Exhibit A - SOW.7.3.26docx.docx

Exhibit A Statement of Work and Rates

1. Purpose The qualified healthcare organization (“Contractor”) will establish and operate enhanced protective placement beds. Pursuant to the legislative mandates set forth in SB 26-149, the Colorado Department of Human Services (CDHS) is required to implement secure, residential options for individuals requiring intensive behavioral and neurocognitive support.

The Contractor will establish and coordinate the availability of adult Enhanced Protective Placement (EPP) beds. These beds function as an essential intermediate tier of care within the state's clinical continuum, serving as a less restrictive step down residential environment for individuals discharging from state inpatient hospitals, or a highly supported step up environment from traditional community care when clinically necessary.

2. Scope of Services & Bed Capacity The Contractor shall fulfill the following core capacity requirements:

2.1 Bed Availability: The Contractor must dedicate a minimum capacity of twelve (12) EPP beds specifically for individuals referred by CDHS.

2.2 Dual Configuration Options: The facility must provide options for both secure memory care settings and unsecure environments to accommodate varying degrees of cognitive impairment, legal statuses, and behavioral risks. The facility may provide restricted-egress and unlocked rehabilitative environments when clinically appropriate and legally authorized. Any restrictive environmental intervention must be individualized, clinically justified, regularly reassessed, and implemented in the least restrictive manner possible and must maintain compliance with all applicable regulatory requirements, including 6 CCR 1011-1 Chapter 5 Section 23 and 42 CFR ⸹⸹ 483.10 and 483.12.

2.3 Operational Readiness: The facility, clinical programs, physical plant modifications, individualized residential support environments designed to minimize restrictive interventions and promote community integration, and staff onboarding must be fully executed and operational, with the capacity to accept admissions, by October 15, 2026.

3. Specialized Brain Injury & Neurocognitive Framework Contractor will have demonstrated a robust clinical and operational capacity to serve individuals with complex neuro-behavioral presentations, including brain injuries (BI), advanced dementia, and other acquired neurocognitive disorders. The Contractor must integrate parallel pathways for secure and unsecure care layouts.

3.1 Secure Memory Care Setting Requirements

For individuals presenting with severe cognitive decline, advanced dementia, or BI-induced executive dysfunction who exhibit high elopement risks or active safety hazards, the Contractor may operate licensed enhanced-support memory care environments consistent with SNF licensure requirements, resident rights protections, and all applicable federal and state regulations.

· Physical Plant Security: Continuously locked perimeter doors utilizing secure electronic access control systems, keypad egress, and anti-wandering technology (e.g., magnetic door locks tied to resident proximity badges).

· Legal & Regulatory Compliance: Strict alignment with Colorado Department of Public Health and Environment (CDPHE) guidelines for secure units, ensuring all placements comply with court-ordered holds, involuntary treatment certifications, or legal guardianships.

· Environmental Design: Inclusion of enclosed, secure outdoor courtyards that permit safe wandering without risk of community elopement. Visual camouflage on exit doors must be utilized to minimize agitation and exit-seeking behaviors.

3.2 Unsecure Setting Requirements

For individuals with milder cognitive impairments, stable TBI presentations, or those undergoing advanced stages of transitional rehabilitation, the Contractor must operate an unlocked wing emphasizing community re-entry:

· Open Layout & Independence: Unlocked residential access that fosters autonomy, independent ADL progression, and uninhibited internal movement.

· Delayed Egress Alerts: Implementation of non-restrictive monitoring, such as auditory delayed egress notifications or alarm systems, to notify staff of movement without physically detaining the resident. Safety monitoring interventions shall be clinically justified, minimally restrictive, and regularly reassessed to ensure consistency with resident rights protections.

· De-escalation Spaces: Easily accessible, unlocked low-stimulus environments where residents can self-refer during periods of sensory overstimulation.

3.3 Shared Clinical and Rehabilitative Programming

· Neurocognitive Rehabilitation: Provision of specialized cognitive retraining, adaptive functional skill building, and physical/occupational/speech therapies tailored to neurodegenerative or post-traumatic trajectories.

· Behavioral De-escalation: Implementation of specialized, non-pharmacological behavioral management strategies designed specifically for neurological agitation, disinhibition, or memory-loss anxiety.

· Multi-Disciplinary Staffing: Direct oversight from a board-certified or specialized neurologist, neuropsychologist, or a psychiatric clinician with certified competencies in neuro-behavioral and memory care.

· Antipsychotic Stewardship: Ongoing psychotropic medication oversight, gradual dose reduction, behavioral-first intervention strategies, and quality review procedures designed to minimize unnecessary chemical restraint risks.

4. Inclusion, Prioritization, and Exclusion Criteria

4.1 Intake Prioritization

The CDHS may prioritize referrals for populations identified under SB 26-149, subject to individualized clinical appropriateness and least restrictive setting determinations including:

1. Individuals diagnosed with a Severe Mental Illness (SMI), an acquired neurocognitive disorder/TBI, or co-occurring substance use disorders (dual diagnoses).

2. Individuals actively under short-term or extended outpatient treatment certifications pursuant to C.R.S. 27-65-111.

3. Clinical step downs from State Hospitals, with a designated emphasis on forensic clients (e.g., individuals adjudicated as Incompetent to Proceed/Not Restorable (ITP/NR) and individuals facing complex community discharge barriers.

Admissions Authority: Client admissions must be supported Monday through Friday. CDHS shall coordinate referrals and placement recommendations in collaboration with the Contractor. Final admission appropriateness shall remain subject to PASRR findings, nursing facility level-of-care determinations, individualized clinical appropriateness, operational capacity, and resident rights protections.

5. Licensing, Operations, and Compliance The selected Contractor must adhere to state regulatory and licensing policies:

· Licensure Alignment: The Contractor must maintain verified, active state licensure matching the specific level of care delivered: Nursing Home and maintain qualifications for Medicaid Supplemental Behavioral Services (10 CCR 2505-10 Section 8.443.10.B.4. and 5). Secure units must hold specific locked memory care endorsements compliant with 6 CCR 1101.1 Chapter 5.

· Institution for Mental Disease (IMD) Capacity Cap: Contractors shall disclose ownership structures, affiliated operations, psychiatric programming, and total licensed bed counts sufficient for the State to evaluate potential IMD implications under federal Medicaid law.

· Geographical Spacing: To align with community integration mandates, separate residential structures operated by the same Contractor must maintain a minimum physical distance of 750 feet from one another.

6. Compensation Model & Financial Terms Financial reimbursement under this SOW adheres to a hybrid structure designed to ensure programmatic stability:

· Bed Availability Incentive Rate: OCFMH guarantees a baseline incentive payment of $307.64 per bed per day for all contracted beds that remain available and/or occupied through June 30, 2027 (up to a maximum daily calculation of $3,691.34 total for the 12-bed complement).

· Primary Payer Coordination: The Contractor must actively bill commercial insurance or Health First Colorado (Medicaid) first. For uninsured or Medicaid-ineligible clients, OCFMH will reimburse in alignment with the daily Medicaid rate plus designated incentive.

· Capital & Renovation Reimbursement (SFY25): The Contractor may request up to a maximum cap of $45,920.00 on a strict cost-reimbursement basis for documented, physical plant renovations executed through June 30, 2027, specifically to meet therapeutic, secure memory care locking systems, low-stimulus environments, or unlocked delayed egress tracking criteria.

· Liquidated Damages & Clawback Provision: Early termination without cause or termination due to acute health/safety/licensing violations within one (1) calendar year of execution requires the Contractor to legally repay 80% of all state-funded renovation, start-up, and capital expenses back to the State of Colorado.

Exhibit A