CMSO. Department of Health Care Policy and Financing. Agency Number UHA Contract Routing # CONTRACT

Transcription

1 Agency Number UHA Contract Routing # Department of Health Care Policy and Financing CONTRACT Page 1 o140 and utilizing CDASS. guardian, if appropriate, who has the judgment and ability to assist the Client in acquiing B. Authorized Representative means an individual designated by the Client or the legal Services as set forth under the Long Term Care Program Rules at 10 C.C.R A. Attendant means the individual who provides Consumer Directed Attendant Support the context otherwise expressly requires a different construction and interpretation: The following terms as used in this contract shall be construed and interpreted as follows unless I. DEFINITIONS this contract, the Department and the Contractor agree as follows: NOW THEREFORE, subject to the terms, conditions, provisions and limitations contained in WHEREAS, the Contractor proposed to subcontract certain services under the Contract to Public Partnerships Colorado, Inc. (PPL, Colorado); WHEREAS, Section , et seq. requires the Department to provide Consumer Directed Attendant Support Services to eligible Clients; and WHEREAS, the Contractor s offer was selected in accordance with state law as a result of RFP Number HCPFKQO9 I OFMS; with appropriate agencies; WHEREAS, required approval, clearance and coordination has been accomplished from and WHEREAS, authority exists in the law and funds have been budgeted, appropriated and otherwise made available for the Individual Allocations of participants in Consumer Directed Attendant Support Services (CDASS); LLC, located at 148 State Street, Boston, MA 02109, hereinafter refelted to as the Contractor. the use and benefit of the Department of Health Care Policy and Financing, 1570 Grant St., THIS CONTRACT. made this 1St of December, 2009, by and between the State of Colorado, for Denver, Colorado 80203, hereinafter referred to as the Department. and Public Partnerships, CMSO

2 regulations. CDASS D. Client means an individual who is a Medicaid Client who chooses to participate in Contractor and the Department. Contractor shall provide a copy of the subcontract between PPL, Colorado may perform other ser\ ices pursuant to written agreements between the amendment to this Contract): associated employer taxes, workers compensanon insurance and other applicable reimbursements. and PPL, Colorado shall be executed. Services to be performed by PPL, Colorado are: The Department recognizes and agrees that certain of the services will be performed by Public Inc. (PPL, Colorado) and a written subcontract between the Contractor Partnerships applicable federal and state statutes, regulations and rules. as now or hereafter amended, the requirements described herein and the Contract. The Contractor shall perform the services The Contractor shall provide the services described in this contract in accordance with all described in this Statement of Work in accordance with the highest standard of care, skill and diligence provided by a professional person or company in perfornrnnce of similar services. The Contractor shall establish a comprehensive method to work with Medicaid Clients who choose to participate in a consumer-directed care delivery option under a Colorado Home and Community Based (HCBS) waiver or elect to participate in any other available Consumer- Directed options to deliver Financial Management Services to the Clients and their Authorized Representatives, if applicable. II. STATEMENT OF WORK receiving CDASS and administered by the Contractor. Authorized Representative or group of Clients and/or Authorized Representatives or an Attendant and/or group of Attendants. F. Complaint is an expression of dissatisfaction, however made, about the service, actions, or lack of action by the Contractor or its staff affecting an individual Client and/or management activities as defined in the Department s Long Term Care rules and C. Case Manager means an individual who meets the qualifications to perform case F. individual Allocation means the funds made available by the Department to Clients G. Grievance is a formal, written raised Complaint by a Client or an Attendant Colorado, I. Serve as the Employer of Record for Attendants: 2. Provide health insurance benefits to \nendants (when provided for by 3. Pay Attendants; 4. Provide workers compensation insurance for Attendants and process claims; 5. Submit reimbursement claims to the Department for Attendant wages and Page of 4()

3 The Contractor remains wholly responsible to the Department for the satisfactory completion by PPL, Colorado. The Contractor will ensure that PPL, Colorado complies with all of all of the services, regardless of whether they are performed by the Contractor directly or Pace of 4() Representative performance issues. The Contractor shall dedicate a customer Managers; set up a secure FTP Intemet site for the exchange of data files. service line, program specific and c-fax account easy accessible to Case to Attendants and associated employer taxes, worker s compensation insurance and other I. Work cooperatively with Case Managers for the purpose of overall service can be changed as agreed upon with the Department and the Contractor; having 2. Work with Case Managers to address Attendant. Client and/or Authorized delivery options management. quality control and evaluation, including quarterly review meetings with consumers and Case Managers. These quarterly meetings Case Managers completed satisfaction surveys. The Contractor shall: authorization of services, quality assurance, utilization review and service monitoring. monthly allocation based on either the Client s history of services utilization or based on protocols. In the event a Client designates an Authorized Representative to assist him or Under the CDASS rule, Case Managers have the option to calculate a client s individual notified of the monthly allocations by the Case Manager as described in the CDASS the services approved in the Client s long tenn care service plan. The Contractor will be The Department utilizes Case Managers from case management agencies for prior her with consumer direction, the Case Manager will notify the Contractor in a timely individual and pursuant to CDASS rules. manner of the pertinent information of the Client s Authorized Representative. Case Managers may adjust Individual Allocations depending upon changes in the needs of the A. COORDINATION WITH CASE MANAGERS PPL, Colorado shall have the same force and effect as if made to Contractor and shall applicable reimbursements will be made directly to PPL, Colorado. All payments made to constitute a discharge of the Department s obligations under the Contract related to reimbursements for Attendant wages and associated employer taxes, worker s compensation insurance and other applicable reimbursements. The Department reserves all of its rights under the Contract against Contractor, particularly the rights of set off against Contractor for payments hereunder regardless of which entity the payments are sent or made out to. Contractor is not discharged with respect to any obligations of the Contract. The Contractor recognizes and agrees that all reimbursement to the Contractor for payments applicable requirement of this contract. including but not limited to those relating to data security. Contractor and PPL, Colorado and any amendments or modifications thereto within five (5) business days of execution.

4 3. Make available to Clients Case Managers the client s monthly expenditure report, via a web portal, in a format approved by the Department The monthly expenditure report shall include all of the following elements: For each Client: a. Certification Period; b. Approved monthly allocation; c. Expenditures; d. Current months over spent amount; e. Current months unspent amount; f. Over / under spend balance for the client s cert period. For each Attendant: a. Name of Attendant; b. Indicator relative or non-relative c. Hours worked; d. Line item summary of expenditures for personal care, homemaker and/or health maintenance activities; e. Hourly wage(s); f. Total payment; and g. Funds withheld (taxes, unemployment, insurance, worker s compensation, benefits, and other funds withheld of Attendants). For all Attendants a. Total hours worked; b. Line item summary of expenditures for personal care, homemaker; and/or health maintenance activities; c. Total payments. Monthly expenditure reports shall be available to Case Managers to view and pull real time expenditure reports at their convenience. B. WORKING WITH CLIENTS AND AUTHORIZE!) REPRESENTATiVES The Contractor shall proviue support to Clients who choose to participate in consumerdirected care delivery options and their Authorized Representatives for all aspects of the process of hiring and managing Attendants and provide related fiscal and personnel management services. The Contractor shall: Work coiiaborativ civ with Chents and Authorized Representatives on all aspects of consumer-directed services ensuring Client and Authorized Representatives. regardless of his or her (ljsihi1i1v or flair e lancuage. have equal access to services Page 4 oi4o

5 2. Verify that all the required submittals by Clients and/or Authorized Representatives are complete, accurate, allocable, timely, and obtain corrected submittals as necessary. 3. Implement procedures, approved by the Department, for handling Grievances from Clients and/or Authorized Representatives regarding services provided by the FMS contractor including how the customer service team is monitored. 4. Provide a monthly expenditure report, referred to as the client s monthly statement, in a format approved by the Department to each Client and/or Authorized Representative for the purpose of monitoring of expenditures. The monthly expenditure report shall include all of the elements as referenced in Section A3 and shall be available to each Client and/or Authorized Representative within ten (10) calendar days following of the end month. C. SKILLS TRAINING The Contractor shall provide comprehensive skills training to all Clients and/or Authorized Representatives interested in consumer direction and referred for training by Case Managers prior to a Client enrollment in the consumer-directed care delivery option. At a niinimum, the skills training shall encompass CDASS Program Overview, Enrollment in CDASS, Working with the Contractor, Client Rights, Client Responsibilities, Planning and Organizing Attendant Services, Budgeting, Personnel Issues, Recognizing and Recruiting Quality Attendant Support, Communication Skills, Managing Your Health, and Using Resources. It has been the Department s experience that clients and/or Authorized Representatives benefited from the use of Peer Trainers for skills training. Peer Trainers assist in providing skills training to clients and/or Authorized Representatives. Peer Trainers are CDASS Clients or Authorized Representatives who demonstrate an ability to effectively manage Attendant support. have a commitment to customer service, and have expertise in providing group and individual training, Peer Trainers are critical to a successful training program and in the Department s experience. Clients and/or Authorized Representatives benefited from the use of Peer Trainers for skills training. The Contractor shall: Provide sk us training in a manner that is accommodating to all Clients and Authorized Representatives. Training options offered to Clients shall include. but not be limited to: one on one. eroup. and self paced web based training. Page 5 of 4()

6 2. Develop a Skills Training Curriculum, accommodating to all client s and/or representatives, specific to consumer direction as it is implemented into the waivers, the curriculum shall be approved by the Department. 3. Develop a skills training curriculum for Case Managers to understand consumer direction and have the knowledge to be an additional resource to client s who have CDASS questions. 4. Develop a Peer Trainer network, using Peer Trainers in its training program and adequate to cover all areas of the state. Develop a Peer Training Curriculum and training materials to be approved by the Department to all Clients and/or Authorized Representatives referred for skills training. Current training materials include a manual and designated forms, The Department will provide the contractor with a draft of the training materials upon commencement of contract. The training manual and forms are available electronically on the Department s website The training manual is considered a working document and shall be updated by the Contractor as needed or when requested by the Department. Revisions and/or updates to training materials shall be submitted to the Department for approval prior to their use. 5. Distribute and reproduce training materials in a format that best meets Clients and/or Authorized Representatives needs, for example in large print, multi lingual, Braille, CD s for audio and electronic files,. 6. Have a training process in place including the handling of expedited requests and a system to track all aspects of the process from the time of the Case Manager s referral to the completion of training, detailing how the Contractor s Web-Portal documents each step in the process to completed enrollment. 7. Provide and complete skills training to the Client and/or Authorized Representative within 45 days from the Case Manager s referral unless otherwise indicated by an expedited request or request for an extension by the Client and/or Authorized Representative. Provide details on how the training process and progress will be tracked through the Contractor s Web-Portal Client and Attendant profile modules to ensure completion deadline dates are met. S. Ensure thai Clients and/or Authorized Representatives understand the philosophy of consumer direction. CDASS niles, and the tasks involved to successfully manage their services ensuring the Contractor develops a skills training program overview to cover how this will be implemented. 9. Verify that Client s Attendant(s) have been successfully trained to perform skilled tasks applicable through review of the certification form completed by the Client and kept on file with the FMS. Also aliov stakeholders to access the clients antlor Authorized Representatives training progress. hen Page 6 of 40

7 adequately trained prior to beginning CDASS, Page 7 of 40 family members may not provide more than 4() hours of paid Attendant care in a seven day period or an average of $8 hours per pay period since Attendants are paid twice a Clients and/or Authorized Representatives may hire a spouse or family member to provide Attendant care. However, spouses and family members may only be paid to provide extraordinary care which is prior authorized by the Client s Case Manager and documented on the Clieni s care plan or individualized habilitation plan. Spouses and Clients and/or and Authorized Representatives may use any number of individuals to ways manage his/her Attendants. Clients and/or Authorized Representatives will have the Authorized Representative will be the supervising employer of his/her Attendants, and will be responsible to hire, train, schedule, set wages, supervise, dismiss and in other flexibility in who they hire and at what rate of pay, as long as they meet Colorado Labor allocation. Law requirements and budget for Attendant care within the parameters of his/her monthly provide his/her Attendant support, depending upon individual needs. The Client and/or D. PERSONNEL SERVICES the web portal. distributed to Clients and/or Authorized Representatives upon completion of training and allow the Department to access survey reports as requested through Representatives and Case Managers prior to changes occurring in procedures, reporting, or systems. requested by the Client, Authorized Representative, Case Manager and/or the Department; or as needed such as when the Client and/or Authorized program rules. Representative over spends the monthly allocation or fails to follow CDASS submit the ASMP, including but not limited to: mail, facsimile, , and Management Plan (ASMP) for appropriateness and forward it to the Case Manager for approval within five (5) business days of receipt of the ASI\P. Allowing Clients and/or Authorized Representatives a variety of formats to electronic submission. II. Reviews the Client s and! or Authorized Representative s Attendant Support Representatives to ensure that the Client and/or Authorized Representative is 10. Conduct a Post Training Assessment of all Clients and/or Authorized 12. Provide additional skills training to Clients and/or Authorized Representatives as 13. Provide periodic information and training to all Clients and/or Authorized 14. Develop a training evaluation form in a fonnat approved by the Department to be iflot1ih.

8 Other Attendants may work more than 40 hours per work week (defined as 12:00 a.m. on Sunday through 11:59 pm on Saturday). However, if they qualify for the companionship services exemption of the Fair Labor Standards Act (FLSA) they will not be eligible for overtime premium pay. The Client s Authorized Representative may not be both the client s Authorized Representative and also be paid to be the Client s Attendant. Attendants are excluded from the Colorado Nurse Practice Act in accordance with , C.R.S. They are not required to be certified or licensed to provide Attendant support services. However, any person who has had his or her license as a nurse or certification as a nurse aide suspended or revoked or his or her application for such license or certification denied shall not be hired to provide services. Attendants may not represent him/herself as a licensed medical professional when acting within the scope of their employment as a CDASS Attendant. The Contractor shall employ eligible Attendants as the employer of record and shall perform all personnel services related to the hiring and employment of Attendants in accordance with all applicable federal, state, and local labor and employment laws and under the direction of the Client andlor Authorized Representative hiring the Attendant. The Contractor shall: 1. Provide an employment packet to all potential Attendants that contain all of the information necessary to be hired as an Attendant, such as necessary forms, applications, agreements and consent forms including explanations on how to complete each form and outlining the role and expectations of potential Attendants. 2. Ensure Attendants paperwork is processed within five (5) business days and indicate provisions for expedited processing when an Attendant must be hired quickly to assure the health and well being of the Client and have a system that allows clients and Attendants to contact the Contractor s staff to assist Attendants as needed with the completion and submittal of paperwork throughout the hiring process. 3. Ensure each Attendant employed through the service delivery options has signed the hiring agreement and any necessary forms and ensuring the signed forms are filed in the Attendants personnel record prior to the Attendant performing work. 4. Perform a background check on Attendants recommended for hire. Such background checks shall utilize at minimum the Colorado Bureau of Investigation (C131). The contractor will bear all costs fbr the background check. 5. Ensure that spouses or other relatives are not reimbursed for providing more than 40 hours of Attendant care in a seven day period or the average of 88 hours per pay period when Attendants are paid hi-monthly. Page 8 of 4()

9 6. Have a system in place that ensures that the Client s Authorized Representative is not also that same client s paid Attendant. 7. Ensure that Clients and/or Authorized Representatives are informed of the procedures and forms to use in reporting any change in Attendants, including Clients and/or Authorized Representatives responsibility to report if an Attendant separates from employment, and for reporting the hours worked by all Attendants. 8. Collect, process, maintain and have a system set up to track the required human resources documentation needed to process payroll for Attendants. 9. Have a system to comply with Title 8, Article 17.5 of the Colorado Revised Statutes, Illegal Aliens Public Contracts for Services, and maintain the relevant documentation in the Attendant s record. 10. Distribute, collect and process all Attendants timesheets in accordance with all applicable statutes, regulations and rules and providing Attendants multiple options for submitting timesheets 11. Make an outbound telephone call and provide an alert to the Client and/or Authorized Representative and the Attendant if a timesheet is denied, delayed or pending payment within two (2) business days of the action and make available to the Client and/or Authorized Representative all information directly related to the denial or delay. 12. Ensure that each Attendant recommended for hire has not had his/her license as a nurse or certification as a nurse aide suspended or revoked or his or her application for such license or certification denied by reviewing licensing and certification information provided by the Colorado Board of Nursing. 13. Ensure that every Attendant has been informed that he or she is prohibited from representing himself or herself to the public as a licensed nurse, a certified nurse aide, a licensed practical or professional nurse, a registered nurse, or a registered professional nurse when acting within the scope of their employment as a CDASS Attendant. 14. Inform Attendants of their rights and options as employees, in writing, ensuring the Attendants sign acknowledgemerd of receiving their rights. 15. Keep abreast of all laws and regulations relevant to the responsibilities it has undertaken with regard to the required federal and state filings and the activities related to being an employer of record. 16. Establish written policies and procedures available to the Department no later than thirty (30) business days after the contract start date. These policies and procedures shall address all vsteins identified above and any other personnel services that the Contractor pros ides. Page 9 of 40

10 The Contractor shall provide comprehensive fiscal services related to the employment of Internal Revenue Service (IRS), U.S. Department of Labor (DOL) laws and regulations Attendants, including, but not limited to, payment of payroll taxes in accordance with The Contractor shall: and State of Colorado Department of Labor and Employment (CDLE) laws and rules. Pae 10 o140 disbursements that exceed the ciicnt s authorized monthly allocation are not paid without documented authorization from the client s Case Manager or the CDASS Program Administrator. and disbursements 1br the Client and/or Authorized Representative ensuring 10. Establish and maintain an account for each Client, which will track allocations being a Fiscal Management Services organization. with regard to the required hderal and state Filings and the activities related to 9. Keep abreast of all laws and regulations relevant to the responsibilities undertaken employee s funds as may he required by local, state and federal laws. Consistent garnishments in accordance with state law. with industry practice, a fee may be charged for setting up and processing 8. Process all judgments, garnishments, tax levies or any related holds on employs and maintain the relevant documentation in the Attendants records. 7. Prepare and distribute any and all required IRS Forms for all Attendants the FMS industry practice, a reasonable fee may be charged for reissuing copies of W-2s to Attendants. maintain the relevant documentation in the Attendant s record. Consistent with 6. Prepare and distribute IRS Form W-2 for Attendants per IRS instructions and timesh eets. timesheets that are submitted on time and are within available authorizations is means to run off-cycle payroll to process payroll for delayed or corrected disbursed by the 10 th and 25 th of each month for 95% of the Attendants with the 5. Pay Attendants twice per month assuring that payment for all properly completed and DOL and CDLE wage and hour, rules and regulations. 4. Have a system to pay Attendants in compliance with federal and state statutes, tax process. 3. Have internal controls to monitor and implement the federal and state end of year within the Attendant s file. 2. Complete and submit all federal and state forms properly and maintain them Revenue Service and DOL regulations, and CDLE rules. 1. Pay all payroll taxes (FICA, FUTA, and SUTA) in accordance with law, Internal E. FISCAL SERVICES

11 11. Make payments from accounts, as directed by Clients andlor Authorized Representatives. No payments shall be made to Attendants without express written approval from the Client and/or Authorized Representative in the form of a hiring agreement and official timesheets signed by both the Client and/or Authorized Representative and the Attendant or via electronic signature using secure access through the PPL Portal. In the event that a Client and/or Authorized Representative is unable to sign a timesheet because of illness, death or refusal to follow procedures, the director of the Contractor may sign upon Departmental or Single Point Agency representative approval. 12. Verify that the services billed are authorized by the Case Manager on the approved Attendant Support Management Plan and Prior Authorization Request (PAR) prior to making payment. 13. Establish procedures to manage worker s compensation insurance and claims for the Department review and comment, to be provided not later than thirty (30) days after the Contract start date. 14. Establish policies and procedures to address payroll systems identified above for the Department s review and comment to be provided not later than thirty (30) days after the Contract start date. F. CUSTOMER SERVICE The Contractor shall provide the Client and/or Authorized Representative customer, personnel and fiscal support needed to direct Attendant support services. It is expected that the Contractor shall demonstrate the ability to provide superior support to effectively and efficiently meet Case Manager, Client, Authorized Representative and Department needs. Customer support shall include all aspects of enrollment, but is not limited, to assistance with: hiring agreements, worker s compensation insurance claims documentation and processing, reading and understanding monthly expenditure reports, tax forms, timesheets, and understanding the Department s rules related to Attendant support. The Contractor shall establish a comprehensive customer services system, which shall include the following as a minimum: I. Establish a statewide toll-free number available 24/7, subject to standard maintenance wmdows. for the exclusive use of the Colorado CDASS stakeholders to include Clients, Authorized Representatives and Attendants to contact the Contractor or make other reasonable accommodations for individuals calling from outside of the local calling area. 2. Make available customer service representatives between the hours of 8:00 am and 5:00 pm. \lountain Time. Monday through Friday. excluding State holidays. with a voice mail box for afier hours calls ensuring voice mail messages are retrieved a minimum of once per day during business hours. Page II of 4()

12 Representatives. Attendants and Case Managers within one (1) business day. 4. Maintain a system to respond to calls from Clients, Authorized Representatives, Page 12 of 40 Support Services delivery option. These reports include aggregate expeaditure reports. The Contractor is required to provide a variety of reports needed by the Department to provide ongoing oversight and quality assurance of the Consumer Directed Attendant monthly individual expenditure and Client over spending reports and annual agreed upon format and are due by the I 5th day followinr the quarter or months end. In demographic reports, quarterly line item reports. quarterly training status reports. and reconciliation reports tbr each individual budget. These reports shall be provided in an C. REPORTS TO THE DEPARTMENT in his/her area. for referral to other Clients and/or Authorized Representatives seeking Attendants 10. Maintain an online registry of potential Attendants who agree to be on the registry response to Clients andlor Authorized Representatives that emphasize the application of the philosophy of consumer direction and cultural sensitivity in all business practices. 9. Have policies and procedures available to the Department upon request regarding employees, Clients and/or Authorized Representatives. employee/client/customer differences, and sensitively responding to all communication by emphasizing the importance of managing diversity, valuing 8. Be culturally sensitive in all business practices such as written and oral devices for the hearing and speech impaired). provided to Clients and!or Authorized Representatives must be available in alternative formats if requested (e.g. large print and use of telecommunication to communicating effectively with Clients with disabilities. Any updates on tax and labor laws or other written reports training materials or other material 7. Develop and provide information and materials in alternative formats appropriate and interpreter services as necessary. Voice messages shall be returned within one business day from the time the message is recorded. adequate to handle the volume of incoming calls and having available translation 6. Maintain a voice messaging capacity in English and Spanish at a minimum based and online timesheet is configured to the fit the needs of the CDASS program. for submitting timesheets online and facsimile. Ensuring that both the paper 5. Operate a secure timesheet submission system, to include at minimum the options business hours and communicate that mechanism to all Clients andlor Authorized 3. Establish a mechanism to respond to urgent Client requests outside of normal

13 1. Quarterly aggregate expenditure reports shall include: Page 13 of 40 a. Number of referrals 4. Quarterly Training Status Reports c. Number of CDAS health maintenance activities used per Client b. Number of CDAS homemaker hours used per Client a. Number of CDAS personal care hours used per Client 3. Quarterly Line Item CDAS expenditure reports shall include: m. Total Complaints received; and a. Total Grievances filed. f. Average Attendant wage; i. Total gross wages; I. Total FMS service fee. f. Total Client and Attendant terminations; i. Total relative Attendants employed; I. Total CBI s completed; k. Total spouses employed as an Attendant; j. Total non-relative Attendants employed; b. Number of new Clients each month of the reporting period; d. Number of Clients withdrawing; g. Number of Colorado Board of Nursing backgiound checks completed; h. Average number of Attendants per Client; a. Number of Clients participating; c. Number of Clients trained; e. Number of Clients deceased; 2. Quarterly demographic reports shall include: g. Highest wage paid; h. Lowest wage paid; k. Total taxes; and d. Total expenditures for the quarter by line item, i.e. number of hours for and year to date; period; personal care, homemaker and health maintenance activities; j. Total hours; b. Amount of total Clients monthly allocations for each month of the reporting a. Total number of Clients being served; c. Total unspent funds remaining of Client allocations for the current period e. Total Attendants employed; addition, the Department may request Ad Hoc reports in a format and time frame to be mutually agreed upon by the Contractor.

14 b. Number of Clients trained c. Method of Training --Group, individual, self paced, etc d. Use of Peer Trainer e. Location & Schedule of trainings f. Evaluation Results g. Average elapsed time from referral to training initiation h. Average elapsed time from training initiation to completion of training 5. Monthly Reports a. Individual Client Expenditure. b. Client Over Spend reports 6. Ad Hoc Reports a. Ad Hoc Reports as requested by the Department and mutually agreed upon with the Contractor. H. QUALITY ASSURANCE The Contractor shall demonstrate a commitment to quality assurance for the provision of the services described in this Contract. The Contractor shall: I. Track the Prior Authorized Requests (PARs) submitted by the Case Manager and monitor the use of prior authorized units by Clients and/or Authorized Representatives to detect patterns of spending indicating premature depletion of units, abuse, or misuse of Medicaid funds. Submit the procedure for approval to the Department no later than thirty (30) after the Contract operational start date. 2. Establish a process to notify the Case Manager if the above issues are identified, within two (2) business days. 3. Ensure that payments do not exceed the prior authorized units. 4. Have a back-up system for timesheet submission in the event of facsimile or internet failure. The contractor shall ensure Clients and/or Authorized Representatives arc aware of the back up plan. 5. Ensure Clients/Authorized Representatives are notified timely of any failure to make timely payment with the option to run an off-cycle payroll in such cases. 6. Maintain a Disaster Recover Plan for processing payroll to ensure that payments are not delayed. 7. Have a procedure tbr handling all Complaints from clients and/or Authorized Representatives. Case Managers, Attendants, the Department or other sources Page 14 of 4()

15 submitted to the Contractor including documentation requirements. The procedure shall be submitted to the Department for approval no later than thirty (30) business days after the Contract operational start date. The Contractor shall notify the Clients and] or Authorized Representative of the Complaint process prior to the Client and/or Authorized Representative CDASS start date. 8. Analyze Complaint data to identify common themes and implement system improvements as necessary. 9. Identify Clients and/or Authorized Representatives who are in need of additional skills training. Failure to follow CDASS rules shall be an indicator of need for additional training. This behavior shall be documented by the Contractor and the Client s and/or Authorized Representative s behavior shall be reported to the Case Manager. 10. Assist the Department and any successor contractor with a transition at the end of the contract. At a minimum, the Contractor shall provide all electronic and hardcopy files to the successor contractor and shall assist in the resolution of any issues associated with the transition. I. ADMINISTRATIVE AND ORGANIZATIONAL STRUCTURE 1. Administrative requirements The Contractor shall: a. Possess the corporate resources necessary to perform financial management services, provide skills training to Clients and/or Authorized Representative, and to act as an employer of record for all Attendants employed by the service delivery options. b. Obtain a Colorado Medicaid Provider number for both Contractor and PPL, Colorado, a Submitter/Trading Partner ID number, an Atypical National Provider identification and a Billing Agent authorization prior to commencing work. The Contractor shall ensure that PPL, Colorado obtains a National Provider Identification number. c. The Contractor shall maintain business hours of 8:00 am. to 5:00 p.m. Mountain Standard Time at minimum. Offices are to be open for business on all weekdays Monday through Friday, except for the following state holidays: 1) New Years Day 2) Nlartin Luther King Day 3) Presidents {)av 4) \Iemorial Day Page 1 5 ni 4()

16 8) Veteran s Day 10) Christmas Day 9) Thanksgiving Day 7) Columbus Day Page l6of4o damages have been established for the initial coneact performance year for these The following are performanle standards for requirements in the Contract. Liquidated I)epartment strongly believes that performance standards are critical to the appropriate management and administration of the Financial Management Services contract. The Financial Management Services Contractor is expected to perform at specified levels of The Department has established performance standards for the required services. The accuracy, timeliness and administrative effectiveness. J. PERFORMANCE STANDARDS clause entitled Insurance. e. The Contractor shall provide insurance as required in General Provisions States. d. All staff shall be located and services performed in the continental United will be available to assist individuals who require support with regard to skills training and or Financial Management Services. with staff assigned to this office who has the authority and capability to provide checks to Clients employees on an emergency basis. Sufficient staff c. Establish and maintain a customer service office in the Denver Metro area sufficient to manage and perform the scope of work. b. Utilize an internal organizational and management structure, which is to provide the services described in the scope of work. a. Employ sufficient staff with the skills, experience and specialties necessary The Contractor shall: 2. Organization requirements subcontracts shall be in writing and shall incorporate the requirements, terms and conditions of this Contract. d. No more than thirty percent (30%) of the work may be subcontracted. All furlough days. The Contractor will maintain regular operations di.uing state designated 6) Labor Day 5) Independence Day

17 and/or Authorized Representatives and Case Managers within ten (10) calendar expenditure reports. days following the end of each month for ninety-five (95%) of accurate monthly I. Provide accurate monthly expenditure reports in a readable format to Clients Page 17 o140 execution of the Contract. The transition plan shall include the Contractor s proposed ipproach to the transition. define each task and subtask necessary for readiness review. The Department and the Contractor will work together during the transition, and specify a completion time lbr each transition task and for the the duties and functions no later than December 1, 2009, the operational start date. during which the Contractor shall prepare to discharge the work described in the Contract, The Contractor shall be fully operational, capable of discharging all of K. TRANSITION training status reports by the 15 th calendar day following the quarter s end. timesheets received on time and within authorization amounts such that any electronic funds transfer (EFT) payment is received by the 10 month and that any paper checks are sent out three (3) calendar days prior to the Billing Reports and Client Over Spending Reports by the 15 following the month s end. th and 25 th calendar day th of each month. Timely payments shall occur not less than ninetyfive percent (95%) of the time. Provide Individual Client Expenditure/Medicaid th and th of each days of the denial or delay. Timely notification shall occur not less than ninetyfive percent (95%) of the time. Attendant if the tirnesheet is denied or processing delayed within two (2) business ASMP from the Client and/or Authorized Representative. Timely submittal shall occur not less than ninety-five percent (95%) of the time. the Case Manager for approval within five (5) business days of receipt of the the Clients and/or Authorized Representatives requesting skills training. referral unless otherwise indicated by an expedited request or request for an extension by the Client and/or Authorized Representative for ninety-five (95%) of 2. Provide skills training within forty-five (45) days from the Case Manager s 3. Review the Client s Attendant Support Management Plan (ASMP) and submit to 4. Provide notification to the Client and/or Authorized Representative and the 5. Pay Attendants twice per month assuring payment for all properly completed 6. Provide quarterly aggregate expenditure reports, demographic, line item and I. The T)epartment anticipates that there will be a sixty (60) day transition phase 2. The Contractor shall submit a transition plan within seven (7) business days of the and Liquidated Damages. performance standards. See Exhibit C, Performance Standards, Reporting Requirements

18 3. During the transition phase, the Contractor shall: as a tool to monitor the progress of all tasks towards operational readiness. Page 1 8 ol 4() infirmation systems are disabled and how software and master files will he j. Provide a disaster recovery plan specifying hardware backup if management ensure that FMS services shall be continued without interruption. i. ldentiy risks associated with the transition and identify alternatives to contractor, subject to review and verification by the Department. h. Obtain data associated with all existing Clients from the incumbent be generated to the Department. communication protocols for reporting. Prepare examples of each report to g. Establish all project control and reporting systems and establish final execution of the Contract. to the Department for review and approval within thirty (30) days of the evaluation protocols that shall be used by the Contractor for Skills Training f. Provide examples of all forms, documents, training manuals and training the current contingency fee. Assure that accounts are appropriately updated and clients are notified. the Client s monthly allocation for direct care services, which shall reflect e. Work with existing Clients, Case Managers and the Department to establish the Department within thirty (30) business days of the final execution of the including Client enrollment and Attendant application packets. Submit to Contract for review and approval. and forms required for the work described in this Statement of Work d. Prepare a policies and procedures manual that includes all systems, functions policies and services through interviews with Department staff and the incumbent contractor staff. c. Identify Colorado FMS requirements, and become familiar with Department a National Provider Identification number. Provider identification and a Billing Agent authorization prior to Colorado, a Submitter/Trading Partner ID number, an Atypical National commencing work. The Contractor shall ensure that PPL, Colorado obtains b. Obtain a Colorado Medicaid Provider number for both Contractor and PPL, a. Select and establish a FMS operations site in the Denver lvi etro Area. developing the transition plan. The transition plan will be used by the Department the transition phase to establish a transition schedule for transitioning Clients to the contractor. The transition schedule shall be used by the Contractor in

19 restored. The disaster recovery plan shall specify alternative methods for continuing all required services. k. Submit weekly written status reports on the progress of tasks against the approved transition plan. L Conduct weekly status meetings with the CDASS Program Administrator and other Department staff, m. Inform the CDASS Program Administrator of delays or setbacks to the project tirneline by close of business on the day that any such issue or problem is identified. 4. A readiness review will be completed by the Department prior to the operational start date to determine whether the contractor has developed and implemented the systems, forms and policies and procedures necessary to act as an FMS in accordance with the provisions set forth in the Contract. The Contractor shall not be declared operational by the Department until the readiness provisions in the Contract are met. During the Readiness Review the Contractor shall: a. Walk the Department staff through the policies and procedures for each function required by the Contract, fourteen (14) days prior to the operational start day of December 1, b. Demonstrate all required systems including key information systems and financial software programs (e.g., Client accounts, and payroll). c. Describe and demonstrate the features of the customer service, record security and confidentiality, skills training, and disaster recovery systems. d. Provide examples of all necessary materials and forms. 5. The Department will provide the Contractor with the review team s findings. If necessary, the Contractor shall develop and implement a Department approved plan of correction prior to the Operational Start Date. If the Contractor fails to satisfy all requirements set forth in the plan of correction, the Department may, at its discretion, postpone the operational start date of the Contract. 6. Develop a project work plan defining all phase-level, project milestones. deliverables, and activity level schedules. necessary hardware and software, and staffing levels. The Contractor shall furnish to the Department a statement of the resources that would be required to provide FMS services. 7. Responsibilities of the State a. Complete a readiness review prior to the Contracer s operational start date. Paee Q üt4o

20 b. Assure compliance with the Colorado Medical Assistance Act (Section et seq.) and Title XIX of the Social Security Act. c. Monitor the performance of the Contractor and provide technical assistance as necessary. d. Assist and work together with the incumbent contractor in providing all files, documents, records, and electronic information regarding training, clients andlor Authorized Representatives and Attendants during the transition period. L. REVIEW REQUIREMENTS The Department will monitor the performance of the Contractor to ensure that performance is in accordance with its approved policies and procedures manual, federal and state rules and regulations, and the Contract. The Department will perform an on-site review of the Contractor, at least annually. Upon request by the Department, the Contractor records must be made available in Colorado for audit or review. M. PROVISION OF HEALTH INSURANCE BENEFITS TO ATTENDANTS In past years members of the advocacy community for persons with disabilities have raised concerns about whether direct care workers providing Attendant support services have sufficient access to affordable health insurance benefits coverage. The Department is currently investigating the available options for such health insurance coverage to direct care workers under the Consumer Directed Attendant Support service delivery option and the feasibility of promoting increased access through the Financial Management Services contractor, which serves as the employer of record. This activity may result in a change to the statement of work. The Department will include the Contractor in the planning, negotiation and implementation process. The Contractor will be given a reasonable amount of time to prepare for, and implement any such change. It is anticipated that any modification to the scope of work would not occur within the first six (6) months of the initial contract period. Any such change to the scope of work is not effective unless contained in a writing agreed to and signed by the Contractor. The adoption of federal or state statute, regulation, rule or policy. subsequent to the execution of this Contract. requiring the Contractor to provide health care insurance to Attendants will require an amendment to the Contract. The parties agree to negotiate the amendment in good faith. If the parties cannot ieach agreement on an amendment to the Contractor as the result of a federal or state statute, regulation, rule or policy to provide health care insurance to Attendants, the Contractor may terminate the Contract for convenience on the same terms applicable to the Department under Section him. Page 20 o14()

21 Contractor. In the event of conflicts or inconsistencies between this Contract and its The provisions of this contract shall govern the relationship of the Department and the A. ORDER OF PRECEDENCE Pae 21 o130 notice to the Contractor. may unikterallv extend this contract for a period of up to two requirements. Flowever. this extension shall terminate at the end of the two month period has not been fully executed by the end date of this contract. the Department. upon written original contract. including, but not limited to prices, rates and service delivery (2) months. The contract shall be extended under the same terms and conditions as the C. HOLDOVER PROVISION satisfied. Such extension shall be made by contract amendment. If the Department The Contract may be renewed for up to three (3) additional one-year periods, at the sole discretion of the Department, contingent upon funds being appropriated, budgeted and otherwise made available, and other contractual requirement, if applicable, being extends this Contract, the extended contract shall be considered to include this renewal provision. The total duration of this Contract, including all the renewal periods, shall not exceed five (5) years. Financial obligations of the State of Colorado payable after any current fiscal year are contingent upon the availability of funds for that purpose. contract performance contemplated herein shall commence on November 1, The operational start date shall be December 1, The services shall be undertaken and performed in the sequence and manner set forth in the scope of work and extend through Contractor prior to the proper execution and State Controller approval of this contract. June 30, The Contractor understands and agrees that the Department shall not be liable for payment of work or services or for costs or expenses incurred by this Financial obligations of the State of Colorado payable after any current fiscal year are contingent upon the availability of funds for that purpose. The contract shall be effective upon approval by the State Controller, or designee. The B. PERFORMANCE PERIOD Damages I. Colorado Special Provisions, pages 38 and HIPAA Business Associate Addendum. 3. Contract, pages 1 to The RFP, Exhibit A. 5. The Contractor s proposal, Exhibit B. 6. Exhibit C, Performance Standards, Reporting Requirements and Liquidated In the event the Department desires to continue the services and a replacement contract the document in the following order of priority: exhibits or attachments, such conflicts or inconsistencies shall be resolved by reference to IlL GENERAL PROVISIONS