting Period as
described in section 4.3.1.3.
4.4. Training Performance Incentive Standard
4.4.1. The Contractor may earn the Training Performance Incentive Payment for each
Reporting Period if at least seventy five percent (75%) of its eligibility technicians
and/or supervisors complete the required number of training hours. The Contractor's
staff that are subject to the Training Performance Incentive Standard requirement is
described in section 4.4.1.1.
4.4.1.1. Staff Subject to Training Performance Incentive Standard and Training Hours
Requirement
4.4.1.1.1. The eligibility technician and/or supervisor will be responsible for eight (8)
hours of training in the contractual period if the eligibility technician and/or
supervisor has the security profile to authorize Medical Assistance as described
in section 4.4.1.1 4.
4.4.1.1.2 The eight(8)hours of training shall be completed from the Approved Training
List. The Approved Training List will be provided to the Contractor at
implementation and will be posted on the Department's County Administration
website.
4.4.1.1.3. Trainings from the Approved Training List can be trained by the Staff
Development Center (SDC) or an SDC-certified trainer using SDC-approved
materials.
4.4.1.1.4. Management and Eligibility Enrollment Specialist (EES) CBMS access users
are subject to the Training Performance Incentive Standard.
4.4.1.2. Training Completion Timeframes and Previously Completed Trainings
4.4.1.2.1. The required amount of training can be completed during the First and Second
Reporting Periods, if the required amount is met by the conclusion of the
Second Reporting Period.
4.4.1.2.2. The Contractor's staff may re-take a previously completed course and be
granted credit so long as the course was not originally taken within the current
fiscal year.
4.4.1.2.2.1. Courses re-taken from a previous fiscal year shall be tracked per the
requirements in section 4.4.1.3.2.
4.4.1.3. Determining Compliance with the Training Performance Incentive Standard
4.41.3.1. 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 Performance Incentive Standard.
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4.4.1.3.1.1. Only eligible trainings as found on the Approved Training List should be
logged in LMS via the Add External Training feature.
4.4.1.3.1.2. Trainings added via Add External Training that are not included on the
Approved Training List will be rejected,
4.4.1.3.1.3. External Training requests must match the amount of training hours offered
as described on the Approved Training List. External Training requests that
request more hours than described on the Approved Training List will be
denied.
4.4.1.3.2. Courses re-taken shall be manually added into the LMS by utilizing the Add
External Training feature.
4.4.1.3.2.1. If a course has not been completed,then the Contractor's staff shall register
for the course and not request approval via Add External Training feature.
4.4.1.3.3. To determine compliance with the required number of training hours, the
Department will request data on users with security profiles listed in section
4.4.2.3. A cross-comparison with the security profiles data pull and LMS
completion reports will determine if the Contractor complied with the seventy
five percent (75%) requirement for the Training Performance Incentive
Standard.
4,4.2. BENCHMARK: 75% of eligibility technicians and supervisors with security profiles
listed in section 4.4.2.3 complete eight (8) hours of training from the Approved
Training List within the contract period as described in section 4.4.1.
4.5. Long Term Services and Supports(LTSS)Performance Incentive Standard
4.5.1. The Contractor may earn a LTSS Performance Incentive Payment for each Reporting
Period if the Contractor achieves ninety five percent (95.00%) timeliness combined
average of Determinations and Redeterminations for Long Term Care(LTC), Home
and Community Based Services (HCBS), and the Program for the All-Inclusive Care
for the Elderly (PACE) over each Reporting Period; achieves eighty five percent
(85.00%) timeliness for Determinations for LTC, HCBS, and PACE; and the
Contractor completes the LTSS Communications Plan as described in section 4.5.1.2.
4.5.1.1. Timeliness of LTC,HCBS,and PACE Determinations and Redeterminations
4.5.1.1.1. The Contractor shall complete at least ninety-five percent (95%) of all LTC,
HCBS, and PACE Determinations and Redeterminations as Timely
Determinations and Timely Redeterminations.
4.5.1.1.1.1. The Department will total all Timely Determinations and Timely
Redeterminations for LTC, HCBS, and PACE the Contractor completed
within the Reporting Period and divide that by the total number of LTC,
HCBS, and PACE Determinations and Redeterminations the Contractor
completed during that Reporting Period to determine the timeliness percent.
The Department will round these calculated percentages to two(2)decimal
places.
4.5.1.1.2. The Contractor shall complete at least eighty-five percent of all LTC, HCBS,
and PACE Determinations as Timely Determinations.
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4.5.1.1.2.1. The Department will total all Timely Determinations for LTC, HCBS, and
PACE the Contractor completed within the Reporting Period and divide that
by the total number of LTC, HCBS, and PACE Determinations the
Contractor completed during that Reporting Period to determine the
timeliness percent. The Department will round these calculated percentages
to two(2)decimal places.
4.5.1.1.3. Determining Compliance with the Timeliness of LTC, HCBS, and PACE
Determinations and Redeterminations
4.5.1.1.3.1. The Department will utilize the MA County Incentives LTSS Timeliness
Report— Summary and MA County Incentives LTSS Timeliness Report—
Detail to determine compliance with the timeliness benchmarks of the LTSS
Performance Incentive Standard.
4.5.1.1.3.2. The MA County Incentives LTSS Timeliness Report—Summary and MA
County Incentives LTSS Timeliness Report—Detail will be pulled the first
working day after the end of each Reporting Period.
4,5.1.1.4. Small County Exemption
4.5.1.1.4.1. If the Contractor processes a total of ten (10) or fewer Determinations and
ten (10) or fewer Redeterminations per Reporting Period, the Contractor
shall be deemed to have met the timeliness percentage benchmark for the
LTSS Performance Incentive Standard so long as they had six (6)or fewer
Untimely Determinations and Untimely Redeterminations during that
Reporting Period.
4.5.1.15. Exemptions for Unusual Circumstances
4.5.1.1.5.1. The Contractor may request an exemption for unusual circumstances for
failure to meet the timeliness benchmarks as described in section 4.5.1.1.
4.5.1.1.5.2. The exemption process for unusual circumstances is descnbed in section 6,
Exemptions.
4.5.1.2. Submission and Approval of the Contractor's LTSS Communications Plan
4.5.1.2.1. The Contractor shall complete the LTSS Communications Plan template,
provided by the Department,in collaboration with the Contractor's Single Entry
Point (SEP), Community Centered Board (CCB), nursing facilities, and other
providers that details the communications between the Contractor and those
partners.
4.5,1.2.1.1. Expectations for the LTSS Communications Plan
4.5.1.2.1.1.1. The Department expects that communications between LTSS partner
agencies and the Contractor are processed differently than
communications and interactions with members.
4.5.1.2.1.1.2. The Department expects that communications between LTSS partner
agencies and the Contractor have adequate, sufficient and documented
processes and timeframes in place to enable timely determinations,
redeterminations and changes in a member's circumstances.
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4.5.1.2.1.1.3. The Department expects that communications between the LTSS
partner agencies and the Contractor have sufficient escalation processes
in the event the LTSS partner agencies and/or the Contractor are not
getting necessary information in a timely manner.
4.5.1.2.1.1.4. The Department expects that, if a member may lose access to LTSS
benefits and services and is notified through an LTSS partner agency,
the Contractor have sufficient processes in place to prioritize the
member's case.
4.5.1.2.1.2. Completion of LTSS Communications Plan Template
4.5.1.2.1.2.1. The Contractor shall complete all fields on the LTSS Communications
Plan Template. Incomplete submissions will make the Contractor
ineligible for a LTSS Performance Incentive Payment for the First
Reporting Period.
4.5.1.2.1.3. Department Review and Approval of LTSS Communications Plan
4.5.1.2.1.3.1. The Contractor's LTSS Communications plan is subject to approval by
the Department. The Department may request revisions to the plan if
any element of the plan is deemed unacceptable and/or not meeting the
Department's expectations as found in section 4.5.1.2.1.1.
4.5.1.2.1.3.2. The Contractor's LTSS Communications Plan is due to the Department
no later than the First Reporting Period due date,January 5, 2019.
4.5.1.2.1.4. Contractor's Revision of LTSS Communications Plan
4.5.1.2.1.4.1. If the Contractor's LTSS Communications Plan is deemed to require
modifications by the Department, the Contractor will work in
collaboration with the partners identified in section 4.5.1.2.1 to modify
the LTSS Communications Plan.
4,5.1.2.1.4.2. The Contractor's revision of the LTSS Communications Plan is due by
June 1, 2019.
4.5.1.2.1.4.3. The Contractor's revision of the LTSS Communications Plan is subject
to the Department's approval. If the revision is not accepted by the
Department, the Contractor will be ineligible for a LTSS Performance
Incentive Payment for the Second Reporting Period.
4.5.1.2.2. Determining Compliance with the LTSS Performance Incentive Standard
4.5.1.2.2.1. The Contractor shall comply with section 4.5.1.1 Timeliness of LTC,
HCBS, and PACE Determinations and Redeterminations and section
4.5.1.2 LTSS Communications Plan to be eligible to earn a LTSS
Performance Incentive Payment.
4.5.1.3. BENCHMARK: 95.00% combined timeliness average for Determinations and
Redeterminations; 85.00%timeliness average for Determinations.
4.5.1.4. DELIVERABLE: LTSS Communications Plan subject to Department approval.
4.6. Case Maintenance Performance Incentive Standard
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4.6.1. The Contractor may earn a Case Maintenance Performance Incentive Payment for each
Reporting Period in which eighty-five percent (85.00%) of the Contractor's
disenrollments are within fifteen (15)calendar days as described in section 4.6.
4.6.1.1. Processing and Timeframes for a Member's Change in Circumstances
4.6.1.1.1. The Contractor shall process all member and partner agency-reported change
in circumstances within fifteen(15)calendar days.
4.6.1.1.1.1. The fifteen (15) calendar day benchmark applies to changes reported by a
member,by a partner agency such as the Single Entry Point or Community
Centered Board or external agencies such as nursing facilities.
4.6.1.1.2. The Contractor shall not pre-screen changes in circumstances to determine if
the change results in a disenrollment. The Contractor shall process the change
in circumstance by entering the information into the Colorado Benefits
Management System(CBMS)within fifteen(15) calendar days.
4.6.1.1.3. The Contractor shall follow existing policy and operational guidance for
entering information relating to a change in circumstances into CBMS.
4.6.1.1.3.1. The calculation for Timely Disenrollments is based on data entry into
CBMS. The Contractor shall ensure that information is correctly entered
into CBMS,including the Date the change in circumstance was reported,to
ensure the Timely Disenrollment calculation is accurate.
4.6.1.2. Timely Disenrollments
4.6.1.2.1. The Contractor will disenroll all members where a change in circumstance has
resulted in ineligibility within fifteen(15)calendar days.
4.6.1.3. Determining Compliance for the Case Maintenance Performance Incentive
Standard
4.6.1.3.1. The Department will utilize the MA Disenrollment Processing Times Report to
determine the Contractor's compliance with the Case Maintenance
Performance Incentive Standard.
4.6.1.3.2. The MA Disenrollment Processing Times Report will be pulled the second
Sunday of the first month after the end of each Reporting Period.
4.6.1.3.3. To determine the Contractor's percentage of timely disenrollments, the
Department will take the total number of timely disenrollments over each
Reporting Period and divide that by the total number of disenrollments
completed. The Department will round the number to two decimal places.
4.6.1.4. BENCHMARK: Eighty-five percent(85.00%)of disenrollments completed within
fifteen(15)calendar days.
4.7. Improving Member Correspondence Performance Incentive Standard
4.7.1. The Contractor may earn an Improving Member Correspondence Performance
Incentive Payment in each Reporting Period in which the Contractor completes data
tracking and deliverable submission relating to customer service interactions with
members regarding member correspondence as found in section 4.7.
4.7.1.1. Contractor's Staff Subject to the Improving Member Correspondence Performance
Incentive Standard
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4.7.1.1.1. To participate in the Improving Member Correspondence Performance
Incentive Standard, the Contractor will designate one (1) staff member
responsible for implementation and contact with the Department.
4.7.1.1.1.1. The Contractor will provide the implementation lead's contact information
through the Data Collection Plan Agreement.
4.7.1.1.2. To earn an Improving Member Correspondence Performance Incentive
Payment, a minimum of ten percent(10%) of the Contractor's member-facing
staff will participate in the Data Collection and Tracking phase.
4.7.1.1.2.1. If ten percent (10%) of the Contractor's staff is equal to less than one (1)
Full Time Equivalent (FTE) position, then a minimum of one FTE will
participate in the Data Collection and Tracking phase.
4.7.1.1.2.2. Member-facing staff include, but are not limited to, eligibility technicians,
administrative assistants responsible for lobby and front desk work and call
center technicians.
4.7.1.1.2.3. If the Contractor identifies staff to participate in the Data Collection and
Tracking phase that cannot participate due to turnover, trainings, or other
issues, the Contractor can substitute other member-facing staff so long as
the ten percent(10%)requirement is met.
4.7.1.1.2.3.1. The Contractor shall identify all substitutes for staff participating in the
Data Collection and Tracking in the Data Collection Plan Agreement.
4.7.1.2. Data Collection Plan Agreement Submission
4.7.1.2.1. To earn an Improving Member Correspondence Performance Incentive
Payment,the Contractor will submit the Data Collection Plan Agreement to the
Department no later than July 31, 2018 for the First Reporting Period and no
later than January 31,2019 for the Second Reporting Period.
4.7.1.2.1.1. If the Contractor fails to submit the Data Collection Plan Agreement by the
due dates listed in section 4.7.1.2.1,the Contractor will be ineligible for an
Improving Member Correspondence Performance Incentive Payment for
the Reporting Period in which the Data Collection Plan Agreement was due.
4.7.1.2.1.2. The Implementation Lead, identified in section 4.7.1.2.2.1, will submit the
Data Collection Plan Agreement electronically to the Department by the due
date.
4.7.1.2.2. The Contractor will complete the Data Collection Plan Agreement by providing
information on:
4.7.1.2.2.1. Who the Contractor's Implementation Lead is and a phone number and
email address for that individual.
4.7.1.2.2.2. Names of the Contractor's staff that will be responsible for the Data
Collection and Tracking phase and their respective roles/primary duties for
the Contractor. The number of staff subject to the Data Collection and
Tracking Phase is found in section 4.7.1.1.2.
4.7.1.2.2.3. The Contractor's selected twenty(20) consecutive business day timeframe
for the Data Collection and Tracking phase as described in section 4.7.1.3.
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4.7.1.2.2.4. Information on Contractor-specific site operations that may impact the Data
Collection and Tracking phase.
4.7.1.2.3. By submitting the Data Collection Plan Agreement, the Contractor agrees to
follow all guidelines and operational guidance to ensure complete and accurate
data collection and tracking.
4.7.1.2.4. By submitting the Data Collection Plan Agreement, the Contractor agrees not
to falsify any information during the Data Collection and Tracking phases.
4.7.1.2.4.1. The Department reserves the right to audit, without notice or prior
authorization,the results of the Contractor's data collection to ensure data
integrity.
4.7.1.2.4.2. If the Department's audit finds that the data collection was falsified, the
Contractor will be deemed ineligible for the Performance Incentive
Payment for the Reporting Period in which the data collection was audited.
4.7.1.2.5. The Contractor's submitted Data Collection Plan Agreement is subject to
review and approval by the Department. The Department can request revisions
by the Contractor if the Agreement fails to meet the requirements of the
Improving Member Correspondence Performance Incentive Standard.
4.7.1.3. Data Collection and Tracking
4.7.1.3.1. The Contractor shall identify in the Data Collection Plan Agreement a
timeframe of the Contractor's choosing in which the Contractor's staff will
participate in the Data Collection and tracking phase.
4.7.1.3.1.1. The Contractor's timeframe shall be twenty(20)consecutive business days
from August 1, 2018 through December 31, 2018 for the First Reporting
Period and February I, 2019 through June 30, 2019 for the Second
Reporting Period.
4.7,1.3.2. The Contractor will ensure all designated staff participating in the Data
Collection and Tracking phases complete an online data collection tutorial prior
to implementation of the Data Collection and Tracking phases,
4.7.1.3.2.1. The data collection tutorial for the First Reporting Period will become
available online July 1, 2018 and will include training for the Data
Collection and Tracking phase to be completed prior to December 31,2018.
4.7.1.3.2.2, The data collection tutorial for the Second Reporting Period will become
available online January 1, 2019 and will include training for the Data
Collection and Tracking phase to be completed prior to June 30, 2019.
4,7.1.3.3. The Contractor shall document member feedback through the online data
collection and tracking tool provided by the Department.
4.7.1.3.3.1. Only data collection submitted through the online data collection and
tracking tool shall be considered valid.
4.7.1.3.3.2. The Contractor will ensure only the Contractor's staff is collecting and
submitting the data through the online data collection and tracking tool.
Members should not have access to the online data collection and tracking
tool.
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4.7.1.3.3.3. The Contractor's staff will ensure that all data fields on the online data
collection and tracking tool are completed. Incomplete submissions will
not be accepted to ensure the validity of the data collected.
4.7.1.3.3.4. Data collection shall occur within a reasonable timeframe after each
customer service interaction,and not later than twenty-four(24)hours after
the interaction regarding member correspondence.
4.7.1.3.4. Correspondence subject to the Data Collection and Tracking phase is limited to
Medical Assistance (Medicaid/CHP+) member correspondence, including
noticing,forms,and speed letters sent from the Colorado Benefits Management
System(CBMS).
4.7.1.3.4.1. CBMS correspondence that includes Medical Assistance but also include
other public assistance programs managed by the Colorado Department of
Human Services (CDHS) or Connect for Health Colorado, where
applicable, are also subject to the Data Collection and Tracking phase.
4.7.1.3.4.2. CBMS correspondence that does not include Medical Assistance is not
subject to the Data Collection and Tracking phase.
4.7.1.4. Reporting Period Surveys
4.7.1.4.1. The Contractor will participate in a survey at the end of each Reporting Period
that provides feedback on the Data Collection and Tracking phase that occurred
within each Reporting Period.
4.7.1.4.2. The due date for completion of the survey is January 5, 2019 for the First
Reporting Period and July 5, 2019 for the Second Reporting Period.
4.7.1.5. Compliance with the Improving Member Correspondence Performance Incentive
Standard
4.7.1.5.1. To earn an Improving Member Correspondence Performance Incentive
Standard, the Contractor will comply with sections 4.7.1.1 Contractor's Staff
Subject to the Improving Member Correspondence Performance Incentive
Standard, section 4.7.1.2. Data Collection Plan Agreement, section 4.7.1.3.
Data Collection and Tracking, and section 4.7.1.4. Reporting Period Surveys.
4.7.1.5.1.1. Failure to meet the requirements as listed in section 4.7.1.5.1.will make the
Contractor ineligible to earn an Improving Member Correspondence
Performance Incentive Payment.
4.7.1.6. Department Implementation Support
4.7.1.6.1. The Contractor has the option of participating in a conference call at the
beginning and at the end of each Data Collection and Tracking phase to ask
questions and provide feedback to the Department.
4.7.1.6.2. The Contractor has the option of requesting implementation support conference
calls at any time during each Reporting Period.
4.7.1.7. DELIVERABLE: Data Collection Agreement Plan,Data Collection and Tracking,
and Reporting Period Survey for each Reporting Period.
5. SEMI-ANNUAL REPORTING
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5.1.1. The Contractor shall submit documentation to the Department to verify the
Contractor's compliance with each Performance Incentive Standard and will submit
such documentation on a semi-annual basis.
5.1.LI. For the First Reporting Period, the Contractor will submit the following
documentation:
5.11.1.1. The meeting agendas, meeting minutes, lists of attendees, and Child Welfare
Incentive Template to document its compliance with the Child Welfare
Performance Incentive Standard.
5.1.1.1.2. My Eligibility Timeliness and Backlog Performance Incentive Standard
exemption forms for the Reporting Period.
5.1.1.1.3. Improved Member Correspondence documentation, including the Data
Collection Agreement Plan, Data Collection and Tracking, and Reporting
Period Survey.
5.1.1.1.4. The LTSS Communications Plan and any LTSS Performance Incentive
Standard exemption forms pertaining to the timeliness benchmarks for the
Reporting Period.
5.1.1.1.5. DUE DATE: January 5, 2019
5.1.1.2. For the Second Reporting Period, the Contractor will submit the following
documentation:
5.1,1.2.1. The meeting agendas, meeting minutes, lists of attendees, and Child Welfare
Incentive Template to document its compliance with the Child Welfare
Performance Incentive Standard.
5.1.1.2.2. Any Eligibility Timeliness and Backlog Performance Incentive Standard
exemption forms for the Reporting Period.
5.1.1.2.3. Improved Member Correspondence documentation, including the Data
Collection Agreement Plan, Data Collection and Tracking, and Reporting
Period Survey.
5.1.1.2.4. The LTSS Communications Plan revision and any LTSS Performance Incentive
Standard exemption forms pertaining to the timeliness benchmarks for the
Reporting Period.
5.1.1.2.5. DUE DATE: July 5,2019
6. EXEMPTIONS
6.1. Exemptions for Unusual Circumstances for the Eligibility Timeliness and Backlog
Performance Incentive Standard and the LTSS Performance Incentive Standard
6.1.1. 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.
6.1.1.1. The Department will not include any Untimely Detetminations/Redeterminations
in its calculation of the Eligibility Timeliness and Backlog Performance Incentive
Standard and/or the LTSS Performance Incentive Standard if the Department has
approved that Untimely Determination/Redetermination as being untimely because
of unusual circumstances as specified in section 6.1.1.
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6.1.1.2. 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.
6.1.1.3. 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.
6.1.2. 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 the Eligibility Timeliness
and Backlog Performance Incentive Standard and/or the LTSS Performance Incentive
Standard.
6.1.2.1. The Department will deny exemption requests that do not meet timeliness definition
set forth in 10 C.C.R. 2505-8.100.3.1)(d)and Section 1.1.12 due to the fault of the
Contractor and/or any exemption requests based on the following:
6.1.2.1.1. 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.
6.1.2.1.2. Failure of the Contractor to act on client verification that was submitted timely
which was requested for a Determination or Redetermination.
6.1.2.1.3. Failure of the Contractor to manually authorize a Determination or
Redetermination with a mass update exception.
6.1.2.1.4. Failure of the Contractor to manually authorize a Redetermination when the
auto re-enrollment or Ex Parte processes were not successful.
6.1.2.1.5. Failure of the Contractor to pull all applicable COGNOS reports for the
purposes of fulfilling Exhibit A-4, Statement of Work.
6.1.2.2. The reasons for denial of an exemption as stated in section 6 are not all-inclusive
and the Department reserves the right to deny any exemption for reasons not stated
in section 6.
6.1.2.2.1. Prior to denying an exemption for reasons beyond those stated in section 6,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 6, Exemptions.
6.1.2.3. The Department may approve or reject any request for exemption due to unusual
circumstances and may limit the total number of exemption requests.
6.2. Exemptions for Unusual Circumstances for Performance Incentive Standards other than
the Eligibility Timeliness and Backlog Performance Incentive Standard and the LTSS
Performance Incentive Standard
6.2.1. Exemptions for unusual circumstances will not be considered for any Performance
Incentive Standard listed under section 6.2.1.
6.2.1.1. Child Welfare Performance Incentive Standard
6.2.1.2. Case Maintenance Performance Incentive Standard
6.2.1.3. Improved Member Correspondence Performance Incentive Standard
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6.2.1.4. Training Performance Incentive Standard
6.2.1.5. The LTSS Communications Plan deliverable of the LTSS Performance Incentive
Standard
6.2,2. The Contractor's performance and compliance with the Performance Incentive
Standards listed under section 6.2,1 will be deemed final and Performance Incentive
Payments made without the opportunity to submit an exemption for unusual
circumstances.
7. NOTIFICATIONS
7.1. After each Reporting Period, the Contractor will be provided a Status Report that details
which Incentive Performance Standards were met.
7.1.1. The Contractor's Status Report will only detail which Incentive Performance Standards
were met for the Reporting Period in question. Funding amounts will not be provided
until the conclusion of the fiscal year.
7.1.2. In the event the Contractor has more than one Reporting Period in the fiscal year to
meet any Incentive Performance Standards, the Status Report will not include the
Contractor's performance in those Performance Standards.
7.2. After the conclusion of the fiscal year,the Department will provide the Contractor a final
Status Report that details which Performance Incentive Standards were met and how much
Performance Incentive Payments were earned by the Contractor.
7.2,1. The final Status Report cannot be disputed; if the Contractor disagreed with the
Department's determination of compliance with any Performance Incentive Standard,
the Contractor shall have disputed that result based on the Reporting Period Status
Report.
7.3. Each Reporting Period Status Report and the final Status Report will be sent to the county
human/social services director and will act as the official notification of the Contractor's
compliance with the Performance Incentives Standards.
7.4. Status Reports for each Reporting Period wilt be sent within ten (10) calendar days after
the Semi-Annual Reporting due date for each Reporting Period as found in Section 5,Semi-
Annual Reporting. The date on which the Status Report for each Reporting Period is sent
to the Contractor will be considered the Status Report Date.
7.5. The final Status Report will be sent upon the Department's determination of final
Performance Incentive Payment amounts.
7.6. The Contractor will have the opportunity to dispute the Status Report results as defined in
section 7,Dispute Resolution.
8. DISPUTE RESOLUTION
8.1. Opportunity and Timeframe for Dispute Resolution
8.1.L In the event the Contractor disagrees with the findings of the official notification as
found in section 7, Notifications, the Contractor will have the opportunity to dispute
the Status Report for the Reporting Period in question.
8.1.1.1. The Contractor will have ten (10) calendar days from the Status Report Date to
review each Reporting Period Status Report and dispute the results.
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8.1.1.2. If the Contractor fails to dispute the Reporting Period Status Report within ten(10)
calendar days from the Status Report Date,the Status Report results will be deemed
final. No further disputes will be allowed, and compensation will be made per
section 9 based on the results of the non-disputed Status Report.
8.2. Allowable Disputes
8.2.1. The Contractor will be allowed to dispute the results of the Status Report based on the
following reasons:
8.2.1.1. The Contractor submitted documentation that was required for an Incentive
Performance Standard, so long as the Contractor has proof that the required
documentation was submitted on or before the contractually-required due date.
8.2.1.2. The Contractor requests a re-review of the Contractor's submitted documentation
that was used to determine compliance with any Incentive Performance Standard.
8.2.2. The Department reserves the right to add additional allowable dispute reasons
throughout the fiscal year based on additional information made available from the
Department and/or Contractor. These additional allowable dispute reasons will be
considered on a case-by-case basis, and the Department's determination of additional
allowable dispute reasons are final and not subject to the Dispute Resolution process
as outlined in section 8.
8.3. Nonallowable Disputes
8.3.1. The Contractor will not be allowed to dispute the results of the Status Report based on
the following reasons:
8.3.1.1. The Contractor failed to meet contractually-specified requirements relating to the
content of submission of deliverables and the timely submission of deliverables.
8.3.1.2. The Contractor failed to meet contractually-specified requirements relating to
performance benchmarks of any Performance Incentive Standard.
8.3.1.3. The Contractor's failure to review and utilize County Incentives Program
documentation, including policy, informational, and operational guidance issued
through the HCPF Memo Series, that resulted in the Contractor failing to meet
performance benchmarks and deliverables relating to any Incentive Performance
Standard.
8 3.1.4. The Department's final determination of the Contractor's exemption request(s) for
the Eligibility Timeliness and Backlog Performance Incentive Standard and the
Long Term Services and Supports Performance Incentive Standard.
8.3.1.5. Any exemption requests for unusual circumstances for other Performance Incentive
Standards other than those listed in 8.3.1.4.
8.3.2. The Department reserves the right to deny a Contractor's dispute based on any reason
not included under section 8.3.1. The Department's determination is final and is not
subject to dispute or appeal.
9. COMPENSATION
9.1. Compensation
9.1.1. Performance Incentive Payment
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9.1.1.1. The Department shall pay the Contractor, after the end of the fiscal year in which
the work was performed, a Performance Incentive Payment for each Performance
Incentive Standard it meets during the applicable Reporting Period as follows:
9.1.1.1.1. The Department shall pay the Contractor an Eligibility Timeliness and Backlog
Performance Standard Payment as shown in Exhibit B for each Reporting
Period that the Contractor meets the requirements for that Performance
Incentive Standard.
9.1,1.1.2. The Department shall pay the Contractor a Collaboration Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.3. The Department shall pay the Contractor a LTSS Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.1.1.4. The Department shall pay the Contractor a Child Welfare Performance
Incentive Payment as shown in Exhibit B for each Reporting Period that the
Contractor meets the requirements for that Performance Incentive Standard.
9.1.1.1.5. The Department shall pay the Contractor a Training Performance Incentive
Payment as shown in Exhibit B for each Reporting Period that the Contractor
meets the requirements for that Performance Incentive Standard.
9.1.2. Remaining Funds Incentive Pool Payment
9.1.2.1. The Department will create a Remaining Funds Incentive Pool each SFY.
9.1.2.1.1. The Remaining Funds Incentive Pool shall include the following:
9.1.2.1.1.1. The total amount of all base Performance Incentive Payments allocated to
any Contractor that selected to not participate in the Performance Incentive
Standards Program for that SFY.
9.1.2.1.1.2. Each of the base Performance Incentive Payments that were not earned by
the Contractor during a Reporting Period in that SFY.
9.1.2.1.2. If 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.
9.1.2.2. The Remaining Funds Incentive Pool will be paid as follows:
9.1.2.2.1. The Contractor shall be eligible for payment from the Remaining Funds
Incentive Pool based on the dollar amount of Incentives met during that SFY.
9.1.2.2.2. 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,
9.1.2.2.3, 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 2,County Determinations.
9.2, Payment Procedures
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9.2.1. The Contractor shall receive Performance Incentive Payments for each Reporting
Period within ninety days (90) days following the end of the fiscal year in which the
Performance Incentive benchmarks were met.This allocation will reflect the maximum
the Contractor can earn for each Performance Incentive Standard per Reporting Period.
9.2.1.1. In the event that the Contractor's county administration line item is over-expended
during the county administration closeout process, the Department may utilize the
Contractor's earned Performance Incentive Payments during the closeout process.
9.2.2. Actual Performance Incentive Payment maximums are dependent on the Contractor's
share of Medicaid county administration expenditure. In no event shall the Contractor
be paid more than the Contractor's county share of Medicaid county administration
expenditure in any Reporting Period,
9.2.3. The Department may add any unearned finds from the First Reporting Period into to
the Second Reporting Period allocation for any SFY.
9.2.3.1. The Contractor shall receive the Incentive Performance Payments through the
County Financial Management System(CFMS).
9.2.4. The Department may use any unearned Second Reporting Period Incentive
Performance Payments during the county administration close out process.
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EXHIBIT C, 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
Lame
Adams El Paso Pueblo
Arapahoe Jefferson Weld
Boulder Larimer
Denver Mesa
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