PROWERS COUNTY, COLORADO BOARD OF COMMISSIONERS JUNE 10, 2025 7:00 a.m. Mark Dorenkamp, Road & Bridge Supervisor Update (AM Breakfast House, / 410 S Main St, Lamar, CO 81052) COMMISSIONERS BOARD ROOM, 2"d FLOOR OF COURTHOUSE 301 S. MAIN STREET, LAMAR, CO 81052 WORK SESSION 9:00 a.m. Jon Saunders, SECOM Update-boardband deployment per email from DW 9:30 a.m. Don Wilson, County Administrator & Paula Gonzales, Finance Director CRMC Update OPC Update 10:00 a.m. Gary Harbert, Veterans' Service Officer County VSO Monthly Report and Certification of Pay 10:15 a.m. Steve Pecharich, Dana Foley- CTSI-LosS Control (DW) 10:30 a.m. BOCC Updates Faron Williams - Fairgrounds update MEETING AGENDA 1:00 p.m. Invocation Pledge of Allegiance Call Meeting to Order Roll Call CONSENT AGENDA ACTION ITEMS: 1. Consider Approval of Adoption of Agenda 2. Consider Approval of Payment of Bills Presented and of Voiding Checks, if any, for all County Funds and DHS Funds, which include WHC and H3C Funds 3. Consider Approval of May 27, 2025 Meeting Minutes PUBLIC APPEARANCES Anyone wishing to address the BOCC may do SO at the discretion of the Board and subject to a three-minute limitation. UPDATES Don Wilson, County Administrator County Administrator update Rose Pugliese, Esq. County Attorney update ACTION ITEMS: 1. Consider approval for Purchase of Service Contract between Prowers County Public Health and Meaningful Collaboration Inc., Independent Contractor and authorizing Public Health Director Meagan Hillman to sign the Contract. 2. Consider ratifying 5-28-2025 email poll approval for payment of bills presented for County General Fund, Payroll, Payroll AP and AP, in the amount of $1,060,073.98, less May State Unemployment of $1,286.31 and Retirement Forfeitures of $3,141.64 for a total Certification to the Treasurer of $1,055,646.03, DHS Payroll, Payroll Ap and AP in the amount of $276,782.73 and H3C Payroll, Payroll AP and AP in the amount of $119,630.99 all with a Certification date of May 29, 2025 and authorizing the use of the Commissioner's signature stamps. 3. Consider ratifying 5-27-2025 verbal poll approval of a letter designating Todd Horning as the Community Representative Lead for efforts of cleaning up and updating the public motocross area located at the County Fairgrounds. 4. Consider approval of Memorandum of Understanding between Prowers County Department of Human Services and Colorado Department of Human Services for participation in the statewide contract for LEAP Administration and authorizing Department of Human Services Director, Lanie Meyers-Mireles to execute the MOU. 2 5. Consider ratifying 5-29-2025 email approval of TANF transfer request between Crowley County Department of Human Services and Prowers County Department of Human Services in the amount of $40,000 with Prowers County assuming the associated Maintenance of Effort. 6. Consider ratifying 5-30-2025 email poll approval of Contract Amendment #5 C24-186984A5, original Contract No. C24-186984 for SFY 2025-2026 in the amount of $22,122,685.00, estimated Contractor Shared $148,530.52 and authorized Public Health Director, Meagan Hillman to execute the Contract electronically who signed on May 27, 2025. 7. Consider approval of Memorandums of Understanding to facilitate the Prowers County Hotline County Connection Center with answer and processing of Child Welfare and Adult Protection Services related Hotline calls and performing tasks outlined in the MOU's effective January 1, 2025 and ending December 31, 2025 with the following counties: Gunnison and Gunnison-Hinsdale and authorizing Director of Human Services, Lanie Meyers-Mireles to execute the MOU. 8. Consider ratifying 6-3-2025 email poll approval of payment of bills presented for County General A/P in the amount of $94,920.58 with a certification date of June 10, 2025, and authorizing the use of the Commissioner's signature stamps. 9. Consider approval for Contract Amendment #3 to original Contract No. 2023*0329 for URHN, total amount for Amendment #3 is $199,994.00 and authorizing Public Health Director, Meagan Hillman to execute the Contract electronically. 10. Consider approval of AracSearch Proposal, estimated project price $670 for digital archiving services related to Commissioner Records from 2021-2024 to add to the Prowers County Historical Document Archive. 11. Consider approval of AracSearch Digital Services Agreement for an annual upload service of Commissioners Record images. PREVIOUSLY TABLED ACTION ITEMS: 1. Consider approval of final Subdivision Exemption Plat Map for Kema Land, LLLP. Application request was approved January 22, 2025 by the Planning Commission and on January 28, 2025 by the BOCC. Minor Subdivision for a Second Subdivision in the SE1/4NW1/4 in Section 11, Township 23, Range 43 West, the 6 P.M. Subdividing 1.56 acres and to be recorded in the County Clerk's Office. 3 EXECUTIVE SESSION Executive Session pursuant to C.R.S. 524-6-402(4)(b) Conference with the attorney for the purposes of receiving legal advice on specific legal questions. Executive Session pursuant to C.R.S. 524-6-402(4)b) Conference with the attorney for the purposes of receiving legal advice on specific legal questions for litigation updates. ADJOURN NOTE: This Agenda is provided for informational purposes only. Action may be taken on any or all of the items. All times are approximate. f any given item is finished earlier than anticipated, the Commissioners may move on to the next item. The only exceptions are public hearings on items which have had published notices of a specific hearing time; those items will not begin until the specific time or after. If you need assistance in participating in this meeting due to a disability as defined under the Americans with Disabilities Act, please call 719-336-8030 at least three days prior to the scheduled meeting to request an accommodation. 4 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 06/10/2025 Submitter: Meagan Hillman, PCPHE Director Submitted to the County Administration Office on: 05/27/2025 Return Originals to: Meagan Hillman, PCPHE Number of originals to return to Submitter:1 Contract Due Date: As soon as signed Item Tite/Recommended Board Action: Consider approval for Purchase of Service Contract between Prowers County Public Health and Meaningful Collaboration Inc., Independent Contractor and authorizing Public Health Director Meagan Hillman to sign the Contract. Justification or Background: The contractor is out of town until after the deadline. The proposal was delayed due to an email glitch on Rose's end and that is why it is not being submitted signed by the contractor. Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: 05/15/2025 & 5/27/2025 Additional Approvals (if required): PLEASE ATTACH THIS SHEET TO ALL AGENDA ITEMS WHEN SUBMITTING TO COUNTY ADMINISTRATION. THANK YOU! PURCHASE OF SERVICES CONTRACT THIS CONTRACT entered into this day of 2025 by and between Prowers County Public Health and Environment, hereinafter referred to as PCPHE and Meaningful Collaboration, Inc, www.meaningful-sollaboration.com, 3000 Robin Way, Denver, CO 80222 and hereinafter referred to as "Independent Contractor". Witnesseth, Whereas, the parties wish to enter into an Independent Contractor Agreement whereby Independent Contractor will furnish certain services to PCPHE upon the terms and conditions hereinafter set forth, NOW THEREFORE, in consideration of the mutual promises and covenants contained herein and other good and valuable consideration, the parties hereto agree as follows: 1. Term. This contract will be effective from this date until the project is completed, unless terminated as set forth herein. 2. Services by Independent Contractor. Independent Contractor agrees to perform the duties as outlined in the Proposal dated April 10, 2025 (attached hereto as Exhibit A). 3. Contract Price. PCPHE will pay Independent Contractor as set forth in Exhibit A upon receipt of a satisfactory invoice. 4. Taxes. Independent Contractor understands that Independent Contractor is obligated to pay all federal and state income tax on all money earned while performing services for The Cornerstone. 5. Indemnify. Independent Contractor agrees to indemnify and hold harmless PCPHE from any action based upon or arising out of damage or injury, including death, to persons or property caused or sustained in connection with the performance of this contract or by conditions created thereby, or based upon any violation of any statute, regulation, and the defense of such claims or actions. Independent Contractor waives any and all claims against PCPHE. 6. Insurance. It is understood that Independent Contractor will furnish its own insurance and will not be eligible for insurance maintained by PCPHE for its employees, including health insurance, workers' compensation insurance, unemployment insurance, life insurance and all other benefits afforded employees. 7. Independent Contractor. Independent Contractor certifies under penalty of perjury that it is an independent contractor and is not an employee ofl PCPHE. Independent Contractor further certifies that PCPHE does not require Independent Contractor to work only for PCPHE, PCPHE does not establish a quality standard for the individual except that PCPHE may provide plans and specifications regarding work but cannot oversee the actual work or instruct Independent Contractor as to how work will be performed, PCPHE does not pay. Individual Contractor a salary or an hourly rate but rather a fixed or contract rate as above set forth, PCPHE does not terminate the work of the service provided during the contract period unless Independent Contractor violates the terms of this contract or fails to produce a result that meets the specifications of this contract, The Contractor shall perform its duties hereunder as an Independent Contractor and not as an employee, neither the Contractor nor any agent or employee of the Contractor shall be or shall be deemed to be an agent or employee ofOwner. Contractor shall pay when due all required employment taxes and income tax and local head tax on any monies paid by Owner pursuant to this contract. Contractor acknowledges that the Contractor and its employees are not entitled to unemployment insurance benefits unless the Contractor or third party provides such coverage and that Owner does not pay for or otherwise provide such coverage. Contractor shall have no authorization, express or implied, to bind Owner to any agreements, liability, or understanding except as expressly set forth herein. Contractor shall provide and keep in force workers' compensation (and provide proof of such insurance when requested by Owner) and unemployment compensation insurance in the amounts required by law, and shall be solely responsible for the acts of the Contractor, its employees and agents. 8. Special Provisions. Independent Contractor agrees not to assign any provision of this contract to a subcontractor, unless approved in writing in advance by PCPHE, and to provide PCPHE with reports and maintain records on the provision of services. 9. Termination. Either party may terminate this contract with or without cause at any time. In the event of such termination, Independent Contractor will be paid for its services to the date oftermination. 10. Assignment. Independent Contractor may not assign this contract without the written consent of] PCPHE. 11. Venue. Jurisdiction for any dispute under this agreement shall be exclusively in the PCPHE, Colorado District or County Court sitting without jury in Lamar, Colorado, and the court shall award to PCPHE, ifit is the substantially prevailing party, its attorney fees, expert witness fees, court costs and any other litigation expense. 12. Appropriation. Any monetary obligation of PCPHE payable after the current fiscal year is subject to appropriation as provided by law. 13. Public Record. In the event PCPHE receives a public records demand pursuant to the Colorado Open Records Act for copies of documents which are or may be confidential, or may otherwise be subject to non-disclosure, PCPHE shall give written notice by facsimile and/or email to the Independent Contractor. Independent Contractor shall notify PCPHE 2 in writing by facsimile and/or email within 3 working days of notification if any documents requested as a public record should not be disclosed. The Independent Contractor shall indemnify and hold harmless PCPHE as provided in Paragraph 6 for any public record requests where the Company requests PCPHE not to disclose such records. 14. Illegal Aliens. Independent Contractor certifies that the Independent Contractor shall comply with the provisions of C.R.S. 8-17.5-101 et seq. Independent Contractor shall not knowingly employ or contract with an illegal alien to perform work under this contract or enter into a contract with a subcontractor that fails to certify to Independent Contractor that the subcontractor shall not knowingly employ or contract with an illegal alien to perform work under this contract. Independent Contractor represents, warrants, and agrees that it (i) has verified that it does not employ any illegal aliens, through participation in the Basic Pilot Employment Verification Program administered by the Social Security Administration and Department of Homeland Security, and (ii) otherwise will comply with the requirements of C.R.S. 8-17.5-102(2)(b). Independent Contractor shall comply with all reasonable requests made in the course of an investigation under C.R.S. 8-17.5-102 by Colorado Department ofLabor and Employment. IfIndependent Contractor fails to comply with any requirement of this provision or C.R.S. 8-17.5-101 et seq., PCPHE may terminate this contract for breach and Company shall be liable for actual and consequential damages to PCPHE. 15. Binding Effect. This Agreement is binding upon the parties and their respective successors and permitted assigns. This Agreement is only for the benefit oft the parties hereto, and no third party shall have any right, claim or interest hereunder. There is no implied covenant of good faith and fair dealing in this Agreement, rather it will be enforced as written. PCPHE REPRESENTATIVE: INDEPENDENT CONTRACTOR: By. By Meagan L Hillman, Director Contractor's Signature Date signed: Date signed: 3 Exhibit A Proposal dated April 10, 2025 Intentionally left blank 4 Prowers County Department of Public Health and Environment Opioid Use Reduction Stakeholder and Community Meeting Statement of Work, Budget, and Timeline April 10, 2025 Lorendia Schmidt Meaningful Collaboration Inc 3000 Robin Way, Denver, CO 80222 orendnemeaninatulrcalaboration.com www.meaningfu-collaboration.com MEANINGFUL COLLABORATION. 303-877-6444 FEIN: 93-4424664 Meaningful Collaboration Inc Overview The following document outlines Meaningful Collaboration's ("Vendor") Statement of Work (SOW) for facilitation of a formal stakeholder and community meeting to identify a common goal and tangible next steps for collective impact related to opioid substance use reduction in Prowers and Kiowa counties. This SOW highlights the responsibilities of both the Vendor and the Project Leaders at the Prowers County Department of Public Health & Environment ("Project Leaders") as it relates to the community meeting project. Any changes to this SOW, Budget, or Timeline shall be agreed upon in writing by the Vendor and the Project Leaders. Timeline Overview Milestone 1 Milestone 2 Milestone 3 2-3 Meeting Facilitation of Final Report Design sessions community submitted to the with Project meeting Project Leaders Leaders 2025 May June July August Design Facilitation ofCommunity Meeting Meeting Report THIS SPACE INTENTIONALLY LEFT BLANK 2 Meaningful Collaboration Inc Budget and Deliverables Item Vendor Project Leaders Cost Responsibilities Responsibilities 1 Facilitation and expertise of Lorendia Schmidt Project Leaders will make themselves available for: 2-3 $1800 pre-meeting planning sessions and one post-meeting debrief Coordination of documents, meeting facilitation supplies, session and other tools as needed Project Leaders will maket themselves available for the Travel to/from the agreed upon location facilitated meetings Milestone 1: Up to three 1-hour preparation meetings with Project leaders will coordinate the workshop, including setting Project Leaders to build the agenda and design the meeting date/time, securing a location, and inviting participants Milestone 2: Facilitation of ani in-person, 4-hour community Project leaders will provide feedback to the report draft within meeting on a date that is agreed upon by' Vendor and three business days Project Leaders Milestone: 3: Preparation of meeting notes and 2-3 page report of the meeting $1,800 Optional: Thef following are costs associated with additional activities that could also be conducted as agreed upon by the Vendor and Project Leaders A Upt to four (4) hours ofi in-person meeting time with Project Leaders will make themselves available for 2-3 $1800 facilitation and expertise of Vendor pre-meeting planning sessions and one post-meeting debrief session Coordination of documents, meeting notes, meeting facilitation: supplies, and other tools as needed Project Leaders will make themselves available for the facilitated meetings : This could be for a Kiowa meeting and/or another meeting with the Prowers and/or Kiowa communities as they begin Project leaders will coordinate the meeting, including setting taking action from the first meeting(s)" date/time and inviting participants 3 Meaningful Collaboration Inc Item Vendor ProjectLeaders Cost Responsibilities Responsibilities B Up to two (2) hours of virtual meeting time with facilitation Project! Leaders will make themselves available for 1 $1000 per and expertise of Vendor to support the Prowers and/or pre-meeting planning sessions and one post-meeting debrief meeting Kiowa communities as they begin taking action ont the steps session agreed upon in the first meeting(s) Project Leaders will make themselves availablei for the Coordination of documents, meeting facilitation supplies, facilitated meetings and other tools as needed Project leaders will coordinate the meeting, including setting Preparation of meeting notes date/time and inviting participants C Upt toi four (4) hours ofv virtual coaching time with Project Project Leaders will make themselves availablei for coaching $800 Leaders tol help design agendas and activities for additional time meetings with community members Project Leaders (with support of the Vendor) will create an agenda with activities for future meetings Project Leaders will coordinate and facilitate meetings For Item 1: Invoicing will occur after delivery of the report. For Optional Add-Ons: Invoicing will occur as agreed upon by the Vendor and Project Leaders. 4 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6-10-2025 Submitter: Paula Gonzales, County Finance Director Submitted to the County Administration Office on: Email Poll -27-2025 Return Originals to: Paula Gonzales & Jana Coen Number of originals to return to Submitter: 1 Contract Due Date: Item Title/Recommended Board Action: Consider ratifying 5-28-2025 email poll approval for payment of bills presented for County General Fund, Payroll, Payroll A.P and AP, in the amount of $1,060,073.98, less May State Unemployment of $1,286.31 and Retirement Forfeitures of $3,141.64 for a total Certification to the Treasurer of $1,055,646.03, DHS Payroll, Payroll Ap and AP in the amount of $276,782.73 and H3C Payroll, Payroll AP and AP in the amount of $119,630.99 all with a Certification date of May 29, 2025 and authorizing the use of the Commissioner's signature stamps. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ PROWERS COUNTY TREASURER CERTIFICATION COUNTY GENERAL FUND-0 01 0010 May29, 2025 75316-75377 $ 77,475.31 May Unemployment $ (1,286.31) Forfeitures $ (3,141.64) Payroll $ 330,760.14 Total Fringes $ 105,958.31 Totals 509,765.81 ARPA - 0018 Totals ROAD & BRIDGE FUND 02 0020 $ 56,277.04 Payroll $ 72,372.18 Fringes $ 20,586.30 Total S 149,235.52 FSA (Cafeteria) 552 0552 $ Totals $ Sheriff's Booking Fees 0675 $ Totals SALES & USE TAX FUND 03 0900 $ Total $ CONSERVATION TRUST FUND -06 0130 $ Totals CAPITAL. FUND - 07 0100 S Total s OTHER AGENCIES FUND- 08 $ Totals LODGING TAX 09 0014 $ 8,100.00 Payroll $ 211.75 Total Fringes_ $ 67.30 Total_s 8,379.05 PUBLIC HEALTH AGENCY 11 0676 $ 7,851.93 Payroll $ 115,614.64 Total Fringes_s 30,963.27 Total_s 154,429.84 CRMC 0016 $ Payroll $ 89,638.39 Total Fringes_ $ 30,368.56 Total $ 120,006.95 )PC 0017 s 62.25 Payroll $ 85.013.22 hhs Total Fringes $ 28,753.39 Total_s 113,828.86 Paula Gonzales, FnanceDirettor GRANDTOTALIS 1.055.646.03 Check Register 9 - 2 Prowers County, CO Packet: APPKI00077 - 104.05.2025 & Payroll I By Check Number CIORAN Vendor Number Vendor Name Payment Date Payment Type Discount Amount Payment Amount Number Bank Code: General Fund Op-General Fund Operating Account VEN00999 4 RIVERS EQUIPMENT, LLC 05/29/2025 Regular 0.00 12,500.29 75316 AIR1 A-1 Rental & Sales 05/29/2025 Regular 0.00 800.00 75317 ABBA ABBA Eye Care 05/29/2025 Regular 0.00 468.90 75318 AFL1 Aflac 05/29/2025 Regular 0.00 2,195.64 75319 AMAZON Amazon Capital Services 05/29/2025 Regular 0.00 1,061.93 75320 VEN00960 ASCEND DIRECT (MARKETING & DIG! 05/29/2025 Regular 0.00 1,665.12 75321 ATM1 Atmos Energy 05/29/2025 Regular 0.00 201.22 75322 AXIOM Axiom Human Resource! Solutions, Ir 05/29/2025 Regular 0.00 111.29 75323 WHITE Barbara White 05/29/2025 Regular 0.00 7,870.32 75324 WalkinshawB Breeann Walkinshaw 05/29/2025 Regular 0.00 500.00 75325 CDPHE RF CDPHE Vitals 05/29/2025 Regular 0.00 521.00 75326 VEN00972 CDPHE (COLORADO DEPT OF PUBLIC 05/29/2025 Regular 0.00 5.74 75327 SALAZ Celia M. Salazar 05/29/2025 Regular 0.00 5,031.00 75328 CISI CENTER FOR INTERNET! SECURITY INI 05/29/2025 Regular 0.00 15,920.00 75329 CINTASCORP CINTAS CORPORATION NO. 2 05/29/2025 Regular 0.00 920.08 75330 LAM1 City ofL Lamar 05/29/2025 Regular 0.00 1,000.00 75331 CLN1 Colonial Life & Accident Ins Co. 05/29/2025 Regular 0.00 1,215.26 75332 CAI1 Continental. American Insurance Con 05/29/2025 Regular 0.00 768.90 75333 VENO1001 Cook's Embroidery 05/29/2025 Regular 0.00 239.39 75334 CHP1 County Health Pool 05/29/2025 Regular 0.00 142,121.59 75335 E3CONSULTING E3 Consulting Services, LLC 05/29/2025 Regular 0.00 2,156.25 75336 EXT1 Express Toll 05/29/2025 Regular 0.00 17.38 75337 FSR1 Family Support Registry 05/29/2025 Regular 0.00 3,332.22 75338 FCSDLS FIRECRACKER: SHOWDOWN LIVESTO 05/29/2025 Regular 0.00 2,500.00 75339 FNB1 Frontier Bank 05/29/2025 Regular 0.00 169,299.07 75340 GOB1 Gobin's 05/29/2025 Regular 0.00 295.66 75341 HST1 Home Store LLC 05/29/2025 Regular 0.00 29.99 75342 FPL5 John Deere Financial 05/29/2025 Regular 0.00 1,883.47 75343 1257 Jose Manuel Soto. JR. 05/29/2025 Regular 0.00 3,968.90 75344 LAP1 Lamar Auto Parts 05/29/2025 Regular 0.00 31.98 75345 LAP1 Lamar Auto Parts 05/29/2025 Regular 0.00 133.85 75346 LBM1 Lamar BMS 05/29/2025 Regular 0.00 87.95 75347 LAWOFF Law Office of Rose F. Pugliese, LLC 05/29/2025 Regular 0.00 8,000.00 75348 LEG1 LegalShield 05/29/2025 Regular 0.00 375.80 75349 Chavez-Verduzco Mandy Chavez-Verduzco 05/29/2025 Regular 0.00 417.00 75350 MTS1 MASA MEDICAL AIR TRANSPORTAT 05/29/2025 Regular 0.00 733.00 75351 Mirage Mirage Technologies 05/29/2025 Regular 0.00 4,485.00 75352 VEN00954 Mountain Peak Law Group, PC 05/29/2025 Regular 0.00 300.00 75353 WINSORN Nancy' Winsor 05/29/2025 Regular 0.00 8,152.86 75354 NCA1 Nationwide Retirement: Solutions 05/29/2025 Regular 0.00 170.00 75355 VENO1000 NORMA VALDEZE F 05/29/2025 Regular 0.00 1,000.00 75356 VEN00983 OLDCASTLE: SW GROUPI INC (UNITED 05/29/2025 Regular 0.00 36,225.00 75357 OAP1 O'Reilly Automotive Parts 05/29/2025 Regular 0.00 69.93 75358 PGC1 Prairie Glass Company 05/29/2025 Regular 0.00 235.00 75359 PRC1 Prowers County 05/29/2025 Regular 0.00 525.00 75360 QUL1 Quill LLC 05/29/2025 Regular 0.00 16.59 75361 RTREDI R & TE Redi Mix 05/29/2025 Regular 0.00 3,310.58 75362 RGR1 Reyman's Grocery 05/29/2025 Regular 0.00 29.62 75363 RPI1 Robinson Printing 05/29/2025 Regular 0.00 365.00 75364 SSR2 Sand and Sage Roundup Fairboard 05/29/2025 Regular 0.00 5,000.00 75365 MRS1 Shred America 05/29/2025 Regular 0.00 62.25 75366 SCCI SOUTHEAST COLORADO CANCER INI 05/29/2025 Regular 0.00 600.00 75367 SPU1 Specimens Unlimited 05/29/2025 Regular 0.00 55.00 75368 TIN1 Terminix Processing Center 05/29/2025 Regular 0.00 4.32 75369 5/23/2025 10:44:42, AM Page 1 of 3 Check Register Packet: APXT00/7-104052025 & Payroll Vendor Number Vendor Name Payment Date Payment Type Discount Amount Payment Amount Number CORNER The Cornerstone Resource Center 05/29/2025 Regular 0.00 4,724.81 75370 HOL1 Town of Holly 05/29/2025 Regular 0.00 225.20 75371 TT1 Tyler Technologies Inc 05/29/2025 Regular 0.00 15,307.50 75372 VIA1 Viaero Wireless 05/29/2025 Regular 0.00 259.44 75373 WAG1 Wagner Equipment Co 05/29/2025 Regular 0.00 483.72 75374 WASH Wash! Spott Car Wash 05/29/2025 Regular 0.00 40.00 75375 WATER Waterway of New Mexico 05/29/2025 Regular 0.00 1,276.00 75376 WRE1 WEX BANK 05/29/2025 Regular 0.00 500.00 75377 Bank Code General Fund Op Summary Payable Payment Payment Type Count Count Discount Payment Regular Checks 98 62 0.00 471,803.01 Manual Checks 0 0 0.00 0.00 Voided Checks 0 0 0.00 0.00 Bank Drafts 0 0 0.00 0.00 EFT's 0 0 0.00 0.00 98 62 0.00 471,803.01 5/23/2025 10:44:42 AM Page 2 of 3 Check Register Packet: APXT00I7-104052025 & Payroll Fund Summary Fund Name Period Amount 999 Pooled Cash 5/2025 471,803.01 471,803.01 5/23/2025 10:44:42 AM Page 3 of 3 6 ) 0 E 8 0 0 E - Z & A 10132.IC sajaw alueT Cimtghen S,# SXO3HO GIGIOA Ayuo uoneunogur ELZ8L'9LZ STVLOL O9 169's IL06-8906 ONI.LVAIdO 09216'22 2806-2406 GONISJ OHA 49'989'0E 89619-Zv649 AIVTVS OHA L8'L6E'01 $1V89-S0089 ONILVAIdO $9'682'96 0EV89-91189 JONPE LVIS8'0I1 689101-86SIOL ASVTVS SEISaEJAI Apuw ENAS SSDIANIS NVIOH JO INIWIIAVaaG, ANNOO SHIAOdd :Aq pauedaud SZOZ '62 ABIWI ILVG SaAA.LIGN34x3 JO NOILVOL4IIN30 AaNSV.L ALNNOO SHIMOdd 101D2110 SARA alueT rtomi L/ W - / S,# SXO3HO GIGIOA Kjuo uonewnojul 660E9611 S'TVIOL 437T3ONV) DEH LV'8ZZ 0EZ4-6224 ONIIVA3dO OEH 91'918'0S LEZV-IEZV AONISS OFH 9E'989'89 6SLIE-EELIE AHVIVS OFH SEISaEWI Apuyw GNAS H3LN3D NOILDINNOO AINAOO INITLOH :Kq paedad SZOZ '62 AEII TLVI SIHA.LIGN34X3 JO NOMVOLILR3) HAHNSVINL ALNNOD SaaMOdd PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6-10-2025 Submitter: Don Wilson, County Administrator Submitted to the County Administration Office on: Verbal Poll 5-27-2025 Return Originals to: Don Wilson & Jana Coen Number of originals to return to Submitter: 1 Contract Due Date: Item Ttle/Recommended Board Action: Consider ratifying 5-27-2025 verbal poll approval of a letter designating Todd Horning as the Community Representative Lead for efforts of cleaning up and updating the public motocross area located at the County Fairgrounds. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: Additional Approvals (if required): Board of County Commissioners Prowers County 301 South Main, Suite 215 OLOR ADO Lamar, Colorado 81052-2857 (719) 336-8025 FAX: (719) 336-2255 TY HARMON RON COOK ROGER STAGNER FIRST DISTRICT SECOND DISTRICT THIRD DISTRICT May 27, 2025 All Interested Parties RE: Community Designee for Fairgrounds Motocross Improvements To Whom It Concern, On May 27, 2025, the Prowers County Board of County Commissioners designated Todd Horning as the Community Representative Lead for the efforts of cleaning up and updating the public motocross area located at the Prowers County Fairgrounds. This designation allows Mr. Horning the ability to lead volunteer groups in the improvement effort. The Prowers County Commissioners reserve the right to all financial decisions, approval of permanent changes to the stated area, and to terminate this designation at any time. For any questions please contact the County Administrator at 719-336-8029. Thank you for your attention in this matter. Sincerely, Ron Cook A In ak County Commissioner Roger Stagner Kerr County Commissioner Ty Harmon M County Commissioner PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6/10/25 Submitter: Department of Human Services Submitted to the County Administration Office on: 5/29/25 Return Originals to: Department of Human Services Number of originals to return to Submitter: 1 Contract Due Date: June 30, 2025 Item Tite/Recommended Board Action: "Consider approval ofMemorandum of Understanding between Prowers County Department of Human Services and Colorado Department of Human Services for participation in the statewide contract for LEAP Administration and authorizing Department ofl Human Services Director, Lanie Meyers-Mireles to execute the MOU." Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: Federal: $ State: Other: $ Approved by the County Attorney on: 5-30-2025 Additional Approvals (if required): PLEASE ATTACH THIS SHEET TO ALL AGENDA ITEMS WHEN SUBMITTING TO COUNTY ADMINISTRATION. THANK YOU! COLORADO CDHS Department of Human Services Memorandum of Understanding CDHS/LEAP Responsibilities: 1. Elicit county commitment to participate in the statewide contract via this Memorandum of Understanding. 2. Contract negotiation with Goodwill throughout the contract period. 3. Oversee and monitor Goodwill's performance in the administration of LEAP. 4. Make all payments to Goodwill for providing services, as defined in the contract. 5. Coordinate with all stakeholders, including the Office of Information Technology, HEAT HELP, the Crisis Intervention Program, the LEAP advertising campaign, and CDHS Settlement Accounting, to transition from county administration to the statewide contract. 6. Provide all necessary training and materials to Goodwill to administer LEAP. 7. Assign and manage county access to the LEAP eligibility system. 8. Provide training on system log-in and access to information and reports. 9. Be available to answer all contractor questions and assist with matters that may arise. Goodwill Responsibilities: 1. Work closely with CDHS and LEAP staff in implementing the contract. 2. Submit detailed monthly invoices to LEAP for payment for services delivered under this contract. 3. Coordinate with other CDHS and LEAP contractors. 4. Process all LEAP applications in a timely manner to meet the State's performance goals. 5. Ensure a team is available to assist clients, as needed, and answer their questions. 6. Provide appropriate equipment required to process LEAP applications. 7. Provide technicians access to the LEAP system. 8. Train staff beyond the pre-season training offered by CDHS and LEAP. 9. Follow all rules, policies and procedures outlined by CDHS and LEAP and adhere to any other state or federal laws applicable to LEAP. 10. Coordinate with vendors on behalf of LEAP clients, as necessary. County Responsibilities: 1. Inform the State LEAP Office of the intention to use services procured with Goodwill by signing the Memorandum of Understanding. 2. If intending to discontinue use of Goodwill and assume local administration of LEAP, inform the State LEAP Office by April 30th of each year. 3. Maintain a county presence for LEAP services. This may be accomplished by using Outreach funds to increase awareness about LEAP in the community, faxing applications received to Goodwill, making copies, providing applications to customers, assisting in emergencies, and more. 4. Provide the State LEAP Office with the name and contact information for the individual who will serve as the county contact for all LEAP-related communication throughout the contract period by August 31st of each year. 5. Assign one individual who will be responsible for accessing county LEAP reports through the LEAP web- based eligibility system. 6. Communicate to the CDHS Settlement Accounting unit its election to leave any expenditures distributed via the Random Moment Sampling cost allocation. process as LEAP expenditures within the County Administration allocation, 50 as to avoid any expenditures being reclassified to the LEAP Administration allocation. Counties will not enter any LEAP Administrative charges in the Colorado Financial Management: System (CFMS). Printed Name & Signature Printed Name & Signature On behalf of the Colorado Department of Human Services On behalf of County OF 1575 Sherman Street, Denver, CO 80203 P: 303.866.5700 www.oloradogow/DHS Jared Polis, Governor I Michelle Barnes, Executive Director 1876 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6/10/25 Submitter: Department ofHuman Services Submitted to the County Administration Office on: email poll 5/27/25 Return Originals to: Department ofl Human Services Number of originals to return to Submitter: 1 Contract Due Date: June 30, 2025 Item Title/Recommended Board Action: "Consider ratifying 5-29-2025 email approval ofTANF transfer request between Crowley County Department ofHuman Services and Prowers County Department of Human Services in the amount of $40,000 with Prowers County assuming the associated Maintenance of Etfort". Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: Federal: $ State: Other: $ Approved by the County Attorney on: Additional Approvals (if required): PLEASE ATTACH THIS SHEET TO ALL AGENDA ITEMS WHEN SUBMITTING TO COUNTY ADMINISTRATION. THANK YOU! Board of County Commissioners Prowers County 301 South Main, Suite 215 7 ) LOR D Lamar, Colorado 81052-2857 (719) 336-8025 FAX: (719) 336-2255 TYH HARMON RON COOK ROGER STAGNER FIRST DISTRICT SECOND DISTRICT THIRD DISTRICT May 27, 2025 Works Allocation Committee Co-Chairs Commissioner Scott James and Clint Woodruff Colorado Counties, Inc. 800 Grant Street, Suite 500 Denver, CO 80203 Dear Commissioner James and Mr. Woodruff, The Prowers County Department of Human Services and the Crowley County Department of Human Services have reached a mutual agreement whereby Crowley County would like to transfer $40,000.00 OfTANF funds to Prowers County. Pending approval by the Works Allocation Committee, Prowers County will assume responsibility for the corresponding Maintenance ofEffort. Should you have any questions regarding this matter, please feel free to contact Lanie Meyers- Mireles, Prowers County Director of Human Services, or Tonia Burnett, Crowley County Department ofHuman Services. Thank you for your time and support in this manner. Sincerely, 1an book Chair of the Board of County Commissioners CC: Crowley County Board of County Commissioners Tonia Burnett, Crowley County Department of Human Services Lanie Meyers-Mireles, Prowers County Director ofHuman Services PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: June 10, 2025 Submitter: Meagan Hillman, Public Health Director Submitted to the County Administration Office on: Email poll 5-28-2025 Return Originals to: Meagan Hillman & Jana Coen Number of originals to return to Submitter: 1 Contract Due Date: Item Title/Recommended Board Action: Consider ratifying 5-30-2025 email poll approval of Contract Amendment #5 C24-186984A5, original Contract No. C24-186984 for SFY 2025-2026 in the amount of $22,122,685.00, estimated Contractor Shared $148,530.52 and authorized Public Health Director, Meagan Hillman to execute the Contract electronically who signed on May 27, 2025. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: 5-29-2025 Additional Approvals (if required): Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-F A243A9F50DF STATE OF COLORADO CONTRACT MODIFICATION CONTRACT AMENDMENT #5 State Agency Contract Performance Beginning Date Department of Health Care Policy and Financing July 1, 2025 Contractor Current Contract Expiration Date Prowers County Public Health and Environment June30, 2026 Original Contract Number Current Contract Maximum Amount C24-186984 Medicaid Programs Amendment Contract Number No Maximum for any SFY C24-186984A5 State General Fund Programs State Fiscal Year 2025-26 $22,122,685.00 Estimated Contractor Shared $148,530.52 THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT Each person signing this Amendment represents and warrants that they are duly authorized to execute this Amendment and to bind the Party authorizing the person's signature. CONTRACTOR STATE OF COLORADO Prowers County Public Health and Environment Jared S. Polis, Governor Meagan L. Hilman, Director Department ofHealth Care Policy and Financing Kim Bimestefer, Exeçutive, Docusigned" Birector Signed by: KRay L. Hilman Muayau OB6A84797EA8493. DC9F30540F6C440. 05/27/2025 I 16:40 MDT 05/27/2025 - 15:28 MDT Date: Date: STATE CONTROLLER Robert Jaros, CPA, MBA, JD Department of Health Care Policy and Financing Jerrod Cotosman, Controller DocuSigned by: ferrod Dotosman 76F69541272B43A 05/28/2025 I 08:39 MDT Amendment Effective Date: In accordance with $24-30-202, C.R.S., this Amendment is not valid until signed and dated above by the State Controller or an authorized delegate. Amendment Contract Number: C24-186984A5 Page 1 of1 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9FS0DF 1. PARTIES This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover Page for this Amendment (the "Contract") is entered into by and between the Contractor and the State. 1. TERMINOLOGY Except as specifically modified by this Amendment, all terms used in this Amendment that are defined in the Contract shall be construed and interpreted in accordance with the Contract 2. AMENDMENT EFFECTIVE DATE AND TERM A. Amendment Effective Date This Amendment shall not be valid or enforceable until the Amendment Effective Date shown on the Signature and Cover Page for this Amendment. The State shall not be bound by any provision of this Amendment before that Amendment Effective Date, and shall have no obligation to pay Contractor for any Work performed or expense incurred under this Amendment either before or after of the Amendment term shown in $3.B ofthis Amendment. A. Amendment Term The Parties' respective performances under this Amendment and the changes to the Contract contained herein shall commence on the Amendment Effective Date shown on the Signature and Cover Page for this Amendment. 3. PURPOSE This Amendment updates Exhibit B Statement of Work and Exhibit E Contractor': s Administrative Requirements. 4. MODIFICATIONS The Contract and all prior amendments thereto, if any, are modified as follows: A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is hereby deleted and replaced with the Current Contract Expiration Date shown on the Signature and Cover Page for this Amendment. B. The Contract Maximum Amount table on the Contract's Signature and Cover Page is hereby deleted and replaçed with the Current Contract Maximum Amount table shown on the Signature and Cover Page for this Amendment. C. Exhibit B-3 is hereby deleted in its entirety and replaced with Exhibit B-4 as follows. All references to Exhibit B, Exhibit B-1, Exhibit B-2, Exhibit B-3, or Exhibit B-4 shall now refer to Exhibit B-5. D. Exhibit E-3 is hereby deleted in its entirety and replaced with Exhibit E-4 as follows. All references to Exhibit E, Exhibit E-1, Exhibit E-2, Exhibit E-3, or Exhibit E-4 shall now refer to Exhibit E-5. 5. LIMITS OF EFFECT AND ORDER OF PRECEDENCE This Amendment is incorporated by reference into the Contract, and the Contract and all prior amendments or other modifications to the Contract, if any, remain in full force and effect except as specifically modified in this Amendment. Except for the Special Provisions contained in the Contract, in the event of any conflict, inconsistency, variance, or contradiction between the Amendment Contract Number: C24-186984A5 Page 1 of2 Docusign Envelope ID: AEFOTFSDBSE454PAABAAOPFA2AA9FSODF provisions ofthis Amendment and any of the provisions of the Contract or any prior modification to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and control. The provisions of this Amendment shall only supersede, govern, and control over the Special Provisions contained in the Contract to the extent that this Amendment specifically modifies those Special Provisions. Amendment Contract Number: C24-186984A5 Page 2 of2 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF EXHBIT B-5, STATEMENT OF WORK 1. CASE MANAGEMENT OBLIGATIONS 1.1. Contractor's Obligations 1.1.1. Contractor shall provide case management activities outlined in this Contract for the following Home and Community Based Services (HCBS) waivers, non-HCBS programs, and State General Fund programs: 1.1.1.1. Community First Choice (CFC) 1.1.1.2. Family Support Services Program (FSSP) 1.1.1.3. HCBS Children with Complex Health Needs (HCBS-CWCHN) 1.1.1.4. HCBS Children's Extensive Supports Waiver (HCBS-CES) 1.1.1.5. HCBS Children's Habilitation Residential Program Waiver (HCBS-CHRP) 1.1.1.6. HCBS Children's Home and Community Based Services Waiver (CHCBS) 1.1.1.7. HCBS Community Mental Health Supports Waiver (HCBS-CMHS) 1.1.1.8. HCBS Complimentary and Integrative Health Waiver (HCBS-CIH) 1.1.1.9. HCBS Developmental Disabilities Waiver (HCBS-DD) 1.1.1.10. HCBS Elderly, Blind and Disabled Waiver (HCBS-EBD) 1.1.1.11. HCBS Brain Injury Waiver (HCBS-BI) 1.1.1.12. HCBS Supported Living Services Waiver (HCBS-SLS) 1.1.1.13. Hospital Back-Up Program (HBU) 1.1.1.14. Intermediate Care Faclities-Intellectual and Developmental Disabilities (ICF-IDD) 1.1.1.15. Nursing Facilities (NF) 1.1.1.16. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS) 1.1.1.17. Program for All-Inclusive Care for the Elderly (PACE) 1.1.1.18. State Supported Living Services Program (State SLS) 1.1.2. Contractor shall abide by and perform its duties and obligations in conformity with relevant federal law, all pertinent federal regulations, State law, rules and regulations of the Department of Health Care Policy and Financing which include, but are not limited to: 1.1.2.1. Colorado Revised Statutes, Title 25.5, Article 6, Sections 104 through and including 107. 1.1.2.2. Colorado Revised Statute, Title 25.5, Article 10 et seq. 1.1.2.3. Colorado Department of Health Care Policy and Financing written communications. 1.1.2.4. Colorado Department of Public Health and Environment at 6 C.C.R. 1011-1 et seq. 1.1.2.5. Colorado Department ofHuman Services 12 C.C.R. 2509-8 7.700 et seq. 1.1.2.6. All State Medicaid regulations promulgated by the Department. These regulations include, but are not limited to: 1.1.2.6.1. FSSP 10 CCR 2505-10, Sections 8.7561 et seq. Exhibit B-5, Statement ofWork Page 1 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.1.2.6.2. Long-Term Care 10 CCR 2505-10, Sections 8.400 through 8.409 et seq. 1.1.2.6.3. Colorado Case Management Agency Requirements 10 CCR 2505-10, Section 8.7200 et seq. 1.1.2.6.4. Community First Choice, 10 CCR 2505-10, Section 8.7600 et seq. 1.1.2.6.5. HCBS-BI 10 CCR 2505-10, Section 8.7101.E et seq. 1.1.2.6.6. HCBS-CWCHN 10 CCR 2505-10 Section 8.7101.D et seq. 1.1.2.6.7. HCBS-CES, 10 C.C.R. 2505-10 Section 8.7101.B et seq. 1.1.2.6.8. HCBS- CHCBS 10 CCR 2505-10, Sections 8.7101.A et seq. 1.1.2.6.9. HCBS-CHRP, 10 C.C.R. 2505-10 Section 8.7101.C et seq. 1.1.2.6.10. HCBS-CIH 10 CCR 2505-10, Section 8.7101.H et seq. 1.1.2.6.11. HCBS-CMHS 10 CCR 2505-10, Section 8.7101.F et seq. 1.1.2.6.12. HCBS-DD, 10 C.C.R. 2505-10 Sections 8.7101.J et seq. 1.1.2.6.13. HCBS-EBD 10 CCR 2505-10, Sections 8.7101.G et seq. 1.1.2.6.14. HCBS-SLS, 10 C.C.R. 2505-10 Sections 8.7101.I et seq. 1.1.2.6.15. PACE Section 25.5-5-412, Section 6a-b., C.R.S et seq. 1.1.2.6.16. Case Management Services, Determination of Developmental Disability, Laboratory and X-Ray, 10 CCR 2505-10 Section 8.607.2 through 8.6660.5.E. 1.1.2.6.17. Support Levels and Algorithms 10 CCR 2505-10 Section 8.7202.AA et seq 1.1.2.6.18. State SLS Program, 10 CCR 2505-10, Section 8.7560 et seq. 1.1.2.6.19. Recipient Appeals, 10 CCR 2505-10, Section 8.057 et seq. 1.1.2.6.20. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), 2 CFR Chapter I, Chapter II, Part 200 et al. 1.1.3. Contractor shall perform its obligations in conformity with the provisions ofTitle XIX ofthe Social Security Act and other applicable federal and state laws and regulations. 1.1.4. Contractor shall ensure applicant, Member, and individual rights are protected in accordance with Title XIX of the Social Security Act, other applicable federal and state laws, and Department regulations. 1.1.5. Contractor shall comply with written Operational Memos, policies, procedures, and guidance issued by the Department. 1.1.6. The general Business Functions of Contractor shall include, but is not limited to, all the following: 1.1.6.1. Contractor shall maintain a physical, publicly accessible, and Americans with Disability Act (ADA) compliant office within the Defined Service Area and appropriate staffing pattern to serve the Defined Service Area. 1.1.6.1.1. Non-standard business hours and method of contact information for urgent situations must be posted on Contractor's website in an easily accessible location and must remain up-to-date and align with Contractor's after-hours policy. Exhibit B-5, Statement ofWork Page 2 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF- A243A9F50DF 1.1.6.1.2. Contractor shall ensure adequate staffing through virtual or in-person services throughout the Defined Service Area in addition to a physical office space, providing access to its office for staff, Members, families, services providers, and others to best meet the needs ofi individuals based on individual preferençes. 1.1.6.1.3. Contractor shall have the ability for case managers to travel, regional coverage, and provide all required Work for the counties in which the agency operates. 1.1.6.1.4. Regular business office hours of operation shall follow an 8-hour schedule Monday through Friday except for federal, state, or local holidays and unplanned closures due to inclement weather or other emergencies. Regular business office hours and holiday closures must be provided to all Members upon enrollment and at least annually, posted publicly at each office location, and posted on Contractor's website. Contractor shall have a procedure for notifying Members and the public ofu unplanned closures or changes to regular business hours due to inclement weather or other emergencies, which includes emergency contact information. 1.1.6.1.5. Contractor shall have internal procedures for accommodating individuals, Members, and families who need assistance or consultation outside regular business office hours. 1.1.6.2. Contractor shall have an after-hours policy and procedure to respond to urgent situations outside of regular business hours as defined herein. 1.1.6.2.1. Contractor's after-hours policy and procedure shall include a response to all telephone calls, voicemails, and emails from Members and families on average within two Business Days of receipt by Contractor. 1.1.6.2.2. Procedures must provide Contractor after-hours contacts, e.g., voicemail, pager, or answering service numbers and alternative contacts and resources, and information, e.g., advocacy groups, community resources, etc., available to Members in urgent situations including, but not limited to, hospital discharges, risk ofhomelessness, and unexpected termination of residential services. 1.1.6.2.3. Procedures must clearly document how Contractor will ensure a commensurate response to urgent situations including, but not limited to, hospital discharges, risk of homelessness, and unexpected termination of residential services. 1.1.6.2.4. Contractor shall notify individuals, Members, families, providers, and community partners ofthe procedures and make it readily available through a variety of methods, including the Contractor's website. 1.1.6.2.5. Non-standard business hours and method of contact information for urgent situations must be posted on Contractor's website in an easily accessible location and must remain up-to-date and align with Contractor" S after-hours policy. 1.1.6.2.6. Contractor shall overcome any geographic barriers within the Defined Service Area, including distance from the agency office to provide timely assessment and case management services to individuals, Members and families, as required by Contract, Federal or State statutes and regulations. This may include staff who reside throughout the Defined Service Area to best meet the needs of individuals and Members. Exhibit B-5, Statement ofWork Page 3 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9F50DF 1.1.6.2.7. Contractor shall protect Members' rights as they relate to the responsibilities of Case Management Agencies as described in this Contract. 1.1.6.2.8. Contractor shall provide access to a telephone system and trained staff to ensure timely response to messages and telephone calls received after hours. 1.1.6.2.9. Contractor shall provide access to telecommunication devices and/or interpreters for the hearing and vocally impaired and foreign language interpreters as needed to fulfil all Work. Contractor shall conduct an assessment of the communication needs oft the Members they serve and ensure their interpretation and telecommunication services sufficiently meet the Member's S need in a timely fashion. 1.1.6.2.10. Contractor shall follow communication standards set by the Department which includes, but is not limited to, Memo Series, technical assistance documents, Provider Bulletins, training documents, and email correspondence. 1.1.6.2.11. Contractor shall ensure all information entered into the Department's systems is accurate and entered within the timelines established within the Contract. 1.1.6.2.11.1. Systems include, but are not limited to, the Colorado interChange Medicaid Management Information System (MMIS) and its subsystems: Bridge HCBS Prior Authorization Request (PAR) subsystem and the Care and Case Management (CCM) System. 1.1.6.2.12. Contractor shall support the Department's National Core Indicators (NCI) efforts. 1.1.6.2.13. Contractor shall enroll and act as a Medicaid Targeted Case Management (TCM) provider for all HCBS waivers and CFC to include, but not limited to, providing ongoing case management and monitoring activities for the Defined Service Area. 1.1.6.2.14. Contractor shall follow 10 C.C.R. 2505-10, Section 8.7202.M et seq. when transferring a Member from one county to another county or from one Defined Service Area to another Defined Service Area. 1.1.6.2.15. Contractor may be granted a Conflict Free Case Management Authorization (CFCMA) by the Department to provide LTSS Case Management within the Defined Service Area when one is necessary to maintain services in rural and frontier service areas. 1.1.6.2.15.1. Contractor shall obtain and maintain approval for the CFCMA throughout the Contract Period to meet program requirements for a Case Management Agency. .1.6.2.15.2. The Department reserves the right to revoke Contractor's CFCMA at any time. 1.1.6.2.15.3. Contractor shall submit an annual report to the Department that includes, but is not limited to, the following information: 1.1.6.2.15.3.1. Written processes in place to ensure remediation of conflict and separation of entities. 1.1.6.2.15.3.2. Documentation ofMember choice and informed consent ofthe conflict ofthe agency being selected. 1.1.6.2.15.3.3. A summary of the individuals participating in direct services and case management at the agency with the CFCMA. Exhibit B-5, Statement ofWork Page 4 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF .1.6.2.15.3.4. Policies and procedures outlining how Contractor will validate that there are no other willing and qualified providers in their Defined Service Area with capacity to provide services for all eligible Members in the service area. 1.1.6.2.15.3.5. How Contractor is supporting the recruitment of providers in their area to remediate conflict. 1.1.6.2.16. IfContractor is denied a CFCMA for any reason, or one is revoked, Contractor must have documented written plans for1 transitioning individuals and Members. Contractor shall continue to provide services until a transition may be successfully implemented. 1.1.6.2.16.1. DELIVERABLE: Annual report and written processes and procedures on implementing rural exception and only willing and qualified provider requirements for CMAS that have been granted a CFCMA. 1.1.6.2.16.2. DUE: June 15th of each year or prior to contract renewal for CMAS with an approved rural exception 1.2. Collaboration with other Care Coordination Entities and Case Management Agencies 1.2.1. Contractor shall comply with written communication from the Department, provided by the Department, between Contractor and community partners and service providers that outline how Contractor will work together with these partners to coordinate care and better serve individuals and Members. Contractor shall establish written memorandum ofu understanding with local care coordination entities that outline roles and responsibilities, avoidance of duplication of effort, and communication expectations. Contractor is responsible for streamlining the Member experience to ensure full range of Medicaid services are being offered and accessed based on the Member's needs. As applicable, a memorandum of understanding shall address partnerships with: 1.2.1.1. Regional Accountable Entities (RAE) 1.2.1.1.1. The RAE is responsible for coordinating for physical health services and providing and arranging for behavioral health services, including, but not limited to mental health services or other non-waiver behavioral services and supports available through Medicaid. The RAE promotes the population's health and functioning, coordinates care across disparate providers, interfaces with LTSS providers, and collaborates social, educational, justice, recreational, and housing agencies to foster healthy communities and address complex needs that span multiple agencies and jurisdictions. The RAE manages a network of primary care physical health providers and behavioral health providers to ensure access to appropriate care for Medicaid Members. 1.2.1.1.1.1. Contractor shall ensure collaboration with RAEs occurs for all shared Members that need care coordination services for physical and behavioral health services. Contractor shall identify which community agencies are responsible for facilitation, follow-up, and solution focused on next steps for each Member collaboration. 1.2.1.1.1.2. Contractor shall collaborate with the appropriate RAE when a Member needs assistance in accessing or coordinating the Member's physical, behavioral, or mental health needs. This shall include but is not limited to Members who have complex medical or behavioral support needs, change of conditions or involvement with Child Welfare or Adult Protection. Exhibit B-5, Statement of Work Page 5 of49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AADF-FA243A9F50DF 1.2.1.1.1.3. Coordinating with the RAE for shared Members who admit to a hospital, to include, but not limited to, communicating reasons for admission, Member's hospital status, and plans for discharge. 1.2.1.1.1.4. Collaborating with the RAE for shared Members discharging from the hospital to ensure all support needs are reflected in the Support Plan and the Member is connected to the necessary services to support a successful discharge. 1.2.1.1.1.5. Enter into a data sharing arrangement for the sharing ofall necessary information for the RAE to assist Members in accessing and coordinating physical and behavioral health needs. 1.2.1.1.1.6. Contractor shall create a complex and creative solutions process with the RAE(s) and designated staff to address needs spanning multiple Medicaid systems for all shared Members. This shall include, but not be limited to, a regularly scheduled joint coordination meeting at a cadence that best meets the Member's needs to ensure holistic case management and care coordination. This process shall be made available upon request. 1.2.1.1.1.7. Contractor shall honor Member's preferences for case management and care coordination, when applicable, while ensuring collaboration with the RAE occurs. 1.2.2. Contractor shall work with the Department to identify a Key Performance Indicator (KPI) to measure the effectiveness ofcoordination between Contractor and RAE. Medicaid Eligibility Sites. 1.2.2.1. County department of human/social services (counties) and Medical Assistance (MA) Sites are designated sites allowed by statute or certified by the Department ofHealth Care Policy and Financing (Department) to process the State-authorized Medical Assistance application for the programs that are administered by the Department and determine eligibility for said programs. The role of county departments, specified in CRS 25.5-1- 118, is specific to the responsibility for the local administration of Medical Assistance. Additionally, the Department is authorized to establish MA sites by statute (CRS 25.5-4- 205 et seq). Counties and MA Sites use the Colorado Benefits Management System (CBMS) to determine eligibility for Child Health Plan Plus (CHP+) and Health First Colorado (Colorado's Medicaid Program) programs. 1.2.2.2. Contractor shall ensure collaboration with all county and Medical Assistance sites pertaining to application, renewal, case changes, or re-application status for Members in Contractor's designated service area. 1.2.2.3. Contractor shall collaborate with the appropriate counties and/or Medical Assistance sites to ensure proper follow-up and communication to support Members in obtaining and maintaining their benefits. 1.2.3. Community Centered Boards 1.2.3.1. Community Centered Boards (CCB) are the agencies responsible for leveraging local and regional resources to meet unmet needs for individuals with Intellectual and Developmental Disabilities (IDD) and their families. 1.2.3.2. Contractor shall collaborate with CCBs, this may include, but is not limited to: Exhibit B-5, Statement of Work Page 6 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.2.3.2.1. Receiving referrals or sharing information necessary for the CCB and/or CMA to assist individuals and Members in accessing LTSS programs targeted for individuals with intellectual and/or developmental delays or disabilities. 1.2.3.2.2. Coordinating care for non-waiver services for individuals and Members with intellectual and developmental delays or disabilities where applicable or appropriate. 1.3. Qualification and Training Requirements 1.3.1. Contractor'. S personnel, including, but not limited to, Case Manager(s) and Case Management Supervisor(s) shall meet all qualification requirements listed in 10 C.C.R. 2505-10, Sections 8.7203.A to 8.7204 et seq. 1.3.2. Contractor shall ensure all case managers meet the qualification requirements established in 10 C.C.R. 2505-10, Section 8.7203.A et seq. 1.3.3. Contractor shall ensure all staff assigned to perform the Work in this Contract pass competency-based training requirements as defined by the Department including, but not limited to disability/cultural competency, person centeredness, soft skills, as well as program specific knowledge and skills. 1.3.4. Contractor shall ensure that all case management staff receive training within 120 Calendar Days after the staff member's hire date and prior to being assigned independent case management duties. All other case management staff must receive retraining as required by the Department, a Departmentapproved vendor, or Contractor. 1.3.5. Training modalities may include the Departments Learning Management System (LMS), web-based training, virtual instructor-led training, in-person training sessions and training materials available on the Department website. Contractor shall utilize training materials provided by the Department. 1.3.6. Required Case Management Training includes, but is not limited to: 1.3.6.1. Applicable Federal and State laws and regulations for LTSS programs 1.3.6.2. Community First Choice 1.3.6.3. Critical Incident Reporting 1.3.6.4. Determination of Developmental Disability or Delay 1.3.6.5. Disability and Cultural Competency 1.3.6.6. Intake and Referral 1.3.6.7. Level ofCare Screen (ULTC 100.2) 1.3.6.8. Long-Term Services and Supports Eligibility 1.3.6.9. Mandatory Reporting 1.3.6.10. Notices and Appeals 1.3.6.11. Nursing Facility Admissions 1.3.6.12. Rapid Reintegration 1.3.6.13. Participant Directed Training 1.3.6.14. Person-Centered Support Planning and Person-Centered Support Plan Exhibit B-5, Statement of Work Page 7 of49 Docusign Envelope ID: ABEFOTF6DBSE4549AAOFFA2ASA9FSODF 1.3.6.15. Pre-Admission Screening and Resident Review (PASRR) 1.3.6.16. State General Fund Program Ongoing Case Management 1.3.6.17. State General Fund Program Requirements and Services 1.3.6.18. System Documentation 1.3.6.19. Waiver Requirements and Services 1.3.6.19.1. DELIVERABLE: Case Management Training 1.3.6.19.2. DUE: Semi-Annually, trainings held between July 1st and December 31st are due January 15th, and trainings held between January 1st through June 1st are due June 15th 1.3.7. Contractor shall maintain supporting documentation demonstrating case managers attended the required trainings and make the information available to the Department upon request. Supporting documentation must include the name and description ofthe training, the date the training was held, case managers in attendance, and trainer sign-off showing the case manager completed the training. 1.3.8. There will be no exemptions to the above list of required trainings as all case managers shall have a basic knowledge ofa all case management activities regardless of ongoing duties. 1.3.9. Contractor shall participate in Department and vendor trainings, which will be tracked by the Department. Participation can be at the time of the presented training or, if applicable, following the training using the materials available from the Department's website or LMS. 1.3.10. For Case Managers who have a documented minimum of one-year immediate prior work experience at a different Colorado CMA, Contractor may assign independent case management activities once Contractor has verified that the Case Manager's training requirements were previously met. 1.3.11. Contractor may elect to perform additional training not outlined in the Contract, but applicable to the Scope of Work, which may include mental health first aid, crisis intervention, and trauma informed care. Contractor may utilize the Department's Case Management Training Template to identify trainings attended that are not required by the Department. 1.3.12. Case Management staff are required to retake training to address and remediate performance concerns as directed by the Department. 1.3.13. Contractor shall provide the date all case management staff, including new and existing staff, were hired and the dates ofreceived training in the areas identified in Section 1.2.3, using the reporting template provided by the Department for review, approval, and payment. 1.3.14. Case Managers shall receive oversight reviews of their performance including their competency with completing the Level of Care Screen. Contractor shall shadow case management staff completing the Level of Care Screen on an annual basis and prior to the end of each Contract Fiscal year to establish case manager's competency administering the Level of Care Screen. Documentation on case manager performance will be maintained by Contractor and provided to thel Department upon request. Supervisors, lead workers, or a case manager with at least three years of case management experience may perform the shadowing. 1.4. Complaints Exhibit B-5, Statement ofWork Page 8 of49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.4.1. Contractor shall develop and maintain a formal complaints procedure, notify Members annually ofthe procedures, and make the procedure publicly available to include posting the procedure to Contractor's website. Procedures must include requirements for member notification in accordance with 10 CCR 2505-10 8.7201.D. 1.4.2. Contractor shall receive, document, and track any complaint received by Contractor as it relates to the services provided through this Contract to include, but not limited to, general business functions, administration, State General Funded Programs, and case management functions outlined in this Contract. Complaints received outside ofthe scope of this Contract shall not be included. Documentation shall consist of a complaint log that includes the date of complaint, name of the complainant, the nature of the complaint and the date and description ofthe resolution. 1.4.3. Contractor shall submit all complaints to the Community Advisory Committee for review, feedback, and input on resolving complaints. 1.4.4. Contractor shall analyze complaints for trends quarterly and shall submit all complaint- oriented trends observed since the Effective Date of this Contract and the remedial actions taken to address them to the Department. 1.4.5. Trend analysis shall include an examination ofinformation including, but not limited to: 1.4.5.1. A comparison of complaint types and number of complaints over a period oftime. 1.4.5.2. Number oftype ofcomplaint against Contractor, time, location, individual involved, staff involved, and/or any additional relevant information. 1.4.5.3. An examination of potential reasons for the increase or decrease in complaints by total number, subcontractor, individual, or staff. 1.4.5.4. An examination of preventative measures that can be mplemented to reduce the number or frequency of future complaints. 1.4.5.5. Implementation of a plan of action or any future actions to take place. 1.4.5.6. An analysis ofwhether thej plan ofa action and changes made were effective or if additional changes need to occur. 1.4.5.7. As part oft the complaint process Contractor shall include, but is not limited to, all of the following: 1.4.5.7.1. Document complaints received. 1.4.5.7.2. Address substantiated complaints. 1.4.5.7.3. Respond to complaints received and document actions taken to resolve and/or mitigate complaints. 1.4.5.7.4. Conduct a quarterly trend analysis ofall complaints received for the full period ofthe Contract. 1.4.5.8. Contractor shall maintain all supporting documentation related to the collection and follow-up to complaints and make it available to the Department upon request. 1.4.5.9. If Contractor received no complaints during the quarter, Contractor may submit the Complaint Trends Analysis to the Department identifying no complaints were reported during the quarter. Exhibit B-5, Statement ofWork Page 9 of49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9FS0DF 1.4.5.10. IfContractor received less than five complaints during the quarter and cannot establish a complaint trend, Contractor may submit the Complaint Trends Analysis to the Department with the complaint log that includes the date of complaint, name of the complainant, the nature oft the complaint and the date and description ofthe resolution. 1.4.5.11. Contractor shall submit the Complaint Trends Analysis to the Department for review and approval. 1.4.5.11.1. DELIVERABLE: Complaint Trend Analysis 1.4.5.11.2. DUE: Quarterly, by October 15th, January 15th, > April 15th and June 15th of each year. 1.5. Continuous Quality Improvement Plan 1.5.1. Contractor shall create and implement a Continuous Quality Improvement Plan for the contract period. The Continuous Quality Improvement Plan shall include, but not be limited to a description oft the following: 1.5.1.1. How Contractor oversees the work performed by Case Managers as outlined in the contract to ensure all tasks are being performed according to the requirements. 1.5.1.2. How Contractor reviews work to determine whether the work is being completed in a correct and high-quality manner. 1.5.1.3. How Contractor identifies and addresses Case Management performance issues. 1.5.1.4. How Contractor notifies the Department ofi identified performance issues. 1.5.1.5. How Contractor will address at a minimum the following areas: operations, quality controls, staffing, training, and community engagement. Required tasks will be outlined in Department template that will be provided to Contractor yearly. 1.5.1.6. Contractor shall participate in the Department hosted Quality Community of Practice. 1.5.2. Contractor shall submit the Continuous Quality Improvement Plan to the Department for review, approval, and payment. The Department will establish ai regularly scheduled cadence with Contractor to review and discuss the CQI Plan, data, and agency specific quality dashboard. Contractor shall review the plan and metrics with the Department annually. 1.5.2.1. DELIVERABLE: Continuous Quality Improvement Plan 1.5.2.2. DUE: Within 90 Business Days after the Effective Date 1.5.3. Contractor shall review its Continuous Quality Improvement Plan on an annual basis and update the plan as appropriate to account for any changes. Contractor shall submit the Continuous Quality Improvement Plan Update or document that the plan was reviewed, and changes were not required. 1.5.3.1. DELIVERABLE: Continuous Quality Improvement Plan Update 1.5.3.2. DUE: Annually, by October Ist 1.6. Appeals 1.6.1. Contractor shall represent the Department and defend any adverse action in accordance with 10 CCR 2505-10 8.7202.R et seq., and 10 CCR 2505-10 Section 8.057 et. seq. in all HCBS, CFC, PACE, Hospital Back-Up Facilities, and Nursing Facility appeals initiated during this Contract. This section does not apply to State General Fund Programs. Contractor shall Exhibit B-5, Statement of Work Page 10 of 49 Docusign Envelope ID: ABEFOTFSDBSE4549AAOFFA2ASA9FSODF coordinate with the Department for any adverse actions necessitating Department attendance at a hearing. 1.6.1.1. Contractor shall identify and disclose to the Department immediately, and no later than 45 Calendar Days prior to a scheduled appeal hearing, any conflict of interest that would interfere with Contractor's ability to represent the Department in any appeal. 1.6.2. Contractor shall represent its actions at Administrative Law Judge hearings when the individual or Member appeals a denial or adverse action affecting individual's or Member's program eligibility or receipt of services. 1.6.3. Contractor shall process appeals in accordance with schedules published by the State of Colorado Office of Administrative Courts and rules promulgated by the Department. 1.6.4. Contractor shall develop an Appeals Packet which contains all relevant documentation to support Contractor's denial or adverse action. 1.6.5. Contractor shall develop an Appeals Packet no later than 20 Business Days prior to the date ofa scheduled hearing. 1.6.6. Contractor shall submit exceptions when applicable and include all relevant information. 1.6.7. Contractor shall cooperate with the Office ofthe State Attorney General for any case in which it is involved. 1.6.8. Contractor shall document all appeals where Contractor attends any hearing in an Administrative Law Court. 1.6.9. Contractor shall make the Appeal Packets available to the Department upon request. 1.6.10. Contractor shall enter all Appeal Packets Created Dates and Court Decision Dates into the CCM system within 10 Business Days of packets being created and court hearings attended. 1.6.10.1. Contractor shall receive reimbursement for all Appeals based on data entry into the CCM. 1.7. Critical Incidents 1.7.1. Critical Incident Reporting 1.7.1.1. Contractor shall be responsible for entering Critical Incident Reports (CIR) in the CCM as soon as possible, but no later than 24 hours (one Business Day) following notification. 1.7.1.2. Contractor shall ensure all suspected incidents of abuse, neglect, and exploitation are immediately reported consistent with current statute; Section 19-3-301 through 19-3-318 C.R.S. Colorado Children's Code, Section 18-8-115 C.R.S. (Colorado Criminal Code - Duty to Report a Crime), 18-6.5-108 C.R.S. (Colorado Criminal Code-Wrongs to At-Risk Adults), and Section 26-3.1-102, C.R.S. (Social Services Code-Protective Services). 1.7.1.3. Contractor shall document all CIR follow-up information in accordance with Department direction in the CCM and maintain detailed documentation. 1.7.2. Critical Incident Follow-Up Completion and Entry 1.7.2.1. Contractor shall ensure all CIRs follow-up is completed and entered into the CCM within the timelines established by the Department and/or the Department's Quality Improvement Organization. Exhibit B-5, Statement ofWork Page 11 of49 Docusign Envelope ID: ABEFOTF6DBSE4549AAOFFA2AA9FSQDF 1.7.2.2. Timelines for follow-up are determined by the Department and depend on the type and severity ofthe CIR. The following are general timelines assigned to remediation and CIR follow up: 1.7.2.2.1. High Priority Follow Up- CIRs which require immediate attention and must be addressed to ensure the immediate health and safety of a waiver or CFC participant must be remediated within and responded to in the CCM within 24-48 hours. 1.7.2.2.2. Medium Priority Follow Up = CIRs which require additional information or follow up to ensure appropriate actions are taken and there is no immediate risk to the health and safety of the waiver or CFC participant must be completed in the CCM within three to four Business Days. 1.7.2.2.3. Low Priority Follow Up- CIRs that have been remediated by CMAs, have addressed immediate and long-term needs, have implemented services or supports to ensure health and safety, and those that have protocols in place to prevent a recurrence of a similar CIR but may require an edit to the CIR or additional information entered into the CCM. The follow-up for CIRs in this category must be completed and entered within five Business Days. 1.7.2.3. PERFORMANCE STANDARD: 90% of all CIRs assigned follow-up are completed and entered into the CCM within the timelines established by the Department and/or the Department's Quality Improvement Organization each quarter. 1.8. Critical Incident Report Administrative Review 1.8.1. Contractor shall conduct a Critical Incident Report Administrative Review upon direction from the Department. 1.8.2. Critical Incident Report administrative reviews shall be initiated by the Department and will require the Contractor to upload documentation to the CCM as assigned. Contractor may be required to document that the reported incident of alleged Mistreatment, Abuse, Neglect, or Exploitation (MANE) was reported to law enforcement, per mandated reporting laws, and to adult/child protection services to be screened for additional investigation by the Colorado Department of Human Services as appropriate. The Department may also request that the Contractor file a report with the Colorado Department of Public Health and Environment as necessary. Critical Incident Report administrative review may also require documentation of whether additional services might be needed as a result of the incident or gathering of additional documentation at the request of the Department. 1.8.3. Contractor shall be reimbursed for all critical incident reports through a Per Member Per Month (PMPM) payment for all Members enrolled in an HCBS waiver or CFC. Reimbursement will be based on all Members that are active in the CCM with the Contractor and have an approved PAR in the Bridge. 1.9. Human Rights Committee (HRC) 1.9.1. Contractor shall establish an HRC. The HRC is composed, to the extent possible, of two professional persons trained in the application ofbehavior development techniques and three representatives comprised of one or more of the following: persons receiving Long-Term Care services, parents, Guardians, or Legally Authorized Representatives of persons receiving or whom have received Long-Term Care services, or persons with lived experience having long-term care needs, or persons caring for a loved one with long-term care needs. An Exhibit B-5, Statement ofWork Page 12 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOPF-FA243A9F50DF employee or board member of a Provider Agency within the Contractor' S designated service area shall not serve as a member of the HRC. 1.9.2. Contractor shall establish and facilitate a Human Rights Committee (HRC) pursuant to 10 C.C.R. 2505-10 Section 8.7202.Q et seq. Contractor shall maintain qualifications for each member ofthe HRC and make it available to the Department upon request. 1.9.3. Contractor shall submit a list of HRC members and documentation of qualifications of all new members annually. 1.9.3.1. DELIVERABLE: HRC Member List 1.9.3.2. DUE: Annually, by August 15th 1.9.4. Contractor shall notify the Department of any changes to the HRC members within 10 Business Days of the date of change. 1.9.4.1. DELIVERABLE: HRC Member Updates 1.9.4.2. DUE: Within 10 Business Days of the date of change to the HRC members 1.9.5. Contractor shall establish at least one HRC as a third-party mechanism to safeguard the rights of persons enrolled in HCBS-CES, HCBS-CHRP, HCBS-SLS, HCBS-DD, State SLS, OBRA-SS, and FSSP. The HRC is an advisory and review body to the administration of Contractor. 1.9.6. Contractor shall develop policies and procedures which include, but are not limited to, HRC responsibilities for the committee's organization, use of Department required universal documents, the review process, mitigation of potential conflicts of interest, and provisions for recording dissenting opinions of committee members in the committee's recommendations. 1.9.7. Contractor shall orient members regarding the duties and responsibilities of the Human Rights Committee and make this information available to the Department upon request. 1.9.8. Contractor shall provide the HRC with the necessary staff support to facilitate its functions. 1.9.9. Contractor shall keep proper documentation and record of all HRC recommendations and ensure that all documentation is a part of the members record in the CCM. 1.9.10. Contractor shall maintain HRC meeting minutes, attendance logs, and supporting documentation related to an HRC meeting and make it available to the Department within 10 Business Days upon request. 1.9.11. Contractor shall notify the Department in writing of any changes to the HRC membership within 10 Business Days. 1.9.12. Contractor shall document all reviews within the CCM within 10 Business Days oft the date of the HRCreview. 1.9.13. Contractor shall be reimbursed for all HRC activities through a PMPM payment for all Members enrolled in HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS. Reimbursement will be based on Members that are active in the CCM with the Contractor and have an approved PAR in the Bridge. 1.9.14. Contractor shall invoice the Department for all State SLS, OBRA-SS, and FSSP Members reviewed by the Human Rights Committee using the template created by the Department. Exhibit B-5, Statement ofWork Page 13 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.9.14.1. DELIVERABLE: Human Rights Committee Invoice for State SLS, OBRA-SS, FSSP 1.9.14.2. DUE: Monthly, by the 15th 2. PRE-ENROLLMENT ACTIVITIES 2.1. LTSS LOC Referral, Intake, and Screening 2.1.1. Contractor shall perform all long-term services and supports Level of Care referral, intake, and screening functionslactivities for enrollment into the following waivers and programs: 2.1.1.1. Community First Choice (CFC) 2.1.1.2. Family Support Services Program (FSSP) 2.1.1.3. HCBS - Children with Complex Health Needs (HCBS-CWCHN) 2.1.1.4. Consumer-Directed Attendant Support Services (CDASS) 2.1.1.5. HCBS - Children' S Extensive Supports Waiver (HCBS-CES) 2.1.1.6. HCBS - Children' S Habilitation Residential Program Waiver (HCBS-CHRP) 2.1.1.7. HCBS - Children's Home and Community Based Services Waiver (CHCBS) 2.1.1.8. HCBS - Community Mental Health Supports Waiver (HCBS-CMHS) 2.1.1.9. HCBS - Complimentary and Integrative health (HCBS-CIH) 2.1.1.10. HCBS - Developmental Disabilities Waiver (HCBS-DD) 2.1.1.11. HCBS - Elderly, Blind, and Disabled Waiver (HCBS-EBD) 2.1.1.12. HCBS - Brain Injury Waiver (HCBS-BI) 2.1.1.13. HCBS -Supported Living Services Waiver (HCBS-SLS) 2.1.1.14. Hospital Back-Up Program (HBU) 2.1.1.15. In Home Supports and Services (IHSS) 2.1.1.16. Intermediate Care Facilities for Individuals with Intellectual and Developmental Disabilities (ICF/IID) 2.1.1.17. Nursing Facilities (NF) 2.1.1.18. Omnibus Reconciliation Act of 1987 Specialized Services Program (OBRA-SS) 2.1.1.19. Program for All-Inclusive Care for the Elderly (PACE) 2.1.1.20. State Supported Living Services Program (State SLS) 2.2. Contractor shall perform all Long Term Supports and Services Level of Care (LTSS LOC) referral, intake, and screening functions/activities in accordance with $25.5-6-104, C.R.S. and 10 CCR 2505-10, Sections 8.7202.B., 8.7202.E, and 8.401 et seq., shall include, but not limited to, the following: 2.2.1.1. Timelines shall be applied based on the location ofthe applicant at the time the Contractor receives the referral for a LOC Screen: 2.2.1.1.1. Hospital, Two Business Days, 2.2.1.1.2. Skilled Nursing Facility, Five Business Days, or 2.2.1.1.3. Community, 10 Business Days Exhibit B-5, Statement of Work Page 14 of49 Docusign Envelope ID: ABEFO7FEDBSE4549AAFFA2A3A9FSODF 2.2.1.2. CMAS shall not require an LTSS LOC Referral Form to intake a referral requesting a LOC Screen. 2.2.1.3. Conduct and document the Colorado Intake Screen Tool (CIST), LOC Screen, and Rapid Reintegration within required timelines set forth by the Department. 2.2.1.3.1.1. Conduct and document the CIST in the CCM within two Business Days referral requesting a LOC Screen for LTSS services, except for applicants entering the Hospital Buck-Up program. 2.2.1.3.2. Timeline to conduct and document the CIST does not extend the LOC Assessment timelines set forth by the Department. 2.2.1.3.3. Ensure documentation includes the individual's need forl LTSS and/or the individual's request for a LOC Screen even if the CIST indicates the individual may not be functionally eligible for LTSS. 2.2.1.3.3.1. Referral form/documentation requesting a LOC Screen is uploaded in the CCM. 2.2.1.3.4. Document all efforts to contact an applicant to conduct the CIST, LOC Screen, and any referrals made to non-LTSS services in the CCM. 2.2.1.4. Have a written policy and procedure for expediting the LTSS LOC referral or another referral for LOC Screen in the event that an applicant is in an emergency situation. 2.2.1.5. Conduct and document a LOC Screen without delay if an applicant has requested al Delay Determination or Developmental Disability Determination required for HCBS-DD, HCBS-SLS, HCBS-CES, and HCBS-CHRP waivers. 2.2.1.5.1. Individuals may opt to delay the LOC Screen while seeking a Delay Determination or Developmental Disability Determination. In such cases, the Contractor shall document this in the individual's record within the Care and Case Management (CCM) system. 2.2.1.5.2. Upon receiving a LTSS LOC referral, CMAS shall attempt to verify whether a LTC Medicaid Application has been submitted, but shall not delay or postpone a LOC Screen if the interview conducted to complete the CIST or subsequent contacts indicate that an applicant had not yet submitted a LTC Medicaid Application by the time the assessment is scheduled. 2.2.1.5.3. The CMA shall refer the applicant to the appropriate resources needed to submit their LTC Medicaid Application, if submission has not been completed throughout the intake referral process and subsequent to completing the assessment. 2.2.1.5.4. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid application verification. 2.2.1.6. Individuals shall be notified at the time of the decision of their application for publicly funded LTSS that they have the right to appeal the actions of Contractor according to 10 CCR 2505-10 section 8.057 and 8.7202.R et seq. The notification shall include the right to request a fair hearing before an Administrative Law Judge. 2.2.1.6.1. PERFORMANCE STANDARD: 100% of LTSS LOC Referrals and all intake referrals submitted to the Contractor are entered or uploaded into the CCM within two Business Days ofthe LTSS LOC Referral or intake referral receipt date. 2.3. Intellectual and/or Developmental Disability and Developmental Delay Determinations Exhibit B-5, Statement ofWork Page 15 of 49 Docusign Envelope ID: ABEFOF6DBSE4549AAPFA2ASA9FSODF 2.3.1. Contractor shall determine whether an applicant meets the definition ofan Individual with an Intellectual and/or Developmental Disability and Developmental Delay as defined under 10 CCR 2505-10, section 8. 7100.A, in accordance with 10 C.C.R. 2505-10 section 8.607.2 et seq. 2.3.2. Contractor may expedite psychological or adaptive behavior testing for Intellectual and/or Developmental Disability and Developmental Delay Determinations when there are delays due to issues identifying a provider or scheduling testing with a provider in order complete the PASRR Level II assessments for individuals residing in skilled nursing facilities. Requests fori testing funding must be submitted on the template prescribed by the Department. 2.3.3. Contractor may request funding for testing necessary to complete Intellectual and/or Developmental Disability and Developmental Delay Determination to move forward with intake and referral activities. This includes cases where an applicant cannot access testing due to financial burden and other funding is not available ifthey have submitted a long-term care. Medicaid application and the financial eligibility has not been determined. Requests for funding must be submitted to the Department for approval prior to funding being approved. 2.3.3.1. DELIVERABLE: Prior Approval for Testing Funding and Invoice 2.3.3.2. DUE: Monthly, by the 15th 2.3.3.3. Contractor shall maintain all supporting documentation related to the testing for DD Determination and make it available to the Department upon request. 2.3.4. Contractor shall complete the individual's determination record and assessment record in the CCM with all applicable dates and information within 10 Business Days after a determination is complete. 2.3.4.1. Contractor shall receive reimbursement for all determinations based on data entry into the CCM. 2.3.5. Contractor shall maintain the individual's determination, documents, and upload them to the CCM. 2.3.6. Contractor shall ensure that all determinations are complete, in accordance with Department regulations, and the individual has been determined to have a disability or delay prior to enrollment into HCBS-DD, HCBS-SLS, HCBS-CHRP (unless eligible through Serious Emotional Disturbance criteria), HCBS-CES, State SLS, FSSP, and OBRA-SS. 2.3.7. Individuals shall be notified at the time of1 the decision oft the determination that they have the right to appeal actions of Contractor to 10 CCR 2505-10 sections 8.057 et seq., 8.7202.R et seq. The notification shall include the right to request a fair hearing before an Administrative Law Judge. 2.4. Waiting List Management 2.4.1. Contractor shall maintain a program specific waiting list within the CCM for all eligible individuals for whom funding is not available. Waiting lists may be applicable for HCBS- DD, State SLS, OBRA-SS and FSSP dependent on available funding. Contractor shall not maintain a waiting list for any oft the other programs included within this Contract. 2.4.2. Contractor shall determine HCBS-DD waiting list eligibility by conducting an assessment that clearly defines detailed and Member-specific information that specifies how the individual meets the HCBS-DD waiver requirement for needing access to services and Exhibit B-5, Statement ofWork Page 16 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF supports twenty-four (24) hours a day pursuant to 10 CCR 2505-10 8.7202.G et seq. and 8.7101.J et seq. 2.4.2.1. Contractor's description of daily living needs of an individual who requires access to twenty-four (24) hour a day services and support in the LOC waiting list assessment should indicate services and support needs that are only available in the HCBS-DD waiver to determine why access to services and supports twenty-four hours a day are necessary for the individual. 2.4.3. The name ofaj person eligible for the program shall be placed on the waiting list by Contractor making the eligibility determination. 2.4.4. When an eligible person is placed on the waiting list for Waiver services, a written notice of action including information regarding individual rights and appeals shall be sent to the person or the person's legal guardian in accordance with the provisions of 10 C.C.R. 2505- 10 8.7202.J et seq. 2.4.5. When funding has been made available for an individual Contractor will remove the person from the "As Soon as Available" (ASAA) waiting list within 10 Business Days. 2.4.6. The placement date used to establish a person's order on an HCBS waiver waiting list shall be: 2.4.6.1. The date on which the person was initially determined to have a developmental disability by Contractor; or 2.4.6.2. The 14th birth date if a child is determined to have a developmental disability by Contractor prior to the age of14. 2.4.7. When an individual is eligible for a program and funding is not available, Contractor shall: 2.4.7.1. Verify demographic information. 2.4.7.2. Compile and correct data. 2.4.8. Contractor shall complete data entry ofWaiting List record into the CCM within 10 Business Days of any addition or change to the Waiting List. 2.4.9. Contractor shall conduct and document, in the CCM, an annual follow-up with individuals 18 and older for all HCBS waivers with a Waiting List timeline of ASAA, Safety Net (SN), or "see date" to update changes in demographic information and ensure the individual is appropriately identified on waiting lists for the program and services the individual is eligible to receive. 2.4.10. Contractor shall enter annual follow-up within the CCM within 10 Business Days of the contact. 2.4.10.1. Contractor shall receive reimbursement for annual waiting list contacts based on data entry into the CCM. 2.4.10.2. PERFORMANCE STANDARD: 100% of HCBS individuals 18 and older with an ASAA, SN, or "see date" timeline on the Waiting List are contacted annually and documented within the CCM within 10 Business Days. 2.5. Program Enrollment from the Waiting List 2.5.1. HCBS-DD Enrollment from the Waiting List Exhibit B-5, Statement ofWork Page 17 of49 Docusign Envelope ID: ABEFOTF6DBSE4549AAOFFA2ASA9FSODF 2.5.1.1. When an enrollment becomes available from the. HCBS-DD Waiting List, the Department will notify Contractor ofthe individual who will be offered an enrollment by the order of selection date. 2.5.1.2. Contractor shall notify the individual ofthe enrollment offer within five Business Days. Contractor shall make three attempts to contact the individual within a 30-calendar day period. Contractor shall document in the CCM all attempts to contact the individual for the enrollment offer. If the individual does not respond to the offer of enrollment, Contractor shall change the individuals waiting list timeline to "Safety Net". 2.5.1.3. Individuals shall be notified at the time of the enrollment offer that they have the right to appeal the actions of Contractor to 10 CCR 2505-10 sections 8.7202.R et seq. and 8.057 et seq. The notification shall include the right to request a fair hearing before an Administrative Law Judge. 2.5.2. HCBS-DD Waiting List Enrollment Capacity Building 2.5.2.1. As appropriated and earmarked by the General Assembly, Contractor may receive capacity building funding to support the enrollment of individuals into the HCBS-DD waiver from the waiting list. 2.5.2.2. Contractor shall receive written notification of any capacity building funding for individuals enrolling into the HCBS-DD waiver from the waiting list. 2.5.2.3. If funding is allocated, Contractor shall report how the capacity building funding was used to support the enrollment of the authorized Member(s) into the HCBS-DD waiver on a template developed by the Department. Funding must be used to support Member enrollment in the following categories: 2.5.2.3.1. Staffing costs 2.5.2.3.1.1. Recruiting and hiring 2.5.2.3.1.2. Professional development 2.5.2.3.1.3. Equipment and supplies 2.5.2.3.1.4. Information technology 2.5.2.3.2. Program costs 2.5.2.3.2.1. Advertising 2.5.2.3.2.2. Equipment and supplies 2.5.2.4. DELIVERABLE: Capacity Building Funding Expenses 2.5.2.5. DUE: Quarterly, if funding is allocated, by October 31st, January 31st, April 30th, and June 15th or the Fiscal Year end close date determined by the Department 2.5.3. FSSP Enrollment from the Waiting List 2.5.3.1. In cooperation with the local Family Support Council, Contractor shall develop procedures for determining how and which individuals on the Waiting List will be enrolled into FSSP. These procedures must comply with Department regulations on waiting list and prioritization of funding. 2.5.3.2. Contractor shall select individuals from the waiting list to enroll into FSSP in accordance with 10 CCR 2505-10 8.756let seq. Exhibit B-5, Statement ofWork Page 18 of 49 Docusign Envelope ID: ABEFOTFSDBSE4549AAOFFA2ASA9FSODF 2.5.4. State SLS Enrollment from the Waiting List 2.5.4.1. Contractor shall develop procedures for determining how and which individuals on the waiting list will be enrolled into the State SLS program in accordance with 10 C.C.R. 2505-10 Section 8.7560. These procedures shall be made available to the Department upon request and used to select individuals from the waiting list to enroll into State SLS. 2.5.5. OBRA-SS Enrollment from the Waiting List 2.5.5.1. Contractor shall determine when funding is not available within Contractor's existing State General Fund program allocation and notify the Department that additional funding is being requested to enroll the individual into OBRA-SS within 10 Business Days of funding needs being identified. 2.5.5.2. Contractor shall place the individual on the waiting list until funding becomes available or Contractor may partially fund services when limited funding is available within existing allocations. 2.5.5.3. Contractor shall develop procedures for determining how and when individuals will be placed on the waiting list and make the procedures available to the Department upon request. 2.5.6. Waiting List Records Maintenance 2.5.6.1. Contractor shall remove individuals from the Waiting List after an enrollment is authorized to the individual and the individual or guardian accepts or refuses the authorization for enrollment within 10 Business Days after the individual or guardian's response or the last communication attempt. 2.5.6.2. If an individual or guardian declines an enrollment, Contractor shall enter the reason for declining an enrollment into the CCM Waiting List record within 10 Business Days of the enrollment being declined. 2.5.6.3. Contractor shall provide information and referrals to individuals, families and/or guardians at the time ofthe annual follow-up. 2.5.6.4. Contractor shall continue to refer individuals on the Waiting List to other community resources that may be available and inform individuals of their choice of providers, waivers, CFC, and services. 2.5.6.5. Contractor shall provide assistance completing Medicaid financial applications or other public assistance program applications at the time assistance is requested by the individual, family, or guardian. 2.5.6.6. Individuals shall be notified at the time ofthe enrollment authorization that they have the right to appeal actions of Contractor as described in 10 CCR 2505-10 section 8.057 et seq., 8.7202.R et seq. The notification shall include the right to request a fair hearing before an Administrative Law Judge. 2.6. Compilation and Correction of Waiting List Data 2.6.1. Contractor shall correct 100% of Waiting List data errors discovered by the Department within 10 Business Days of notification from the Department of an error. 2.6.1.1. PERFORMANCE STANDARD: 100% of Waiting List data corrected within 10 Business Days of notification. Exhibit B-5, Statement ofWork Page 19 of 49 Docusign Envelope ID: ABEFOF6DBSE4549AAPAAOFFA2A3A9FSODF 2.7. Authorization and Reporting of] HCBS-DD Enrollments 2.7.1. Contractor shall obtain prior authorization from the Department for all enrollments into the HCBS-DD waiver. 2.7.2. In accordance with 10 CCR 2505 Section 8.7101.J, Contractor shall inform the Department of all vacancies in the HCBS-DD waiver. Vacancies shall be submitted to the Department monthly on the date and template prescribed by the Department. 2.7.3. Individuals shall be notified at the time of the enrollment authorization that they have the right to appeal the actions of Contractor to 10 CCR 2505-10 section 8.7202.R and 8.057 et seq. The notification shall include the right to request a fair hearing before an Administrative Law Judge. 2.7.3.1. DELIVERABLE: HCBS-DD Vacancy Reporting 2.7.3.2. DUE: Monthly, by the 15th on the template prescribed by the Department 2.7.4. Contractor shall report all enrollment dates or changes to enrollment status for the HCBS- DD waiver to the Department monthly on the date and template prescribed by the Department. 2.7.4.1. DELIVERABLE: HCBS-DD Enrollment Date and Enrollment Change Reporting 2.7.4.2. DUE: Monthly, by the 15th on the template prescribed by the Department 3. ASSESSMENT AND ANNUAL REASSESSMENT 3.1. Contractor shall perform the Level of Care (LOC) Screen (ULTC 100.2) for each individual as directed by the Department and in accordance with regulations. 3.2. Contractor shall provide staff that meet the case manager qualifications set forth in state statutes and regulations to perform all LOC Screens. 3.3. Contractor shall utilize and conduct the Department prescribed tools for the Initial LOC Screen for all new applicants to HCBS, CFC, PACE, Nursing Facilities, Hospital Back-Up, and ICF- IDD. 3.4. Initial LOC Screens include the following Assessment Event types: Initial, HCBS-DD Waitlist, Deinstitutionalization (DI), and Reverse Deinstitutionalrzation. LOC Screen Reassessments include the following Assessment Event type: Continued Stay Review.. LOC Screen Unscheduled Reviews include the following Assessment Event type: Onscheduled Review. 3.4.1. An Unscheduled Review Event Type shall be utilized when a LOC Screen is completed due to a significant change in the Member functioning and support needs including documented medical conditions, post hospitalization, or significant change in activities of daily living. 3.5. Contractor shall perform all Initial and Annual Reassessment Level of Care Screens for the operation of a CMA in accordance with $25.5-6-104, C.R.S., 10 CCR 2505-10, Section 8.401, and 10 CCR 2505-10, Sections 8.7202.E et seq. and 8.7202.F et seq. 3.6. The Initial LOC Screen shall include and ensure, but not limited to, the following: 3.6.1. Contractor shall attempt to verify that a LTC Medicaid Application has been submitted after receiving a LTSS LOC: referral but should not delay a LOC Screen ifthe interview conducted to complete the intake indicates that an applicant has not submitted a LTC Medicaid Application. Exhibit B-5, Statement of Work Page 20 of 49 Docusign Envelope ID: ABEFO7F6DBE4549AAOFFA2A3A9FSQDF 3.6.1.1. Hospital and Skilled Nursing Facility referrals do not require LTC Medicaid application verification. 3.6.2. Contractor shall consider an Initial LOC Screen to be complete when the following has been done: an in-person assessment is completed, the PMIP has been obtained and verified to be accurate by the Case Manager to certify LOC, the attestation form, if applicable, has been obtained and verified to be accurate by the Case Manager to determine target criteria, and the assessment has been entered in the CCM. 3.7. The Annual LOC Screen Reassessment shall include and ensure, but not limited to, the following: 3.7.1. A review of financial eligibility information. 3.7.1.1. Contractor shall take action regarding Member Medicaid eligibility within one Business Day of receipt from the eligibility site. 3.7.1.2. Contractor shall notify all providers of the discontinuation of services no later than 11 Calendar Days prior to the certification end date that services shall not be authorized past the certification end date. 3.7.1.2.1. In the event Contractor fails to discontinue HCBS waiver and/or CFC services for a Member found ineligible for a HCBS and/or CFC, Contractor shall be responsible for reimbursing any providers for services rendered. 3.7.1.3. A review ofthe LOC Screen information. 3.7.1.4. A review of all supportive information related to the LOC for the Member to include, but not limited to, documentation and interviews. 3.7.1.5. A review of relevant medical, educational, social, or other assessment records or information when applicable. 3.7.1.6. A review of all community living information and options as an alternative to nursing faciliyinstiutionalized care. 3.8. The Initial LOC Screen and Annual LOC Screen Reassessment shall include and ensure, but not limited to, the following: 3.8.1. Contractor shall ensure all LOC Screens are conducted in person with the individual, at minimum, and in the place where the individual or Member resides. 3.8.2. A review ofHCBS waiver Target Criteria for individual participation. 3.8.3. Determine individual Level of Care Eligibility for enrollment in HCBS, CFC, PACE, HBU, Nursing Facility admission, or ICF-IDD admission. Analyzing the information obtained to determine the most appropriate responses to the LOC Screen questions. 3.8.3.1. Contractor shall verify that a Member meets institutional Level of Care by receiving a PMIP signed by a treating licensed medical professional and dated no earlier than six months from the certification start date and no later than 90 Calendar Days from the evaluation date of an Initial Level of Care Screen; and within 90 Calendar Days of the certification start date and before the certification end date for a Reassessment for all individuals and Members currently receiving services through Hospital Back-Up Unit (HBU), Nursing Facility (NF), Intermediate Care Facility forl Individuals with Intellectual and Developmental Disabilities (ICF-IDD), and Program for All-Inclusive Care for the Elderly (PACE). Exhibit B-5, Statement ofWork Page 21 of4 49 Docusign Envelope ID: ABEFOTFEDBSE4549AAOFFA2A3A9FSQDF 3.8.3.1.1. PERFORMANCE STANDARD: Contractor shall ensure a Professional Medical Information Page (PMIP) is signed within 90 Calendar Days of the certification start date and before the certification end date for a LOC Screen Reassessment for all applicants and individuals currently receiving services through the Hospital Back-Up Unit (HBU), Nursing Facility (NF), Intermediate Care Facility for Individuals with Intellectual and Developmental Disabilities (ICF-IDD), and Program for All- Inclusive Care for the Elderly (PACE). 3.8.4. Communicating Level of Care Eligibility status to the appropriate eligibility site. 3.8.5. A LOC Certification notice shall be provided to referring agencies such as PACE organizations, Nursing Facilities, or Hospitals upon obtaining written consent provided by the individual that meets HIPAA standards. 3.8.6. Providing Notice of Action to applicants and Members of all appealable actions related to their eligibility in a LTSS program. 3.8.6.1. Members shall be notified at the time ofthe denial ofineligibility decision that they have the right to appeal the actions ofContractor to 10 CCR 2505-10 Section 8.057 et seq. and 8.7202.R The notification shall include the right to request a fair hearing before an Administrative Law Judge. 3.8.6.2. Representing the Department in all appeals relevant to a LTSS program eligibility. 3.8.7. Documenting and maintaining LOC Screens, including all relevant information, utilizing the CCM within the timeframes established in 10 CCR 2505-10, Sections 8.7202.E and 8.7202.F et seq. 3.9. Failure by Contractor to complete the. Annual LOC Reassessment shall cause a break in payment authorization for waiver and/or CFC services for the individual or Member. 3.9.1. Contractor shall ensure that this break in payment authorization shall not affect the continued delivery of waiver and/or CFC services to the individual or Member. Service costs incurred during a break in payment authorization are non-allowable costs. 3.9.2. Contractor shall bear the sole financial responsibility for all costs incurred during this break in payment authorization and shall be responsible for reimbursing any providers for services rendered during the gap in eligibility. 3.9.3. Contractor shall schedule an in-person Initial LOC Screen in accordance with 10 CCR 2505- 10 Section 8.7202.E and shall adhere to the following processes and timelines based on type: 3.9.3.1. Hospital to HCBS or CFC 3.9.3.1.1. Contractor conducts and documents the LOC Screen and generates the electronic LOC Eligibility Determination in the Care and Case Management (CCM) system within two Business Days of receiving a referral. 3.9.3.1.2. LOC Eligibility Determination start date for Assisted Care Facility may be the date of referral on the LTSS LOC referral form received by the Contractor. 3.9.3.1.3. Referral to LOC Eligibility Determination not to exceed two Business Days. 3.9.3.2. Hospital to Skilled Nursing Facility Exhibit B-5, Statement of Work Page 22 of4 49 Docusign Envelope ID: ABEFOF6DBSE4549AAOFFA2AA9FSODF 3.9.3.2.1. Contractor conducts and documents the LOC Screen and PASRR Level I Screen and generates the electronic LOC Eligibility Determination in the CCM within two Business Days of receiving a referral. 3.9.3.2.2. Contractor completes and documents the Nursing Facility Length of Stay form to indicate the length of stay necessary to meet the applicant' S needs. 3.9.3.2.3. LOC Eligibility Determination start date may be the date the LTSS LOC Referral Form is received by the Contractor. 3.9.3.2.4. Referral to LOC Eligibility Determination not to exceed two Business Days. 3.9.3.2.5. Hospital timelines apply to any applicant in al hospital wanting to enroll in PACE and HBU. 3.9.3.3. Skilled Nursing Facility to HCBS or CFC 3.9.3.3.1. Contractor conducts and documents the LOC Screen and generates the electronic LOC Eligibility Determination in the CCM within 5 Business Days of receiving a referral. 3.9.3.3.2. Referral to LOC Eligibility Determination not to exceed 5 Business Days. 3.9.3.4. Skilled Nursing Facility Payer Source Change 3.9.3.4.1. Contractor conducts and documents the LOC Screen and generates the electronic LOC Eligibility Determination in the CCM within 5 Business Days of receiving a referral. 3.9.3.4.2. Referral to LOC Eligibility Determination not to exceed 5 Business Days. 3.9.3.5. HCBS or CFC to Skilled Nursing Facility 3.9.3.5.1. Contractor conducts and documents the LOC Screen and PASRR Level I Screen and generates the electronic LOC Eligibility Determination in the CCM within 10 Business Days of receiving a referral. 3.9.3.5.2. Contractor completes the Nursing Facility Length of Stay form to indicate the length of stay necessary to meet the applicant's needs. 3.9.3.5.3. LOC Eligibility Determination start date may be the Referral Form signature date. 3.9.3.5.4. Referral to LOC Eligibility Determination not to exceed 10 Business Days. 3.9.3.6. Community to HCBS or CFC 3.9.3.6.1. Contractor conducts and completes the LOC Screen and generates the electronic LOC Eligibility Determination in the CCM within 10 Business Days ofreceiving a referral. 3.9.3.6.2. LOC Eligibility Determination start date for Assisted Care Facility may be the Referral Form signature date. 3.9.3.6.3. Referral to LOC Eligibility Determination not to exceed 10 Business Days. 3.9.3.7. Contractor shall conduct an Annual LOC Screen Reassessment no earlier than 90 Calendar Days prior to and no later than 30 Calendar Days prior to the current LOC Screen certification end date. 3.9.3.7.1. PERFORMANCE STANDARD: 100% of Initial LOC Screens and Annual LOC Screen Reassessments are conducted within required timelines at 10 CCR 2505-10, Exhibit B-5, Statement of Work Page 23 of 49 Docusign Envelope ID: ABEFO)FEDBSE454PAAFFA2ASA9FSODF Sections 8.7202.E et seq. and 8.7202.F et seq. and are entered into the CCM following the timelines at 10 CCR 2505-10 Section 8.7202.E et seq. 3.9.3.8. Contractor shall receive reimbursement for all initial and reassessment LOC Screens based on data entry into the CCM. 3.10. At-Risk Diversion 3.10.1. Contractor shall: 3.10.1.1. Outreach the identified At-Risk Diversion individuals in conjunction with timelines determined by the Department to ensure basic health and safety needs in the community are being met to avoid nursing facility placement. 3.10.1.2. Initial Outreach shall include Member's first occurrence on the at-risk determination list as indicated by the Department. 3.10.1.3. Ongoing Outreach shall include Member's subsequent occurrence on the at-risk determination list as indicated by the Department. 3.10.1.3.1. At-Risk Diversion activities shall include, but are not limited to: 3.10.1.3.1.1. Assessing the effectiveness of current support and services to determine if there is a need for additional resources, supports, and/or services. 3.10.1.3.1.2. Support in assessing if the individual has become eligible for any other resources including community resources and other Medicaid resources. 3.10.1.3.1.3. Documenting all At-Risk Diversion activities in detail in the CCM within 10 Business Days oft the activity. 3.10.1.3.1.4. Maintaining all supporting documentation and make it available to the Department upon request. 3.10.1.3.1.4.1. DELIVERABLE: At-Risk Diversion Invoice 3.10.1.3.1.4.2. DUE: Monthly, by the 15th 3.11. Rapid Reintegration 3.11.1. Contractor shall initiate the Rapid Reintegration if applicable, during the LOC Screen for Nursing Facility. 3.11.1.1. Contractor shall provide Members information about community-based services using the Member preference guide available on the CCM and website. 3.11.1.2. Contractor shall complete the Rapid Reintegration within the CCM if the Member expresses a desire to return to the community. 3.11.1.3. Contractor shall ensure the Rapid Reintegration includes the Rapid Reintegration barrier questions and either the Rapid Reintegration Plan or Rapid Referral as determined by the CCM. 3.11.1.4. Contractor shall ensure that any referrals deemed necessary during the Rapid Reintegration process are completed within two Business Days oft the LOC Screen. 3.11.1.5. Contractor shall complete the post Rapid Reintegration satisfaction survey at the next scheduled contact with the Member or within 90 Calendar Days of the transition, whichever is earlier. The Rapid Reintegration survey shall be completed with any Exhibit B-5, Statement ofWork Page 24 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AA0P-FA243A9F50DF Member transitioning from a Nursing Facility to the community that received a Rapid Reintegration Plan or Rapid Referral. 3.11.1.5.1. DELIVERABLE: Rapid Reintegration Diversion Invoice 3.11.1.5.2. DUE: Monthly, by the 15th 3.12. Interim Support Level Assessment 3.12.1. The Contractor shall establish one point of contact for Interim Support Level Assessment (ISLA) related processes and communications. 3.12.2. Contractor shall conduct an ISLA for initial HCBS-DD and HCBS-SLS enrollments when criteria set forth at 10 C.C.R. 2505-10 Section 8.7202.AA et seq. are met, the Member has never had a Supports Intensity Scale (SIS) Assessment, and the Member is seeking Day Habilitation, Prevocational, Supported Employment Services and/or Residential Habilitation, Contractor shall not be reimbursed for an ISLA prior to the individual being determined eligible for a waiver through the Level of Care Screen and confirmation of financial eligibility. 3.12.3. Contractor shall conduct all initial ISLAS within 30 Calendar Days of the Member meeting both functional and financial eligibility. 3.12.4. Contractor shall upload the ISLA into the CCM within 10 Business Days of the assessment date. 3.12.5. Contractor shall complete the Deparment-preserbped ISLA invoice, including attaching a copy ofthe ISLA, and submit it to the Department within 30 Calendar Days ofthe assessment date. 3.12.6. Contractor shall complete the ISLA and enter the Department-specified outcomes from the ISLA into the Bridge prior to completion ofthe Pre Prior. Authorization (PPA) and before the PAR Start Date. 3.12.6.1. DELIVERABLE: Completed Interim Support Level Assessment Invoice 3.12.6.2. DUE: Within 30 Calendar Days of the Assessment Date 3.13. HCBS-CES Applications 3.13.1. Contractor shall complete initial and CSR applications for persons applying for the HCBS- CES waiver as set forth by the Department's prescribed guidelines. 3.13.2. Initial HCBS-CES applications shall be submitted to the designated entity for review no more than 30 Calendar Days after the initial LOC is completed or no more than 30 Calendar Days after the Applicant/family has chosen enrollment onto the HCBS-CES waiver. 3.13.3. CSR HCBS-CES applications shall be submitted to the designated entity in accordance with timelines as set forth by the Department in order to prevent any break in services. 3.13.4. Contractor shall maintain all HCBS-CES applications and supporting documentation and make it available to the Department upon request. 3.14. HCBS-CHRP Support Need Level Assessment 3.14.1. Contractor shall conduct a Support Need Level Assessment for all HCBS-CHRP enrollments and re-assessments as set forth by the Department's prescribed guidelines. Exhibit B-5, Statement of Work Page 25 of49 Docusign Envelope ID: ABEFOTF6DBSE4549AAOFFA2AA9FSODF: 3.14.2. Contractor shall conduct an initial Support Need Level Assessment within 45 Calendar Days from the date oft the Initial Level of Care Screen. Contractor shall conduct all reassessments as necessary when individual's needs change. 3.14.3. Contractor shall submit a list of all completed HCBS-CHRP Support Need Level Assessments on a template prescribed by the Department. 3.14.3.1. DELIVERABLE: Completed HCBS-CHRP Support Need Level Assessment List 3.14.3.2. DUE: Monthly, by the 15th 3.14.4. Contractor shall maintain all Support Need Level Assessments and supporting documentation and make it available to the Department upon request. 3.14.4.1. PERFORMANCE STANDAND: Support Need Level Assessment 3.14.4.2. DUE: Within 10 Business Days of the Department' S request 4. STATE GENERAL FUND PROGRAM OBLIGATIONS 4.1. Service and Support Requirements 4.1.1. Contractor shall administer the three State General Fund Programs: State SLS, OBRA-SS, and FSSP and purchase services and supports for persons determined to be eligible under this Contract. If Contractor has been determined to be the only willing and qualified provider by the Department for the Defined Service Area, Contractor must administer the State Programs and purchase and/or provide services and supports for persons determined to be eligible under this Contract. Contractor shall not be responsible for guaranteeing services to eligible persons under this Contract if there are no Providers available to provide services and supports. Contractor must ensure separation of case management responsibilities and the provision of services for both State SLS and OBRA-SS. 4.1.2. Contractor shall ensure that written notifications are provided to individuals and Members informing them of their rights and the potential influence Contractor has on the Support Planning process, such as exercising free choice of providers. 4.1.3. Contractor shall provide the individual, Members, and/or guardian with written information about how to file a provider agency complaint as well as how to make a complaint against Contractor. 4.1.4. Contractor shall have procedures for a dispute resolution process, as described in 10 C.C.R. 2505-10, Section 8.7202.S et seq-, when an action to terminate, change, reduce or deny services is initiated by the provider service agency. 4.2. State General Fund Service Expenditure Reporting 4.2.1. Contractor shall report all State SLS, FSSP, and OBRA-SS direct service expenditures on the template provided by the Department. All services must be reported and reimbursed within the fiscal year the service is provided. 4.2.1.1. DELIVERABLE: State General Fund Program Service Expenditure Reports 4.2.1.2. DUE: Monthly, by the 15th of each month or Fiscal Year end close date determined by the Department for the month ofJune. 4.2.2. Adjustments to direct service expenditures must be added to the next direct service expenditure report submitted by Contractor at the time of discovery. If the adjustment is identified after the close of the fiscal year the service is rendered, Contractor must report the Exhibit B-5, Statement ofWork Page 26 of49 Docusign Envelope ID: ABEFOTF8DBSE4549AAOFFA2AASFSODF adjustment to the Department within 10 Business Days of discovery and a check must be sent to the Department with the amount of the overpayment in addition to details about the overpayment to include Member name, program, services, and dollar amount. 4.2.3. Contractor shall verify all services are supported with required documentation as required in 10 C.C.R. 2505-10 Sections 8.7560 et seq., 8.7561 et seq., and 8.7202.V et seq. 4.3. State Supported Living Services (State SLS) 4.3.1. General Requirements 4.3.1.1. Contractor shall operate the State SLS program pursuant to 10 C.C.R. 2505-10 Section 8.7560et seq. 4.3.1.2. Contractor shall not add surcharges to the purchase of covered services for State SLS. 4.3.1.3. Contractor shall provide a list of qualified providers for all services to Members and families, during the State SLS Individual Support Plan process, and to other interested parties upon request. 4.3.1.4. Contractor shall provide or coordinate with local service providers to provide community services to individuals enrolled in State SLS who meet the intellectual and developmental disabilities criteria and the eligibility requirements for the specific program required in 10 C.C.R. 2505-10 Section 8.7560 et seq. 4.3.1.5. The Department will notify Contractor of the target number of individuals that shall be served through State SLS prior to the start of each State Fiscal Year (SFY). Contractor may choose to enroll more individuals in State SLS than authorized, ensuring all individuals can be served within the funding allocated. Target caseload is calculated using the unique number ofMembers that receive direct services during the contract period. 4.3.2. State SLS Eligibility 4.3.2.1. Contractor shall determine eligibility for the State SLS program pursuant to 10 C.R.S. 2505-10 Section 8.7560.B et seq. 4.3.2.2. Contractor shall provide options counseling for State SLS after it is demonstrated that the Member has applied for HCBS waiver services and explored long-term care services offered under the State Plan, including CFC, and has demonstrated that available Medicaid services cannot meet the Member's needs. 4.3.2.3. Contractor shall document any State SLS service needs for Member's enrolled in HCBS and/or CFC. 4.3.2.4. Eligibility for the State SLS program does not guarantee the availability of services and supports. 4.3.3. State SLS Individual Support Plans 4.3.3.1. Pursuant to 10 C.R.S. 2505-10 Section 8.7560.D et seq. all State SLS Members must have a State SLS ISP. 4.3.3.2. Contractor shall develop a State SLS Individual Support Plan (State SLS ISP) within 10 Business Days after an initial Individual Support Plan (ISP) meeting for those individuals not established with Contractor and with a Developmental Disability determination at time of referral. Contractor shall have up to 10 Business Days to complete additional meetings and/or assessments that allow for the creation of the State SLS ISP during this Exhibit B-5, Statement of Work Page 27 of4 49 Docusign Envelope ID: ABEFOTFEDBE4549AA-AOPFA2ASA9FSODF time. Contractor shall ensure the State SLS ISP is signed by all required parties prior to implementation. 4.3.3.3. The State SLS ISP shall be developed through an in-person meeting that includes, at a minimum, the individual seeking services and Contractor. 4.3.3.4. Contractor shall utilize the ISP within the CCM. 4.3.3.5. Contractor shall document and finalize all ISP information in the CCM within 10 Business Days of the date ofthe initial ISP meeting. 4.3.3.5.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% of the State SLS ISPs are developed within 10 Business Days ofthe individual's referral to a State General Fund program or after the initial ISP meeting. 4.3.3.6. The State SLS ISP shall be effective for no more than one year and reviewed by Contractor at least every six months in an in-person monitoring contact. 4.3.3.7. If an individual seeks additional supports or alleges a change in need, Contractor shall review and update the ISP prior to changing the authorized services and supports. 4.3.4. State SLS Ongoing Case Management 4.3.4.1. Contractor shall utilize appropriated funds to perform Case Management duties in accordance with 10 C.C.R. 2505-10 Section 8.7560.E et seq.: 4.3.4.1.1. Intake and referral. 4.3.4.1.2. Determining program eligibility. 4.3.4.1.3. Supporting individuals with learning and accessing other community resources. 4.3.4.1.4. Developing a State SLS Individual Support Plan. 4.3.4.1.5. Maintaining the determination of eligibility for services and supports. 4.3.4.1.6. Providing service and support authorization and coordination. 4.3.4.1.7. Program transition coordination. 4.3.4.1.8. Case Management, policy, and regulation training. 4.3.4.1.9. Service records maintenance. 4.3.4.1.10. Otilization review. 4.3.4.2. Contractor shall document all ongoing case management activities in detail in the CCM within 10 Business Days of the activity. 4.3.4.3. Contractor shall be reimbursed for ongoing case management activities based on information entered into the CCM. 4.3.4.4. The use of mass email communication, robotic and/or automatic voice messages cannot be used to replace Contractor" S required individualized case management activities. 4.3.5. State SLS Monitoring 4.3.5.1. State SLS Monitoring shall be person centered and include at least one in person contact with the Member and three additional monitoring contacts per year using the individual's selected modality; in person or virtual and should be discussed and determined based on Member preference and need. Exhibit B-5, Statement of Work Page 28 of 49 Docusign Envelope ID: ABEFOFEDBSE4549AASAAOFFA2ASA9FSODF 4.3.5.1.1. The Member's selected modality must be documented within the case notes for each monitoring contact within the CCM. 4.3.5.1.2. State SLS Monitoring activities shall include, but not be limited to: 4.3.5.1.2.1. Monitoring all services and supports delivered pursuant to the State SLS Individual Support Plan. 4.3.5.1.2.2. Assessing the effectiveness of the State SLS supports and services. 4.3.5.1.2.3. Assessing if additional State SLS supports and services are needed. 4.3.5.1.2.4. Support in assessing ift the individual has become eligible for any other resources including community resources and other Medicaid resources. 4.3.5.1.2.5. Reviewing health and safety concerns. 4.3.5.1.2.6. Reviewing any Critical Incidents. 4.3.5.1.3. Contractor shall document all monitoring activities in detail in the CCM within 10 Business Days of the activity. 4.3.5.1.4. Contractor shall be reimbursed for monitoring activities based on information entered into the CCM. 4.3.5.1.4.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the required quarterly interval. 4.3.6. State SLS Transfers 4.3.6.1. Contractor shall manage State SLS transfers in accordance with 10 C.R.S 2505-10 Section 8.7560.F et seq. 4.3.7. State SLS Direct Services 4.3.7.1. Contractor shall utilize appropriated funds to provide or subcontract with providers to provide services to support individuals with an intellectual and developmental disability living in the community in accordance with 10 C.C.R. 2505-10 Section 8.7560.H. 4.3.8. State SLS Records Maintenance 4.3.8.1. Contractor shall maintain supporting documentation capable of substantiating all expenditures and shall make it available to the Department upon request as required in 10 C.C.R. 2505-10 Section 8.7560.H et seq. 4.3.8.2. Receipts, invoices, and service logs must contain, at a minimum: Member name, service description, provider name, first and/or last date of service, service rate, and amount due or paid. 4.3.8.3. If Contractor does not maintain supporting documentation in the required format for all services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505- 10 Section 8.076 et seq. 4.3.8.4. Through ongoing monitoring, Contractor shall ensure all services reimbursed by Contractor are rendered by service providers in accordance with the State SLS Individual Support Plan. 4.3.8.5. Contractor shall attempt to resolve any discrepancies with the service provider directly. Exhibit B-5, Statement of Work Page 29 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 4.3.8.6. Contractor shall notify the Department of any instances of suspected fraud or waste, and any supporting documentation at the time of discovery. 4.3.8.7. Contractor shall notify all service providers that all records and supporting documentation related to services rendered through State SLS are subject to inspection and recovery by the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq. 4.4. Omnibus Budget Reconciliation Act of 1987 Specialized Services (OBRA-SS) 4.4.1. Contractor shall provide or arrange for the provision of OBRA-SS to any individual where the Pre-Admission Screening and Resident Review (PASRR) Level II Evaluation identified the need for placement into a nursing facility and need for additional specialized services. Contractor shall ensure the OBRA-SS being provided are listed on the individual's Notice of Determination (NOD). Contractor shall ensure that OBRA-SS are related to the individual's intellectual or developmental disability or related condition and individualized to the resident's needs. 4.4.2. PASRR Level II Evaluation 4.4.2.1. Contractor will review the PASRR Level II Evaluations received from the Skilled Nursing Facility or State appointed vendor prior to developing an OBRA-SS Individual Support Plan or providing services. 4.4.3. Maintaining Eligibility and Enrollment 4.4.3.1. Contractor shall enroll individuals into OBRA-SS, ifthe individual resides in a nursing facility, demonstrates a need, and agrees to receive services. 4.4.3.2. Upon approval of the nursing facility admission by the State Intellectual Disability Authority and receipt ofthe Final Notice ofDetermination, Contractor shall send referrals to providers for OBRA-SS within 10 Business Days from the date the PASRR Notice of Determination is issued and/or received from the Skilled Nursing Facility or State appointed vendor. / 4.4.3.3. Contractor shall maintain Member records within the CCM. All changes to OBRA-SS enrollments, shall be entered into the CCM within 10 Business Days ofthe change. The Department may adjust the number of authorized enrollments based on fluctuating enrollments. If the individual does not receive OBRA-SS within one calendar month Contractor shall inactivate the individual's record in the CCM. 4.4.4. OBRA-SS Individual Support Plans 4.4.4.1. Contractor shall develop an OBRA-SS Individual Support Plan (ISP) within 10 Business Days after an initial ISP meeting for those individuals not established with Contractor and with a Developmental Disability determination at time of referral. Contractor shall have up to 10 Business Days to complete additional meetings and/or assessments that allow for the creation of the OBRA-SS ISP during this time. Contractor shall ensure the OBRA-SS ISP is signed by all required parties prior to implementation. 4.4.4.2. The OBRA-SS ISP shall be developed through an in-person meeting that includes, at a minimum, the individual seeking services and Contractor. 4.4.4.3. Contractor shall utilize the ISP template within the CCM. 4.4.4.4. Contractor shall document and finalize all ISP information in the CCM within 10 Business Days of the date of the initial ISP meeting. Exhibit B-5, Statement of Work Page 30 of 49 Docusign Envelope ID: ABEFOTFSDBSE4549AAOFFA2ASA9FSODF 4.4.4.4.1. PERFORMANCE STANDARD: Contractor shall ensure that 100% ofthe OBRA- SS Individual Support Plans are developed within 10 Business Days of the individual's S referral to a State General Fund program or after the initial ISP meeting. 4.4.4.5. The OBRA ISP shall be effective for no more than one year and reviewed by Contractor at least every six months in an in-person monitoring contact. 4.4.4.6. Ifal Member seeks additional supports or alleges a change in need, Contractor shall review and update the ISP prior to changing the authorized services and supports. 4.4.4.7. Contractor shall maintain all OBRA-SS ISPs and supporting documentation and make them available to the Department upon request. 4.4.5. OBRA-SS Ongoing Case Management 4.4.5.1. Contractor shall utilize appropriated funds to perform Case Management duties to include: 4.4.5.1.1. Intake and referral. 4.4.5.1.2. Verifying a PASRR Level II Evaluation and Skilled Nursing Facility residency. 4.4.5.1.3. Developing an OBRA-SS Individual Support Plan. 4.4.5.1.4. Maintaining the determination of eligibility for services and supports. 4.4.5.1.5. Providing service and support authorization and coordination. 4.4.5.1.6. Ensuring there is not a duplication of authorized services with the services provided in the nursing facility. 4.4.5.1.7. Program transition coordination. 4.4.5.1.8. Service records maintenance. 4.4.5.1.9. Case Management, policy, and regulation training. 4.4.5.1.10. Utilization review. 4.4.5.2. Contractor shall document all ongoing case management activities in detail in the CCM within 10 Business Days ofthe activity. 4.4.5.3. Contractor shall be reimbursed for ongoing case management activities based on information entered into the CCM 4.4.5.4. The use of mass email communication, robotic and/or automatic voice messages cannot be used to replace Contractor's required individualized case management activities. 4.4.6. OBRA-SS Monitoring 4.4.6.1. Monitoring shall be person centered and include at least one in person contact with the Member and three additional monitoring contacts per: year using the individual's selected modality; in person or virtual and should be discussed and determined based on Member preference and need. The Member's selected modality must be documented within the narrative for each monitoring contact within the CCM. 4.4.6.2. Monitoring activities shall include but not be limited to: 4.4.6.2.1. Monitoring all services and supports delivered pursuant to the OBRA-SS ISP. 4.4.6.2.2. Assessing the effectiveness ofthe supports and services. Exhibit B-5, Statement ofv Work Page 31 of 49 Docusign Envelope ID: ABEF07F6-DB5E-4549-AAOF- A243A9F50DF 4.4.6.2.3. Assessing if additional supports and services are needed. 4.4.6.2.4. Support in assessing if the individual has become eligible for any other resources including community resources or other Medicaid resources. 4.4.6.2.5. Reviewing health and safety concerns. 4.4.6.2.6. Reviewing any Critical Incidents. 4.4.6.3. Contractor shall document all monitoring activities in detail in the CCM within 10 Business Days ofthe activity. 4.4.6.4. Contractor shall be reimbursed for monitoring activities based on information entered into the CCM. 4.4.6.4.1. PERFORMANCE STANDARD: 100% of monitoring activities shall occur at the required quarterly interval. 4.4.7. OBRA-SS Direct Services 4.4.7.1. Contractor shall not utilize OBRA-SS funds to purchase mental health related services. Contractor shall seek provision of, or payment for, mental health services for those individuals through the Medicaid-funded mental health system or other local sources of funding. 4.4.7.2. Contractor shall not utilize or authorize OBRA-SS funds to provide or purchase services and supports that are covered and provided by the nursing facility. 4.4.7.3. Contractor shall utilize appropriated funds to provide services or coordinate with a provider to support individuals with intellectual and developmental disabilities living in a nursing facility. Contractor shall not utilize funding for services that are provided by the Nursing Facility through Medicaid reimbursement. Services eligible through OBRA include: 4.4.7.3.1. Assistive Technology 4.4.7.3.2. Behavioral Consultation 4.4.7.3.3. Behavioral Line Services 4.4.7.3.4. Behavioral Counseling 4.4.7.3.5. Behavioral Counseling Group 4.4.7.3.6. Behavioral Plan Assessment 4.4.7.3.7. Day Habilitation - Specialized Habilitation 4.4.7.3.8. Day Habilitation - Supported Community Connections 4.4.7.3.9. Dental - Basic 4.4.7.3.10. Dental - Major 4.4.7.3.11. Mileage 4.4.7.3.12. Other Public Conveyance 4.4.7.3.13. Prevocational Services 4.4.7.3.14. Recreational Facility Fees/Passes Exhibit B-5, Statement of Work Page 32 of49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 4.4.7.3.15. Job Coaching - Individual 4.4.7.3.16. Job Coaching Group 4.4.7.3.17. Job Development - Individual 4.4.7.3.18. Job Development - Group 4.4.7.3.19. Job Placement 4.4.7.3.20. Vision 4.4.7.4. Services must be provided in accordance with the service definitions found in 10 C.C.R. 2505-10 Section 8.7500 et seq. 4.4.8. OBRA-SS Records Maintenance 4.4.8.1. Contractor shall maintain supporting documentation capable of substantiating all expenditures and shall make it available to the Department upon request as required in 10 C.C.R. 2505-10 Section 8.130.2 et seq. 4.4.8.1.1. Receipts or invoices must contain, at a minimum: Member name, service description, provider name, first and/or last date of service, service rate, and amount due or paid. 4.4.8.2. If Contractor does not maintain supporting documentation in the required format for all services rendered, the Department may recover these funds pursuant to 10 C.C.R. 2505- 10 Section 8.076 et seq. 4.4.8.3. Through ongoing monitoring, Contractor shall ensure all services reimbursed by Contractor are rendered by service providers in accordance with the OBRA-SS Individual Support Plan. 4.4.8.4. Contractor shall attempt to resolve any discrepancies with the service provider directly. 4.4.8.5. Contractor shall notify the Department of any instances of suspected fraud and any supporting documentation at the time of discovery. 4.4.8.6. Contractor shall notify all service providers that all records and supporting documentation related to services rendered through OBRA-SS are subject to inspection and recovery by the Department pursuant to 10 C.C.R. 2505-10 Section 8.076 et seq. 4.4.9. Mental Health Services Prohibited 4.4.9.1. Contractor shall not utilize state funds to purchase mental health related services for individuals with intellectual disabilities who are Medicaid eligible and who also have a Medicaid covered mental health diagnosis. 4.4.9.2. Contractor shall seek provision of, or payment for, mental health services for those individuals through the Medicaid funded mental health system or other local sources of funding. 4.5. Family Support Services Program (FSSP) 4.5.1. Contractor shall administer and provide or purchase Family Support Services pursuant to $25.5-10-305, C.R.S. and 10 C.C.R. 2505-10 Section 8.7561 et seq. 4.5.2. Eligibility, Needs Assessment, and Prioritization of Families. 4.5.2.1. Contractor shall determine individual eligibility for the FSSP pursuant to 10 C.R.S2505- 10 Section 8.7561.C. Exhibit B-5, Statement ofWork Page 33 of 49 Docusign Envelope ID: ABEFOTFSDBSE454PAAOFFA2ASA9FSODF 4.5.2.2. Contractor shall provide options counseling for FSSP after it is demonstrated that the Member has applied for HCBS waiver services and has demonstrated that the waiver cannot meet the Member's needs. 4.5.2.3. Contractor shall document any FSSP service needs for Member's enrolled in HCBS. 4.5.2.4. After FSSP eligibility has been determined, Contractor shall conduct an FSSP Needs Assessment prior to authorizing services. Contractor shall develop a Needs Assessment Tool that is, at a minimum, inclusive of all requirements outlined in 10 C.C.R 2505-10 Section 8.7561.F and have documented scoring criteria for the tool. The tool shall be included in Contractor's policies and procedures. 4.5.2.4.1. DELIVERABLE: Needs Assessment Tool Template and Scoring Criteria 4.5.2.4.2. DUE: Annually, by August 15th 4.5.2.5. Any revisions to the needs assessment tool template and scoring criteria must be submitted to the Department within 10 Business Days of the updated tool being implemented. 4.5.2.6. Contractor shall assess all families, both on the waiting list as "As Soon as Available" and currently receiving FSSP services, for level ofneed on an annual basis in accordance with 10 CCR 2505 Section 8.7561.F et seq. 4.5.2.7. Contractor shall document all completed FSSP Needs Assessments within the CCM within 10 Business Days of completion ofthe assessment. 4.5.2.7.1. Contractor shall be reimbursed for most in need assessments based on information entered into the CCM. 4.5.2.8. Contractor shall maintain all Needs Assessment documentation and make it available to the Department upon request. 4.5.2.9. The Department will notify Contractor of the target number of individuals that shall be served through FSSP prior to the start of each State Fiscal Year (SFY). Contractor may choose to enroll more individuals in FSSP than targeted, ensuring all individuals can be served within the funding allocated. Target caseload is calculated using the unique number ofMembers that receive direct services during the contract period. 4.5.3. Family Support Plans (FSP) 4.5.3.1. Contractor shall ensure that individuals and families enrolled in the FSSP have an individualized Family Support Plan (FSP) which meets the requirements of an Individualized Plan, as defined in Section 25.5-10-202 et seq. and 25.5-10-211 C.R.S prior to receiving services. 4.5.3.2. The FSP shall be developed by, at a minimum, a family representative, and Contractor. Contractor shall ensure the FSP is signed by all required parties prior to implementation. 4.5.3.3. The FSP shall be effective for no more than one year. 4.5.3.4. If the Member seeks additional supports or alleges a change in need, Contractor shall review and update the FSP prior to changing the authorized services and supports. 4.5.3.5. Contractor shall upload a copy of the FSP information in the CCM within 10 Business Days oft the FSP effective date. 4.5.4. FSSP Ongoing Case Management Exhibit B-5, Statement of Work Page 34 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 4.5.4.1. Pursuant to 10 C.R.S 2505-10 Section 8.7561.G Contractor shall provide case management for the FSSP, to include coordination of services provided for individuals with an IDD or Developmental Delay that consists of facilitating enrollment, assessing needs, locating, coordinating, and monitoring needed FSSP funded services, and monitoring the effective and efficient provision of services across multiple funding sources. 4.5.4.2. Contractor shall not charge families to provide direct services and case management for Family Support Services. 4.5.4.3. Contractor. shall provide al list ofc qualified providers for appropriate services to applicants, Member(s), and families, during the individualized planning process, and to other interested parties upon request. 4.5.4.4. Contractor shall utilize appropriated funds to perform case management duties in accordance with 10 CCR 2505 8.7561.G et seq. to include: 4.5.4.4.1. Development, application assistance, and annual re-evaluation ofthe Family Support Plan (FSP) which shall be conducted at least once per year and include making changes to the FSP as indicated. 4.5.4.4.2. Providing service authorization and support coordination to include but not limited to assessing the effectiveness ofFSSP supports and services. 4.5.4.4.3. Ensuring all services and supports are delivered in accordance with the FSP. 4.5.4.4.4. Coordinating with families to obtain required documentation for services. 4.5.4.4.5. Supporting the individual in assessing eligibility for other community and/or Medicaid resources. 4.5.4.4.6. Program transition coordination. 4.5.4.4.7. Service records maintenance. 4.5.4.4.8. Case Management, policy, and regulation training. 4.5.4.4.9. Otilization review. 4.5.4.5. Contractor shall document all ongoing case management activities in detail in the CCM within 10 Business Days ofthe activity. 4.5.4.5.1. Contractor shall be reimbursed for ongoing case management activities based on information entered into the CCM. 4.5.4.5.2. The use of mass email communication, robotic and/or automatic voice messages cannot be used to replace Contractor's required individualized case management activities. 4.5.5. FSSP Direct Services 4.5.5.1. Contractor shall utilize appropriated FSSP funds to purchase services and/or reimburse or advance funds to families for expenses that are incurred as a result of supporting the family and/or individual with an intellectual or developmental disability or delay living in the family home. 4.5.5.2. Contractor shall only authorize and advance or reimburse services that are needed as a result of the individual's Intellectual and Developmental Disability or Developmental Exhibit B-5, Statement of Work Page 35 of 49 Docusign Envelope ID: ABEFOTFSDBSE454PAAOFFA2ASA9FSODF Delay and shall not be approved ifthe need is a typical age-related need. The correlation between need and disability must be documented in the FSP. 4.5.5.3. Contractor shall ensure that all services are provided in the most cost-effective manner, meaning the least expensive manner to meet the need. 4.5.5.4. Contractor shall ensure that all services are authorized pursuant to the FSP. 4.5.5.5. Contractor shall utilize FSSP funds to provide funding to families for expenses referenced in $25.5-10-305(-), C.R.S and 10 C.R.S. 2505-10 Section 8.7561.D Contractor shall not authorize or provide any service that is not outlined in these regulations. 4.5.5.6. Contractor shall ensure the authorized services through FSSP are not duplicative of other resources the family has access to, including HCBS, CFC, third party insurance, etc. 4.5.5.7. Contractor shall prioritize funding for the FSSP pursuant to 10 C.R.S 2505-10 Section 8.7561.F et seq. 4.5.6. Family Support Council 4.5.6.1. Contractor shall establish and maintain a Family Support Council (FSC) pursuant to $25.5-10-304 et seq., C.R.S. and 10 C.C.R. 2505-10 Section 8.7561.B et seq. 4.5.6.2. Contractor shall ensure that the FSC is comprised primarily of individuals in services, family members, and guardians of individuals enrolled in FSSP. 4.5.6.3. Contractor shall submit a list of FSC members annually. 4.5.6.3.1. DELIVERABLE: FSC Member List 4.5.6.3.2. DUE: Annually, by August 15th 4.5.6.4. Contractor shall notify the Department in writing of any changes to the FSC within 10 Business Days. 4.5.6.4.1. DELIVERABLE: FSC Member Updates 4.5.6.4.2. DUE: Within 10 Business Days of the date of change to the FSC members 4.5.6.5. Contractor shall provide orientation and training to all FSC members on the duties and responsibilities of the FSC. The training and orientation shall be documented with a record ofthe date ofthe training, who provided the training, training topic, and names of attendees. Contractor shall make the training and orientation materials available to the Department upon request. 4.5.6.6. Contractor shall ensure the FSC fulfills all duties outlined in 10 C.C.R. 2505-10 Section 8.7561.B et seq. Contractor shall document the meeting minutes and submit them to the Department. Contractor shall maintain all supporting documentation related to an FSC meeting and make it available to the Department upon request. 4.5.6.6.1. DELIVERABLE: FSC Meeting Minutes 4.5.6.6.2. DUE: Monthly, by the 15th of each month and by June 30th 4.5.7. FSSP Annual Report and Evaluation 4.5.7.1. In coordination with the FSC, Contractor shall be responsible for evaluating the effectiveness of the FSSP on an annual basis. Contractor shall ensure the annual program evaluation addresses all areas required in 10 CCR 2505-10 Section 8.7561.I et seq. Exhibit B-5, Statement of Work Page 36 of 49 Docusign Envelope ID: ABEFOIFSDBSE4549AABAAOFFA2ASA9FSODF 4.5.7.2. Contractor shall create and submit an FSSP Annual Report and Evaluation to the Department. The FSSP Annual Report and Evaluation shall contain all requirements outlined in 10 CCR 2505-10 Section 8.7561.K et seq. Council member signatures approving the report must be submitted as a separate attachment to the deliverable. 4.5.7.3. Contractor must ensure the Annual Report and Evaluation does not contain Member PHI. 4.5.7.4. Contractor shall provide the Annual Report and Evaluation to the Department for review and post the report on the Contractor"': S website. 4.5.7.4.1. DELIVERABLE: FSSP Annual Report and Evaluation and Council Signature Page 4.5.7.4.2. DUE: Annually, by October 1st 4.5.8. FSSP Records Maintenance 4.5.8.1. Contractor shall maintain supporting documentation capable of substantiating all expenditures and reimbursements made to providers, Members and/or families. 4.5.8.2. When Contractor purchases services or items directly for Members and/or families, Contractor shall: 4.5.8.2.1. Maintain receipts or invoices from the service provider and documentation demonstrating that the provider was paid by Contractor. 4.5.8.2.1.1. Receipts or invoices must contain, at a minimum: Member and/or family name, provider name, first and/or last date of service, item(s) or service(s) purchased, item(s) or service(s) cost and amount due or paid. 4.5.8.3. When Contractor reimburses Members and/or families for services or items, Contractor shall: 4.5.8.3.1. Ensure the Member and/or family provides Contractor with receipts or invoices prior to reimbursement. 4.5.8.3.2. Maintain receipts or invoices from the Member and/or family, and documentation demonstrating that the individual and/or family was reimbursed by Contractor. 4.5.8.3.3. Ensure all receipts or invoices provided by the Members and/or family contain, at a minimum: Member and/or family name, provider name, first and/or last date of service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount paid. 4.5.8.4. When Contractor provides funding to Members and/or families for the purchase of services or items in advance, Contractor shall include, but is not limited to: 4.5.8.4.1. Establish policies and procedures outlining Contractor's processes for advancing funds, ensuring supporting documentation is received by the Member and/or family, and remedial action steps Contractor will take if supporting documentation is not received. The policies and procedures shall identify timelines and shall be made available to the Department upon request. 4.5.8.4.2. Notify the Member and/or family that they are required to submit invoices or receipts to Contractor ofall purchases made prior to the close oft the State Fiscal Year. 4.5.8.4.3. Ensure the Member and/or family provides Contractor with receipts or invoices. Exhibit B-5, Statement of Work Page 37 of 49 Docusign Envelope ID: A8EF07F6-DBSE-4549-AAOF-FA243A9F50DF 4.5.8.4.4. Maintain receipts or invoices from the Members and/or family, and documentation demonstrating that the Members and/or family was provided with advanced funds by Contractor. 4.5.8.4.5. Ensure all receipts or invoices provided by the Members and/or family contain, at a minimum: Members and/or family name, provider name, first and/or last date of service, item(s) or service(s) purchased, items(s) or service(s) cost, and amount paid. 4.5.8.4.6. Contractor shall ensure the documentation received by the Member and/or family indicates that the amount was paid. 4.5.8.4.7. If a Member and/or family does not submit invoices or receipts, Contractor shall document all attempts to obtain receipts or paid invoices and any remedial action taken. Contractor shall make all supporting documentation available to the Department upon request. 4.5.8.4.8. If Contractor cannot provide supporting documentation as described in this section, the Department may recover any unsubstantiated expenditure from Contractor. 4.5.8.5. Contractor shall ensure supporting documentation is recorded for all FSSP dollars for multiple family services to include a detailed description of the service provided and the date(s) of service. 4.5.8.5.1. Contractor shall ensure all program expenses related to multiple family expenses can be substantiated through time tracking, wage costs, benefit costs, or any other supporting documentation to verify expenses related to proving the services. 5. DATA ENTRY, DATA MONITORING, AND OVERSIGHT 5.1. Individual/Member Records 5.1.1. Contractor shall: 5.1.1.1. Comply with all reporting and billing policies and procedures established by the Department, document individual and! Member records within the CCM and adhere to the system requirements provided by the Department for these systems. Systems include, but are not limited to, the Colorado interChange Medicaid Management Information System (MMIS) and its subsystems: Bridge HCBS PAR subsystem and the Care and Case Management (CCM) System. Contractor shall have access to Member eligibility, PAR, and claims data through reporting provided through a COGNOS data query application. 5.1.1.2. Comply with all data entry guidelines for report-based Contract payments posted by the Department. 5.1.1.3. Maintain individual and Member records within the CCM for the purposes of individual and Member information management. 5.1.1.4. Maintain accurate and detailed documentation ofall case management and State General Fund Program activities required through the Contract. 5.1.1.5. Maintain accurate and detailed supporting documentation of all activities required through this Contract to substantiate reimbursement and make all documentation available to the Department upon request if not documented within the CCM. 5.1.1.6. Correct 100% of data errors discovered by the Department and confirm the accuracy of the data entered into the CCM within 10 Business Days of notification from the Department of an error. Exhibit B-5, Statement of Work Page 38 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 5.1.1.6.1. PERFORMANCE STANDARD: 100% of data errors corrected within 10 Business Days of notification. 5.1.1.7. Develop and implement aj plan to conduct, at minimum, an annual data integrity review. That includes, but is not limited to, the following: 5.1.1.7.1. Member program records completeness and accuracy as directed by the Department. 5.1.1.7.2. Member demographic information completeness and accuracy. 5.1.1.7.3. Member care team provider and team staff accuracy and completeness, as directed by the Department. 5.1.1.7.3.1. DELIVERABLE: Data Integrity and Data Quality Policies and Procedures 5.1.1.7.3.2. DUE: Annually, October 1St after the Contract Start Date or within 10 Business Days as revisions are made. 5.2. Systems Access and Training 5.2.1. Contractor shall develop and implement policies and procedures to internally oversee data integrity and data quality to include but not limited to how Contractor will: 5.2.1.1. Ensure all staff receive the required systems training as specified in this Contract. 5.2.1.2. Be responsible fori management of user access and timely revocation for required systems to include the CCM, MMIS, Bridge, COGNOS, and PeakPro. 5.2.1.3. Ensure all provision forms are reviewed and submitted accurately and completely within at least 14 Calendar Days prior to needing access. Any forms submitted without all necessary information are subject to resubmission and delay. 5.2.1.4. Ensure all revocation forms are submitted immediately upon knowledge of license user's separation of employment. 5.2.1.5. Conduct an internal audit of all provisioned user licenses monthly or quarterly to ensure that the list of users is up to date, permissions are accurate, and revocation forms are submitted in a timely manner. 6. ACCOUNTING 6.1. Contractor's accounting methods shall conform to the standards of Generally Accepted Accounting Principles (GAAP), and any updates thereto, throughout the Term ofthe Contract. 6.2. Contractor shall establish and maintain internal control systems and standards that apply to the operation oft the organization. 6.3. Contractor shall assure, all financial documents are filed in a systematic manner to facilitate audits, all prior years' expenditure documents are maintained for use in the budgeting process and for audits, and records and source documents are made available to the Department, its contracted representative, or an independent auditor for inspection, audit, or reproduction. 6.4. Contractor shall establish any necessary cost accounting systems to identify the application of funds and record the amounts spent. 6.5. Contractor shall document all transactions and funding sources, and this documentation shall be available for examination by the Department within 10 Business Days of the Department's request. Exhibit B-5, Statement ofWork Page 39 of 49 Docusign Envelope ID: ABEFO7FSDBSE4549AAOPFA2ASA9FSODF 6.5.1. DELIVERABLE: Transaction and Funds Documentation 6.5.2. DUE: Within 10 Business Days ofthe Department' s Request 7. SUBRECIPIENT STATUS AND REQUIREMENTS 7.1. Contractor has been determined to be a Subrecipient under 2 CFR Chapter I, Chapter II, Part 200 et al. Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance); Final Rule (the "Final Rule"), released December 26, 2013, and subsequently updated, and thus shall be required to follow all requirements and guidance contained in the Final Rule. 7.2. Single Audits 7.2.1. Under the Final Rule, all Non-Federal Entities, as defined in the Final Rule, expending $1,000,000.00 or more from all federal sources (direct or from pass-through entities) must have a single or program-specitic audit conducted for that year in accordance with Subpart F oft the Final Rule. 7.2.2. Contractor shall notify the State when expected or actual expenditures of federal assistance from all sources equal or excèed $1,000,000.00. 7.2.3. If the expected or actual expenditures of federal assistance from all sources do not equal or exceed $1,00,000.00 Contractor shall provide an attestation to the State that they do not qualify for a Single Audit. 7.2.4. Pursuant to the Final Rule $200.512 (a)(1) the Single Audit must be completed and submitted to the Department within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or nine months after the end of the audit period. Ift the due date falls on a Saturday, Sunday, or federal holiday, the reporting package is due the next Business Day. 7.2.4.1. DELIVERABLE: Single Audit 7.2.4.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or nine months after the end ofi the audit period 7.2.5. IfContractor did not receive enough federal funds to require a Single Audit, Contractor shall submit an attestation form stating a Single Audit was not required utilizing the Department's template. 7.2.5.1. DELIVERABLE: Attestation Form 7.2.5.2. DUE: Within the earlier of 30 Calendar Days after receipt of the auditor's report(s), or nine months after the end ofthe audit period 7.2.6. The audit period shall be Contractor's fiscal year. 7.3. Treatment of Funds 7.3.1. All funding identified as a subaward with matching federal dollars received through this Contract is subject to the requirements within Uniform Guidance. 7.3.1.1. All subawards must be used on allowable expenses associated with performing the activities outlined in this Contract and on allowable expenses per Uniform Guidance. 7.3.1.2. Any subawards not used on the activities outlined in this Contract is subject to recovery at the end ofthe Period of] Performance as identified by the Department. 7.4. Subcontracting Subawards Exhibit B-5, Statement ofWork Page 40 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 7.4.1. Contractor shall ensure any Subcontractors performing activities outlined in this Contract on behalfofthe Contractor fulfill all obligations outlined within this Contract and all obligations ofa a subrecipient. 8. FINANCIAL TRANSPARENCY 8.1. Contractor shall comply with all transparency requirements pursuant to C.R.S. Title 25.5-6-1708. 8.2. Contractor shall ensure all documents are available on Contractor's website in an easily accessible location and format. Board ofDirector or Governing Body Changes 8.2.1. Contractor shall notify the Department in writing of any changes to the Board ofDirectors or Governing Body within 10 Business Days. 8.2.1.1. DELIVERABLE: Written notification of changes to Board of Director or Governing Body membership 8.2.1.2. DUE: Within 10 Business Days oft the effective date 9. COMPENSATION AND INVOICING 9.1. State General Fund Program Allocations 9.1.1. The Department will notify Contractor in writing of Contractor's individual allocation for State SLS, OBRA-SS, and FSSP for each State Fiscal Year. 9.1.2. Reimbursement for activities and services performed by Contractor shall not exceed the maximum amount identified in Contractor's individual allocation. Activities and services must be rendered during the State Fiscal Year. 9.1.3. The Department, in its sole discretion, may increase or decrease Contractor's individual allocations under this Contract by notifying Contractor's Representative. Increases or decreases in the amount of State funding during the term of this Contract may be made by written notice by the Department to Contractor or by amendment of the Contract. The circumstances may include but shall not be limited to: 9.1.3.1. Ifn necessary to fully utilize program appropriations. 9.1.3.2. Adjustments to reflect prior year final contract utilization and current year expenditures. 9.1.3.3. Supplemental appropriation changes resulting in an increase or decrease in the amounts originally appropriated and available for the purposes ofthis program. 9.1.3.4. Closure of programs and/or termination ofrelated contracts. 9.1.3.5. Delay or difficulty in implementing new programs or services. 9.1.3.6. Other special circumstances as deemed necessary by the Department. 9.1.3.7. Changes in Member utilization due to changing needs, new enrollments, terminations, and/or delays in services. 9.1.3.8. Target caseloads not being met. 9.2. State General Fund Program Target Caseloads 9.2.1. The Department will notify Contractor in writing of the target number of individuals that shall be served in State SLS, OBRA-SS, and FSSP prior to the start ofeach State Fiscal Year. 9.2.2. Contractor may choose to enroll more individuals in State SLS, OBRA-SS, and FSSP than authorized, ensuring all individuals can be served within the funding allocated. Exhibit B-5, Statement of Work Page 41 of49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 9.2.3. Target caseload is calculated by the Department using the unique number of Members that receive direct services during the contract period. 9.2.4. Contractor shall enroll Members into OBRA-SS ifthe need for services is identified through the PASRR Level II and shall notify the Department if sufficient funding is not available in Contractor's individual allocation to support the individual's needs or to enroll a Member into the program. 9.2.5. Contractor shall redirect unallocated funding from one State General Fund program to another to fully utilize funding allocated and best serve Member needs within the Defined Service Area. Contractor shall notify the Department if Contractor cannot use all of the funding allocated for State General Fund programs or if Contractor has additional funding needs that could support Members with unmet needs during the Fiscal Year. 9.3. State General Fund Program Compensation 9.3.1. The compensation under this Contract shall consist ofrates-based reimbursement intended to cover the costs of all State General Fund activities provided through this Contract. The Department shall pay Contractor for the State SLS and OBRA-SS activities at the rates specified in Exhibit C, Rates. Direct services for State SLS and OBRA-SS shall be reimbursed at the corresponding HCBS-SLS rates posted and distributed on the Department's website on the Provider Rates and Fee Schedule. Contractor shall be reimbursed for services that have individual support level rates at the level 4 rate for State SLS and at the level 6 rate for OBRA-SS. The Department shall pay Contractor for FSSP activities at the rates specified in Exhibit C, Rates. Direct services for FSSP shall be reimbursed at one dollar per unit. 9.3.2. The liability of the State, at any time, for such payment shall be limited to the unexpended amount remaining of such funds available to the Department. 9.3.3. Payments shall be made in accordance with rates as specified in Exhibit C, Rates of this Contract as determined by the Department and may be amended during the term of the contract using an Option Letter. When Contractor' S maximum allocation ofState funding has been paid to Contractor, no additional funds shall be provided under this Contract. 9.3.4. Payment pursuant to this Contract is contingent upon Contractor, or subcontractor(s), securing and properly maintaining all necessary licenses, certifications, approvals, etc., required to properly provide the services or goods covered by the contract. 9.3.5. The rates specified in Exhibit C; Rates are determined by the approved appropriation from the Colorado General Assembly. The Department, at its discretion, shall have the option to increase or decrease these rates as the Department determines is necessary based on its approved appropriation or to correct an administrative error in rate calculations. To exercise this option, the Department shall provide written notice to Contractor in a form substantially similar to the Sample Option Letter in the original Contract, and any new rates table or exhibit shall be effective as of the effective date of that notice unless the notice provides for a different date. The Department may modify the rates shown in this section based on the Medicaid Provider rate increases or decreases authorized by the Colorado legislature or due to an administrative error. Ifthe Department does modify these rates, the Department may modify them using an Option Letter. 9.3.6. The rates for State SLS and OBRA-SS direct services will be posted on the Department's website on the HCBS-SLS Provider Rates and Fee Schedule. Contractor shall bill all FSSP direct services at one dollar per unit. Exhibit B-5, Statement of Work Page 42 of 49 Docusign Envelope ID: ABEFO)FEDBSE454BAAFFA2A3A9FSODF 9.4. Adjustments to Fund Disbursement Amounts 9.4.1. The Department reserves the right to adjust during the Contract period and post-period adjustment to disbursements following the end ofthe Contract period, or an adjustment to the Fiscal Year contract if: 9.4.2. Contractor does not achieve the Performance Standards identified for each program. 9.5. Case Management Agency Compensation 9.5.1. The compensation under this Contract shall consist of rates-based reimbursement intended to cover the costs of all activities provided through this Contract. 9.5.2. Contractor will receive payment as specified in Exhibit C, Rates. 9.5.2.1. The rates specified in Exhibit C are determined by the approved appropriation from the Colorado General Assembly. The Department, at its discretion, shall have the option to increase or decrease these rates as the Department determines necessary based on its approved appropriation or to correct an administrative error in rate calculations. To exercise this option, the Department shall provide written notice to Contractor in a form substantially similar to the Sample Option Letter in the original Contract, and any new rates table or exhibit shall be effective as of the effective date of that notice unless the notice provides for a different date. The Department may modify the rates shown in this section based on the Medicaid Provider rate increases or decreases authorized by the Colorado legislature or due to an administrative error. If the Department does modify these rates, the Department may modify them through the use of an Option Letter. 9.6. Rural or Urban Designation 9.6.1. The Department shall determine whether Contractor is a Rural and Frontier or an Urban agency. 9.7. Detailed Invoicing and Payment Procedures 9.7.1. Contractor shall meet all data entry requirements published by the Department for Contract payments based on data entered into the CCM, invoices submitted, and deliverables submitted in order to be reimbursed for the activities described below. 9.7.2. Applications - HCBS-CES 9.7.2.1. Contractor shall submit all HCBS-CES applications to the Department's vendor for review and approval, as directed by the Department. The Department will pay for initial application per person applying for HCBS-CES per year, as well as CSR HCBS-CES application each year thereafter. The Department will not pay for initial or CSR applications that were denied due to being incomplete. Incomplete applications include any application that did not contain: a signature page, a completed Level of Care, DD or Delay Determination date, dates of service, or partial application (missing pages) which are required from Contractor necessary to process the application. An incomplete application denial is different than a denial fori the individual not meeting nighttime and/or daytime criteria. The Department will pay for HCBS-CES applications from reports received by the Department's S vendor on the 11th ofthe month for assessments from the previous month. 9.7.3. Appeal Packets and Hearing Attendance Exhibit B-5, Statement of Work Page 43 of49 Docusign Envelope ID: ABEFOFEDBSE4549AAOFFAZAA9FSOD: 9.7.3.1. Contractor shall ensure that all Appeal Packets and Hearing Attendance information is entered into the CCM within the required timeframe. The Department will pay for all Appeal Packets and Hearing Attendances from data pulled from the CCM on the 15th day of the month for Appeal Packets and Hearing Attendance from the previous month. Contractor shall maintain all supporting documentation and packets related to all Appeals. 9.7.4. At-Risk Diversion 9.7.4.1. Contractor shall complete all At-Risk Diversion activities as required by the Department and shall invoice the Department for all completed contacts by the 15th day of the month for all contacts completed in the previous month. The Department will pay for contacts once the invoice and supporting documentation are reviewed and accepted. 9.7.5. Case Management Training 9.7.5.1. Contractor shall submit the Case Management Training deliverable. Contractor will receive payment once the Department has reviewed and accepted the Deliverable. Ift the original submission is rejected by the Department, Contractor shall not receive payment until a revised deliverable has been received and accepted by the Department. Ifa case manager did not receive one or more of the required trainings prior to being assigned independent duties, Contractor shall not receive payment for the Deliverable until all trainings have been provided. Contractor shall have 30 Calendar Days to provide any outstanding trainings and resubmit the Deliverable. 9.7.6. Community Advisory Committee Updates 9.7.6.1. Contractor shall submit the Committee Updates Deliverable. Contractor shall receive payment once the Department has reviewed and accepted the Deliverable. If the Deliverable shows that no committee meeting updates have been included, Contractor shall not receive payment for the Deliverable. 9.7.7. Complaint Log and Trend Analysis 9.7.7.1. Contractor shall submit a quarterly Complaint Log and Trend Analysis deliverable. Contractor will receive payment once the Department has reviewed and accepted the Deliverable. Ifthe original submission is rejected by the Department, Contractor shall not receive payment until a revised deliverable has been received and accepted by the Department. 9.7.8. Continuous Quality Improvement Plan 9.7.8.1. Contractor shall submit the Continuous Quality Improvement Plan deliverable and updates. Contractor shall receive payment once the Department has reviewed and accepted the Deliverable. If the original submission is rejected by the Department, Contractor shall not receive payment until a revised deliverable has been received and accepted by the Department. 9.7.9. Critical Incident Quarterly Follow-Up Completion and Entry Performance Standard 9.7.9.1. Contractor is eligible to receive a quarterly performance-based payment for timely completion of the requested HCBS and CFC CIR follow-up action. To receive this quarterly performance-based payment, Contractor must have 90% of all CIRs assigned follow-up completed and entered into the CCM within the timelines assigned by the Department and/or Department Quality Improvement Organization. The Department will Exhibit B-5, Statement of Work Page 44 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9F50DF calculate Contractor" S performance at the close of each quarter to determine ifContractor will be awarded the performance-based payment. HCBS and SGF CIRs will be calculated and paid separately. 9.7.10. Critical Incident Reports and Critical Incident Report Administrative Review: HCBS IDD waivers 9.7.10.1. Contractor shall ensure all CIRs have been entered in the CCM within the required timeframe. The Department will pay per. Member enrolled each month based on actively enrolled Members pulled from the CCM on the 15th day of the month for HCBS-CES, HCBS-CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous month. 9.7.11. Critical Incident Reports: HCBS LTSS Waivers and CFC 9.7.11.1. Contractor shall ensure all CIRs have been entered in the CCM within the required timeframe. The Department will pay per. Member enrolled each month based on actively enrolled Members pulled from the CCM on the 15th day of the month for CHCBS, HCBS-BI, HCBS-CIH, HCBS- CWCHN, HCBS-CMHS, HCBS-EBD, and CFC. 9.7.12. Critical Incident Reporting and Critical Incident Report Administrative Review State SLS, OBRA-SS, FSSP 9.7.12.1. Contractor shall ensure all CIRs have been entered in the CCM within the required timeframe. The Department will pay for all State SLS, OBRA-SS, and FSSP CIRs MANE and CIRs non-MANE based on data pulled from the CCM on the 15th day ofthe month for CIRS from the previous month. 9.7.13. Developmental Disability and Delay Determinations 9.7.13.1. Contractor shall input all disability determinations into the CCM within the required timeframes. The Department will pay disabilityd determinations, based on data pulled from the CCM on the 15th day oft the month for determinations from the previous month. 9.7.14. Direct Services: State SLS, OBRA-SS, FSSP 9.7.14.1. Contractor shall submit the State General Fund program direct service expenditure report invoice for all direct service expenditures for State SLS, OBRA-SS, and FSSP by the 15th of each month. The Contract shall receive reimbursement for allowable direct services not to exceed maximum for State General Fund programs for all reimbursable activities for the fiscal year. 9.7.15. Testing for IDD Determinations 9.7.15.1. Contractor shall obtain prior approval from the Department for IDD Determination Testing funding by invoicing the Department each month for the costs of IDD Determination testing by the 15th day ofthe month. Ifa approved, the Department will pay for the actual cost oftesting once the request has been approved and the invoice has been reviewed and accepted. All invoices shall be submitted in the format prescribed by the Department. 9.7.16. Family Support Council Meetings 9.7.16.1. Contractor shall submit meeting minutes to the Department for FSC meetings attended by the 15th day of the month for meetings attended in the previous month, and by June 30th or the Fiscal Year end close date determined by the Department for all meetings attended in June. The Department will pay: for up to six FSC meetings for the Designated Exhibit B-5, Statement of Work Page 45 of4 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9F50DF Service Areas attended within the Fiscal Year once the invoice has been reviewed and accepted. Contractor shall maintain all supporting documentation related to an FSC meeting and make it available to the Department upon request. 9.7.17. FSSP Annual Report and Evaluation 9.7.17.1. Contractor shall submit an FSSP Annual Report and Evaluation on an annual basis to the Department. Contractor shall receive payment for the Deliverable after it has been reviewed and accepted by the Department. 9.7.18. HCBS-DD Waiting List Enrollment Capacity Building 9.7.18.1. The Department will pay Contractor for each new Member enrolled into the HCBS-DD waiver from the waiting list as authorized by the Department and as funding is appropriated and earmarked by the General Assembly. The Department will determine which HCBS-DD enrollments from the waiting list qualify for capacity building funding as defined in this Contract. 9.7.19. Human Rights Committee: HCBS IDD Waivers 9.7.19.1. Contractor shall create all HRC packets in accordance with Department requirements and timeframes. Contractor shall maintain all supporting documentation related to a Human Rights Committee meeting and make it available to the Department upon request. The Department will pay per Member enrolled each month based on actively enrolled Members pulled from the CCM on the 15th day of the month for HCBS-CES, HCBS- CHRP, HCBS-DD, and HCBS-SLS enrollments from the previous month. 9.7.20. Human Rights Committee Packet Creation: State SLS, OBRA-SS, FSSP 9.7.20.1. Contractor shall invoice the Department for all State SLS, OBRA-SS, and FSSP Member packets created during a Human Rights Committee meeting by the 15th day ofthe month for all meetings held in the previous month. The Department will pay for each packet created once the invoice has been reviewed and accepted. All invoices shall be submitted in the format prescribed by the Department. 9.7.21. Interim Support Level Assessments 9.7.21.1. Contractor shall submit all completed assessments in the timeline and manor specified by the Department. The Department will pay for all completed assessments based on data submitted by Contractor on the 15th of each month. 9.7.22. Level of Care Screen: Initial and Reassessments 9.7.22.1. Contractor shall conduct and enter all initial and reassessment Level of Care Screens into the CCM within the required timeframes. The Department will pay for initial and reassessment Level ofCare Screens based on data pulled from the CCM on the 15th day of the month for Screens conducted in the previous month. 9.7.23. Long-Range Plan 9.7.23.1. Contractor shall submit a Long-Range Plan on an annual basis and present it to the Department. Contractor shall receive payment for the Long-Range Plan after it has been reviewed and accepted by the Department. 9.7.24. Monitoring Contacts: State SLS and OBRA-SS Exhibit B-5, Statement of Work Page 46 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AA0P-FA243A9F50DF 9.7.24.1. Contractor shall conduct and enter all monitoring contacts for State SLS and OBRA-SS into the CCM within the required timeframe. Contractor shall receive payment for the four required monitoring contacts per support plan year. The Department will pay for monitoring contacts based on data pulled from the CCM on the 15th day ofthe month for contacts conducted in the previous month. 9.7.25. Most in Need Assessment: FSSP 9.7.25.1. Contractor shall conduct and enter all completed Needs Assessments into the CCM within the required timeframe. Contractor shall receive payment for one Needs Assessment for Members enrolled or on the FSSP ASAA waiting list per fiscal year. The Department will pay for Needs Assessments each month based on data pulled from the CCM on the 15th day of the month for assessments conducted in the previous month. 9.7.26. Needs Assessment: Initial and Reassessment 9.7.26.1. Contractor shall conduct and enter all initial and reassessment Needs Assessments into the CCM within the required timeframes. The Department will pay for initial and reassessment Needs Assessments based on data pulled from the CCM on the 15th day of the month for assessments conducted in the previous month. 9.7.27. Ongoing Case Management: State SLS, OBRA-SS, FSSP 9.7.27.1. Contractor shall conduct and enter all ongoing case management activities for State SLS, OBRA-SS, and FSSP into the CCM within the required timeframe. Contractor shall receive one ongoing case management payment each month per Member for allowable activities completed. The Department will pay for ongoing case management activities based on data pulled from the CCM on the 15th day oft the month for activities conducted in the previous month. 9.7.28. Operations Guide 9.7.28.1. Contractor shall develop an Operations Guide that meets all requirements outlined in this Contract for year one. Contractor shall receive payment for the Operations Guide once the deliverable has been reviewed and accepted by the Department. 9.7.29. Operations Guide Updates 9.7.29.1. Contractor shall review the Operations Guide for years two, three, four, and five oft this Contract, and determine if any modifications are required. Updates shall include but not be limited to any changes in the Work, in the Department' S processes and procedures, or in Contractor's processes and procedures. Contractor shall submit the Annual Operations Guide Update as well as a summary of all changes to the Department or an explanation demonstrating that the Operations Guide was reviewed, and Contractor determined that no edits were necessary. The Department shall review the Operations Guide Update and the summary to determine whether significant modifications were completed. Contractor shall receive payment for the updated Operations Guide only after the Department has determined that significant changes were made, and the Department has accepted the Deliverable. Ifminor changes or no changes were completed Contractor shall not receive payment for this deliverable. The Department does not consider changes such as updating dates, contact information or locations to be significant changes. 9.7.30. Rapid Reintegration Exhibit B-5, Statement ofWork Page 47 of49 Docusign Envelope ID: ABEFOFEDBSE4549AAOF-FA2AA9FSODF: 9.7.30.1. Contractor shall conduct and enter all Rapid Reintegration activities at the Level of Care Assessment into the CCM within the required timeframes. The Department will pay for Rapid Reintegration based on an invoice template provided by the Department or data pulled from the CCM on the 15th day of the month for Rapid Reintegration completed in the previous month. Rapid Reintegration shall include reimbursement for completing Rapid Reintegration barrier questions, assessment and support, and post survey questions. 9.7.31. Rural Travel Add-On for Rural and Frontier Counties 9.7.31.1. Contractor shall receive an additional payment for Rural Travel Add-On for Rural and Frontier Counties for the following activities only: initial and Reassessment Level ofCare Screen, initial and Reassessment Needs Assessment, In-person initial At-Risk Diversion outreach, State SLS and OBRA-SS In-Person Monitoring, and State SLS and OBRA-SS In-Person Individualized Support Plans. Payment shall be based on approved invoices or data pulled from the CCM on the 15th day ofthe month for activities from the previous month. 9.7.32. Support Need Level Assessment - HCBS-CHRP 9.7.32.1. Contractor shall maintain all supporting documentation related to the Support Need Level Assessment and make it available to the Department upon request. Contractor shall invoice the Department for all completed assessments by the 15th day of the month for all assessments completed in the previous month. The Department will pay for assessments once the invoice and supporting documentation are reviewed and accepted. 9.7.33. Waiting List Management 9.7.33.1. Contractor shall enter all waiting list management contacts with individuals and families into the CCM within the required timeframe. The Department will pay for required waiting list contacts from data pulled from the CCM on the 15th ofthe month for contacts from the previous month. The Department shall not pay for more than one contact per individual (18 and older) on the HCBS-DD ASAA, See Date and Safety Net waiting list and State SLS, OBRA-SS, or FSSP ASAA waiting list per year. Contractor shall only be reimbursed for one waiting list contact for the HCBS-DD, State SLS or FSSP waiting list when the event occurs during the same contact. 9.7.34. Year End Close Deadlines 9.7.34.1. The due dates identified in this section shall be adhered to, and information entered into the CCM and/or submitted to the! Department by a date identified in this Contract. For the month ofJune, the Department will notify Contractor oft the modified due date to account for year-end closing. Any submission past the assigned year end close date will not be reimbursed. 9.8. Payment and Billing Errors 9.8.1. Contractor shall review all payments made by the Department to ensure all activities are appropriately reimbursed. 9.8.2. Contractor shall notify the Department of any errors in billing or payment by the 15th ofthe month for the prior month's payment on the Department's prescribed template to ensure over and under payments are adjusted. 9.8.2.1. DELIVERABLE: Payment Correction Form Exhibit B-5, Statement ofWork Page 48 of 49 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 9.8.2.2. DUE: On the 15th of each month for corrections on the prior month's payment, with exception ofJune payments which must meet year-end close deadlines established by the Department. Contractor shall specify on the form if corrections have not been identified for the prior month's s payment. 9.9. Unexpended Funds 9.9.1. Contractor shall remit any Subawards disbursed under this Contract that are not expended by the close ofthe Period of Performance. 9.10. Closeout Payments 9.10.1. Notwithstanding anything to the contrary in this Contract, all payments for the final month of this Contract shall be paid to Contractor no sooner than 10 Business Days after the Department has determined that Contractor has completed all the requirements of the Closeout Period. Exhibit B-5, Statement of Work Page 49 of4 49 Docusign Envelope ID: A8EFO7F6-DB5E-4549-AAUF-F FA243A9F50DF EXHIBIT E-5, CONTRACTORS ADMINISTRATIVE REQUIREMENTS 1. CONTRACTOR'S GENERAL REQUIREMENTS 1.1. The Department will contract with only one organization, Contractor, and will work solely with that organization with respect to all tasks and deliverables to be completed, services to be rendered and performance standards to be met under this Contract. 1.2. Contractor shall serve as the Case Management Agency for the following counties: 1.2.1. Baca County 1.2.2. Kiowa County 1.2.3. Prowers County 1.3. Contractor may be privy to internal policy discussions, contractual issues, price negotiations, confidential medical information, Department financial information, advance knowledge of legislation and other Confidential Information. In addition to all other confidentiality requirements of the Contract, Contractor shall also consider and treat any such information as Confidential Information and shall only disclose it in accordance with the terms ofthe Contract. 1.4. Contractor shall work cooperatively with Department staff and, if applicable, the staff of other State contractors to ensure the completion of the Work. The Department may, in its sole discretion, use other contractors to perform activities related to the Work that are not contained in the Contract or to perform any of the Department" S responsibilities. In the event of a conflict between Contractor and any other State contractor, the State will resolve the conflict and Contractor shall abide by the resolution provided by the State. 1.5. Contractor shall inform the Department on current trends and issues in the healthcare marketplace and provide information on newt technologies in use that may impact Contractor'sr responsibilities under this Contract. 1.6. Contractor shall maintain complete and detailed records ofall meetings, system development life cycle documents, presentations, project artifacts, and any other interactions or Deliverables related to the Work described in the Contract. Contractor shall make such records available to the Department upon request throughout the term of the Contract. 1.7. Contractor shall submit a Media Event Report in instances where Contractor is contacted directly or indirectly by the media, including but not limited to newspaper or television, or Contractor believes an event has occurred that may result in what the Contractor deems to be potentially negative media coverage for Contractor's agency, the Department, or the Member's served by Contractor. Immediately following direct or indirect contact with or knowledge of media contact, Contractor must notify the Department using the template provided. 1.7.1. DELIVERABLE: Media Event Report 1.7.2. DUE: Immediately Following Direct or Indirect Contact with or Knowledge of Media Contact 1.8. Deliverables 1.8.1. All Deliverables shall meet Department-approved format and content requirements. The Department will specify the number of copies and media for each Deliverable. Exhibit E-5, Contractor's. Administrative! Requirements Page 1 of22 Docusign Envelope ID: ABEFOTFEDBSE4548AAOFFA2ASA9FSODF 1.8.1.1. Contractor shall submit each Deliverable to the Department for review and approval and shall adhere to the following Deliverable process such for any documentation creation, review, and acceptable cycle, Contractor shall: 1.8.1.1.1. Gather and document requirements for the Deliverable. 1.8.1.1.2. Create a draft in the Departmentapproved format for the individual Deliverable. 1.8.1.1.3. Perform internal quality control review(s) of the Deliverable, including, but not limited to: 1.8.1.1.3.1. Readability. 1.8.1.1.3.2. Spelling. 1.8.1.1.3.3. Grammar. 1.8.1.1.3.4. Completion. 1.8.1.1.3.5. Accessibility. 1.8.1.1.4. Adhere to all required templates or development of templates. 1.8.1.1.5. Perform modifications that include version control and tracked changes. 1.8.1.2. The Department will review the Deliverable and may direct Contractor to make changes to the Deliverable. Contractor shall make all changes within five Business Days following the Department's direction to make the change unless the Department provides a longer period in writing. 1.8.1.2.1. Changes the Department direct include, but are not limited to, modifying portions of the Deliverable, requiring new pages or portions of the Deliverable, requiring resubmission oft the Deliverable or requiring inclusion ofi information or components that were left out of the Deliverable. 1.8.1.2.2. The Department may also direct Contractor to provide clarification or provide a walkthrough of any Deliverable to assist the Department in its review. Contractor shall provide the clarification or walkthrough as directed by the Department. 1.8.1.3. Once the Department has received an acceptable version ofthe Deliverable, including all changes directed by the Department, the Department will notify Contractor of its acceptance of the Deliverable in writing. A Deliverable shall not be deemed accepted prior to the Department' S notice to Contractor ofi its acceptance ofthat Deliverable. 1.8.2. Contractor shall employ an internal quality control process to ensure that all Deliverables are complete, accurate, easy to understand and of high quality, as described herein. Contractor shall provide Deliverables that, at a minimum, are responsive to the specific requirements for that Deliverable, organized into a logical order, contain accurate spelling and grammar, are formatted uniformly, and contain accurate information and correct calculations. Contractor shall retain all draft and marked-up documents and checklists utilized in reviewing Deliverables for reference as directed by the Department. 1.8.3. In the event any due date for a Deliverable falls on a day that is not a Business Day, the due date shall be automatically extended to the next Business Day, unless otherwise directed by the Department. Exhibit E-5, Contractor's Administrativel Requirements Page 2 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9F50DF 1.8.4. All due dates or timelines that reference a period of days, months or quarters shall be measured in Calendar Days, months and quarters unless specifically stated as being measured in Business Days or otherwise. All times stated in the Contract shall be considered to be in Mountain Time, adjusted for Daylight Saving Time as appropriate, unless specifically stated otherwise. 1.8.5. No Deliverable, report, data, procedure or system created by Contractor for the Department that is necessary to fulfilling Contractor's responsibilities under the Contract, as determined by the Department, shall be considered proprietary. 1.8.6. If any Deliverable contains ongoing responsibilities or requirements for Contractor, such as Deliverables that are plans, policies or procedures, then Contractor shall comply with all requirements oft the most recently approved version ofthat Deliverable. Contractor shall not implement any version of any such Deliverable prior to receipt of the Department': S written approval of that version ofthat Deliverable. Once a version ofany Deliverable described in this subsection is approved by the Department, all requirements, milestones, and other Deliverables contained within that Deliverable shall be considered to be requirements, milestones and Deliverables oft this Contract. 1.8.6.1. Any Deliverable described as an update of another Deliverable shall be considered a version ofthe original Deliverable for the purposes oft this subsection. 1.9. Stated Deliverables and Performance Standards 1.9.1. Any section within this Statement of Work headed with or including the term DELIVERABLE" or PERFORMANCE STANDARD" is intended to highlight a Deliverable or performance standard contained in this Statement of Work and provide a clear due date for the Deliverables. The sections with these headings are for ease of reference not intended to expand or limit the requirements or responsibilities related to any Deliverable or performance standard, except to provide the due date for the Deliverables. 1.10. Communication with the Department 1.10.1. Contractor shall enable all Contractor staff to exchange documents and electronic files with the Department staff in formats compatible with the Department's systems, including Microsoft Office products. Contractor shall communicate with the Department's primary designee, who will be identified to Contractor, to obtain information about the specific Microsoft products currently in use, as may be upgraded from time to time. At a minimum, Contractor shall have the capability to exchange documents and electronic files compatible with Microsoft Office 365, unless the Department's primary designee otherwise specifies. If Contractor uses a compatible program, then Contractor shall ensure that all documents or files delivered to the Department are completely transferrable and reviewable, without error, on the Department': S systems. 1.10.2. The Department will use a transmittal process to provide Contractor with official direction within the scope ofthe Contract. Contractor shall comply with all direction contained within a completed transmittal. For a transmittal to be considered complete, it must include, at a minimum, all ofthe following: 1.10.2.1. The date the transmittal will be effective. 1.10.2.2. Direction to Contractor regarding performance under the Contract. Exhibit E-5, Contractor's. Administrative Requirements Page 3 of22 Docusign Envelope ID: ABEFOFEDBSE454BAAOFFA2AA9FSODF: 1.10.2.3. A due date or timeline by which Contractor shall comply with the direction contained in the transmittal. 1.10.2.4. The signature oft the Department employee who has been designated to sign transmittals. 1.10.2.4.1. The Department will provide Contractor with the name ofthe person it has designated to sign transmittals on behalf of the Department, who will be the Department's primary designee. The Department will also provide Contractor with a list ofbackups who may sign a transmittal on behalf of the Department if the primary designee is unavailable. The Department may change any of its designees from time to time by providing notice to Contractor through a transmittal. 1.10.2.5. The Department may deliver a completed transmittal to Contractor in hard copy, as a scanned attachment to an email or through a dedicated communication system, if such a system is available. 1.10.2.5.1. If a transmittal is delivered through a dedicated communication system or other electronic system, then the Department may use an electronic signature to sign that transmittal. 1.10.2.6. IfContractor receives conflicting transmittals, Contractor shall contact the Department's primary designee, or backup designees ifthe primary designee is unavailable, to obtain direction. If the Department does not provide direction otherwise, then the transmittal with the latest effective date shall control. 1.10.2.7. In the event that Contractor receives direction from the Department outside of the transmittal process, it shall contact the Department's primary designee, or backup designees if the primary designee is unavailable, and have the Department confirm that direction through a transmittal prior to complying with that direction. 1.10.2.8. Transmittals may not be used in place of an amendment, and may not, under any circumstances be used to modify the term ofthe Contract or any compensation under the Contract. Transmittals are not intended to be the sole means of communication between the Department and Contractor, and the Department may provide day-to-day communication to Contractor without using a transmittal. 1.10.2.9. Contractor shall retain all transmittals for reference and shall provide copies of any received transmittals upon request by the Department. 1.10.3. Contractor shall provide written notification to the Department in instances where Contractor has not been successful in meeting requirements or timelines identified in this Contract. This requirement applies to instances where multiple Members are impacted and there is an established pattern over time. Contractor shall not include single instances. This notification must be provided to the Department within three Business Days of discovery on a template provided by the Department. 1.10.3.1. DELIVERABLE: Self-Disclosure of Contract Requirements Not Met 1.10.3.2. DUE: Within Three Business Days of Discovery 1.11. Individual and Member Engagement 1.11.1. Person- and Family-Centered Approach Exhibit E-5, Contractor's. Administrative Requirements Page 4 of22 Docusign Envelope ID: ABEFOF6DBSE4549AAOFFA2AA9FSODF 1.11.2. Contractor shall actively engage Members in their health and well-being by demonstrating the following: 1.11.2.1. Responsiveness to Member and family/caregiver needs by incorporating best practices in communication and cultural responsiveness in service delivery. 1.11.2.2. Utilization ofvarious tools to communicate clearly and concisely. 1.11.2.3. Contractor shall align Member engagement activities with the Department's person- and family-centered approach that respects and values individual preferences, strengths, and contributions. 1.12. Cultural Responsiveness 1.12.1. Contractor shall comply with the requirements within 42 CFR $ 438.206(C)(2) to provide and facilitate the delivery of services in a culturally competent manner to all individuals and Members consistent with a Managed Care Organization. 1.12.2. Contractor shall provide all information for individuals and Members in a manner and format that may be easily understood and is readily accessible by individuals and Members. 1.12.3. Readily accessible is defined as electronic information and services that comply with modern accessibility standards, such as Section 508 of the Americans with Disabilities Act, Section 504 ofthe Rehabilitation Act. 1.13. Language Assistance Services 1.13.1. Contractor shall provide language assistance services including bilingual staff and/or interpreter services, at no cost to any individual or Member. Language assistance shall be provided at all points of contact, in a timely manner and during all hours of operation. 1.13.2. Contractor shall make oral interpretation available in all languages. 1.13.3. Contractor shall ensure the competence of language assistance provided by interpreters and bilingual staff. 1.13.4. Contractor shall not use family and friends to provide interpretation services except by request ofi the individual or Member. 1.13.5. Contractor shall provide interpreter services for all interactions with individuals and Members when there is no Contractor staff person available who speaks a language understood by an individual or Member. 1.13.6. Contractor shall notify individuals and Members verbally regarding the individual's or Member's right to receive the following language assistance services, as well as how to access the following language assistance services. 1.13.7. Oral interpretation for any language. Oral interpretation requirements apply to all non- English languages, not just those that the state identifies as prevalent. 1.13.8. Contractor shall ensure that language assistance-services shall include, but are not limited to, the use of auxiliary aids such as TTY/TDY and American Sign Language. 1.13.9. Contractor shall ensure that customer service telephone functions easily access interpreter or bilingual services. 1.14. Written Materials for Individuals and Members Exhibit E-5, Contractor's s Administrative Requirements Page 5 of22 Docusign Envelope ID: ABEF07F6DBSE4549. A0F-FA243A9FS0DF 1.14.1. Contractor shall ensure that all written materials it creates for distribution to individuals and Members meet all noticing requirements of 45 C.F.R. Part 92. 1.14.2. Contractor shall ensure that all written materials it creates for distribution to individuals and Members are culturally and linguistically appropriate to the recipient. 1.14.3. Contractor shall write all materials in easy-to-understand language. 1.15. Individual and Member Communications 1.15.1. Contractor shall maintain consistent communication, both proactive and responsive, with individuals and Members. 1.15.2. Contractor shall assist any individual or Member who contacts Contractor, including individuals and Members not in Contractor's Defined Service Area who need assistance with contacting their CMA, CCB, RAE, or other agencies. 1.16. Individual and Member Rights 1.16.1. Contractor shall have written policies guaranteeing each individual's and Member's right to be treated with respect and due consideration for their dignity and privacy. 1.16.2. Contractor shall provide information to individuals and Members regarding their rights that include, but are not limited to: 1.16.2.1. The right to be treated with respect and due consideration for their dignity and privacy. 1.16.2.2. The right to participate in decisions regarding their services. 1.16.2.3. The right to be free from any form of restraint or seclusion used as a means of coercion, discipline, convenience or retaliation. 1.16.2.4. The right to request and receive a copy of their records. 1.16.2.5. The right to obtain available and accessible services under the Contract. 1.16.3. Contractor shall post and distribute rights to individuals, including but not limited to: 1.16.3.1. Individuals/Members. 1.16.3.2. Individual'sMember's families. 1.16.3.3. Providers. 1.16.3.4. Case Workers. 1.16.3.5. Stakeholders. 1.17. Start-Up Plan 1.17.1. Contractor shall create a Start-Up Plan in year one of the Contract that contains, at a minimum, the following: 1.17.1.1. A description of all steps, timelines, and milestones necessary to fully transition the services described in the Contract from a prior contractor to Contractor. 1.17.1.2. A description of all steps, timelines, milestones, and Deliverables necessary for Contractor to be fully able to perform all Work by the Operational Start Date. 1.17.1.3. A listing of all personnel involved in the start-up and what aspect of the start-up they are responsible for. Exhibit E-5, Contractor's, Administrative Requirements Page 6 of22 Docusign Envelope ID: ABEFOTFEDBSE454BAP-AOFFA2ASA9FSODF 1.17.1.4. An operational readiness review for the Department to determine if Contractor is ready to begin performance of all Work. 1.17.1.5. The risks associated with the start-up and a plan to mitigate those risks. 1.17.1.5.1. DELIVERABLE: Start-Up Plan 1.17.1.5.2. DUE: 20 Calendar Days Prior to the Contract Start Date 1.18. Start-Up Period 1.18.1. With input from the Department, Contractor shall complete all of the following during the Start-Up Period in year one ofthe Contract: 1.18.1.1. Schedule and facilitate a Kickoff Meeting that includes the following: 1.18.1.1.1. Key Personnel. 1.18.1.1.2. Department Leadership. 1.18.1.1.3. Department Project Team Members. 1.18.1.1.4. Any other relevant and needed persons or organizations. 1.18.1.2. Develop Kickoff Meeting materials and an agenda that contains, at a minimum, the following: 1.18.1.2.1. Initial timelines for starting the Work and creating initial Deliverables. 1.18.1.2.2. Establishment of Communication channels to describe how the Work is to be completed. 1.18.1.2.3. Transmission methods and specific Deliverable templates or requirements. 1.18.1.2.4. Any other item required to initiate and ensure Work is started and completed on time. 1.18.1.3. Prepare Kickoff Meeting Minutes and deliver them to the Department for review and approval. 1.18.1.3.1. DELIVERABLE: Kickoff Meeting Agenda & Materials 1.18.1.3.2. DUE: Within three Business Days after the Kickoff Meeting 1.18.2. Policy and Procedures Manual 1.18.2.1. Create a Policy and Procedures Manual that contains the policies and procedures for all systems and functions necessary for Contractor to complete its obligations under the Contract. Such policies and/or procedures shall be included, but are: not limited to: 1.18.2.1.1. Determination of Developmental Disability 1.18.2.1.2. Defined Service Area Exceptions Process 1.18.2.1.3. Member Rights 1.18.2.1.4. Critical Incident Reporting 1.18.2.1.5. Gnievance/Complaint Procedures 1.18.2.1.6. Monitoring 1.18.2.1.7. Human Rights Committee Exhibit E-5, Contractor's Administrative Requirements Page 7 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOPF-FA243A9F50DF 1.18.2.1.8. Community Advisory Committee 1.18.2.1.9. Training 1.18.2.1.10. Case Management Operations 1.18.2.1.11. After-hours Policies and Procedures 1.18.2.1.12. Denial and Discontinuation ofServices 1.18.2.1.13. Safeguards Necessary to Prevent Conflict of Interest 1.18.2.2. Prepare all documents, forms, training materials, and any other documents, information and protocols that require approval by the Department prior to the end of the Start-Up Period and are necessary for Contractor to begin work on the Operational Start Date. Contractor shall deliver all documents, forms, training materials, and any other documents, information and protocols that require approval by the Department to the Department for review and approval in a timely manner that allows the Department to review and approve those documents prior to end ofthe Start-Up Period. 1.18.2.2.1. DELIVERABLE: Policies & Procedures Manual 1.18.2.2.2. DUE: No later than the Operational Start Date 1.19. Operations Guide 1.19.1. Contractor shall not engage in any Work under the Contract, other than the Work described in Sections 1.17 and 1.18 prior to the Operational Start Date. The Department shall not be liable to Contractor for, and Contractor shall not receive, any payment for any period prior to the Operational Start Date under this Contract. 1.19.2. Contractor shall create and implement an Operations Guide. The Operations Guide shall include the creation and management ofthe following: 1.19.2.1. Communication Plan. 1.19.2.2. Business Continuity Plan. 1.19.2.3. Closeout Plan. 1.19.3. Contractor shall submit the Operations Guide to the Department for review and approval. 1.19.3.1. DELIVERABLE: Operations Guide 1.19.3.2. DUE: Within 30 Business Days after the Effective Date 1.19.4. Contractor shall review its Operations Guide on annual basis and determine if any modifications are required to account for any changes in the Work, in the Department's processes and procedures or in Contractor's processes and procedures and update the Guide as appropriate to account for any changes. Contractor shall submit an Annual Operations Guide Update that contains all changes from the most recently approved prior Operations Guide or Annual Operations Guide Update or shall note that there were no changes. 1.19.4.1. DELIVERABLE: Annual Operations Guide Update 1.19.4.2. DUE: Annually, by July 31st 1.19.5. The Operational Start Date shall not occur until Contractor has completed all requirements ofthe Operations Guide unless the Department provides written approval otherwise. Exhibit E-5, Contractor's/ Administrative Requirements Page 8 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.19.6. Communication with Members, Providers, and Other Entities 1.19.6.1. Contractor shall create a Communication Plan that includes, but is not limited to, all of the following: 1.19.6.1.1. A description of how Contractor will communicate to Members any changes to the services those Members will receive or how those Members will receive the services. 1.19.6.1.2. A description of the communication methods, including things such as email lists, newsletters and other methods, that Contractor will use to communicate with Providers and Subcontractors. 1.19.6.1.3. The specific means of immediate communication with Members and a method for accelerating the internal approval and communication process to address urgent communications or crisis situations. 1.19.6.1.4. A general plan for how Contractor will address communication deficiencies or crisis situations, including how Contractor will increase staff, contact hours or other steps Contractor will take if existing communication methods for Members or Providers are insufficient. 1.19.6.1.5. A listing ofthe following individuals within Contractor's organization, including cell phone numbers and email addresses: 1.19.6.1.5.1. An individual who is authorized to speak on the record regarding the Work, the Contract or any issues that arise that are related to the Work. 1.19.6.1.5.2. An individual who is responsible for any website or marketing related to the Work. 1.19.6.1.5.3. Back-up communication staff that can respond in the event that the other individuals listed are unavailable. 1.19.6.1.5.4. An outline of the process for the Contractor's communication, timely responses and emergency protocols in the event there is a natural disaster or Pandemic. 1.19.6.1.5.5. Communication Plan shall include steps for responding to the Department, provider agencies, Members and community organizations in the event there is a natural disaster or Pandemic. 1.19.7. Business Continuity Plan 1.19.7.1. Contractor shall create a Business Continuity Plan that Contractor will follow in order to continue operations after a Disaster or a Business Interruption to include but not limited to a Disaster, Pandemic, power outage, strike, loss of necessary personnel, or computer virus. The Business Continuity Plan shall include, but is not limited to, all of the following: 1.19.7.1.1. The essential services and functions provided by Contractor. 1.19.7.1.2. The lead person and response team responsible for implementing the business continuity plan, individual/team roles, and contact information. 1.19.7.1.3. How emergency responses procedures will be implemented and who will activate the business continuity plan. Exhibit E-5, Contractor's. Administrative Requirements Page 9 of22 Docusign Envelope ID: ABEFOTFEDBSE4549AAOPFA2A3A9FSODF 1.19.7.1.4. How Contractor will implement a flexible work plan that includes social distancing, hygiene etiquette, cancellation ofnon-essential activities, closure ofbuildings, and/or relocation to alternative facilities. 1.19.7.1.5. How Contractor will address training personnel, preparing equipment, and backup systems. 1.19.7.1.6. How Contractor will address budget and finance mechanisms to ensure financing of essential services. 1.19.7.1.7. How Contractor will ensure necessary supplies and equipment are available to maintain essential services. 1.19.7.1.8. How Contractor will replace staff that are lost or unavailable during or after a Business Interruption sO that the Work is performed in accordance with the Contract. 1.19.7.1.9. How Contractor will manage employees who are exposed to a Pandemic related illness or are suspected to be ill or become ill at a worksite, such as infection control response and immediate mandatory sick leave. 1.19.7.1.10. How Contractor will ensure or enhance communication and information technology infrastructure to support tele-commuting. 1.19.7.1.11. How Contractor will back-up all information necessary to continue performing the Work remotely, SO that no information is lost because ofa Business Interruption. 1.19.7.1.12. In the event of a Disaster, the plan shall also include how Contractor will make all information available at its back-up facilities. 1.19.7.1.13. How Contractor will maintain complete back-up copies of all data, databases, operating programs, files, systems, and software pertaining to enrollment information at a Department-approved, off-site location. 1.19.7.1.14. How Contractor will minimize the effects on Members of any Business Interruption to include how Contractor will notify Members of closures and cancellations. 1.19.7.1.15. How Contractor will communicate with the Department during the Business Interruption and points of contact within Contractor's organization the Department can contact in the event ofa Business Interruption. 1.19.7.1.16. How Contractor will transition from in-person meetings to conference calls or other virtual platforms or cancel or delay meetings as necessary. 1.19.7.1.17. Planned long-term back-up facilities out ofwhich Contractor can continue operations after a Disaster. 1.19.7.1.18. The time period it will take to transition all activities from Contractor's regular facilities to the back-up facilities after a Disaster. 1.19.7.1.19. How Contractor will prepare necessary internal staff for implementing the business continuity plan, which may include tests, drills, or training annually and revising the plan based on lessons learned. 1.19.7.1.20. How Contractor will identify and engage with external organizations to help the community, such as sharing best practices and sharing timely and accurate information about a Business Interruption. Exhibit E-5, Contractor's Administrative: Requirements Page 10 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.19.7.1.21. How Contractor will implement steps to return to normal after a Business Interruption. 1.19.8. Closeout Plan 1.19.8.1. Contractor shall create a Closeout Plan that describes all requirements, steps, timelines, milestones, and Deliverables necessary to fully transition the services described in the Contract from Contractor to the Department or to another contractor selected by the Department to be Contractor after the termination of the Contract. The Closeout Plan shall include, but is not limited to: 1.19.8.1.1. Transfer of individuals and Members 1.19.8.1.2. Transfer of documentation to include all electronic and physical documentation. 1.19.8.1.3. Transfer of all individual and Member records through the Department Case Management Systems. 1.19.8.1.4. Transfer of services 1.19.8.1.5. Transfer of Case Management Services 1.19.8.2. The Closeout Plan shall also designate an individual to act as a closeout coordinator who will ensure that all requirements, steps, timelines, milestones, and deliverables contained in the Closeout Plan are completed and work with the Department and any other contractor to minimize the impact of the transition on Members and the Department. 1.19.8.2.1. Contractor shall ensure all policy, procedures, training, and appeals information are transferred to the Department. 1.19.8.3. Contractor shall deliver the Closeout Plan to the Department for review and approval. 1.19.8.4. Contractor shall provide weekly updates to the Department throughout the creation ofand the performances within the Operations Guide, that show Contractor's status toward meeting the milestones described herein. 1.19.8.5. Contractor shall be ready to perform all Work by the Operational Start Date. 1.19.9. Closeout Period 1.19.9.1. During the Closeout Period, Contractor shall complete all of the following: 1.19.9.1.1. Implement the most recent Closeout Plan or Closeout Plan Update as approved by the Department in the Operations Guide, as described herein and complete all steps, Deliverables and milestones contained in the most recent Closeout Plan or Closeout Plan Update that has been approved by the Department. 1.19.9.1.2. Provide to the Department, or any other contractor at the Department's direction, all reports, data, systems, Deliverables, and other information reasonably necessary for ai transition as determined by the Department or included in the most recent Closeout Plan or Closeout Plan Update that has been approved by the Department. 1.19.9.1.3. Ensure that all responsibilities under the Contract have been transferred to the Department, or to another contractor at the Department's direction, without significant interruption. 1.19.9.1.4. Notify any Subcontractors of the termination of the Contract, as directed by the Department. Exhibit E-5, Contractor's Administrative Requirements Page 11 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.19.9.1.5. Notify all Members that Contractor will no longer be the CMA as directed by the Department. Contractor shall create these notifications and deliver them to the Department for approval. Once the Department has approved the notifications, Contractor shall deliver these notifications to all Members, but in no event shall Contractor deliver any such notification prior to approval of that notification by the Department. 1.19.9.1.5.1. DELIVERABLE: Member Notifications 1.19.9.1.5.2. DUE: 90 Calendar Days prior to termination of the Contract 1.19.9.2. Continue meeting each requirement of the Contract as described in the Department- approved and updated Closeout Plan, or until the Department determines that specific requirement is being performed by the Department or another contractor, whichever is sooner. The Department will determine when any specific requirement is being performed by the Department or another contractor and will notify Contractor of this determination for that requirement. 1.19.9.3. The Closeout Period may extend past the termination of the Contract. The Department will perform a closeout review to ensure that Contractor has completed all requirements of the Closeout Period. If Contractor has not completed all of the requirements of the Closeout Period by the date of the termination of the Contract, then any incomplete requirements shall survive termination oft the Contract. 1.19.10. Long-Range Plan 1.19.10.1. The Contractor shall create and present to the Department a Long-Range Plan for its Defined Service Area that describes, at a minimum, the following: 1.19.10.1.1. Administrative and case management accomplishments of Contractor in the previous year. 1.19.10.1.2. Identified unmet needs of eligible persons in the Defined Service Area and action steps necessary to meet those needs. 1.19.10.1.3. How Contractor will solicit input from Members and families to ensure quality services. 1.19.10.1.4. Local area issues that impact or are expected to impact the Defined Service Area and action steps on how to resolve those issues. 1.19.10.1.5. Policies that are considered by Contractor to be a barrier to ensuring a comprehensive case: management system and suggested modifications to overcome the barriers. 1.19.10.1.6. A summary ofhow Contractor is working to recruit and retain case management staff currently and for the future to maintain and improve the case management services in its Defined Service Area. 1.19.10.1.7. A summary of how Contractor is working to recruit new and existing providers to expand their services in the Defined Service Area. 1.19.10.1.8. A summary of past efforts and future plans to accelerate access for people with disabilities. 1.19.10.1.9. The Contractor's efforts to recruit members of the Community Advisory Committee who represent the characteristics oft the community. Exhibit E-5, Contractor's Administrative! Requirements Page 12 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9FS0DF 1.19.10.1.10. How Contractor will engage with and facilitate existing social networks including, but not limited to: CCBs, RAEs, Behavioral Health Authorities, schools, nursing facilities and other unpaid supports and advocacy partners will be used to support Members in the Defined Service Area. 1.19.10.1.11. How State General Fund programs and supports will be used to support individuals, Members, and families within the Defined Service Area. 1.19.10.1.12. How feedback will be obtained from community members, Members receiving services, and individuals seeking or waiting for services and how the feedback will be incorporated into strategies for delivering case management services within the Defined Service Area. 1.19.10.1.12.1. DELIVERABLE: Long-Range Plan 1.19.10.1.12.2. DUE: At this interval: 1.19.10.1.13. September 15, 2026 for Contractors with names beginning in A through M 1.19.10.1.14. September 15, 2027 for Contractors with names beginning in N through Z 1.19.10.1.15. September 15, 2028 for Contractors with names beginning in A through M 1.19.10.1.16. September 15, 2029 for Contractors with names beginning in N through Z 1.19.10.2. Contractor shall present the key findings from the Long-Range Plan to the Department within 20 Business Days of the Long-Range Plan being submitted to the Department. 1.19.10.3. Contractor shall make any changes to the Long-Range Plan as directed by the Department and resubmit the Deliverable within 10 Business Days of the request. 1.19.11. Community Advisory Committee 1.19.11.1. Within 30 Calendar Days of the Contract execution date, Contractor shall establish a Community Advisory Committee ofno less than five committee members that will meet at least quarterly1 to obtain public input and guidance for CMA operations and follow rules and regulations set forth in C.R.S. 8.7201.C. 1.19.12. The Community Advisory Committee shall include, but not be limited to, at least one person as the regional representation from among the following categories: 1.19.12.1. The Defined Service Area's county commissioners, area agencies on aging, medical professionals, physical and/or intellectual disability professionals, ombudsmen, human services agencies, county government officials, mental/behavioral health professionals, and 1.19.12.2. Regional representation from one or more LTSS Members or family members of individuals receiving LTSS and make every effort to recruit and maintain a majority of individuals with this lived experience on the committee: 1.19.12.2.1. Members with I/DD and/or 1.19.12.2.2. Members with disabilities 1.19.12.2.3. Members shall be given priority of selection over family members. 1.19.13. Contractor shall submit the Community Advisory Committee member list annually on the template prescribed by the Department. Exhibit E-5, Contractor's. Administrative Requirements Page 13 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9F50DF 1.19.14. IfContractor is unable to recruit and maintain a majority ofmembers, advocates, and people with lived experience on the committee, Contractor shall outline efforts to do SO with their deliverable submissions. 1.19.14.1. DELIVERABLE: Community Advisory Committee Member List 1.19.14.2. DUE: Annually, by August 15th 1.19.15. Contractor shall notify the Department of any changes to Community Advisory Committee membership within 10 Business Days of the date of change. 1.19.15.1. DELIVERABLE: Community Advisory Committee Membership Updates 1.19.15.2. DUE: Within 10 Business Days oft the date of change to the membership list. 1.19.16. The Community Advisory Committee shall include at least two regional representatives of individuals or family members of individuals receiving long-term disability and/or I/DD services. 1.19.17. The Contractor shall demonstrate efforts to recruit members oft the committee who represent the characteristics ofthe community. These efforts shall be reflected in the Long-Range Plan. 1.19.18. The Community Advisory Committee is an advisory body to the Contractor that provides recommendations and is not a decision-making body. As such the Community Advisory Committee shall: 1.19.18.1. Provide public input and guidance to the Contractor in the review of service delivery policies and procedures, marketing strategies, resource development, overall operations, service quality, individual Member satisfaction and other related programmatic opportunities. The Contractor shall receive and consider recommendations from the Community Advisory Committee to modify policies and procedures to address systemic barriers at a local or regional level, in the Long-Range Plan. 1.19.18.2. Support the Contractor with developing strategies for resolving complaints at the local or regional level. 1.19.18.3. Maintain and post public notices of meetings, meeting minutes, and documented follow up on Contractor': S website. 1.19.18.4. Contractor shall post the meeting date, time, and location ofthe meeting and the meeting agenda at least 10 Business Days prior to the meeting on Contractor's website. 1.19.18.5. Contractor shall post meeting minutes and any related follow-up action items once approved by the Community Advisory Committee and Contractor on Contractor's website. 1.19.18.6. Report to the Contractor's governing body or board of directors quarterly on all case management complaints trends and follow-up completed by the Contractor. 1.19.18.7. Provide reports to the Department and its committees upon request. 1.19.18.8. The Community Advisory Committee may be combined in purpose or name with other CMA committees in the Contractor's defined service area SO long as it meets the above purpose, criteria, and reports. 1.19.18.9. The Community Advisory Committee must use the operational templates prescribed by the Department as minimum standards. Exhibit E-5, Contractor's. Administrativel Requirements Page 14 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.19.18.9.1. DELIVERABLE: Semi-annual Community Advisory Committee Meetings Summary 1.19.18.9.2. DUE: Semi-Annually, for meetings held between July 1st and December 31st, Committee Updates are due January 15th, > and for meetings held between January 1st through June 15, Committee Updates are due June 15th 1.20. Performance Reviews 1.20.1. The Department may conduct performance reviews or evaluations of Contractor in relation to the Work performed under the Contract. 1.20.2. The Department may work with Contractor in the completion of any performance reviews or evaluations or the Department may complete any or all performance reviews or evaluations independently, at the Department's: sole discretion. 1.20.3. Contractor shall provide all information necessary for the Department to complete all performance reviews or evaluations, as determined by the Department, upon the Department's request. Contractor shall provide this information regardless of whether the Department decides to work with Contractor on any aspect of the performance review or evaluation. 1.20.4. The Department may conduct these performance reviews or evaluations at any point during the term ofthe Contract, or after termination ofthe Contract for any reason. 1.20.5. The Department may make the results of any performance reviews or evaluations available to the public or may publicly post the results ofany performance reviews or evaluations. 1.20.6. The Department may recoup funding as a result of any performance review or evaluation where payment was rendered for services not complete or not in alignment with federal and/or state regulations or this Contract. 1.21. Corrective Action Plan 1.21.1. When the Department determines that Contractor is not in compliance with any term oft this Contract, Contractor, upon written notification by the Department, shall develop a corrective action plan. Corrective action plans shall include, but not be limited to: 1.21.1.1. A detailed description of actions to be taken including any supporting documentation. Contractor's employee(s) responsible for implementing the actions. 1.21.1.2. The implementation time frames and a date for completion. 1.21.2. Contractor shall submit the Corrective Action Plan to the Department within 10 Business Days oft the receipt of a written request from the Department. 1.21.2.1. DELIVERABLE: Corrective Action Plan 1.21.2.2. DUE: Within 10 Business Days of receipt of a written request from the Department 1.21.3. Contractor shall notify the Department in writing, within three Business Days, ifit will not be able to present the Corrective Action Plan by the due date. Contractor shall explain the rationale for the delay and the Department may grant an extension, in writing, of the deadline for Contractor's compliance. Exhibit E-5, Contractor's. Administrative! Requirements Page 15 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOF-FA243A9FS0DF 1.21.4. Upon receipt ofContractor's Corrective Action Plan, the Department will accept, modify, or reject the proposed Corrective Action Plan. Modifications and rejections shall be accompanied by a written explanation. 1.21.5. In the event of a rejection of Contractor's Corrective Action Plan Contractor shall re-write a revised Corrective Action Plan and resubmit it along with requested documentation to the Department for review. 1.21.5.1. DELIVERABLE: Revised Corrective Action Plan 1.21.5.2. DUE: Within five Business Days of the Department's rejection 1.21.6. Upon acceptance by the Department Contractor shall implement the Corrective Action Plan. 1.21.7. If corrections are not made by the timeline and/or quality specified by the Department then funds may be withheld from this Contract. Payments of funds from this Contract will resume beginning the month that the correction is made and accepted by the Department. 1.21.8. As part of the Corrective Action Plan, supporting documentation demonstrating that deficiencies have been remediated may be required. Contractor shall ensure all supporting documentation is submitted within the timeframes established in the Corrective Action Plan. 1.21.9. Upon receipt of Contractor's supporting documentation, the Department will accept, request modifications, or reject the documentation. Modifications and rejections shall be accompanied by a written explanation. 1.21.10. In the event of a rejection of Contractor's supporting documentation to the Corrective Action Plan, Contractor shall correct and resubmit the supporting documentation to the Department for review. 1.21.11. If a Corrective Action Plan or any supporting activities or documentation are required to correct a deficiency, are not submitted within the requested timeline and/or quality specified by the Department, funds may be suspended or withheld from this Contract. 1.21.11.1. DELIVERABLE: Revised Supporting Documentation 1.21.11.2. DUE: Within five Business Days oft the Department's rejection 1.21.12. Ifcorrections are not made bythe timeline and quality specified by the Department then funds may be withheld and recovered from this Contract. Payments offunds from this Contract will resume beginning the month that the correction is made and accepted by the Department. 1.22. Renewal Options and Extensions 1.22.1. The Department may, within its sole discretion, choose to not exercise any renewal option in the Contract for any reason. If the Department chooses to not exercise an option, it may reprocure the performance ofi the Work in its sole discretion. 1.22.2. The Parties may amend the Contract to extend beyond eight years, in accordance with the Colorado Procurement Code and its implementing rules, in the event that the Department determines the extension is necessary to align the Contract with other Department contracts, to address state or federal programmatic or policy changes related to the Contract, or to provide sufficient time to transition the Work. 1.23. Department System Access Exhibit E-5, Contractor's. Administrative! Requirements Page 16 of2 22 Docusign Envelope ID: ABEFOTFEDBSE454B/AAOFFAZAA9FSODF: 1.23.1. In the event that Contractor requires access to any Department computer system to complete the Work, Contractor shall have and maintain all hardware, software, and interfaces neçessary to access the system without requiring any modification to the Department's system. Contractor shall follow all Department policies, processes, and procedures necessary to gain access to the Department's systems. 1.23.2. Contractor shall be responsible for any costs associated with obtaining and maintaining access to systems needed to perform the Work under this solicitation, as determined by the Department. The Department will not reimburse Contractor for any costs associated with obtaining and maintaining access to Department systems. 1.24. Provider Fraud 1.24.1. Contractor shall notify the Department and the Colorado Medicaid Fraud Control Unit ofthe Colorado Department ofLaw (MFCU) ifi it identifies or suspects possible Provider Fraud as ai result of any activities in its performance of this Contract. 1.24.2. Upon identification or suspicion of possible Provider Fraud, Contractor shall complete Contractor Suspected Fraud Written Notice Form provided by the Department. 1.24.2.1. For each incident of identified or suspected Provider Fraud, Contractor shall provide all ofthe following, at a minimum: 1.24.2.1.1. Written documentation oft the findings. 1.24.2.1.2. Information on any verbal or written reports. 1.24.2.1.3. All details ofthe findings and concerns, including a chronology ofContractor actions which resulted in the reports, in a format agreed to by the Department. 1.24.2.1.4. Information on the identification of any affected claims that have been discovered. 1.24.2.1.5. Any claims data associated with its report (in a mutually agreed upon format, if possible). 1.24.2.1.6. Any additional information as required by the Department. 1.24.3. For each incident of identified or suspected Provider Fraud, Contractor shall deliver the completed Contractor Suspected Fraud Written Notice Form to the Department and the MFCU. 1.24.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form 1.24.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or suspected Fraud 1.24.4. Contractor shall revise or provide additional information related to Contractor Suspected Fraud Written Notice Form as requested by the Department or the MFCU. 1.24.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional Information 1.24.4.2. DUE: Within three Business Days following the Department's or the MFCU's request, unless the Department or MFCU provides for a different period in its request. 1.25. Member Fraud Exhibit E-5, Contractor's. Administrative Requirements Page 17 of22 Docusign Envelope ID: A8EF07F6-DB5E-4549-AAOP-FA243A9F50DF 1.25.1. Contractor shall notify the Department if it identifies or suspects possible Member Fraud as ai result of any activities in its performance ofthis Contract. 1.25.2. Upon identification or suspicion of possible Member Fraud, Contractor shall complete Contractor Suspected Fraud Written Notice Form provided by the Department. 1.25.2.1. For each incident of identified or suspected Member Fraud, Contractor shall provide all oft the following, at a minimum: 1.25.2.1.1. All verbal and written reports related to the suspected fraud. 1.25.2.1.2. All details of the findings and concerns, including a chronology ofContractor actions which resulted in the reports, and the Member's State ID number, and Member's date of birth ifa applicable. 1.25.2.1.3. Information on the identification of any affected claims that have been discovered. 1.25.2.1.4. Any claims data associated with its report in a format agreed to by the Department. 1.25.2.1.5. Any additional information as required by the Department. 1.25.3. For each incident of identified or suspected Member Fraud, Contractor shall deliver the completed Contractor Suspected Fraud Written Notice Form to the Department at report.clienttraud@state.co.us, or at such other email address as provided by the Department from time to time. 1.25.3.1. DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form 1.25.3.2. DUE: Within three Business Days following the initial discovery of the Fraud or suspected Fraud 1.25.4. Contractor shall revise or provide additional information related to Contractor Suspected Fraud Written Notice Form as requested by the Department. 1.25.4.1. DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional Information 1.25.4.2. DUE: Within three Business Days following the Department's request, unless the Department provides for a different period in its request. 2. CONTRACTOR PERSONNEL 2.1. Personnel General Requirements 2.1.1. Contractor shall provide qualified Key Personnel and Other Personnel as necessary to perform the Work throughout the term ofthe Contract. 2.2. The following positions can concurrently be assigned to other CMA contractual designee roles and responsibilities as needed by the CMA but must be included in at least one position description within the CMA. 2.2.1. Contractor shall designate the following Key Personnel positions: 2.2.1.1. Executive Director or Administrator 2.2.1.2. Finance Director 2.2.1.3. Case Management Director 2.2.1.4. Continuous Quality Improvement Lead Exhibit E-5, Contractor's Administrative Requirements Page 18 of22 Docusign Envelope ID: ABEFO7F6DBSE4549AAP-AOFFA2ASA9FSODF 2.2.1.5. Contract Lead 2.2.1.6. Information Technology Liaison 2.2.1.7. Regional Accountable Entity (RAE) Liaison 2.2.1.8. Medical Assistance (MA) Site/County Eligibility Liaison 2.2.1.9. Member and Family Liaison 2.2.2. The Contract Lead shall be responsible for all the following: 2.2.2.1. Serving as Contractor': s primary point of contact for the Department. 2.2.2.2. Serving as Contractor's primary point of contact for contract deliverables and other contract-related questions or issues for the Department. 2.2.2.3. Ensuring the completion of all Work in accordance with the Contract's requirements. This includes, but is not limited to, ensuring the accuracy, timeliness, and completeness of all work. 2.2.2.4. Ensuring the timely submission and accuracy of all Deliverables submitted to the Department. 2.2.3. The Continuous Quality Improvement Lead shall be responsible for all the following: 2.2.3.1. Development, implementation and ongoing oversight of the Contractors Continuous Quality Improvement Plan, 2.2.3.2. Reporting to the Department on identified quality trends 2.2.3.3. Operate as the Contractor's point of contact for activities including but not limited to Quality Improvement Strategies, Performance and Quality Reviews, Corrective Action Plan implementation. 2.2.4. The Information Technology Liaison shall be responsible for all the following: 2.2.4.1. Operate as the Contractor's point of contact for CCM and Bridge vendors, 2.2.4.2. Provide oversight of data integrity within Contractor system(s), if applicable, and data entered into CCM and Bridge. 2.2.5. The RAE Liaison shall be responsible for all the following: 2.2.5.1. Coordination between Contractor and the RAE(s) contracted within the Contractor's designated service area, 2.2.5.2. Actively participate in RAE/CMA workgroup meetings. 2.2.6. The MA Site/County Eligibility Liaison shall be responsible for all oft the following: 2.2.6.1. Coordination between Contractor and MA Site/County Eligibility within the Contractor designated service area, 2.2.6.2. Establishing and maintaining point of contact between agencies for Member escalations as they occur. 2.2.7. The Member and Family Liaison shall be responsible for all the following: 2.2.7.1. Regulatory and contractual requirements of Community Advisory Committee, Exhibit E-5, Contractor's. Administrative Requirements Page 19 of22 Docusign Envelope ID: ABEFO7FEDBSE464SAAAAOFFA2AA9FSODF 2.2.7.2. CMA internal policies and procedures to ensure Member and family access to a primary point ofcontact at the CMA to ensure al Member and family always have aj point of contact regardless of case management assigned, 2.2.7.3. CMA internal policies and procedures to ensure Member and family access to communication in their primary language and any reasonable accommodations, 2.2.7.4. CMA internal policies and procedures to review: 2.2.7.4.1. Critical Incident Reports Trends Analysis, 2.2.7.4.2. Complaints and Grievances, 2.2.7.5. Review and ensure responses occur to urgent and prioritized needs as outlined in the Member's contingency plan and/or back-up plan and the CMA's After-hours policy and procedures as outlined in 1.18.2 to mitigate health and safety risks and deploy appropriate community resources. 2.2.8. Contractor shall post the name and contact information for the individual appointed as the Member and Family Liaison on Contractor's website. 2.2.9. Contractor shall provide the Department with a final list of individuals assigned to the Contract and appropriate contact information for those individuals using the template provided by the Department. Contractors with more than one Defined Service Area must submit the final list of individuals assigned to the Contract using the template provided by the Department for each Defined Service Area. The Department shall determine which Key Personnel may be allocated across organizational functions, which Key Personnel must be dedicated to the Contract, and which Key Personnel or Other Personnel must be dedicated to each Defined Service Area. 2.2.9.1. DELIVERABLE: Key Personnel, final list of individuals assigned to the Contract 2.2.9.2. DUE: Within five Business Days after the Effective Date and annually by July 15th 2.2.10. Contractor shall update this list upon the Department" S request to account for changes in the individuals assigned to the Contract. 2.2.10.1. DELIVERABLE: Key Personnel, updated list ofindividuals assigned to the Contract 2.2.10.2. DUE: Within five Business Days after any change to the Key Personnel list 2.2.11. Contractor shall not permit any individual proposed for assignment to Key Personnel positions to perform any Work prior to the Department's approval of that individual to be assigned as Key Personnel. 2.2.12. Other Personnel 2.2.12.1. Contractor shall have sufficient staffing levels to include case managers, case aids, supervisors, and other staff as necessary to complete the Work and to maintain caseload sizes to support the Work. Contractor shall meet or exceed best practice standards as set forth by the Department. Contractor shall not exceed the best practice caseload size standard of 1:65 without written approval from the Department. 2.2.12.2. Contractor's Case Manager(s) shall meet all the qualifications listed in 10 C.C.R. 2505- 10, Section 8.7203.A et seq. Exhibit E-5, Contractor's Administrative! Requirements Page 20 of2 22 Docusign Envelope ID: ABEFOTF6DBSE4549AAOFFA2ASA9FSODF 2.2.12.3. Contractor shall ensure appropriate staffing and infrastructure to address the needs of all populations including children and adults for all HCBS waivers and CFC. 2.3. Background Checks 2.3.1. Contractor shall conduct background checks on all new applicants for positions in which direct care, as defined in section $26.3.1.101(3.5), C.R.S. will be provided to an at-risk adult, as defined in section $26-3.1-101 (1.5), C.R.S to include at a minimum a Colorado Bureau of Investigation check. On and after January 1, 2019, prior to employment, Contractor shall submit the name of aj person who will be providing direct care, to an at-risk adult, as well as any other required identifying information, to the Colorado Department of Human Services for a check of the Colorado Adult Protective Services data system pursuant to section $26- 3.1-111, C.R.S. to determine ifthe person is substantiated in a case of mistreatment of an at- risk adult. 2.3.2. If any of Contractor's Key Personnel, or Other Personnel, are required to have and maintain any professional licensure or certification issued by any federal, state, or local government agency, then Contractor shall maintain copies of such current licenses and certifications and provide them to the Department upon request. 2.4. Personnel Availability 2.4.1. Contractor shall ensure Key Personnel and Other Personnel assigned to the Contract are available for meetings with the Department during the Department' S normal business hours, as determined by the Department. Contractor shall also make these personnel available outside oft the Department' s normal business hours and on weekends with prior notice from the Department. 2.4.2. Contractor shall ensure that appropriate Key Personnel and Other Personnel are available for all regularly scheduled meetings between the Contractor and the Department. The Department may, at times, require specific personnel to attend a meeting and will notify the Contractor of such request. 2.4.3. Contractor shall ensure that the Key Personnel and Other Personnel attending all meetings between the Department and Contractor have the authority to represent and commit Contractor regarding work planning, problem resolution and program development. 2.4.4. At the Department' S direction, Contractor shall make its Key Personnel and Other Personnel available to attend meetings as subject matter experts with stakeholders both within the State government and external private stakeholders. 2.4.5. All of Contractor's Key Personnel and Other Personnel that attend any meeting with the Department or other Department stakeholders shall be present at the meeting through video conference, telephonic, or in-person depending on the purpose and intent of the meeting. If Contractor has any personnel attend by telephone or video conference, Contractor shall provide all additional equipment necessary for attendance, including any virtual meeting space or telephone conference lines. 2.4.6. Contractor shall respond to all telephone calls, voicemails, and emails from the Department within two Business Days of receipt by Contractor. 2.4.7. Contractor shall respond to Department directed escalations according as prescribed by the Department. Exhibit E-5, Contractor's Administrative Requirements Page 21 of22 Docusign Envelope ID: AEFO7FSDBSE4549AAOFFA2A3A9FSQDF 2.5. Other Personnel Responsibilities 2.5.1. Contractor shall use its discretion to determine the number of Other Personnel necessary to perform the Work in accordance with the requirements of this Contract. If the Department determines that Contractor has not provided sufficient Other Personnel to perform the Work in accordance with the requirements of this Contract, Contractor shall provide all additional Other Personnel necessary to perform the Work in accordance with the requirements of this Contract at no additional cost to the Department. 2.5.2. Contractor shall ensure that all Other Personnel have sufficient training and experience to complete all portions of the Work assigned to them. Contractor shall provide all necessary training to its Other Personnel, except for State-provided training specifically described in this Contract. 2.5.3. Contractor may subcontract to complete a portion ofthe Work required by the Contract. The conditions for using a Subcontractor or Subcontractors are as follows: 2.5.3.1. Contractor shall not subcontract more than 40% ofthe Work. 2.5.3.2. Contractor shall provide the organizational name of each Subcontractor and all items to be worked on by each Subcontractor to the Department for approval prior to commencement ofWork. 2.5.3.2.1. DELIVERABLE: Name of each Subcontractor, description of work being completed, and percentage ofwork being completed by the Subcontractor. 2.5.3.2.2. DUE: Annually, by July 15th 2.5.3.3. Contractor shall notify the Department of any changes to Subcontractors within 10 Business Days of the change. 2.5.3.4. Contractor shall obtain prior consent and written approval for any use ofSubcontractor(s. Exhibit E-5, Contractor's Administrative Requirements Page 22 of 22 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6/10/25 Submitter: Department ofHuman Services Submitted to the County Administration Office on: 5/30/25 Return Originals to: Department of Human Services Number of originals to return to Submitter: 1 Contract Due Date: ASAP Item Title/Recommended Board Action: "Consider approval ofMemorandums ofUnderstanding to facilitate the Prowers County Hotline County Connection Center with answer and processing of Child Welfare and Adult Protection Services related Hotline calls and performing tasks outlined in the MOU's effective January 1, 2025 and ending December 31, 2025 with the following counties: Gunnison and Gunnison- Hinsdale and authorizing Director of Human Services, Lanie Meyers-Mireles to execute the MOU. Justification or Background: This MOU will allow Prowers County Hotline County Connection Center to provide call coverage for child abuse/neglect and adult protective services reports for said counties. Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: Other: Approved by the County Attorney on: 5-30-2025 Additional Approvals (if required): PLEASE ATTACH THIS SHEET TO ALL AGENDA ITEMS WHEN SUBMITTING TO COUNTY ADMINISTRATION. THANK YOU! Docusign Envelope ID: 32D88857-B09D-4F7C-B78C-E7B87EB250D1 MEMORANDUM OF UNDERSTANDING Between GUNNISON COUNTY and PROWERS COUNTY INTRODUCTION: This Memorandum of Understanding ("MOU") is entered into by and between Prowers County, Colorado body corporate and politic by and through its Board of County Commissioner ("Prowers County'), and Gunnison County, Colorado ("Gunnison County") a body corporate and politic by and through its Board of County Commissioners. Prowers County and Gunnison County shall jointly be referred to as the "Parties." PURPOSE: 1. This MOU is developed in partnership between Prowers County and Gunnison County, with confirmation by the State of Colorado ("State"), for Prowers County to manage and administer calls to the hotline regarding persons that reside in Gunnison County, Colorado. 2. Prowers County, through its Hotline County Connection Center ("HCCC"), agrees to answer and process Child Welfare ("CW") related and APS related hotline calls on behalf of Gunnison County ("Call Coverage Services"). Prowers County will perform the tasks outlined in this MOU as they relate to Call Coverage Services. Gunnison County will perform the tasks identified in the MOU to assist the HCCC with successfully receiving the Hotline calls sO Gunnison County can complete the final disposition ofe each call. TERM, AMENDMENT, TERMINATION: 1. Term of MOU: a. This MOU becomes effective January 1, 2025 for the period of 12 months, ending December 31, 2025. b. The parties shall notify each other at least 30 days prior to expiration of the MOU to execute an extension. 2. Amendments: a. The Parties may request changes to this MOU, which shall be effective only upon the written agreement ofthe Parties. b. Any changes, modifications, revisions, or amendments to this MOU shall be incorporated by written instrument, executed and signed by the Parties, and will be effective in accordance with the terms and conditions contained herein. 3. Termination: a. Any party may, at its sole discretion, terminate or cancel the MOU upon 30 days' written notice to the other party. RATE FOR SERVICES: 1. The calculations used to determine the rate of the Call Coverage Services are based on an annual projection of the number of Child Protection Program Area 5, Program Area 4, and Institutional reports taken and an equivalent number of Other Child Welfare ("Other CW") Inquiry related call reports. For purposes of this MOU, 10 "Other CW" calls will equal 1 report. a. Projected numbers of Program Area 5, Program Area 4, Institutional, "Other CW", and APS reports will be based on a combination ofinformation from the Results Oriented Management data base and the actual numbers of calls received through the HCCC for the previous 12 months. Page 1 of 4 Docusign Envelope ID:: 32D88857-B09D-4F7C-B78C-E7B87EB250D1 2. Gunnison County is allocated 4 free reports, child abuse/neglect or APS reports, each month for a total of48 free reports of any type per year. 3. Prowers County has entered into agreements with other Colorado counties to provide the same services as contemplated in this MOU. In the event the HCCC must expend additional funds to accommodate adding additional positions to take calls on behalf of all of the other counties including Gunnison County, the cost oft that expansion may be proportionately distributed amongst all of the counties that receive HCCC Call Coverage Services. Should this situation arise, Gunnison County will be notified 60 days in advance of any additional costs required for HCCC's services sO it can determine whether to terminate the MOU. 4. Prowers County will invoice for the Call Coverage Services. Invoices shall include a description of the services performed as Gunnison County may request. Gunnison County will submit payment for services satisfactorily performed within 60 days of receipt. 5. The rates of Call Coverage Services provided to Gunnison County per the terms of the MOU are: Estimated number of Child Abuse/Neglect Reports Jan 2025 - Dec 2025 52 C/W Inquiries 0 Divided by 10 0 Total Estimated Reports 52 Less the Allotment of Reports (4 per month or 12 per quarter) -48 Total Estimated Reports to be billed 4 Rate per Report $ 25.00 Estimated Investment for C/W Reports $ 100.00 Estimated number of APS reports Jan 2025 - Dec 2025 8 Rate per APS Report $ 25.00 Estimated Investment for APS reports $ 200.00 Total Investment for Call Coverage services $ 300.00 6. Gunnison County will be billed quarterly for actual number of reports taken, less the allotted reports 12 reports of any type per quarter. JOINT RESPONSIBILITIES SHARED BETWEEN GUNNISON COUNTY AND PROWERS COUNTY HCCC: 1. Both Prowers County and Gunnison County acknowledge that the State of Colorado Department of Human Services must approve this MOU prior to final execution. 2. This MOU was preceded by an official requcst for Call Coverage Services from the Board of County Commissioners for Gunnison County. 3. Both parties understand that nothing in this MOU supersedes or replaces each party's requirements and responsibilities to follow and adhere to all requirements as set forth in state and federal statute, Volume 7 Rules and/or Division ofChild Welfare Policy. GENERAL RESPONSIBILITIES OF PROWERS COUNTY HCCC: 1. The Prowers County HCCC will make the appropriate routing changes and take all the after-hours calls for Gunnison County. After-Hours is defined as any time outside of normal business operating hours, including week-ends and holidays. 2. All next step decisions regarding Hotline call records will be left to the discretion of Gunnison County. Gunnison County will be responsible to complete a review of all information in THA and Trails to ensure appropriate disposition. 3. Reports, which can be referred to as Referrals, taken by the HCCC will be entered into the THA, submitted, and transferred to Gunnison County's Trails Inbox. HCCC will notify Gunnison County of a referral via email during business hours and by personal contact during after-hours (pursuant to Volume Page 2 of 4 Docusign Envelope ID: 32D88857-B09D-4F7C-B78C-E7B87EB250D1 71 Rules). It will be the responsibility ofGunnison County to check the pending queue and manage the final disposition of all records. a. HCCC will provide the Hotline ID and/or Referral ID number (pursuant to Volume 7 Rules) to an entity designated by Gunnison County. 4. Ift the HCCC believes the report is of an immediate response nature, the HCCC will notify Gunnison County while information is being entered into the THA or CAPS. 5. Information and Referral (non-CW) calls will be sent to Gunnison County's Pending Incoming Hotline Queue (pursuant to Volume 7 Rule). It will be the responsibility of Gunnison County to check the pending queue and manage the final disposition of all records. Call purpose will be included in the comments. Callers will be redirected back to the Gunnison County main Department ofHuman Services number. Gunnison County can request a brief synopsis. 6. IfHCCC receives a call from law enforcement or medical personnel that requires immediate response from Gunnison County, HCCC will transfer the call to an Gunnison County on-call designee. Ifthe Gunnison County on-call designee is not available, HCCC will take a message and continue to make attempts to notify the County. Ifappropriate, the HCCC will take a report while notifying the County. 7. APS reports will be documented in the Colorado Adult Protection System, ("CAPS") and in the THA. Once complete, the record will be transferred to the County's Pending Incoming Hotline Queue. Gunnison County will confirm receipt and update in the THA. a. Ifan APS call is regarding an adult over 70 years old, the HCCC will document the call in the THA and advise the reporter to call local law enforcement. The HCCC will then notify the County ofthe call. b. Notification to Gunnison County that an. APS report has been taken by the HCCC will be made by email during both open and after-hours. GENERAL RESPONSILITIES OF GUNNISON COUNTY 1. Gunnison County will provide an updated list of on-call Gunnison County employees' name(s) or designees and telephone/cellphone numbers and email addresses at all times. The on-call list will include backup contact name(s) and number(s) and email addresses in case the first employee is unable to answer within the notification time frame as outlined in Volume 7 Rules. Ifthe designee changes, it is the Gunnison County's responsibility to immediately inform the HCCC of the change and to provide the required contact information. 2. Gunnison County will notify the HCCC of any special circumstances where Gunnison County staff will be unavailable by email (business hours) or voice telephone/celiphone (i.e. employees are in court, meetings, training after-hours, etc.) Gunnison County should make every attempt to identify another entity that can receive notifications. This can be any entity designated by Gunnison County. GENERAL PROVISIONS 1. This MOU is not intended to create any agency or employment relationships between the parties nor is iti intended to create any third-party rights or beneficiaries. 2. Nothing contained herein shall be construed as a waiver of any party or any immunity at law including immunity granted under the Colorado Governmental immunities Act. 3. No modification or waiver ofthis MOU or of any covenant, condition, or provision herein contained shall be valid unless in writing and duly executed by the party to be charged therewith. 4. This MOU and the parties conduct hereunder shall be subject to local, state and federal laws and regulations, including requirements associated with confidentiality ofi information and HIPAA privacy requirements. Page 3 of 4 Docusign Envelope ID: 32D88857-B09D-4F7C-B78C-E7B87EB250D1 5. The Parties to this MOU are subject to the provisions of Colorado Constitution, Article X, Section 20 regarding multiple fiscal year obligations. Therefore, no obligation extending beyond Deçember 31, 2025 shall be enforceable unless and until County, acting through the Board, has adopted a budget for 2026 providing for payment of such obligations. Gunnison County shall immediately notify Prowers County should funding under this MOU fail to be appropriated in such instance, Prowers County may immediately terminate this MOU. 6. All three of the authorizing and confirming agencies listed below must agree to the conditions set forth in the proceeding document before the MOU can be finalized. 7. All signatories have the appropriate delegation of authority to sign this MOU. 8. This MOU is subject to all applicable federal, state and local laws, regulations and rules, whether now in force or hereafter enacted or promulgated. Ifany term or provision oft this MOU is held to be invalid or illegal, such term or provision shall not affect the validity or enforceability of the remaining terms and provisions. Meeting the terms of this MOU shall not excuse any failure to comply with all applicable laws and regulations, whether or not these laws and regulations are specifically listed herein. 9. No third-Party Beneficiary. Itis expressly understood and agreed that enforcement of the terms and conditions of this MOU, and all rights of action relating to such enforcement, shall be strictly reserved to the Parties, and nothing contained in this MOU shall give or allow any such claim or right of action by any other or third person or entity on such MOU. Iti is the express intention of the parties hereto that any person or entity, other than the Parties, receiving services or benefits under this MOU shall be deemed to be incidental beneficiaries only. 10. Each Party agrees to be responsible for its own liability incurred as a result of its participation in this MOU. In the event any claim is litigated, each Party will be responsible for its own expenses of litigation or other costs associated with enforcing this MOU. No provision of this MOU shall be deemed or construed to be a relinquishment or waiver of any kind of the applicable limitation of liability provided to each Party by the Colorado governmental Immunity Act, C.R.S. 24-101-101 et seq. and Article XI of the Colorado Constitution. Approving Entities Approving Entities Signed by: Bernadette Rodigney Signed: Signed: 1810545785E9448- Name: OSATHA A. Houck Name: Bernadette Rodriguez Title: CMASEMANL Title: Entity: GUNBTSON BocL Entity: State Confirmation Date: Signed: Name: Title: Entity: Page 4 of 4 Docusign Envelope ID: 754D46FE-870B-4626-8E85-C42D9E5003F3 MEMORANDUM OF UNDERSTANDING Between GUNNISON-HINSDALE BOARD OF HUMAN SERVICES and PROWERS COUNTY INTRODUCTION: This Memorandum of Understanding ("MOU") is entered into by and between Prowers County, Colorado body corporate and politic by and through its Board of County Commissioner ("Prowers County'), and Gunnison-Hinsdale Board of Human Services, Colorado "Gunnison-Hinsdale Board of Human Services") a body corporate and politic by and through its Board of County Commissioners. Prowers County and Gunnison-Hinsdale Board of Human Services shall jointly be referred to as the "Parties.' >> PURPOSE: 1. This MOU is developed in partnership between Prowers County and Gunnison-Hinsdale Board of Human Services, with confirmation by the State of Colorado ("State"), for Prowers County to manage and administer calls to the hotline regarding persons that reside in Gunnison-Hinsdale Board of] Human Services, Colorado. 2. Prowers County, through its Hotline County Connection Center ("HCCC"), agrees to answer and process Child Welfare ("CW") related and APS related hotline calls on behalf of Gunnison-Hinsdale Board ofHuman Services ("Call Coverage Services"). Prowers County will perform the tasks outlined in this MOU as they relate to Call Coverage Services. Gunnison-Hinsdale Board of Human Services will perform the tasks identified in the MOU to assist the HCCC with successfully receiving the Hotline calls SO Gunnison-Hinsdale Board of Human Services can complete the final disposition of each call. TERM, AMENDMENT, TERMINATION: 1. Term of MOU: a. This MOU becomes effective January 1, 2025 for the period of 12 months, ending December 31, 2025. b. The parties shall notify each other at least 30 days prior to expiration of the MOU to execute an extension. 2. Amendments: a. The Parties may request changes to this MOU, which shall be effective only upon the written agreement of the Parties. b. Any changes, modifications, revisions, or amendments to this MOU shall be incorporated by written instrument, executed and signed by the Parties, and will be effective in accordance with the terms and conditions contained herein. 3. Termination: a. Any party may, at its sole discretion, terminate or cancel the MOU upon 30 days' written notice to the other party. RATE FOR SERVICES: 1. The calculations used to determine the rate oft the Call Coverage Services are based on an annual projection oft the number ofChild Protection Program Area 5, Program Area 4, and Institutional reports taken and an equivalent number of Other Child Welfare ("Other CW") Inquiry related call reports. For purposes of this MOU, 10 "Other CW" calls will equal 1 report. Page 1 of! 5 Docusign Envelope ID: 754D46FE-870B-4626-8E85-C42D9E5003F3 a. Projected numbers of Program Area 5, Program Area 4, Institutional, "Other CW", and APS reports will be based on a combination ofi information from the Results Oriented Management data base and the actual numbers of calls reçeived through the HCCC for the previous 12 months. 2. Gunnison-Hinsdale Board of Human Services is allocated 4 free reports, child abuse/neglect or APS reports, each month for a total of 48 free reports ofany type per year. 3. Prowers County has entered into agreements with other Colorado counties to provide the same services as contemplated in this MOU. In the event the HCCC must expend additional funds to accommodate adding additional positions to take calls on behalf of all of the other counties including Gunnison- Hinsdale Board of Human Services, the cost of that expansion may be proportionately distributed amongst all of the counties that receive HCCC Call Coverage Services. Should this situation arise, Gunnison-Hindale Board of Human Services will be notified 60 days in advance of any additional costs required for HCCC's services SO it can determine whether to terminate the MOU. 4. Prowers County will invoice for the Call Coverage Services. Invoices shall include a description of the services performed as Gunnison-Hinsdale Board ofHuman Services may request. Gunnison-Hinsdale Board of Human Services will submit payment for services satisfactorily performed within 60 days of receipt. 5. The rates of Call Coverage Services provided to Gunnison-Hinsdale Board ofHuman Services per the terms of the MOU are: Estimated number of Child Abuse/Neglect Reports Jan 2025 - Dec 2025 55 C/W Inquiries 0 Divided by 10 0 Total Estimated Reports 55 Less the Allotment of Reports (4 per month or 12 per quarter) -48 Total Estimated Reports to be billed 7 Rate per Report $ 25.00 Estimated Investment for C/W Reports $ 175.00 Estimated number of APS reports Jan 2025 - Dec 2025 8 Rate per APS Report $ 25.00 Estimated Investment for APS reports $ 200.00 Total Investment for Call Coverage services $ 375.00 6. Gunnison-Hinsdale Board of Human Services will be billed quarterly for actual number of reports taken, less the allotted reports 12 reports of any type per quarter. JOINT RESPONSIBILITIES SHARED BETWEEN GUNNISON-HINSDALE BOARD OF HUMAN SERVICES AND PROWERS COUNTY HCCC: 1. Both Prowers County and Gunnison-Hinsdalc Board ofHuman Services acknowledge that the State of Colorado Department of Human Services must approve this MOU prior to final execution. 2. This MOU was preceded by an official request for Call Coverage Services from the Board ofCounty Commissioners for Gunnison-Hinsdale Board of Human Services. 3. Both parties understand that nothing in this MOU supersedes or replaces each party's requirements and responsibilities to follow and adhere to all requirements as set forth in state and federal statute, Volume 71 Rules and/or Division of Child Welfare Policy. GENERAL RESPONSIBILITIES OF PROWERS COUNTY HCCC: 1. The Prowers County HCCC will make the appropriate routing changes and take all the after-hours calls for Gunnison-Hinsdale Board ofHuman Services. After-Hours is defined as any time outside of normal business operating hours, including week-ends and holidays. Page 2 of 5 Docusign Envelope ID: 754D46FE-870B-4626-8E85-C42D9E5003F3 2. All next step decisions regarding Hotline call records will be left to the discretion of Gunnison-Hinsdale Board of Human Services. Gunnison-Hinsdale Board ofl Human Services will be responsible to complete a review of all information in THA and Trails to ensure appropriate disposition. 3. Reports, which can be referred to as Referrals, taken by the HCCC will be entered into the THA, submitted, and transferred to Gunnison-Hinsdale Board of Human Services' Trails Inbox. HCCC will notify Gunnison-Hinsdale Board of Human Services of a referral via email during business hours and by personal contact during after-hours (pursuant to Volume 71 Rules). It will be the responsibility of Gunnison-Hindale Board of Human Services to check the pending queue and manage the final disposition of all records. a. HCCC will provide the Hotline ID and/or Referral ID number (pursuant to Volume 71 Rules) to an entity designated by Gunnison-Hinsdale Board of Human Services. 4. Ifthe HCCC believes the report is of an immediate response nature, the HCCC will notify Gunnison- Hinsdale Board of Human Services while information is being entered into the THA or CAPS. 5. Information and Referral (non-CW) calls will be sent to Gunnison-Hinsdale Board ofHuman Services' Pending Incoming Hotline Queue (pursuant to Volume 71 Rule). It will be the responsibility of Gunnison-Hinsdale Board ofHuman Services to check the pending queue and manage the final disposition of all records. Call purpose will be included in the comments. Callers will be redirected back to the Gunnison-Hindale Board ofHuman Services main Department of Human Services number. Gunnison-hHinsdale Board ofHuman Services can request a briefsynopsis. 6. IfHCCC receives a call from law enforcement or medical personnel that requires immediate response from Gunnison-Hinsdale Board of Human Services, HCCC will transfer the call to an Gunnison- Hinsdale Board ofHuman Services on-call designee. Ifthe Gunnison-Hinsdalc Board of Human Services on-call designee is not available, HCCC will take a message and continue to make attempts to notify the County. Ifappropriate, the HCCC will take a report while notifying the County. 7. APS reports will be documented in the Colorado Adult Protection System, ("CAPS") and in the THA. Once complete, the record will be transferred to the County's Pending Incoming Hotline Queue. Gunnison-Hinsdale Board ofHuman Services will confirm receipt and update in the THA. a. Ifan APS call is regarding an adult over 70 years old, the HCCC will document the call in the THA and advise the reporter to call local law enforcement. The HCCC will then notify the County of the call. b. Notification to Gunnison-Hinsdale Board ofHuman Services that an APS report has been taken by the HCCC will be made by email during both open and after-hours. GENERAL RESPONSILITIES OF GUNNISON-HINSDALE BOARD OF HUMAN SERVICES 1. Gunnison-Hinsdale Board of Human Services will provide an updated list of on-call Gunnison-Hinsdale Board of Human Services employees' name(s) or designees and telephone/celiphone numbers and email addresses at all times. The on-call list will include backup contact name(s) and number(s) and email addresses in case the first employee is unable to answer within the notification time frame as outlined in Volume 7 Rules. Ifthe designee changes, it is the Gunnison-Hinsdale Board ofHuman Services' responsibility to immediately inform the HCCC of the change and to provide the required contact information. 2. Gunnison-Hinsdale Board of Human Services will notify the HCCC of any special circumstances where Gunnison-Hinsdale Board of Human Services staff will be unavailable by email (business hours) or voice elephone/cellphone (i.e. employees are in court, meetings, training after-hours, etc.) Gunnison- Hinsdale Board ofHuman Services should make every attempt to identify another entity that can receive notifications. This can be any entity designated by Gunnison-Hinsdale Board ofHuman Services. Page 3 of 5 Docusign Envelope ID: 754D46FE-870B-4626-8E85-C42D9E5003F3 GENERAL PROVISIONS 1. This MOU is not intended to create any agency or employment relationships between the parties nor is iti intended to create any third-party rights or beneficiaries. 2. Nothing contained herein shall be construed as a waiver of any party or any immunity at law including immunity granted under the Colorado Governmental immunities Act. 3. No modification or waiver of this MOU or of any covenant, condition, or provision herein contained shall be valid unless in writing and duly executed by the party to be charged therewith. 4. This MOU and the parties conduct hereunder shall be subject to local, state and federal laws and regulations, including requirements associated with confidentiality ofi information and HIPAA privacy requirements. 5. The Parties to this MOU are subject to the provisions ofColorado Constitution, Article X, Section 20 regarding multiple fiscal year obligations. Therefore, no obligation extending beyond December 31, 2025 shall be enforceable unless and until County, acting through the Board, has adopted a budget for 2026 providing for payment ofsuch obligations. Gunnison-Hinsdale Board ofHuman Services shall immediately notify Prowers County should funding under this MOU fail to be appropriated in such instance, Prowers County may immediately terminate this MOU. 6. All three ofthe authorizing and confirming agencies listed below must agree to the conditions set forth in the proceeding document before the MOU can be finalized. 7. All signatories have the appropriate delegation of authority to sign this MOU. 8. This MOU is subject to all applicable federal, state and local laws, regulations and rules, whether now in force or hereafter enacted or promulgated. Ifa any term or provision ofthis MOUi is held to be invalid or illegal, such term or provision shall not affect the validity or enforceability ofthe remaining terms and provisions. Meeting the terms oft this MOU shall not excuse any failure to comply with all applicable laws and regulations, whether or not these laws and regulations are specifically listed herein. 9.- No third-Party Beneficiary. It is expressly understood and agreed that enforcement of the terms and conditions oft this MOU, and all rights of action relating to such enforcement, shall be strictly reserved to the Parties, and nothing contained in this MOU shall give or allow any such claim or right of action by any other or third person or entity on such MOU. Iti is the express intention of the parties hereto that any person or entity, other than the Parties, receiving services or benefits under this MOU shall be deemed to be incidental beneficiaries only. 10. Each Party agrees to be responsible for its own liability incurred as a result ofi its participation in this MOU. In the event any claim is litigated, each Party will be responsible for its own expenses of litigation or other costs associated with enforcing this MOU. No provision of this MOU shall be deemed or construed to be a relinquishment or waiver of any kind of the applicable limitation of liability provided to each Party by the Colorado governmental Immunity Act, C.R.S. 24-101-101 et seq. and Article XI of the Colorado Constitution. Approving Entities Approving Entities Signed! by: Bernadette Rodrignes Signed: Signed: 1B1D5457B5E044B. Name: Sonathan Houck Name: Bernadette Rodriguez Title: Chairperson Title: Entity: hunnissn Counity Entity: State Confirmation Page 4 of 5 Docusign Envelope ID: 754D46FE-870B-4626-8E85-C42D9E5003F3 Date: Signed: Name: Title: Entity: Page 5 of 5 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6-10-2025 Submitter: Paula Gonzales, Finance Director Submitted to the County Administration Office on: Email Poll 6-3-25 Return Originals to: Paula Gonzales & Jana Coen Number of originals to return to Submitter: 1 Contract Due Date: Item Ttle/Recommended Board Action: Consider ratifying 6-3-2025 email poll approval of payment of bills presented for County General A/P in the amount of $94,920.58 with a certification date of June 10, 2025, and authorizing the use of the Commissioner's signature stamps. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: Additional Approvals (if required): PROWERS COUNTY APPROVE TO PAY APPROVE PAYMENTS AS HEREIN SET FORTH. CHECK NUMBERS AS LISTED BELOW ARE ALL INCLUSIVE, ARE SET OPPOSITE THEIR NAMES, AND TOTALING THE SUM OF: $94,920.58 DRAWN ON COUNTY GENERAL FUNDS. DATED AS OF: June 3, 2025 # A/P PAYROLL FRINGES COUNTY GENERAL FUND $ 85,699.63 ARPA FUND $ FSA ACCOUNT $ BOOKING FEES ACCOUNT $ PUBLIC HEALTH AGENCY $ 4,193.84 ROAD & BRIDGE FUND $ 5,027.11 SALES & USE TAX FUND $ CONSERVATION TRUST FUND $ CAPITAL FUND $ OTHER AGENCIES FUND $ LODGING TAX FUND $ CRMC FUND $ OPC FUND $ Totals $ 94,920.58 $ DATE: June 3, 2025 A / BOCC OHAIRMAN DATE: June 3, 2025 4MISS; PNER DATE: June 3, 2025 CON MISIONE R DATE: June 3, 2025 A CLERK TO THE BOARD Total Paid Approve To Pay $ 94,920.58 AP + Fringes $ 94,920.58 Total Pd Certification Payroll $ 94,920.58 Total Payroll + Fringes $ STATE OF COLORADO) Ending Check No. 75402 - SS: Beginning Check No. 75378 COUNTY OF PROWERS) 1 Total Number of Checks: 25 lolou Commploall Prowers County Treasurer's Office PROWERS COUNTY TREASURER CERTIFICATION COUNTY GENERAL FUND-01 0010 June 3,2025 75378-75402 S 85,699.63 Payroll S Total Fringes_ $ Totals 85,699.63 ARPA- 0018 Total_s ROAD & BRIDGE FUND. -02 0020 S 5,027.11 Payroi $ Fringes $ Totalfs 5,027.11 FSA (Cafeterla) 552 0552 S 2024 s - Totals Sheriffs Booking Fees 0675 $ 2024 $ Payroll $ Totals SALES & USE TAXI FUND . 03 0900 $ 2024 S Totals CONSERVATION TRUST FUND . 06 0130 $ 2024 S Total_s CAPITAL FUND -07 0100 S 2024 S Totals OTHER AGENCIES FUND- 08 $ 2024 $ Totals LODGING TAX: 09 0014 $ Payroil s Total Fringes s Total_s PUBLIC HEALTHAGENCY 11 0676 $ 4,193.84 Payroll $ Total Fringes_s Totals 4,193.84 CRMC 0016 $ Payroll s Total Fringes_ s Total/ $ OPC 0017 $ Payroll S Total Fringes s Totals Pauia Gonzales Finance Director GRAND TOTALLS 94.920.58 Check Register 2 Prowers County, CO Packet: APPKT00079 - 101.06.2025 06032025 I By Check Number CIORAN Vendor Number Vendor Name Payment Date Payment Type Discount Amount Payment Amount Number Bank Code: General Fund Op-General Fund Operating Account Alll Airgasi intermountain Inc. 06/03/2025 Regular 0.00 338.49 75378 AMAZON Amazon Capital Services 06/03/2025 Regular 0.00 269.45 75379 ATM1 Atmos Energy 06/03/2025 Regular 0.00 130.38 75380 ATM1 Atmos Energy 06/03/2025 Regular 0.00 713.69 75381 Canon1 Canon Financial Services 06/03/2025 Regular 0.00 889.98 75382 CINTASCORP CINTAS CORPORATIONI NO. 2 06/03/2025 Regular 0.00 701.35 75383 DAF1 District Attorney 06/03/2025 Regular 0.00 32,734.67 75384 SKB1 Glaxosmithkline. Pharmaceuticals 06/03/2025 Regular 0.00 751.58 75385 GOB1 Gobin's 06/03/2025 Regular 0,00 438.86 75386 VEN00944 GREAT WESTERN: STATES SUPPLY 06/03/2025 Regular 0.00 600.10 75387 FPL5 John Deere Financial 06/03/2025 Regular 0.00 1,242.58 75388 LAP1 Lamar Auto Parts 06/03/2025 Regular 0.00 355.20 75389 LBM1 Lamar BMS 06/03/2025 Regular 0.00 4.48 75390 MCKESS McKesson Mediçal Surgical 06/03/2025 Regular 0.00 129.75 75391 MSD1 Merck Sharp & Dohme Corp 06/03/2025 Regular 0.00 674.49 75392 PZI1 Pfizer, Inc 06/03/2025 Regular 0.00 904.60 75393 STAGNERR Roger Stagner 06/03/2025 Regular 0.00 195.00 75394 CKN1 Ron Cook 06/03/2025 Regular 0.00 195.00 75395 SSR2 Sanda and Sage Roundup Fairboard 06/03/2025 Regular 0.00 50,000.00 75396 MRS1 Shred America 06/03/2025 Regular 0.00 32.25 75397 SKS1 Skyline Steel 06/03/2025 Regular 0.00 2,477.84 75398 STR1 Stericycle Inc 06/03/2025 Regular 0.00 172.09 75399 DUNAG Thomas Dunagan 06/03/2025 Regular 0.00 100.00 75400 VEN00958 TY HARMON 06/03/2025 Regular 0.00 195.00 75401 WRE1 WEX BANK 06/03/2025 Regular 0.00 673.75 75402 Bank Code General Fund Op Summary Payable Payment Payment Type Count Count Discount Payment Regular Checks 33 25 0.00 94,920.58 Manual Checks 0 0 0.00 0.00 Voided Checks 0 0 0.00 0.00 Bank Drafts 0 0 0.00 0.00 EFT's 0 0 0.00 0.00 33 25 0.00 94,920.58 5/29/2025 9:37:47 AM Page 1 of 2 Check Register Packet: APPKT00079-101.06.2025 06032025 Fund Summary Fund Name Period Amount 999 Pooled Cash 6/2025 94,920.58 94,920.58 5/29/2025 9:37:47 AM Page 2 oi 2 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 06/10/2025 Submitter: Meagan Hillman, PCPHE Director Submitted to the County Administration Office on:06/03/2025 Return Originals to: Meagan Hillman, PCPHE Number of originals to return to Submitter: Contract Due Date: 07/01/2025 Item Tite/Recommended Board Action: Consider approval for Contract Amendment #3 to original Contract No. 2023*0329 for URHN, total amount for Amendment #3 is $199,994.00 and authorizing Public Health Director, Meagan Hillman to execute the Contract electronically. Justification or Background: This is our Youth Council Contract Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: 06/04/2025 Additional Approvals (if required): PLEASE ATTACH THIS SHEET TO ALL AGENDA ITEMS WHEN SUBMITTING TO COUNTY ADMINISTRATION. THANK YOU! Docusign Envelope ID: 600979AFDA4BIF-9T0 D9-FOC6A42DA0F7 FOR SUBRECIPIENTS ONLY This is a supporting document for Contract Number: 2023*0329 The updated information provided here does not modify the original contract or original task order in any way. The information provided here informs the grantee of updated items that are required under 2 CFR 200.332. Data Required by 2 CFR 200.332 (All pass through entities must ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time ofthe subaward. If any of these data elements change, the changes are to be reflected in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best available information when some oft the information below is unavailable. A pass-through entity must provide the unavailable information when iti is obtained.): A. Subrecipient name (which must match the name associated with its unique entity identifier): Shown in Contractor box on cover page oforiginal contract and subsequent modifications. B. Subrecipient's unique entity identifier: Y8C4HSXY95M6 C. Federal Award Identification Number (FAIN): B08TI088095 D. Federal Award Date (when Federal award was signed by authorized official ofthe Federal awarding agency): 02/24/2025 E. Subaward Period of Performance Start and End Date: Start date shown on cover page of original contract and end date shown on cover page of original contract, as updated by any subsequent modifications. F. Subaward Budget Period Start and End Date: Start date shown on cover page of original contract and end date shown on cover page of original contract, as updated by any subsequent modifications. G. Amount of Federal Funds Obligated by this action by the pass-through entity to the subrecipient: Shown on Budget Exhibit in column matching this contract modification. H. Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation: Shown on cover page of this contract modification and on Budget Exhibit. I. Total Amount of the Federal Award committed to the subrecipient by the pass-through entity: Shown on cover page of this contract modification and on Budget Exhibit. J. Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA): Substance Abuse Prevention, Treatment, and Recovery Services Block Grant K. Pass-through entity is shown on the cover page in the State Agency box. Name ofFederal awarding agency: Department ofHealth and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Contact information for the awarding official oft the Pass-through entity: Dannette Smith, dammetesmith@sHeco.s 303- 866-7400 L. Assistance Listing number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listing Number at time of disbursement: Block Grants for Prevention and' Treatment ofSubstance Abuse, $9,055,548, and 93.959 M. Identification of whether the award is R&D: No N. Indirect cost rate for the Federal award (including if the de minimis rate is charged) per $ 200.414: Shown on Budget Exhibit as indicated by indirect rate and amount. Ver 10/2024 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CONTRACT AMENDMENT #3 SIGNATURE AND COVER PAGE State Agency: Original Contract Number: Colorado Department Of Public Health and Environment 2023*0329 4300 Cherry Creek Drive South Denver, Colorado 80246 Contractor: Amendment Contract Number: Board of County Commissioners of Prowers County 2023*0329 Amendment #3 (a political subdivision of the state of Colorado) 301 South Main Street, #215 Lamar CO 81052 for the use and benefit of the Prowers County Public Health 1001 South Main Street Lamar CO 81052-3838 Contract Performance Beginning Date: Current Contract Expiration Date: July 1, 2022 June 30, 2026 CONTRACT MAXIMUM AMOUNT TABLE Federal Funding State Funding Other Funding Document Type Contract Number Term (dates) Total Amount Amount Amount Original 2023*0329 $199,994.00 $0.00 $0.00 7/1/2022 - $199,994.00 Contract 6/30/2023 Amendment #1 2023*0329 $199,994.00 $0.00 $0.00 7/1/2023 - $199,994.00 Amendment #1 6/30/2024 Amendment #2 2023*0329 $199,994.00 $0.00 $0.00 7/1/2024 = $199,994.00 Amendment #2 6/30/2025 Amendment #3 2023*0329 $199,994.00 $0.00 $0.00 7/1/2025 - $199,994.00 Amendment #3 6/30/2026 Current Contract Maximum Cumulative Amount $799,976.00 Contract Amendment: 2023*0329 Amendment #3 Page 1 of4 Version OSC A1I.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 SIGNATURE PAGE THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment and to bind the Party authorizing his or her signature. CONTRACTOR STATE OF COLORADO Board of County Commissioners of Prowers County Jared S. Polis, Governor (a political subdivision ofthe state of Colorado) Colorado Department ofl Public Health and Environment for the use and benefit oft the Jill Hunsaker Ryan, MPH, Executive Director Prowers County Public Health By: Signature By: Signature FULL NAME Name of Person Signing for Contractor Name of Executive Director Delegate TITLE Title of Person Signing for Contractor Title of Executive Director Delegate Date: Date: In accordance with $24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Signature Name of State Controller. Delegate Title of State Controller Delegate Amendment Effective Date: Contract Amendment: 2023*0329 Amendment #3 Page 2 of4 Version OSC AlL.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 1. PARTIES This Amendment (the "Amendment") to the Original Contract shown on the Cover Page for this Amendment (the "Contract") is entered into by and between the Contractor, and the State. 2. TERMINOLOGY Except as specifically modified by the Amendment, all terms used in this Amendment that are defined in the Contract shall be construed and interpreted in accordance with the Contract. 3. AMENDMENT EFFECTIVE DATE AND TERM A. Amendment Effective Date This Amendment shall not be valid or enforceable until the Amendment Effective Date shown on the Signature and Cover Page for this Amendment. The State shall not be bound by any provision oft this Amendment before that Amendment Effective Date, and shall have no obligation to pay Contractor for any Work performed or expense incurred under this Amendment either before or after the Amendment term shown in $3.B ofthis Amendment. B. Amendment Term The Parties' respective performances under this Amendment and the changes to the Contract contained herein shall commence on the Amendment Effective Date shown on the Signature and Cover Page for this Amendment or July 1, 2025, whichever is later, and shall terminate on the termination ofi the Contract or June 30, 2026, whichever is earlier. 4. PURPOSE The Parties entered into the agreement to reduce substance misuse and abuse among under- resourced high need communities. The Parties now desire to renew for an additional term and change the current Contract Maximum Total for the following reason: to add funds to support the renewal term. 5. MODIFICATIONS The Contract and all prior amendments thereto, if any, are modified as follows: A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is hereby deleted and replaced with the Current Contract Expiration Date shown on the Signature and Cover Page for this Amendment. B. The Contract Maximum Amount table on the Contract's cover Page is hereby deleted and replaçed with the Current Contract Maximum Amount table shown on the Signature and Cover Page for this Amendment. C. The Parties now agree to modify Exhibit B., Statement of Work. Exhibit B., Statement of Work., is deleted and replaced in its entirety with Exhibit B., Statement of Work., attached to this Amendment, for the following reason: To continue services and update the Statement ofWork (SOW) for a new fiscal year. D. The Parties now agree to modify Exhibit C., Budget, oft the agreement. Exhibit C., Budget, is deleted and replaced in its entirety with Exhibit C., Budget, attached to this Amendment for the following reason: To add funds for FY26 renewal. Contract Amendment: 2023*0329 Amendment #3 Page 3 of4 4 Version OSC A11.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 E. The Parties now agree to modify Exhibit G., - Federal Provisions. Exhibit G., - Federal Provisions, is deleted and replaced in its entirety with Exhibit G., - Federal Provisions, attached to this Amendment, for the following reason: To provide an updated version of the Federal Provisions Exhibit. 6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE This Amendment is incorporated by reference into the Contract, and the Contract and all prior amendments or other modifications to the Contract, if any, remain in full force and effect except as specifically modified in this Amendment. Except for the Special Provisions contained in the Contract, in the event of any conflict, inconsistency, variance, or contradiction between the provisions ofthis Amendment and any ofthe provisions ofthe Contract or any prior modification to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and control. The provisions of this Amendment shall only supersede, govern, and control over the Special Provisions contained in the Contract to the extent that this Amendment specifically modifies those Special Provisions. Contract Amendment: 2023*0329 Amendment #3 Page 4 of4 Version OSC A11.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD44B1F-97D9-FOC6A42DA0F7 EXHIBIT B Statement of Work Evidence-Based Prevention Programs & Policies (EBPs) and Under Resourced High Need (URHN) Communities These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above. Article 1 Purpose and Target Population 1.1 Purpose. The purpose ofthis Contract is to continue primary prevention services for the five-year Primary Prevention funding cycle Substance Abuse Prevention and Treatment Block Grant (SABG) that is aligned with federal and state prevention priorities based on the statewide needs assessment and the statewide strategic plan. The SABG guidelines include Primary Prevention activities that are directed at individuals who do not require treatment for a Substance Use Disorder. To facilitate this undertaking, the Substance Abuse and Mental Health Services Administration (SAMHSA) developed the Strategic Prevention Framework (SPF), a planning approach that is utilized to prevent and address substance abuse and misuse and related behavioral health concerns. The Department has identified three areas for SABG-funded Primary Prevention programs, policies, and strategies: a. Preventing and reducing alcohol, marijuana, prescription drugs, and other drug use for those under 18 years of age (tobacco excluded). b. Changing community policies and norms regarding alcohol, marijuana, prescription drugs, and other drug use (tobacco excluded). C. Addressing population-based needs regarding alcohol, marijuana, prescription drugs, and other drug use (tobacco excluded). The Contractor shall continue to develop and implement a Comprehensive Primary Prevention initiative that employs Evidence-Based Prevention Programs and Policies, which include strategies directed at the following populations: children, youth, young adults, and/or families. Implementing evidence-based primary prevention programs and policies will assist the Department in meeting state-level outcomes, such as reductions in substance use, increased attendance at school, decreases in substance-related arrests, increased family communication around substance use, increases in youth exposure to prevention messaging, and a reduction in Adverse Childhood Experiences (ACEs). The State goal is to have a significant impact on the identified state level outcomes by funding Primary Prevention programs, policies, and strategies to address substance abuse and misuse. Page 1 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD44B1F-97D9-FOC6A42DA0F7 EXHIBIT B 1.2 Target Population. The Contractor shall continue to develop or maintain and implement a Comprehensive Primary Prevention initiative that employs Evidençe-Based Prevention Programs and Policies, which includes strategies directed at the following populations: children, youth, young adults, and/or families. Article 2 Definitions and Acronyms Term Definition An Excel workbook, filled in by the Contractor, which organizes the key activities and processes toward executing the chosen foundational and supplemental strategies. It includes a comprehensive program summary, outcome statement, and outlines CSAP strategy usage. CSAP strategy information provides a structure Action. Plan to guide the Contractor through implementation oftheir program and which milestones and activities they seek to complete each year. The Contractor will submit an Action Plan (template provided) for each State Fiscal Year and may update the plan quarterly in conjunction with Department staff. Specific types of potentially traumatic experiences that occur to people under the age of 18. The 10 core ACES are divided into 3 categories: abuse (physical, sexual, and moliomalpsychological, Adverse Childhood neglect (physical and moliomalpychologica), and household Experiences (ACEs) dysfunction (substance abuse, mental illness, domestic violence, incarceration, and separation/divorce). ACEs have been linked to chronic health conditions and risky health behaviors, including substance use. Each Contractor must choose at least one evidence-based program or policy from the approved list that is categorized into one ofi two Center. for SAMHSA - Center for Substance Abuse and Prevention (CSAP) Substance Abuse foundational strategies - Eduçation or Environmental. If an and Prevention evidence-based program is chosen, it will align with the Education (CSAP) Strategy strategy. Ifan evidence-based policy is chosen, it will align with the Environmental strategy. Contractor can choose more than one evidence-based program or policy to implement. Page 2of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B Contractors then must choose one or more supplemental CSAP strategies Information Dissemination, Alternatives, Community- Based Processes, Problem Identification & Referral, Education or Environmental - to accompany and support the selected EBP program or policy. Ifselecting two or more EBP programs or policies, each of the selected EBP programs or policies will require a supplemental strategy. The evidence-based program or policy (Education or Environmental foundational CSAP strategy) and supplemental strategy, when combined, will form a Comprehensive Primary Prevention program or policy. A formal arrangement for cooperation and collaboration between groups or sectors of a community. Each group retains its identity, but all agree to work together toward a common goal of building a safe, healthy, and drug-free community. Coalition intervention efforts can Coalition be categorized into providing information, enhancing skills, providing support, enhancing access/reducing barriers to prevention services, changing consequences, changing the physical design oft the environment, and modifying or changing policies. A model which embraces the idea that no single organization can solve any major social problem by itself. It takes collaboration Collective Impact between all community stakeholders - - including government, nonprofit, education, business, youth, and families to achieve long- term measurable change. A licensed and bonded entity that has the potential to successfully Commumty-Based serve youth and their families with selected program services. It may Organization (CBO) be ai non-profit or faith-based organization. The web-based data reporting system through which Contractor will Colorado submit process data relating to their SABG funded prevention Prevention System activities. An approach which aims to impact outcomes through multiple strategically aligned CSAP strategies. Contractor are required to Comprehensive implement a Comprehensive Primary Prevention approach by Primary Prevention utilizing data to inform the implementation of at least one foundational strategy (education, environmental) and at least one supplementary strategy (information dissemination, alternatives, community-based processes, or problem identification and referral) Page 3 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B to support the implementation and effectiveness oft the foundational strategy and increase likelihood of favorable outcomes. The ability of an individual or organization to interact effectively with and provide services equitably to members of diverse population groups. Culturally responsive individuals and organizations can learn Cultural from and relate respectfully to people from your own and other Competence & cultures. Prevention professionals should broaden their understanding Responsiveness and acceptance of cultural and individual differences and, in SO doing, render services and provide information sensitive to those differences. For more information, visit: htps/wwsamhasowisstinmlulunkseneviesgurss A process of critically examining an intervention. It involves collecting and analyzing information about an intervention's Evaluation activities, characteristics, and outcomes. The purpose ofevaluation is to make judgments about, improve, and communicate about the effectiveness of an intervention. A document which details the process ofe evaluating a program or Evaluation Plan policy over the course ofthe Grant Cycle. Scientific research which indicates whether an intervention has been Evidence shown to influence and/or change an outcome ofinterest. Programs and policies which have been shown, through multiple Evidence-Based rigorous research studies, to positively impact selected outcomes in Programs and the target population. Please contact Department staff for an Policies (EBPs) approved list of EBP programs and policies. The extent to which delivery of an intervention adheres to the protocol or program model originally developed. Characteristics to consider when assessing fidelity include the target population, Fidelity setting, number and timing of sessions or implementations, method of delivery, order, and content ofthe intervention components, and more. Increased fidelity improves the odds that an intervention will work as intended. Preventable differences in the burden of disease, injury, violence, or Health Disparities opportunities to achieve optimal health that are experienced by socially disadvantaged populations such as racial, ethnic, and Page 4 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B linguistic minorities; those with low socioeconomic status; LGBTQ+ individuals; and more. Health equity is achieved when everyone has a fair and just opportunity to be as healthy as possible, regardless of social group. Programs and policies whose effectiveness is supported by some evidence, but which do not currently reach the level of evidence based. Innovative programs also target one or more of priority Innovative subpopulations listed in the Innovate Prevention Program RFP. Programs and Innovative programs include (1) adaptations ofexisting EBPs which Policies better meet the needs of a priority subpopulation, and (2) independent programs/policies specifically developed to reach a priority subpopulation. A systematic and visual way to describe the sequence of related events connecting the need for the planned strategy with the strategy's desired results. A logic model shows the clear connection between the resources put into a strategy, activities required to implement the strategy, the number or number of products or services Logic Model to be provided, short- and medium-term outcomes expected to result from the strategy, and long-term impacts. For more information on the purpose, components, and structure of logic models, visit: htpsy/wkfisuelaboreleriomance witl-logic-models.hm! A set of 15 standards set forth by the U.S. Department of Health & Human Services which aim to improve healthcare quality and National Standards advance health equity by establishing a framework for organizations for Culturally and to serve the nation's increasingly diverse communities. The principal Linguistically standard is to, "Provide effective, equitable, understandable and Appropriate respectful quality care and services that are responsive to diverse Services (CLAS cultural health beliefs and practices, preferred languages, health Standards) literacy and other communication needs.' 99 For a full list oft the CLAS standards, visit: https/Ahinkculturalheallh.hhsgov/clas/standards The result that an intervention aims to influence and/or change. Outcomes typically reflect behaviors, such as reducing 30-day use of substances. Interventions may also impact knowledge (e.g., Outcome knowledge ofhealth impacts of vaping), attitudes (e.g., perception of risk ofharm of using marijuana), or skills (e.g., peer refusal skills in youth). Page 5 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B An intentional, prosocial approach that engages youth within their communities, schools, organizations, peer groups, and families, in a manner that is productive and constructive. PYD recognizes, utilizes, Positive Youth and enhances young people's strengths, and promotes positive Development (PYD) outcomes for young people by providing opportunities, fostering positive relationships, and building on their leadership strengths. tpsy/cdphe.coloradotogovmatcmlamend-chle-healhpost ve-youth- development A framework that aims to keep an adverse outcome from occurring or becoming established by reducing risks or increasing resilience. There are two primary efforts: (1) to reduce dysfunction or promote Primary Prevention health before the onset of disorder, and (2) to be population-focused, targeted to either the whole population or to subgroups with known vulnerabilities. Data which describes the internal processes of an organization or Process Data intervention, including but not limited to trainings attended, number of intervention implementations, and numbers served or reached. Specialized training, formal or informal education, or advanced Professional professional learning intended to help professionals improve their Development knowledge, competence, skill, and effectiveness. Characteristics of an individual, family, or community which are known to be associated with an increase (risk factors) or decrease (protective factors) in the ikelihood of developing an undesirable health Outcome. Characteristics which predict more than one Risk and Protective Outcome are known as shared Risk and Protective Factors Factors (e.g., family conflict is associated with both mental health problems and substance use). Primary Prevention aims to decrease substance use by decreasing risk factors and increasing protective factors related to substance use. A framework used to help guide goal setting. SMART is an acronym that stands for: SMART Goal Specific: Well-defined, clear, and unambiguous. Measurable: Includes criteria that measure your progress towards the accomplishment of the goal. Achievable: Attainable and realistic to achieve. Relevant: Directly related to your desired outcome. Page 60 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B Timely: With a clearly defined timeline, including a starting date and ai target date. An example ofa SMART goal could be, "In order to improve my health, I will do aerobic exercise for àt least 20 consecutive minutes, 3 times per week for the next 6 months. 93 For more information on SMART goals, visit: htps/hwwwsmarshetiomhbwssemlilam-guide-writing-smart goals A model which explains how behaviors form based on characteristics ofi individuals, communities, nations, and levels in between. The Socio-Ecological model emphasizes multiple levels of influence (such as individual, Model interpersonal, organizational, community, and public policy) and that behaviors both shape and are shaped by the social environment. SAMHSA's planning model to support coordinated, data-driven planning and accountability in prevention. The model consists of five Strategic Prevention dynamic and iterative steps (assessment, capacity building, planning, Framework (SPF) implementation, and evaluation) and is guided by two primary principles (sustainability and cultural competence) which are integrated into each step. Occurs when a person's use of alcohol, marijuana, or other drugs leads to health issues or problems at work, school, or home. The SABG guidelines include Primary Prevention activities that are Substance Use directed at individuals who do not require treatment for SUD. SABG Disorder (SUD) Primary Prevention set-aside funds can only be used to fund strategies that are intended to prevent substance misuse and abuse and cannot be used to fund treatment activities or referral to treatment. A framework in which programs simultaneously address the needs of parents and children to improve Outcomes for the whole family. Fragmented approaches to serving families can leave either the child Two-Generation or the caregiver behind, reducing the likelihood of success for all (2Gen) Approach members ofthe family. 2Gen approaches draw from findings that the well-being of parents is crucial to their children's social-emotional, physical, and economic well-being. Page 7 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B Upstream interventions and strategies focus on improving social structures and systems in a community in order to decrease risk Upstream factors and increase protective factors that allow people to achieve Prevention their full health potential. Upstream interventions can benefit larger numbers of people and may be ultimately more effective than downstream individual-level interventions. Q1 July 1- September 30; Q2 October 1- December 31; Q3 January Quarter 1-1 March 31; Q4 April 1-June 30. Article 3 Work Plan: Activities and Services Contractor shall provide primary, upstream substance abuse and misuse primary prevention services to children, youth, young adults, families, and communities in Colorado. The content below includes the requirements of the Contractor. This section details the critical work necessary to meet the deliverable(s) oft the contract. This section should be detailed and specific and is what the contract monitoring team will review and the program staff needs to monitor for invoice approval. 3.1 Strategic Prevention Framework (SPF) a. Contractor shall complete and submit a one-year Action Plan (template to be provided) detailing proposed activities to be implemented during the year, Contractor shall have the opportunity to update the Action Plan on a quarterly basis in consultation with, and approval from, the Program Manager and evaluation staff. b. In accordance with the SPF model, Contractor shall complete substance abuse and misuse primary prevention activities with the five SPF stages in mind: Assessment, Capacity Building, Planning, Implementing, and Evaluation. The Contractor shall also make Cultural Responsiveness and Sustainability an integral part ofeach phase. 1. Contractor shall review and update the five-year strategic plan. The strategic plan builds upon the original application, existing data, the readiness assessment and shall include but is not limited to: a) Identification of challenges that the community faces and strategies to address them. b) Identification and description of data and process behind strategy selection. c) Identification of the party/parties responsible for Page 8 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B implementation ofthe strategies. d) Identification oft the expected timeline for implementation ofthe strategies. e) A Logic Model that lllustrates inputs; activities; outputs; short, medium, and long-term Outcomes. Sustainability planning C. Evidence Based Programs & Policies 1. Contractor shall implement the chosen EBP with Fidelity. 2. Contractor shall implement the EBP with the following parameters: a) Maintain a comprehensive substance abuse and misuse primary prevention program that includes at least one of the following Center for Substance Abuse Prevention (CSAP) strategies as a foundational evidence-based strategy: i. Education ii. Environmental b) Incorporate at least one or more ofthe following CSAP supplemental strategies as needed: i. Problem Identification and Referral ii. Information Dissemination iii. Community-based Processes iv. Alternative Activities V. Education vi. Environmental 3. Contractor shall guarantee that most funds are dedicated to and support the chosen evidençe-based program or policy (Education or Environmental foundational strategies). Contractor shall track spent funds throughout the State Fiscal Year (July 1 to June 30) by demonstrating and reporting that most funds support the EBP program or policy in the Closeout Narrative. 4. Contractor shall ensure that all the strategies and activities implemented are directly related to the planned activities noted in the Action Plan. All the outlined activities shall be directly related to the identified Risk and Protective Factors and prevention outcomes. d. Collaboration - Collective Impact Approach 1. Contractor shall promote community efforts to raise awareness and generate support from multiple community sectors for the intended EBP program or policy. 2. Contractor shall have critical support from county commissioners, existing Coalitions, and other community partners with similar goals within its geographical target area. Page 9 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B 3. Contractor shall consider implementing a 2Gen approach to create opportunities for both youth and the adults in their lives together. 4. Health Equity and National Standards for Culturally and Linguistically Appropriate Services a) Contractor shall use local data to identify subpopulations in the community that are experiencing disparities and continue to work towards reducing these disparities as identified in the Five-Year Strategic Plan. b) Contractor shall use the CLAS Standards to help the organization and programs take into account cultural health beliefs, preferred languages, health literacy levels, and communication needs. c) Contractor shall submit a CLAS implementation checklist and action worksheet to guide organization and program practices. Follow up on action worksheet will be addressed during site visits. 3.2 Required Training and Technical Assistance (TA) a. Contractor shall attend the following required trainings: 1. The Colorado Shared Risk & Protective Factors Conference annually. The conference committee is planning on an in-person conference or virtual option. Budgets should reflect in-person costs (i.e. mileage, hotel, per diem). Registration costs should be captured in the Supplies & Operating category on the budget form. 2. Substance Abuse Prevention Skills Training (SAPST) and Prevention Ethics Training for all staff positions included in the budget that have not taken these two trainings previously. All program staff working at .25 FTE or more on the contract shall complete these two training sessions within a timeframe acceptable to the Program Manager. b. Contractor shall work with the assigned Program Manager, assigned evaluation staff, and the assigned technical assistance provider. C. The Department will provide technical assistance. Additional training and TA must be approved in advance by your designated Program Manager. Page 10 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B Article 4 Deliverables 4.1 Deliverables Table a. Items shall be emailed to the Program Manager/evaluation staff unless otherwise specified in the table below. Reimbursement of expenses shall be contingent upon receipt of deliverables by the specified deadline. Deliverable Date* Method of Delivery Annual Action Plan Template provided to grantees Email to Program July 1, annually Manager and evaluation staff Annual Action Plan due July 30, annually Action Plan quarterly Q2 - October to December Email to Program updates changes due by September 30, Manager and evaluation staff annually Q3 - January to March changes due by December 30, annually Q4 - April to June changes due by March 31, annually Implementation Process QI - July to September* Q2 - Via Colorado Prevention Data October to December* Q3 - System online database January to March* * Due on the last working day ofthe following month at the end of the quarter Q4 - April to June (1) Data from April 1 to May 31 - submission due May 31 Page 11 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B (2). All data submitted by June 30 Submit pre/post participant April 15 or within established Email Program and surveys timeline such as when a Evaluation staff when session is completed paper surveys are being mailed to CDPHE. Email digital surveys not hosted by CDPHE to Evaluation staffi in Excel format. Review and update (as Annually, and as needed. Participation in call with needed) Evaluation Plan Evaluation staff and Program Manager. FY25 Year-end Outcome September 30, 2026 Email to Program Summary Narrative Report Manager, CC evaluation including any external staff evaluation reports Substance Abuse Completed within a timeframe Email certificate to Prevention Skills Training acceptable to the Department Program Manager (SAPST) and Prevention Ethics Training Colorado Shared Risk and Attend annually. Submit certification of Protective Factor attendance to Program Conference Manager Grant-indicated Within 10 business days of Email to Program staff changes the change Manager CC evaluation staff Page 12 of1 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B External Evaluation Submit all external data Email to Program Reports (if Applicable) reports by June 1, 2026 Manager CC Evaluation staff Compliance Calls Every month/bi-monthly or Participation in call. quarterly or as needed Program Manager and evaluation staff will verify attendance CLAS Check-in on progress made Email to Program Implementation towards the 3 goals. Review Manager, CC evaluation Checklist and and update (as needed) staff Action Worksheet *Dates are subject to change at the discretion ofthe Department. Any due dates beyond the initial contract period of July 1, through June 30 are contingent upon executing contract renewals, funds being appropriated, budgeted, and otherwise made available, and other contractual requirements, ifa applicable, being satisfied. Ifany discrepancies exist between Article 3 Work Plan: Activities and Services and Article 4 - Deliverables, Article 4 - Deliverables prevails. Article 5 Performance Outcome Measures 5.1 Monitoring: The Department' S monitoring of this contract for compliance with performance requirements will be conducted throughout the contract period by the Program Manager and evaluation staff. Methods used will include a review of documentation determined by the Department to be reflective of performance to include progress reports and other fiscal and programmatic documentation as applicable. The Contractor's performance will be evaluated at set intervals and communicated to the contractor. A Final Contractor Performance Evaluation will be conducted at the end oft the life of the contract. 5.2. Administrative and Compliance Requirements: To ensure active contract management and delivery of quality substance abuse and misuse primary prevention services to communities throughout Colorado, Contractor is responsible for the following administrative and compliance activities: a. Communications Between Contractor and Department staff 1. All email and phone inquiries made by Department staff, or the Contractor shall be responded to within 3 business days. 2. Grant Project Coordinator (or approved appointee) shall participate in compliance calls with the Program Manager and evaluation staff at a minimum ofevery three months. Page 13 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B 3. Contractor shall be available for calls between compliance calls as the need arises. b. Quality and Performance Management 1. Performance monitoring - Contractor shall submit Process Data into the Colorado Prevention System, the web-based data reporting system. Implementation and demographic data shall be entered quarterly. 2. Reporting - Contractor shall submit a FY 25 End of Year Narrative Report in the fall and a Closeout Report (template provided) at the end of the fiscal year. 3. Quality Improvement - Contractor shall use data to inform decision- making and to improve project implementation and outcomes. C. Grant Managemen/Complance 1. Contractor shall participate (at minimum) in-person community visit conducted by Department staff at least once during the five year grant cycle. Department staff: shall provide Contractor with a document outlining required documentation at least 10 working days prior to the community visit and Contractor shall provide all requested documentation at the community visit. Department staff shall draft a narrative report on the community visit that shall then be available for the Contractor's review and records. a) At minimum, Contractor shall have the following available for review: i. Agency policies and procedures to assist with grant compliance ii. Agency organizational chart iii. Department sub-contracts and MOUS supported by this contract iv. Proof of attendance for mandatory trainings and certifications V. Strategic plan, Evaluation Plan, Logic Model, Action Plan, and budget 5.3 Evaluation & Outcome Measurements: To ensure that federal reporting requirements to SAMHSA are met, Contractor shall participate in the following Department data collection and evaluation efforts: 1. Any newly hired Grant Project Coordinator shall attend training on the use of the Colorado Prevention System within two months oft their hire date. a. Ifstaffing changes require new staff to work with the system, the staff member shall complete training with the assigned evaluation staff before being granted system access. Page 14 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 EXHIBIT B 2. Contractor shall review the Evaluation Plan and make updates as needed. 3. Contractor shall not change the three- and six-year Outcome statements, as approved in the Evaluation Plan, without written approval by the Program Manager and evaluation staff. 4. A data submission timeline, including process and outcomes data submission, at least annually. 5. Contractor shall track and regularly communicate information related to the process (e.g., numbers served) through the Colorado Prevention System. Process data shall be reported on a data reporting cycle as specified by evaluation staff (e.g., monthly, quarterly, annually, depending upon the type and availability of the data). 6. Ifapplicable, Contractor shall collect and report on required performance measures using Deparment-provided measurement tools. 7. Ifapplicable, Contractor shall submit required pre/post survey data annually or within established submission timelines such as when a session is completed. 8. Contractor shall share any additional evaluation activities (above and beyond the requirements for evaluation and outcome measurements) ofthe implemented EBP program or policy as requested. This can include but is not limited to measurement tools, data collected, and reports 5.4 Resolution of Non-Compliance: The Contractor will be notified in writing within 15 calendar days of discovery of a compliance issue. Within 30 calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to determine the action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed. The action(s) and timeline for completion will be documented in writing and agreed to by both parties. Ife extenuating circumstances arise that requires an extension to the timeline, the Contractor must email a request to the Program Manager and receive approval for a new due date. The State will oversee the competomimpememation of the action(s) to ensure timelines are met and the issue(s) is resolved. Ifthe Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may exercise its rights under the provisions of this contract. Page 15 of 15 Contract Amendment: 2023*0329 Amendment #3 Docusign Envelope ID: 98D09783AFDA4BIF-S7DSFOC8MADADF7 EXHIBIT C BUDGET COLORADO Department of Public CDPHE Health 8 Environment PREVENTION SERVICES DIVISION- 12 MONTH BUDGET WITH JUSTIFICATION FORM Original Contract Routing #2023*0329 Meagan Hillman, Director Contractor Name Prowers County Public Health and Environment Program Contact Name, 719-336-8721 Title, Phone and Email maimanepowerounmyaet Reyna Perez, Accountant Period Fiscal Contact Name, Budget 7/1/2025 - 6/30/2026 Title, Phone and Email 719-336-8721 phacoummtepowesaw Project Name URHN Contract (CT or PO) 2023*0329 Number Expenditure Categories Personal Services Salaried Employees Gross or Percent of Total Amount Position Title Description of Work Annual Fringe Time on Requested from Salary Project CDPHE Coordinate grant, facilitators, ensure deliverables Project Manager are met in a timely manner. Fringe includes 62,069.00 8,038.00 50.00% 35,053.50 pension, PTO, insurance. Work with Project Manager to provide administrative oversight and approval of events Administrator/Drector and projects. Helps with budget. Helps bring stakeholders tot the table. Keeps Prowers County 116,369.00 25,541.00 5.00% 7,095.50 Youth Council connected to community through meetings and updates. Personal Services Hourly Employees Total # of Total Amount Position Title Description of Work Hourly Wage Hourly Hours on Requested from Fringe Project CDPHE Assist Project Manager with making copies, PH: Staffer ordering and buy food for youth councils, buying 18.54 7.76 120.00 3,156.00 supplies, helping with events and cover the project manager if scheduled out of office. Total Personal Services (including fringe benefits) 45,305.00 Supplies & Operating Expenses Contract Amendment: 2023*0329 Amendment #3 Page 1 of 3 Docusign Envelope ID: 96D09793-AFD44 48 B1 FOC6A42DA0F7 EXHIBIT C BUDGET Total Amount Item Description of Item Rate Quantity Requested from CDPHE Council meetings and youth night locations rental fees, and Building Rent associated cost for the FY26 ($1,648 x 12 months) *Excluded 1,648.00 12.00 19,776.00 fromi indirects Internet for Building Internet access for youth council meetings and youth nights 85.00 12.00 1,020.00 Utilities for Building Gas and Electric 379.90 12.00 4,558.80 Background Checks Background checks for youth council facilitators 40.00 5.00 200.00 SRPF Conference Project Manager and PH Staffer/Administrator 325.00 2.00 650.00 SAdeRPuVeE for youth and staff to wear tol Youth Council Branding 15.00 200.00 3,000.00 events, stickers for folders, table clothes for events Communication Office phone/cell phone (12 months x $50) 50.00 12.00 600.00 Copies Flyers, reminder postcards, invitations ($1.50x1000) 1.50 500.00 750.00 Office Supplies Sticky pads, markers, pens, notepads, etc. 25.00 12.00 300.00 Supplies for youth initiated projects (4 councils). Supplies are focused on community involvement and youth prosocial opportunities. Items expected to be purchased are: books for Youth Project mplementation and SEL little library projects, new little library stands, movies in the park, 1,325.00 4.00 5,300.00 Programming supplies for movies in the park, arts and crafts supplies, supplies for community service projects (Supplies can vary due to student deay/mplementation). Art and craft supplies, supplies for projects, variety of age- appropriate games and video games, miscellaneous program Youth Council Meeting Supplies 1,000.00 4.00 4,000.00 related supplies, paper towls, soap, cleaning projects, seating, tables, décor, plates, bowls, napkins, silverwear, cups, etc. Food @ $175/session x4 locations for council meetings for 45 Food for Youth Council Meetings and weeks. 36,000.00 1.00 36,000.00 Youth Night Food @ $100/session for youth nights for 45 nights Conference or prevention-related professional development Professional Development (with approval of Administrator, Commissioners) for Project 500.00 1.00 500.00 Manager. Alcohol and drug free after prom: support for four school Mini Grants 500.00 4.00 2,000.00 districts. Total Supplies & Operating 78,654.80 Travel Total Amount Item Description of Item Rate Quantity Requested from CDPHE Milage Local milage to grant programming 0.70 1300.00 910.00 Per diem for Project Manager and PH: staffer (3 days in state Per Diem 100.00 3.00 300.00 travel x 2 staffx $50/day/person Project Manager in state travel; cost estimated at $150/nightx3 Lodging 150.00 3.00 450.00 nights Lodgingi for SRPF Conference Cost estimated at $175/night x3 3 nights 175.00 3.00 525.00 Total Travel 2,185.00 Contract Amendment: 2023*0329 Amendment #3 Page 2 of3 Docusign Envelope ID: 60073AFDA-BIF-7DSFOC6MADA0F7 EXHIBIT C BUDGET Contractual Total Amount Subcontractor Name Description of Item Rate Quantity Requested from CDPHE Youth night facilitators for use at Prowers County Youth Council Youth Night acilitators 200.00 45.00 9,000.00 "Youth Night" (2 facilitators at $100/session X 45 sessions.) Youth Leaders to attend once monthly council meetings to CO- facilitate with adult staff and provide leadership to younger kids. Youth Mentor/Leaders Also helpt to create social media content and help to build 400.00 12.00 4,800.00 newsletter and calendars for youth councils. ($100 per month per youth council) Council Facilitator for Youth Council- Adult facilitators to attend weekly council meetings (21 facilitators Lamar at $100/session. x 45: sessions.) 200.00 45.00 9,000.00 Council Facilitator for Youth Council- Adult facilitators to attend weekly council meetings (2 facilitators Wiley at $100/session x 45: sessions.) 200.00 45.00 9,000.00 Council Facilitator for Youth Council- Adult facilitators to attend weekly council meetings (2 facilitators 200.00 45.00 Granada at $100/session. x4 45: sessions.) 9,000.00 Council Facilitator for Youth Council- Adult facilitators to attend weekly council meetings (2 facilitators 200.00 45.00 9,000.00 Holly at $100/session x 45 sessions.) Total Contractual 49,800.00 SUB-TOTAL OF DIRECT COSTS 175,944.80 Less: Expenses per OMB 2 CFR 200 Subcontractor in excess of $50,000 $- Rent $19,776.00 Equipment in excess of $10,000 $- Other Unallowable expenses $- Total Expenses per OMB 2 CFR 200 $19,776.00 Modified Total Direct Costs (MTDC) $156,168.80 Indirect Total Amount Item Description of Item Percentage Requested from Federally-Negotiated Indirect Cost Rate CDPHE-Negotiated Indirect Cost Rate To be applied towards personal time not billable on the grant and other costs 24,049.20 associated with grant management (CY2025 rate: 15.40% MTDC) 15.40% De minimis Indirect Cost Rate* Total Indirect 24,049.20 TOTAL 199,994.00 Contract Amendment: 2023*0329 Amendment #3 Page 3 of 3 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 1. EXHIBIT G, GRANT FEDERAL PROVISIONS 1. Applicability of] Provisions. 1.1. The Grant to which these Federal Provisions are attached has been funded, in whole or in part, with an Award of Federal funds. In the event of a conflict between the provisions of these Federal Provisions, the Special Provisions, the body oft the Grant, or any attachments or exhibits incorporated into and made a part of the Grant, the provisions of these Federal Provisions shall control. 1.2 These Federal Provisions are subject to the Award as defined in $2 of these Federal Provisions, as may be revised pursuant to ongoing guidance from the relevant Federal or State ofColorado agency or institutions of! higher education. 2. Definitions 2.1. For the purposes of these Federal Provisions, the following terms shall have the meanings ascribed to them below. For a full list ofdefinitions (as ofOctober 1, 2024) under the Uniform Guidance, see 2 CFR 200.1. 2.1.1. "Award" means an award of Federal financial assistance, and the Grant setting forth the terms and conditions of that financial assistance, that a non-Federal Entity receives or administers. 2.1.2. "Entity" means: 2.1.2.1.a Non-Federal Entity; 2.1.2.2.a non-profit organization or for profit organization; 2.1.3. "Executive" means an officer, managing partner or any other employee in a management position. 2.1.4. "Federal Awarding Agency" means a Federal agency providing a Federal Award to a Recipient as described in 2 CFR 200.1. 2.1.5. "Grant" means the Grant to which these Federal Provisions are attached. 2.1.6. "Grantee" means the party or parties identified as such in the Grant to which these Federal Provisions are attached. Grantee also means Subrecipient. 2.1.7. "Non-Federal Entity" means a State, local government, Indian tribe, institution ofhigher education, or nonprofit organization that carries out a Federal Award as a Recipient or a Subrecipient. 2.1.8. "Nonprofit Organization" organization, that: 2.1.8.1. Is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; Contract Amendment: 2023*0329 Amendment #3 Page 1 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 980079AFDA4B1FS7D9FOC8MADA0F7 2.1.8.2. Is operated primarily for scientific, educational, service, charitable, or similar purposes in the public interest; 2.1.8.3. Is not organized primarily for profit; and 2.1.8.4. Uses net proceeds to maintain, improve, or expand the organization's operations; and 2.1.8.5. Is not an IHE. 2.1.9. "OMB" means the Executive Office of the President, Office of Management and Budget. 2.1.10. Pass-through Entity" means a recipient or subrecipient that provides a Subaward to a Subrecipient (including lower tier subrecipients) to carry out part of a Federal program. The authority of the pass-through entity under this part flows through the Subaward agreements between the pass-through entity and subrecipient. 2.1.11. Recipient" means the Colorado State agency or institution ofhigher education identified as the Grantor in the Grant to which these Federal Provisions are attached. 2.1.12. "Subaward" means an award provided by aj pass-through entityto a Subrecipient to contribute to the goals and objectives of the project by carrying out part of a Federal award received by the pass-through entity. The term does not include payments to a contractor, beneficiary or participant. 2.1.13. "Subrecipient" means an entity that receives a subaward from a pass-through entity to carry out part of a Federal award. The term subrecipient does not include a beneficiary or participant. A subrecipient may also be a recipient of other Federal awards directly from a Federal agency. Subrecipient also means Grantee. 2.1.14. "System for Award Management (SAM)" means the Federal repository into which an Entity must enter the information required under the Transparency Act, which may be found at htplwww.sam.goy. 2.1.15. "Total Compensation" means the cash and noncash dollar value an Executive earns during the entity's preceding fiscal year. This includes all items of compensation as prescribed in 17 CFR 229.402(c)(2). 2.1.16. "Tansparency Act" means the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by $6202 of Public Law 110-252. 2.1.17. "Unique Entity ID" (UEI) is the universal identifier for federal financial assistance applicants, as well as recipients and their direct subrecipients (first tier subrecipients). 2.1.18. Uniform Guidance" means the Office of Management and Budget Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. The terms and conditions ofthe Uniform Guidance flow down to Awards to Subrecipients unless the Uniform Guidance or the terms and conditions of the Federal Award specifically indicate otherwise. Contract Amendment: 2023*0329 Amendment #3 Page 2 of8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 3. Compliance. 3.1. Subrecipient shall comply with all applicable provisions ofthe Transparency Act and the regulations issued pursuant thereto, all applicable provisions ofthe Uniform Guidance, and all applicable Federal Laws and regulations required by this Federal Award. Any revisions to such provisions or regulations shall automatically become a part ofthese Federal Provisions, without the necessity ofeither party executing any further instrument. The State of Colorado, at its discretion, may provide written notification to Subrecipient of such revisions, but such notice shall not be a condition precedent to the effectiveness of such revisions. 4. System for Award Management (SAM) and Unique Entity ID Requirements. 4.1. SAM. Subrecipient must obtain a UEI but are not required to fully register in Sam.gov. Subrecipient shall maintain the currency ofits information in SAM until the Subrecipient submits the final financial report required under the Award or receives final payment, whichever is later. Subrecipient shall review and update SAM information at least annually after the initial registration, and more frequently ifre required by changes in its information. 4.2. Unique Entity ID. Subrecipient shall provide its Unique Entity ID to its Recipient, and shall update Subrecipient's information at ittp:/www.sam.goy at least annually after the initial registration, and more frequently if required by changes in Subrecipient's information. 5. Total Compensation. 5.1. Subrecipient shall include Total Compensation in SAM for each ofi its five most highly compensated Executives for the preceding fiscal year if: 5.1.1. The total Federal funding authorized to date under the Award is $30,000 or more; and 5.1.2. In the preceding fiscal year, Subrecipient received: 5.1.2.1. 80% or more of its annual gross revenues from Federal procurement contracts and subcontracts and/or Federal financial assistance Awards or Subawards subject to the Transparency Act; and 5.1.2.2. $25,000,000 or more in annual gross revenues from Federal procurement contracts and subcontracts and/or Federal financial assistance Awards or Subawards subject to the Transparency Act; and 5.1.2.3. The public does not have access to information about the compensation of such Executives through periodic reports filed under section 13(a) or 15(d) ofthe Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d) or $ 6104 ofthe Internal Revenue Code of 1986. Contract Amendment: 2023*0329 Amendment #3 Page 3 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 6. Reporting. 6.1. Pursuant to the Transparency Act, Subrecipient shall report data elements to SAM and to the Recipient as required in this Exhibit. No direct payment shall be made to Subrecipient for providing any reports required under these Federal Provisions and the cost of producing such reports shall be included in the Grant price. The reporting requirements in this Exhibit are based on guidance from the OMB, and as such are subject to change at any time by OMB. Any such changes shall be automatically incorporated into this Grant and shall become part of Subrecipient's S obligations under this Grant. 7. Effective Date and Dollar Threshold for Reporting. 7.1. Reporting requirements in $8 below apply to new Awards as of October 1, 2010, if the initial award is $30,000 or more. Ifthe initial Award is below $30,000 but subsequent Award modifications result in a total Award of$30,000 or more, the Award is subject to the reporting requirements as of the date the Award exceeds $30,000. Ifthe initial Award is $30,000 or more, but funding is subsequently de-obligated such that the total award amount falls below $30,000, the Award shall continue to be subject to the reporting requirements. 7.2. The procurement standards in $9 below are applicable to new Awards made by Recipient as ofl December 26, 2015. The standards set forth in $11 below are applicable to audits of fiscal years beginning on or after December 26, 2014. 8. Subrecipient Reporting Requirements. 8.1. Subrecipient shall report as set forth below. 8.1.1. To SAM. A Subrecipient shall report the following data elements in SAMfor each Federal Award Identification Number (FAIN) assigned by a Federal agency to a Recipient no later than the end ofthe month following the month in which the Subaward was made: 8.1.1.1. Subrecipient Unique Entity ID; 8.1.1.2. Subrecipient Unique Entity ID if more than one electronic funds transfer (EFT) account; 8.1.1.3. Subrecipient parent's organization Unique Entity ID; 8.1.1.4. Subrecipient's: address, including: Street Address, City, State, Country, Zip + 4, and Congressional District; 8.1.1.5. Subrecipient': S top 5 most highly compensated Executives ifthe criteria in $4 above are met; and Subrecipient's Total Compensation oftop 5 most highly compensated Executives if the criteria in $4 above met. 8.1.2. To Recipient. A Subrecipient shall report to its Recipient, upon the effective date ofthe Grant, the following data elements: 8.1.2.1. Subrecipient's S Unique Entity ID as registered in SAM. 9. Primary Place of Performance Information, including: Street Address, City, State, Country, Zip code + 4, and Congressional District. Procurement Standards. Contract Amendment: 2023*0329 Amendment #3 Page 4 of 8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 9.1. Procurement Procedures. A Subrecipient shall use its own documented procurement procedures which reflect applicable State, local, and Tribal laws and applicable regulations, provided that the procurements conform to applicable Federal law and the standards identified in the Uniform Guidance, including without limitation, 2 CFR 200.318 through 200.327 thereof. 9.2. Domestic preference for procurements (2 CFR 200.322). As appropriate and to the extent consistent with law, the non-Federal entity should, to the greatest extent practicable under a Federal award, provide a preference for the purchase, acquisition, or use of goods, products, or materials produced in the United States (including but not limited to iron, aluminum, steel, cement, and other manufactured products). The requirements ofthis section must be included in all subawards including all contracts and purchase orders for work or products under this award. 9.3. Procurement of Recovered Materials. Ifa Subrecipient is a State Agency or an agency ofa political subdivision of the State, its contractors must comply with section 6002 ofthe Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery Act. The requirements of Section 6002 include procuring only items designated in guidelines oft the Environmental Protection Agency (EPA) at 40 CFR part 247, that contain the highest percentage of reçovered materials practicable, consistent with maintaining a satisfactory level of competition, where the purchase price ofthe item exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year exceeded $10,000; procuring solid waste management services in a manner that maximizes energy and resource recovery; and establishing an affirmative procurement program for procurement of recovered materials identified in the EPA guidelines. 9.4. Never contract with the enemy (2 CFR 200.215). Federal awarding agencies and recipients are subject to the regulations implementing "Never contract with the enemy" in 2 CFR part 183. The regulations in 2 CFR part 183 affect covered contracts, grants and cooperative agreements that are expected to exceed $50,000 during the period of performance, are performed outside the United States and its territories, and are in support of a contingency operation in which members ofthe Armed Forces are actively engaged in hostilities. 9.5. Prohibition on certain telecommunications and video surveillance equipment or services (2 CFR 200.216). Subrecipient is prohibited from obligating or expending loan or grant funds on certain telecommunications and video surveillance services or equipment pursuant to 2 CFR 200.216. 10. Access to Records. 10.1. A Subrecipient shall permit Recipient and its auditors to have access to Subrecipient's records and financial statements as necessary for Recipient to meet the requirements of2 CFR 200.332 (Requirements for pass-through entities), 2 CFR 200.300 (Statutory and national policy requirements) through 2 CFR 200.309 (Modification to period of performance), 2 CFR 200.337 (Access to Records) and Subpart F-Audit Requirements of the Uniform Guidance. Contract Amendment: 2023*0329 Amendment #3 Page 5 of8 OSC. A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 10.2. A Subrecipient must collect, transmit, and store information related to this Subaward in open and machine-readable formats (2 CFR 200.336). 11. Single Audit Requirements. 11.1. Ifa Subrecipient expends $1,000,000 or more in Federal Awards during the Subrecipient's fiscal year, the Subrecipient shall procure or arrange for a single or program-specific audit conducted for that year in accordance with the provisions of Subpart F-Audit Requirements ofthe Uniform Guidance, issued pursuant to the Single Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR 200.501. 11.1.1. Election. A Subrecipient shall have a single audit conducted in accordance with Uniform Guidance 2 CFR 200.514 (Scope of audit), except when it elects to have a program-specific audit conducted in accordance with 2 CFR 200.507 (Program-specific audits). The Subrecipient may elect to have a program- specific audit if Subrecipient expends Federal Awards under only one Federal program (excluding research and development) and the Federal program's statutes, regulations, or the terms and conditions of the Federal award do not require a tinancial statement audit of) Recipient. A program-specific audit may not be elected for research and development unless all of the Federal Awards expended were received from Recipient and Recipient approves in advance a program-specific audit. 11.1.2. Exemption. If a Subrecipient expends less than $1,000,000 in Federal Awards during its fiscal year, the Subrecipient shall be exempt from Federal audit requirements for that year, except as noted in 2 CFR 200.503 (Relation to other audit requirements), but records shall be available for review or audit by appropriate officials of the Federal agency, the State, and the Government Accountability Office. 11.1.3. Subrecipient Compliance Responsibility. A Subrecipient shall procure or otherwise arrange for the audit required by Subpart F oft the Uniform Guidance and ensure it is properly performed and submitted when due in accordance with the Uniform Guidance. Subrecipient shall prepare appropriate financial statements, including the schedule of expenditures of Federal awards in accordance with 2 CFR 200.510 (Financial statements) and provide the auditor with access to personnel, accounts, books, records, supporting documentation, and other information as needed for the auditor to perform the audit required by Uniform Guidance Subpart F-Audit Requirements. 12. Required Provisions for Subrecipient with Subcontractors. 12.1. In addition to other provisions required by the Federal Awarding Agency or the Recipient, Subrecipients shall include all ofthe following applicable provisions; 12.1.1. For agreements with Subrecipients Include the terms in the Grant Federal Provisions Exhibit (this exhibit) 12.1.2. For contracts with Subcontractors - Include the terms in the Contract Federal Provisions Exhibit. Contract Amendment: 2023*0329 Amendment #3 Page 6 of8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 13. Certifications. 13.1. Unless prohibited by Federal statutes or regulations, Recipient may require Subrecipient to submit certifications and representations required by Federal statutes or regulations on an annual basis. 2 CFR 200.415. Submission may be required more frequently if Subrecipient fails to meet a requirement oft the Federal award. Subrecipient shall certify in writing to the State at the end of the Award that the project or activity was completed or the level of effort was expended. Ifthe required level of activity or effort was not carried out, the amount of the Award must be adjusted. 14. Exemptions. 14.1. These Federal Provisions do not apply to an individual who receives an Award as a natural person, unrelated to any business or non-profit organization he or she may own or operate in his or her name. 14.2. A Subrecipient with gross income from all sources of less than $300,000 in the previous tax year is exempt from the requirements to report Subawards and the Total Compensation of its most highly compensated Executives. 15. Event of Default and Termination. 15.1. Failure to comply with these Federal Provisions shall constitute an event of default under the Grant and the State of Colorado may terminate the Grant upon 30 days prior written notice ift the default remains uncured five calendar days following the termination of the 30- day notice period. This remedy will be in addition to any other remedy available to the State ofColorado under the Grant, at law or in equity. 15.2. Termination (2 CFR 200.340). The Federal Award may be terminated in whole or in part as follows: 15.2.1. By the Federal Awarding Agency or Pass-through Entity, if a Non-Federal Entity fails to comply with the terms and conditions of a Federal Award; 15.2.2. By the Federal awarding agency or Pass-through Entity with the consent of the Non-Federal Entity, in which case the two parties must agree upon the termination conditions, including the effective date and, in the case of partial termination, the portion to be terminated; 15.2.3. By the Non-Federal Entity upon sending to the Federal Awarding Agency or Pass-through Entity written notification setting forth the reasons for such termination, the effective date, and, in the case of partial termination, the portion to be terminated. However, if the Federal Awarding Agency or Pass-through Entity determines in the case of partial termination that the reduced or modified portion ofthe Federal Award or Subaward will not accomplish the purposes for which the Federal Award was made, the Federal Awarding Agency or Pass- through Entity may terminate the Federal Award in its entirety; or 15.2.4. By the Federal Awarding Agency or Pass-through Entity pursuant to termination provisions included in the Federal Award. 16. Additional Federal Requirements. 16.1. Whistle Blower Protections Contract Amendment: 2023*0329 Amendment #3 Page 7 of8 OSC. A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 An employee of a subrecipient must not be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing to a person or body described in paragraph (a)(2) of41 U.S.C. 4712 information that the employee reasonably believes is evidence of gross mismanagement of a Federal contract or grant, a gross waste of Federal funds, an abuse of authority relating to a Federal contract or grant, a substantial and specific danger to public health or safety, or a violation of law, rule, or regulation related to a Federal contract (including the competition for or negotiation of a contract) or grant. The subrecipient must inform their employees in writing of employee whistleblower rights and protections under 41 U.S.C. 4712. See statutory requirements for whistleblower protections at 10 U.S.C. 4701, 41 U.S.C. 4712, 41 U.S.C. 4304, and 10 U.S.C. 4310. Contract Amendment: 2023*0329 Amendment #3 Page 8 of8 OSC A.12.24/CDPHE A.12.24 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FoC6A42DA0F7 FOR SUBRECIPIENTS ONLY This is a supporting document for Contract Number: 2023*0329 The updated information provided here does not modify the original contract or original task order in any way. The information provided here informs the grantee of updated items that are required under 2 CFR 200.332. Data Required by 2 CFR 200.332 (AIl pass through entities must ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward. Ifany oft these data elements change, the changes are to be reflected in subsequent subaward modification. When some of this information is not available, the pass-through entity must provide the best available information when some of the information below is unavailable. A pass-through entity must provide the unavailable information when it is obtained.): A. Subrecipient name (which must match the name associated with its unique entity identifier): Shown in Contractor box on cover page of original contract and subsequent modifications. B. Subrecipient's unique entity identifier: Y8C4HSXY95M6 C. Federal Award Identification Number (FAIN): B08TI088095 D. Federal Award Date (when Federal award was signed by authorized official of the Federal awarding agency): 02/24/2025 E. Subaward Period ofPerformance Start and End Date: Start date shown on cover page of original contract and end date shown on cover page of original contract, as updated by any subsequent modifications. F. Subaward Budget Period Start and End Date: Start date shown on cover page of original contract and end date shown on cover) page of original contract, as updated by any subsequent modifications. G. Amount ofl Federal Funds Obligated by this action by the pass-through entity to the subrecipient: Shown on Budget Exhibit in column matching this contract modification. H. Total Amount of Federal Funds Obligated to the subrecipient by the pass-through entity including the current financial obligation: Shown on cover page of this contract modification and on Budget Exhibit. I. Total Amount oft the Federal Award committed to the subrecipient by the pass-through entity: Shown on cover page ofthis contract modification and on Budget Exhibit. J. Federal award project description, as required to be responsive to the Federal Funding Accountability and Transparency Act (FFATA): Substance Abuse Prevention, Treatment, and Recovery Services Block Grant K. Pass-through entity is shown on the cover page in the State Agency box. Name of Federal awarding agency: Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substançe Abuse Treatment. Contact information for the awarding official of thel Pass-through entity: Dannette Smith, amnstemih2seo.s 303- 866-7400 L. Assistance Listing number and Title; the pass-through entity must identify the dollar amount made available under each Federal award and the Assistance Listing Number at time ofdisbursement: Block Grants for Prevention and Treatment of Substance Abuse, $9,055,548, and 93.959 M. Identification of whether the award is R&D: No N. Indirect cost rate for the Federal award (including ifthe de minimis rate is charged) per $ 200.414: Shown on Budget Exhibit as indicated by indirect rate and amount. Ver 10/2024 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 STATE OF COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT CONTRACT AMENDMENT #3 SIGNAIURE AND COVER PAGE State Agency: Original Contract Number: Colorado Department Of Public Health and Environment 2023*0329 4300 Cherry Creek Drive South Denver, Colorado 80246 Contractor: Amendment Contract Number: Board of County Commissioners of Prowers County 2023*0329 Amendment #3 (a political subdivision oft the state ofColorado) 301 South Main Street, #215 Lamar CO 81052 for the use and benefit of the Prowers County Public Health 1001 South Main Street Lamar CO 81052-3838 Contract Performance Beginning Date: Current Contract Expiration Date: July 1, 2022 June 30, 2026 CONTRACT MAXIMUM AMOUNT TABLE Federal Funding State Funding Other Funding Document Type Contract Number Term (dates) Total Amount Amount Amount Original 2023*0329 $199,994.00 $0.00 $0.00 7/1/2022 $199,994.00 Contract 6/30/2023 Amendment #1 2023*0329 $199,994.00 $0.00 $0.00 7/1/2023 - $199,994.00 Amendment #1 6/30/2024 Amendment #2 2023*0329 $199,994.00 $0.00 $0.00 7/1/2024 $199,994.00 Amendment #2 6/30/2025 Amendment #3 2023*0329 $199,994.00 $0.00 $0.00 7/1/2025 - $199,994.00 Amendment #3 6/30/2026 Current Contract Maximum $799,976.00 Cumulative Amount Contract Amendment: 2023*0329 Amendment #3 Page 1 of 4 Version OSC A11.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-B1F-97D9-FOC6A42DA0F7 SIGNATURE PAGE THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment and to bind the Party authorizing his or her signature. CONTRACTOR STATE OF COLORADO Board of County Commissioners ofl Prowers County Jared S. Polis, Governor (a political subdivision of the state of Colorado) Colorado Department of] Public Health and Environment for the use and benefit of the Jill Hunsaker Ryan, MPH, Executive Director Prowers County Public Health By: Signature By: Signature FULL NAME Name of Person Signing for Contractor Name of Executive Director Delegate TITLE Title of Person Signing for Contractor Title of Executive Director Delegate Date: Date: In accordance with $24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or an authorized delegate. STATE CONTROLLER Robert Jaros, CPA, MBA, JD By: Signature Name of State Controller Delegate Title of State Controller Delegate Amendment Effective Date: Contract Amendment: 2023*0329 Amendment #3 Page 2 of4 Version OSC A11.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 1. PARTIES This Amendment (the "Amendment") to the Original Contract shown on the Cover Page for this Amendment (the "Contract") is entered into by and between the Contractor, and the State. 2. TERMINOLOGY Except as specifically modified by the Amendment, all terms used in this Amendment that are defined in the Contract shall be construed and interpreted in accordance with the Contract. 3. AMENDMENT EFFECTIVE DATE AND' TERM A. Amendment Effective Date This Amendment shall not be valid or enforceable until the Amendment Effective Date shown on the Signature and Cover Page for this Amendment. The State shall not be bound by any provision ofthis Amendment before that Amendment Effective Date, and shall have no obligation to pay Contractor for any Work performed or expense incurred under this Amendment either before or after the Amendment term shown in $3.B ofthis Amendment. B. Amendment Term The Parties' respective performances under this Amendment and the changes to the Contract contained herein shall commence on the Amendment Effective Date shown on the Signature and Cover Page for this Amendment or July 1, 2025, whichever is later, and shall terminate on the termination ofthe Contract or June 30, 2026, whichever is earlier. 4. PURPOSE The Parties entered into the agreement to reduce substance misuse and abuse among under- resourced high need communities. The Parties now desire to renew for an additional term and change the current Contract Maximum Total for the following reason: to add funds to support the renewal term. 5. MODIFICATIONS The Contract and all prior amendments thereto, ifa any, are modified as follows: A. The Contract Initial Contract Expiration Date on the Contract's Signature and Cover Page is hereby deleted and replaced with the Current Contract Expiration Date shown on the Signature and Cover Page for this Amendment. B. The Contract Maximum Amount table on the Contract's cover Page is hereby deleted and replaced with the Current Contract Maximum Amount table shown on the Signature and Cover Page for this Amendment. C. The Parties now agree to modify Exhibit B., Statement of Work. Exhibit B., Statement of Work., is deleted and replaced in its entirety with Exhibit B., Statement of Work., attached to this Amendment, for the following reason: To continue services and update the Statement ofv Work (SOW) for a new fiscal year. D. The Parties now agree to modify Exhibit C., Budget, ofthe agreement. Exhibit C., Budget, is deleted and replaced in its entirety with Exhibit C., Budget, attached to this Amendment for the following reason: To add funds for FY26 renewal. Contract Amendment: 2023*0329 Amendment #3 Page 3 of4 Version OSC A11.24/CDPHE A1.23.25 Docusign Envelope ID: 96D09793-AFD4-4B1F-97D9-FOC6A42DA0F7 E. The Parties now agree to modify Exhibit G., - Federal Provisions. Exhibit G., - Federal Provisions, is deleted and replaced in its entirety with Exhibit G., - Federal Provisions, attached to this Amendment, for the following reason: To provide an updated version of the Federal Provisions Exhibit. 6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE This Amendment is incorporated by reference into the Contract, and the Contract and all prior amendments or other modifications to the Contract, if any, remain in full force and effect except as specifically modified in this Amendment. Except for the Special Provisions contained in the Contract, in the event of any conflict, inconsistency, variance, or contradiction between the provisions ofthis Amendment and any oft the provisions ofthe Contract or any prior modification to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and control. The provisions of this Amendment shall only supersede, govern, and control over the Special Provisions contained in the Contract to the extent that this Amendment specifically modifies those Special Provisions. Contract Amendment: 2023*0329 Amendment #3 Page 4 of 4 Version OSC A11.24/CDPHE A1.23.25 PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6-10-2025 Submitter: Jana Coen, Prowers County Clerk Submitted to the County Administration Office on: 6-4-2025 Return Originals to: 2 Number of originals to return to Submitter: 2 Contract Due Date: Item Title/Recommended Board Action: Consider approval of AracSearch Proposal, estimated project price $670 for digital archiving services related to Commissioner Records from 2021-2024 to add to the Prowers County Historical Document Archive. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: 5-30-2025 Additional Approvals (if required): ArcaSearch Digital Archiving Services PROWERS COUNTY CO DIGITAL PRESERVATION OF: COMMISSIONER RECORDS (2021-2024) & ADDITION OF IMAGES TO THE EXISTING PROWERS COUNTY HISTORICAL DOCUMENT ARCHIVE Proposal #05212025P1V1 May 21, 2025 Prepared for: Prowers County 301 S. Main Street, Suite 210 Lamar, CO 81052 Jana Coen Clerk and Recorder 719.336.8011 coen@posercoums.net Confidential 0 2025 ArcaSearch www.arcasearch.com 2 Project Benefits for Prowers County CO: Addition of 2021 - 2024 Commissioner Records to existing searchable Archive Staffe efficiencies (reduced costs) on research requests with enhanced search tools such as Word Search (Names, Events, Vendors, Topics, etc.) to locate relevant pages Additional content increases the value of the existing Prowers County Historical Document Archive Continuation of established records management practice for this permanent record OVERVIEW ArcaSearch is pleased to be considered as a digital archiving and processing partner with Prowers County, CO. Enclosed you will find our response to your request for a proposal including project benefits, record group/product details, estimated timing, estimated costs, and agreement terms. Commissioner Records (existing) Approximate Pages 650 Date Range December 2021 through 2024 Page Size 8.5" x 14" Condition Good Bindery Pinned Page Capture RGB Page Resolution Web Optimized PDF-A Files & JPEG image files OCR Yes, oft typed text File Format Web Optimized PDF-A Files & JPEG Thumbnail Images Delivery Single page Metadata Book name, year, actual page number Work Location Materials to be digitized at ArcaSearch Key Assumptions Customer will provide physical books for capture at ArcaSearch document preservation lab in St. Cloud, MN Addition to existing digital Archive Actual Page Numbers will be indexed Assumes 2021 (Dec) - 2024 meeting minutes Welcome Notes updated Update to Archive with current Splash page verbiage and "About" button Confidential 9 2025 ArcaSearch www.arcasearch.com 3 ARCASEARCH DIGITAL ARCHIVING As your digital archiving partner, we provide project management and will use ArcaSearch echnology/Petrsonne. to: Digitize pages from provided materials Optimize PDF for vieving/searching within the Compass Eclipse Research System using patented technology Provide two complete sets of Web Optimized PDF-A Files and JPEG Thumbnail Images on external hardware upon receiving final payment for project We look forward to working with Prowers County, CO. Below are a few items ArcaSearch will need to begin your project. Provide a detailed manifest of archive material (required to start your project) Notify ArcaSearch ofany scheduling requirements Provide courier delivery to and from ArcaSearch for the original content ESTIMATED TIMING The following is a timeline for your planning purposes. The scheduled start month will be determined after receipt of the signed contract, down payment, completion of the job plan (if applicable) signed by both parties. Any discrepancies will be resolved before the start of the project. ArcaSearch anticipates the start date to be within 12 months from the receipt of down payment. Please allow 2 months for project's completion. Confidential @ 2025 ArcaSearch ww.arcasearch.com 4 COMPASS ECLIPSE RESEARCH SYSTEM The core technology employed in the updated Compass Eclipse Research System has proven to be the single most cost-effective solution to historic-records management. The Compass Eclipse Research System is adapted to the specific requirements of each individual for the secure preservation and ready access ofi its document archives. Your annual software subscription includes web-hosting ofy your archive digitized by ArcaSearch. With ArcaSearch hosting the archive, you will avoid capital equipment costs and minimize the impact on local network infrastructure and personnel. You simply need a connection to the Internet and a few basic system requirements. System Requirements PC: Windows 7 or newer, macOS, or Linux operating system recommended PC: Chromium based browser (Google Chrome, Microsoft Edge, etc...) Pop up blockers should be disabled for optimum viewing Product Modules A product is comprised of a single category of materials. The key to a user-friendly research application is to search and navigate information by product types, both separately and aggregated. The Compass Eclipse Research System will provide access to your archive that will satisfy the advanced researcher. Digital Archive Hosting With ArcaSearch hosting the archive, you are avoiding capital equipment costs and minimizing the impact on local network infrastructure and IT personnel. ArcaSearch ensures worry-free operation of the archive and will perform all maintenance and update actions. Your archive is protected from unauthorized access by your choice of security control: IP address registration, username/password or your own intranet protocols. Technology Updates Updates are crucial to maintaining a functional archival delivery system. Our cloud-based application assures that your service will operate properly when change comes. Service Level ArcaSearch maintains a 99.9 percent "up time" during business hours year-round fori its hosted client services. Maintenance is performed during off-hours. In the unlikely event maintenance shut- down is required during regular business hours; the client will receive advance notice ofthe reason and expected duration. Unexpected service interruptions, historically are limited in duration and service is quickly restored. At these times, communication and coordination with our clients is of the utmost importance. Confidential C 2025 ArcaSearch ww.arcasearch.com 5 STANDARD FEATURES OF THE COMPASS ECLIPSE RESEARCH SYSTEM Hosting your Research site at a secure location ArcaSearch has elected to host your site link at the highly secure Level 3, Data Center building in downtown Minneapolis for security, service redundancy and to minimize downtime. The Data Center building, its tenants, and its parking areas have exceptional security. Entry to the facility is controlled by on-site security and each door/floor is controlled through card- -access entry. -Multi-level physical access controls Personal verification with properly issued ID Card access entry with photo verification IP Video surveillance recorded and stored for 90 days, both inside and outside the facilities *Man-trap entries Locked cabinets, cages, storage, and suites We have a Diverse Tier 1 backbone providers connected via diverse paths -100/1000 MB Fast Ethernet connections. On-net, Carrier neutral facility The Data Center building is backed a N+2 HVAC system. They monitor environmental systems 24 hours a day, seven days a week. N+2 temperature and humidity with multiple segregated cooling zones environment Raised floors with automated moisture detectors under the floors Zoned smoke and heat detectors Dry-pipe, pre-action fire sprinkler systems -Managed and monitored 24x7 -Professional quarterly maintenance Secure Protection of Data and Infrastructure - 24x7 Multi-Level Security The Data Center building has redundant power systems (2 megawatt generator, transfer switch, UPS systems, battery plants, flexible power configurations). If any one component in the network or electrical system fails, a redundant system designed to carry the full load immediately takes control. Should the entire primary HVAC system fail, a secondary system designed to immediately handle the full capacity for cooling maintains the proper temperature in the data center. 110 volt, single phase 208 volt, single phase/three phase Diverse A/B electrical circuits Custom power Protection Power Plan" or Variable Power Plan" 100% Power Availability Redundant power infrastructure Redundant backup battery systems +Diesel-powered generators Weekly, rigorous system testing Professional quarterly maintenance Network Availability Confidential @ 2025 ArcaSearch wwarcasearch.com 6 Authentication & Access Options We offer a broad selection of authentication features such as public and premium(private) access. Users can decide if they want a single option access to their research site or a tiered level access which separates access privileges to users. This authentication process includes a multifaceted feature that includes username/password challenge and IP Filtering. UsernamelPassword Ifs specified to require username & password authentication, the research site will not be accessible until a user has entered valid credentials for access to the site IP Filter Login can be further restricted to specific IP addresses provided by the customer. This will restrict access to users who use the provided IP addresses. This can be combined with Username/Password authentication for increased security. End User Technical Support A service provided by ArcaSearch to work with technical questions and problems related to the Compass Eclipse Research System in its current configuration to end users. Technical Support does not include generic computer, software, or internet training or third-party users. Phone and Email Support Phone and email support are available Monday through Friday 8am 4:30pm CST Data Management and Storage ArcaSearch will provide 2 forms of back-up hardware for storage and transfer of Web Optimized PDF-A Files and JPEG Thumbnail Images to be used as the final repository at client location. The hardware will remain the property oft the client. Additional file back-ups are available. Price dependent on the request of files to be duplicated. Antivirus Software Antivirus software is run at the Data Center on the file storage servers. Confidential @ 2025 ArcaSearch www.arcasearch.com 7 TERMS AND CONDITIONS Document Care ArcaSearch will exercise great professional care in preserving and digitizing the documents of the Client, as ArcaSearch performs this project. Client will not hold ArcaSearch responsible for any damage sustained to original documents, aperture cards or microfilm, due to fire, water damage, natural disaster orforce majeure while on premises ofthe Client. The parties acknowledge that some of the original documents are of such age as to have been tom from past handling, and brittle, sO as to be subject to splits and tears upon handling. Client will not hold ArcaSearch responsible for any incidental damage in handling oft the documents, except for any damage alleged to be caused by gross negligence of ArcaSearch employees. Confidentiality Subject to provisions of the Freedom ofl Information Act (5 U.S.C. S 552) and any conforming statutes of the state in which this Proposal is executed, the parties and their attorneys shall keep the specific terms, conditions and covenants of this Proposal confidential except: 1. Where mutually agreed to. in writing by the parties; ii. Where necessary to share such information with the parties' accountants or attorneys; iii. Where disclosure to a government entity is required; or iv. Where disclosure is ordered by a court of competent jurisdiction. The parties and their attorneys shall not communicate with anyone associated with any media or publication entities concerning the terms of this Proposal. This confidentiality provision is a material term of this document, and its violation shall constitute a breach of this Proposal. Content of Documents Client shall be solely responsible for the content of documents to be duplicated, digitized, printed and/or preserved by ArcaSearch in the performance of this agreement. ArcaSearch will not be responsible for payment of any claims or damages alleging content of said documents or records to be defamatory, or to violate or infringe upon the rights of third parties. Limitation of Liability In recognition of the relative risks and benefits of this project, to both the Client and ArcaSearch, the risks have been allocated such that the Client agrees, to the fullest extent permitted by law, to limit the liability of ArcaSearch to Client for any and all claims, losses, costs, damages of any nature whatsoever, or expenses related to any such claims or causes, including attoreys' fees and costs and expert witness fees and costs, sO that the total aggregate liability of. ArcaSearch to Client shall not exceed 75 percent of ArcaSearch total fee for services rendered on this project. Itis intended that this limitation apply to any and all liability or cause of action, however asserted, alleged, pled or arising, unless otherwise prohibited by law. Warranty ArcaSearch warrants and represents that all products or deliverables specified and furnished by or through ArcaSearch under this agreement meet the completion criteria set forth in this agreement, and that services will be provided in a workmanlike manner in accordance with industry standards. Confidential 9 2025 ArcaSearch ww.arcasearch.com 8 Termination During the terms of this agreement for this archive project, both ArcaSearch and Client will have the right to terminate this agreement for cause with 30 days written notice. Terms giving either party just cause to terminate are as follows: If one of the parties does not adhere to the responsibilities set forth in this agreement, and/or if payment(s) has not been made in accordance with terms of this agreement. Client may also terminate without cause if funding becomes unavailable. In the event of termination, for this, or any other reason, resulting in an underage between the estimated Page count represented in this proposal and the actual page count, the difference will be priced at an adjusted rate of70 percent of the per page rate used to determine the estimated project price in this proposal. (Estimated project price divided by the estimated page count equals per page rate) The decrease-allowance shall not be more 80 percent of the proposal total. Client will receive a prorated refund on the annual fee if the agreement is terminated prior to yearly renewal. Terms and conditions may be updated annually. Confidential G 2025 ArcaSearch wwwarasearch.com e PRICING Project Estimating In consultation with our clients, ArcaSearch experienced sales representatives and technicians make every effort to accurately estimate the number of documents and associated pages other items in the proposed digital archive. This estimate is one of the primary components in the overall proposal ArcaSearch presents to its customers. Final invoice will reflect the actual number of pages at the completion of this project. Additional pages over the estimated page count for this project will be priced at the per page rate of this project. Single Page Definition: one side ofa sheet of paper in a collection of sheets bound together, especially as a book, magazine, or newspaper. Two-Page Definition: a pair of facing pages, typically the left and right pages in a publication like a book, magazine or newspaper. Each side is a chargeable page. Payment Terms ArcaSearch will invoice 50 percent of the project price upon receipt of this signed proposal and 25% after imaging is completed. Final payment of the project will be invoiced upon completion and final acceptance from the customer. Applicable local and federal tax will be applied in addition to proposal price. Failure to pay an invoice within 90 days ofinvoice date may result in access termination of your research site. Oversized Documents and Inserts Maximum page size for this proposal is 15 inches x 23 inches. Individual books containing separate oversized supporting documents or loosely oversized inserted pages other than what has already been identified in this proposal will be billed at rate of $9.50 per page. Additional Programming Additional programming, beyond the scope of this proposal will be billed at $225/hour with 1-hour minimum. ArcaSearch will do our best at providing clients the highest quality searchable page when digital pages have been provided to us tO be added to our research site. We are not responsible for missing pages or naming errors on pages that are provided to us in a digital born format or paper to digital format. Confidential @ 2025 ArcaSearch wwwarasearch.com 10 By signing this agreement for Proposal #05212025P1V1 the client is acknowledging the signatory below has read, understands and agrees to the terms presented in this document. No understanding exists other than those expressed in this agreement. This proposal is valid for 6 months from its issuance and supersedes all previous proposals or agreements. PROJECT PRICE Estimated Project Price: $670 Includes: > Patented document creation process delivers the highest OCR accuracy possible, without sacrificing the visual integrity of the final PDF files > Two-step verification process for pages quality and accuracy > Two complete copies of your archived files on external media ANNUAL FEE Compass Eclipse Research System Annual Fee Increase: $15 Includes: > Seamless integration of Analog Documents within the Compass Eclipse Research System ACCEPTED BY: Client: Date: Client Name- Signature Client: Date: Client Name- Printed For ArcaSearch: Tammy fookata Date: 6.4.2025 A AraSearb CONTACT INFORMATION: David Frank Tammy Hoekstra Document Preservation Consultant Special Assistant Arcasearch, LLC ArcaSearch, LLC 720 St. Germain St. 720 St. Germain St. St. Cloud, MN 56301 St. Cloud, MN 56301 320.282.4375 800.846.9433 david.frank@arcarcasearch.com lommy.hoekstrogarcaxegrch.com Confidential 0 2025 Arcasearch www.arcasearch.com PROWERS COUNTY AGENDA ITEM REQUEST FORM Hearing Date Requested: 6-10-2025 Submitter: Jana Coen, Prowers County Clerk Submitted to the County Administration Office on: 6-4-2025 Return Originals to: 2 Number of originals to return to Submitter: 2 Contract Due Date: Item Tite/Recommended Board Action: Consider approval of AracSearch Digital Services Agreement for an annual upload service of Commissioners Record images. Justification or Background: Fiscal Impact: This item is budgeted in the following account code: County: $ Federal: $ State: $ Other: $ Approved by the County Attorney on: -30-2025 Additional Approvals (if required): ArcaSearch Digital Archiving Services May 21, 2025 Prowers County 301 S. Main Street, Suite 210 Lamar, CO 81052 Jana Coen Clerk and Recorder 719.336.8011 coeneprowerscounty.net Re: Annual Uploads Dear Jana: ArcaSearch is pleased to offer Prowers County, CO an annual upload service of your digital Commissioner Record images. By accepting and signing this agreement, you agree to have ArcaSearch upload your digital content to the Prowers County, CO research site no more than once a year at the pricing terms listed below. All images will be sent to ArcaSearch via the file transfer site. Prowers County Date Tammy fookate 6.4.2025 ArcaSearch Date Annual Pricing Terms Please initial below Price for creation of new PDFS to the research site $0.55/per image Price for Setup for the creation of new PDFS to the research site $325/per year *Files need to be upload to the ArcaSearch file transfer site in the ArcaSearch file structure. Any files that come in corrupt or that need to be renamed will be charged an extra $0.25 S00-8469133 21 S5 Fr - SUDE 200 S5 Cous I Ssc1