Example Statement of Work MINDSOURCE Brain Injury Network EXAMPLE Statement of Work (SOW)

CONTRACT FOUNDATION & SCOPE OF WORK

A. Program Background:

The MINDSOURCE program serves three primary functions: as the lead state agency on brain injury, managing the Brain Injury Trust Fund and Board, and implementing the Colorado State Plan on Brain Injuries in collaboration with the Colorado Advisory Council on Brain Injuries.

B. MINDSOURCE Mission:

MINDSOURCE strives to enhance the quality of life for everyone in Colorado living with or affected by brain injury, and their communities.

C. The Colorado Department of Human Services (CDHS) Background:

CDHS connects people with assistance, resources, and support for living independently in our state. Colorado has a state-supervised and county-administered human services system. Under this system, county departments are the main providers of direct services to Colorado’s families, children, and adults. CDHS supports people and families by connecting them with assistance, resources, and support at every stage of their lives. CDHS serves Coloradans through bold and innovative health and human services. And together, we empower Coloradans to thrive.

D. Project Description:

Under statute, all individuals receiving assistance from the Trust Fund through the services program area may receive service coordination and skill development. The Contractor shall serve as the Care Coordination Agency to deliver client services as defined in C.R.S. 26-1-301 and 304:

· Program eligibility for children, youth, and adults;

· Person-centered service coordination;

· Skill development supporting greater independence and enhanced self-advocacy;

· Groups, classes, and workshops that teach and support skill development programming for people living with brain injury;

· Supports populations who have higher prevalence rates of brain injuries and those who have disparate access to post-injury services;

· Ability to align program services to be responsive to ever-evolving research on effective interventions for people living with brain injury;

· Ability to align program services to the Colorado State Plan on Brain Injuries;

· Ability to be responsive to individual, regional, and systemic needs of people living with brain injury;

· Program evaluation; and

· Program administration.

PROGRAM OPERATIONS & ADMINISTRATION

A. The Contractor shall maintain a toll-free telephone number so that individuals with brain injuries throughout the state can contact program staff by telephone, free of charge, Monday through Friday, 8:30 a.m. to 4:00 p.m.

B. The Contractor shall maintain a secure, cloud-based database for all documentation and tracking of services. MINDSOURCE shall be granted a license to the Contractor’s database to access data and reports as needed. The database shall consist of information related to all functions of the program, including: Brain Injury Resource Facilitation service tracking; skill development programming services; groups, classes, and workshops; and pilot programs. This database and the variables tracked within will be used for program and pilot evaluation, quality assurance, continuous quality improvement, and program monitoring.

C. The Contractor shall use the cloud-based database from above to ensure real-time data access and visualization. This data visualization shall be displayed in a data dashboard approved by the MINDSOURCE Director or designee. The data dashboard shall be maintained and updated by the 5th of each following month, and be available to the public via the MINDSOURCE website. The Contractor shall ensure that all data visualizations comply with applicable data security, privacy regulations, and Colorado Accessibility Standards for Individuals with a Disability, as adopted by the Office of Information Technology, pursuant to §24-85-103, C.R.S.

D. The Contractor shall update internal Policies and Procedures on an annual basis. All updates shall be approved by the MINDSOURCE Director or designee prior to finalization.

E. The Contractor shall ensure that Brain Injury Resource Facilitation, skill development programming, and groups, classes, & workshops are available statewide. The Contractor shall ensure face-to-face service delivery is available to Program Clients regardless of their geographic location.

F. The Contractor shall adjust the ratio of Brain Injury Resource Facilitation Program Clients to Brain Injury Resource Facilitators based on the complexity of needs and available Program resources.

G. The Contractor shall implement and utilize quality assurance and quality control measures of all contracted deliverables. Quality of contracted deliverables will be reviewed by MINDSOURCE through ongoing fiscal and program monitoring activities. Areas of improvement may require a written improvement plan initiated by the Contractor. Unaddressed areas of improvement may result in a formal Performance Improvement Plan initiated by the Program.

Program Materials and Equipment A. The Contractor shall ensure all electronic and printed materials are written in plain language and accessible in accordance with Colorado Accessibility Laws and the Accessibility Standards for Individuals with a Disability, as adopted by the Office of Information Technology, pursuant to § 24-85-103, C.R.S.

B. The Contractor shall ensure the MINDSOURCE Director or designee approves of all program-funded materials and broad communications prior to dissemination. Program materials include, but are not limited to, Program Client documents, outreach materials, presentations and presentation materials, MINDSOURCE-related communications / letters / notices, and educational materials.

C. The Contractor shall include MINDSOURCE's visual identity on materials created through support of the contract. MINDSOURCE may be identified in program materials through use of the MINDSOURCE logos, typography, layout, design elements, and taglines.

D. The Contractor shall purchase and maintain the capital resources necessary for program administration, including, but not limited to, computer systems, equipment, hardware/software, telephones, fax equipment, photocopiers, and access to virtual private network connections.

CLIENT INTAKE AND CASE MANAGEMENT

Program Accessibility A. Applicants and Program Clients requiring assistance completing a program application and / or OBISSS screening shall be offered assistance by a staff member.

B. The Contractor shall provide support and/or reasonable accommodations, as defined by Section 504 of the Rehabilitation Act or the Americans with Disabilities Act (ADA), for individuals upon request at the time of application and throughout case management service delivery.

C. The Contractor shall ensure that physical facilities are accessible to individuals with disabilities and meet ADA requirements.

D. The Contractor shall provide training on the Americans with Disabilities Act, Section 504 of the Rehabilitation Act, to all staff, including all new hires.

E. The Contractor shall arrange and pay for alternative methods of communication when needed by an Applicant or Program Client from the point of inquiry to case closure. Applicants or Program Clients who require alternative methods of communication may include those individuals with limited or no English proficiency, individuals who are Deaf or hard-of-hearing, individuals who are visually impaired or blind, and individuals who have other communication deficits such as aphasia. Alternative methods are limited to professional interpretation and translation in the Applicant or Program Client’s primary language and auxiliary aids and services as defined by the ADA.

F. The Contractor shall have all approved printed materials translated into Spanish within ninety (90) calendar days after State approval.

Eligibility Determinations A. The Contractor shall ensure that individuals who disclose a brain injury are processed for eligibility in the program utilizing medical records and / or OBISSS results.

B. The Contractor shall ensure current impairments are identified by utilizing the OBISSS results.

A. Program eligibility determinations and initial Program Client contact shall be made within three (3) business days of the receipt of the application. Any delay beyond three (3) business days must be documented and shall not exceed seven (7) business days without written approval from the MINDSOURCE Director.

B. The Contractor shall ensure that individuals receiving program services:

· have a brain injury and current impairment based on a positive OBISSS screen and / or appropriate medical or educational documentation; and

· live within the State of Colorado and consider Colorado to be their place of residence based on self-report.

C. The Contractor shall ensure program applicants determined ineligible for the Self- Management program receive:

· a secondary review of application information by the Program Manager for skill development programming or designee;

· resource information and referrals for other community resources; and

· an ineligibility letter within ten business days of the determination, along with appeal rights and information.

D. The Contractor shall ensure that all program applicants receive appeal and grievance information, regardless of acceptance status.

Case Initiation A. All applications should identify which Program Clients can participate in services virtually, through hybrid (a mix of individual and virtual), and those who are only able to participate in-person. For Program Clients who require in-person navigation, they shall be scheduled in the next available time slot.

B. Skill development programming services shall be an option for youth between the ages of 16-21 and adults over the age of 22 when case management needs meet skill development programming model criteria.

C. With approval from the MINDSOURCE Director or designee, applications for any program services may be suspended when warranted to address program or operational priorities. If suspension is warranted, written approval from the MINDSOURCE Director or designee shall be received by the Contractor at least one week prior to application suspension.

D. The Contractor shall identify re-enrollees, or individuals who have previously received services by the Contractor. Whenever suitable, re-enrollee records already on file with the Contractor shall be utilized to establish eligibility for services. Re-enrollees shall complete updated release(s) of information and acknowledgement of appeal and privacy rights.

E. Except during any planned application suspension period, the Contractor shall ensure program applications are processed when returned with all information and signatures necessary to initiate the eligibility determination process are provided, including:

· Name, address, demographic info

· Contact information and documentation of Power of Attorney (POA) or Guardianship (if applicable)

· If necessary, signed Authorization for Release of Information

· Signed receipt of Privacy Practices, Grievance, and Appeals Notices

· Medical documentation of a brain injury, or a completed OBISSS F. Program applications and associated signed documents, available evidence of medical diagnosis of Brain Injury and / or OBISSS screening results shall be stored within Program Client files on the Contractor’s secure server.

Wait List A. The Contractor may institute a wait list for services in accordance with program policies and procedures and approval from the MINDSOURCE Director or designee, if the number of individuals seeking services exceeds the capacity of available FTE to provide quality services. The Contractor shall review wait list assignments weekly for movement into active service delivery. Additional wait list review processes may be implemented at the request of the MINDSOURCE Director or designee.

B. The Contractor shall adjust internal resources and service delivery models to avoid waitlists. These adjustments may include shifting service modality from in-person to virtual, from individual to group, or other strategies designed to ensure that Program Clients are able to receive services rather than entering a wait list.

C. Prior to instituting a wait list for services, the Contractor shall determine how a wait list will be implemented and how people on the list will be prioritized for services. This prioritization model shall receive approval from the MINDSOURCE Director or designee prior to implementation.

D. The Contractor shall utilize an internal process, approved by the MINDSOURCE Director or designee, for evaluating the health, safety, and welfare needs of Program Clients and determining priority of placement on a wait list, appropriateness of expediting assignment into services, or bypassing a wait list. Documentation by the Director of MINDSOURCE programs and the MINDSOURCE Director or designee shall be evidenced in the case record for any Program Client who bypasses the wait list for reasons of health, safety, and/or welfare.

E. While waiting for any service, the Contractor shall ensure Program Clients have access to classes, workshops, and other regionally appropriate community offerings. For individuals waiting for skill development programming services, access to Brain Injury Resource Facilitation shall continue to be available.

PROGRAM SERVICES DELIVERY

Brain Injury Resource Facilitation A. The Contractor shall assess and prioritize Program Client needs and goals in collaboration with the Program Client. The Contractor shall ensure that goals are focused on brain injury-related needs.

B. The Contractor shall provide Brain Injury Resource Facilitation through various modalities, including phone, e-mail, face-to-face, and video chat support with an indefinite duration of services based on individualized goal(s); variable amounts of contact will be individualized based on complexity of need. All Brain Injury Resource Facilitators can work with Program Clients in the formats described above.

C. The Contractor shall provide the Program Client with, at a minimum, regional resources and resources that are accessible within the person’s resources.

D. Case activity notes in the program database will be used to document ongoing contact and support to Program Clients to show clear progress towards case completion.

E. A Brain Injury Resource Facilitation Case shall be considered closed when the Program Client has been provided with resources and/or referrals for identified goals.

F. Program Clients are eligible to re-engage with Brain Injury Resource Facilitation services upon the identification of new, documented needs.

Skill Development A. The Contractor shall assess the fit and feasibility of Program Clients who have applied for skill development services. This assessment shall include, at a minimum, an evaluation of the Program Client’s goals and an exploratory meeting.

B. Applicants who are determined not be a good fit for skill development programming will be provided referrals to resources better suited to meet their needs.

C. The Contractor shall provide opportunities for skill development through various modalities and methodologies, including virtual and in-person, group and individual services.

D. The Contractor shall ensure the Program Client’s support plan and associated data tracking result from a person-centered planning process. The Contractor shall align skill development to identified areas of disability outlined in C.R.S. 26-1-301 and 304.

E. The support planning process shall involve the use of consistent tools to evaluate progress on plans and interventions that are used to address potential service needs related to functional tasks. The support plan shall be developed within three weeks following the initial contact with the Brain Injury Advisor unless extenuating circumstances exist beyond the Advisor’s control. Any extenuating circumstances shall be documented in the Program Client’s file.

F. MINDSOURCE Director or designee-approved tools shall be utilized to assist the Brain Injury Advisor in identifying Program Clients’ strengths, priorities, goals, specific compensatory strategy needs, and available support.

G. Evidence of contacts and progress on goal attainment shall be documented in the case record. Brain Injury Advisors shall directly provide services and supports to help Program Clients reach their skill development programming goals to the degree their skills and expertise allow.

H. The Contractor shall ensure that skill development Program Clients receive contact an average of four hours per month. The program duration is not to exceed six months without approval of the MINDSOURCE Director or designee. If approved, this extension will not exceed three months.

I. The Contractor shall develop a sustainable and individualized transition plan that provides the Program Client with, at a minimum, regional resources and resources that are accessible within the person’s resources.

J. Program Clients may not re-enter the skill development program for a minimum period of six months post-discharge.

Groups, Classes, and Workshops A. The Contractor shall deliver groups, classes, and workshops totaling a minimum of seventy (70) hours over the course of the contract year. All groups, classes, and workshops will be tailored to support brain injury needs across a person's life, including individuals of all ages.

B. The Contractor may make groups, classes, and workshops available to family members of those living with brain injury; however, in-state and current program participants must be given priority when limited space is available.

C. The Contractor shall consider geographic location and methodology of group, class, and / or workshop offerings and submit the proposed list to the MINDSOURCE Director or designee by July 31st and December 31st of each calendar year.

D. Groups, classes, and workshops shall assist program participants in skills designed to teach and support development of compensatory strategies to address post-injury deficits, including, but not limited to: attention, memory, reasoning, problem solving, speed of processing, decision-making, learning, perception, sensory impairment, speech and language, motor and physical functioning, or psychosocial behavior.

E. The Contractor shall partner with community agencies to offer groups, classes, and workshops as requested.

F. The Contractor shall make all groups, classes, and workshops available to all qualified Program Clients, providing statewide accessibility, and assist in accommodations necessary to participate in the classes, e.g., ADA accommodations, translation services, etc.

G. The Contractor may subcontract with other entities to facilitate classes or workshops.

Duration Of Program Services A. Program Clients are eligible to receive Brain Injury Resource Facilitation services indefinitely and upon request. Skill development programming Program Clients shall be provided up to six (6) months of service, which starts on the day the Brain Injury Advisor initiates contact with an eligible skill development Programming Client. Program Clients may repeat groups, classes, and workshops as often as they are able and space is available.

B. In the event a Program Client requires additional skill development programming services beyond the initial 6-month program, extensions shall be justified by a case manager and approved by the MINDSOURCE Director or designee, for the time minimally needed to achieve skill development programming goals, not to exceed three (3) months.

Program Client Closures A. The Contractor shall ensure case closures respect and accommodate the cognitive and behavioral challenges following brain injury. All individuals seeking to access or receive services shall be treated sensitively and fairly in all case closure discussions and decisions. Contractor staff shall not close a case in the absence of one of the closure reasons listed below:

· Successfully completed program;

· Elects to discontinue services;

· Despite support, does not complete the requirements necessary to proceed with the program;

· Has moved out of state;

· Cannot be located by the Contractor;

· Has been institutionalized under circumstances that preclude delivery of services for at least six months;

· Has been non-cooperative with, or abusive of, Contractor staff and/or service providers to the extent that services cannot be delivered in a way that respects boundaries of programs and Contractor;

· Has been non-cooperative with, or abusive of, Contractor staff and/or service providers to the extent that services cannot be delivered; or,

· Has died.

B. When a closure is due to non-cooperation or staff or service provider abuse, the Contractor shall ensure review and approval of the closure action by the Director of MINDSOURCE programs and the MINDSOURCE Director or designee.

C. The Contractor may elect to require a participation contract outlining program participation requirements in lieu of program discharge for any Program Client who enrolls for services.

D. When a case is closed, the Contractor shall ensure written closure notification along with appeal rights and information about the appeal process.

E. The Contractor shall ensure that closures due to “unable to locate” occur after a minimum of three attempts to reach the Program Client by various methods. The Contractor shall ensure that attempts to contact, as well as the reason for closure, are documented in the case record.

F. Applicant status shall occur when ineligibility for the skill development program is based on program requirements.

G. The Contractor shall ensure Program Clients receiving skill development program services are made aware, in writing, when skill development programming services will conclude, along with information about the ongoing availability of Brain Injury Resource Facilitation services.

H. The Contractor shall ensure that Program Clients who are completing and preparing for closure from skill development services receive an individualized, tailored, achievable, and sustainable transition plan.

Program Pilot The Contractor shall work with the MINDSOURCE program to identify areas of opportunity to update program service delivery models based on research-informed and evidence-based practices. These pilots may be driven by findings from grants funded by the Colorado Brain Injury Trust Fund or other research sources.

Evaluation The Contractor shall evaluate each program offering to facilitate process and outcome evaluations. Findings shall drive program improvements, to be determined during periods of contract renewals and amendments. The Contractor and Program may agree to pilot program changes prior to making changes. The Contractor will be required to submit a logic model and associated evaluation plan during contract negotiations each March 1st for approval by the MINDSOURCE Director or designee.

Logic Model:

Evaluation Plan:

REPORTING AND DELIVERABLES

Contractor FTE Time Allocation The Contractor shall demonstrate that Full-Time Equivalent (FTE) staff who provide direct client services spend 60% of their time on direct client services. The Contractor shall provide time utilization reports with payroll invoices and ensure that the Program can replicate these findings during contract monitoring activities.

Direct client services are defined as: 1:1 time, time spent researching services or supports, facilitating groups, classes, and workshops, preparing to facilitate groups, classes, and workshops, travel, and documentation.

· Direct 1:1 time with Program Clients shall not exceed one hour per week.

· Documentation shall not exceed 15 minutes per case entry.

· Class & Workshop preparation shall not exceed 15 minutes per group or workshop.

Documentation Case documentation shall follow a logical thread, ensuring that reviewers can logically connect intake, symptoms, plan & goals, interventions and resources, outcomes, and discharge plan (for skill development Program Clients).

Time Limitations within Direct Client Services

· Direct 1:1 time with Program Clients shall not exceed one hour per week.

· Documentation shall not exceed 15 minutes per case entry.

· Class & Workshop preparation shall not exceed 15 minutes per group or workshop.

Reporting Requirements Reporting Data will include the de-aggregated data outlined in the tables below.

A. Monthly Reporting

a. The Contractor shall report aggregate demographic data monthly on all program services, to be displayed in the approved data dashboard (as described in the Program Operations & Administration section).

b. Dashboard Metrics for Brain Injury Resource Facilitation: Number of active Program Clients (including variables for TBI/nTBI separation), first-time vs. returning clients, age, gender, region, and number of discharged Program Clients.

c. Dashboard Metrics for Skill Development: The same variables as Resource Facilitation, plus the number of applications received, the number of approved/denied applications, the number of Program Clients on the waitlist, and the length of time on the waitlist.

d. Dashboard Metrics for Groups, Classes, and Workshops: Specific sessions provided and the number of clients who attended each.

B. Semi-annual Reporting:

a. Semi-annual reporting will be entered into the data dashboard no later than January 30th of each state fiscal year.

b. The Contractor must notify the MINDSOURCE Director or designee and Contract Manager when mid-year reporting is complete.

c. Any additional narrative information should be submitted by January 30th.

d. Additional Variables for Semi-Annual Reports (beyond monthly data):

i. Number of unique clients served living at Valor on the Fax

ii. Average length of stay

iii. Number of goals set

iv. Number and percentage of goals achieved in each category C. Annual Report The Contractor shall provide a final year-end report no later than September 1st of each year. The Annual Report shall align with the strategic plan and include findings of internal evaluation outcomes. This report shall include all service areas and be submitted in a format approved by the MINDSOURCE Director or designee. To coincide with the Annual Report, the Contractor shall provide a presentation to the Brain Injury Trust Fund Board of Directors each fall (typically in October). Reporting measures shall include, at a minimum, all data points from monthly and semi-annual reports, an evaluation of the effectiveness of the Contractor’s funded programs, and additional data points specified in the reporting table.

D. Legislative Report The Contractor shall provide data and information for the Colorado Legislative report no later than the last week of July each year, to include each of the following:

· Number of unique Program Clients served through Brain Injury Resource Facilitation, skill development programming, and groups, classes, and workshops

· Number of children/youth served through Brain Injury Resource Facilitation and skill development programming.

· Number of groups, classes, and workshops offered E. Any other information as requested by the MINDSOURCE Director or designee

COMPLIANCE, SECURITY, AND OVERSIGHT

Confidentiality A. The Contractor shall uphold the privacy and security of the Protected Health Information (PHI) of Program Clients in accordance with its HIPAA Policy.

B. The Contractor shall require all program staff to read, acknowledge through signature, and follow its HIPAA policy.

C. The Contractor shall provide HIPAA compliance training at new employee orientation and annually for program staff.

D. Supervisors will review HIPAA compliance with their staff every quarter to address hybrid and remote work settings.

E. The Contractor shall utilize and maintain secure internet connections at all working locations to heighten privacy and secure the Program Client database.

F. The Contractor shall utilize an agency Notice of Privacy Practices Acknowledgement form and manage any health information disclosure grievances in accordance with its HIPAA policy.

G. The Contractor shall ensure that passwords are required to access Applicant and Program Client records.

H. The Contractor shall ensure the confidentiality of all written or oral communications regarding Applicants and Program Clients.

I. All hard copy records shall be secured in locked filing cabinets within a locked office.

Staff Training and Certification It will be the responsibility of the Contractor to ensure that all direct service staff and managers are qualified and have the credentials necessary to provide services specialized for those living with brain injuries. Any training should be specific to brain injury and include, at a minimum:

All People:

· Incidence and prevalence

· Neurobehavioral impairments

· Impact on lives

· Accommodating symptoms

· Continuum of services

· Brain anatomy and brain-behavior relationships

· Community resources

· Person-centered thinking, empowerment, self-determination, and planning

· Effective communication technique

· De-escalation

· Americans with Disabilities Act Children/Youth Specific Training:

· Brain Injury and Child Development

· School systems and school supports, 504 plans, Individuals with Disabilities Education Act (IDEA) Older Adults Specific Training:

· Brain injury risks and prevention for older adults

· Changes to the aging process for people living with brain injury

· Living with a brain injury for older adults

The Contractor shall demonstrate how staff will become Certified Brain Injury Specialists or receive an equivalent certification or training.

Staff who do not have the above training or certification at the time they begin providing services under this contract will have twelve months to complete training and certification. Once certified, staff should keep their certification current by completing annual renewal requirements. The Contractor shall be responsible for ensuring ongoing training opportunities are offered, associated costs are covered, and for maintaining training records for all staff.

Program Client Records A. The Contractor shall store and retain all records for individuals served by the program. Program Client files shall be stored on the Contractor’s secure server and include:

· Program application and associated documents;

· Evidence of medical diagnosis of brain injury and a completed online Symptoms Questionnaire and / or online Brain Injury Screening and Support (OBISSS) results;

· Documentation of eligibility or ineligibility;

· Applicable release(s) of information;

· Service tracking for Program Clients;

· Progress notes for each contact with Program Clients receiving services;

· Wait list status, should a wait list become necessary;

· Original appeal and grievance documentation and all Contractor responses to appeals and grievances; and

· Case closure status and reason.

B. The Contractor shall ensure the collection of name and contact information at the point of program initial contact.

C. The Contractor shall use the Online Brain Injury Screening and Support System (OBISSS) to screen for probable lifetime history of brain injury and current symptoms.

D. The Contractor shall, to the best of their ability, ensure the collection of additional demographic information for Program Clients to include:

· County of residence

· Gender

· Date of birth

· Ethnicity

· Military Status

· Primary Language

· Date of injury

· Mechanism of injury

· Other demographics as requested by the program during annual contract review E. Records of Applicants and Program Clients served are made available, upon request, to the Department or any other State or federal agency with review and audit authority.

F. All records of Applicants and Program Clients served are the property of the State of Colorado and shall be surrendered to the State upon request.

Record Retention A. The Contractor shall maintain all material which pertains to delivery of services for a period of ten (10) years after the date of termination of the contract or final payment, except in the event of an unresolved matter or an audit. In the event of an unresolved matter, such as litigation or an audit, records shall be maintained until the matter is fully resolved.

B. The Contractor shall use purging processes in accordance with HIPAA.

C. The Contractor shall retain a copy of medical records, if obtained, for children, youth, and adults for eleven (11) years from the date of case closure.

D. The Contractor shall follow provider directives regarding the re-release of medical records.

Audit, Record Retention, and Monitoring A. Records of Applicants and Program Clients served are made available, upon request, to the Department or any other State or federal agency with review and audit authority.

B. All records of Applicants and Program Clients served are the property of the State of Colorado and shall be surrendered to the State upon request.

C. The Contractor shall permit the Department or any other duly authorized agent of a governmental agency to audit, inspect, examine, excerpt, copy and/or transcribe the Contractor's records during the term of this contract and for a period of three (3) years following termination of this contract or final payment, whichever is later, to ensure compliance with the terms, or to evaluate the Contractor's performance. The Contractor shall also permit these same described entities to monitor all activities conducted by the Contractor pursuant to the terms of this contract. As the monitoring agency may, in its sole discretion, deem necessary or appropriate, such monitoring may consist of internal evaluation procedures, examination of program data, special analyses, on-site checks, or any other reasonable procedure.

D. The Contractor shall undergo an annual independent financial audit and shall submit the final audit report to the MINDSOURCE Director or designee within thirty (30) calendar days of the Contractor's receipt of the final report from the independent audit agency.

Grievances and Appeals A. Applicants for the Brain Injury Resource Facilitation and skill development programs shall receive written notice of grievance and appeal and grievance procedures at the time of application. An appeal notice shall also be provided at the time of any adverse decision and at the time of any case closure. The appeal notice sent at the time of an adverse decision shall include the decision made, the reasons for the decision, the right of the Applicant or Program Client served to appeal the decision, and the appeal procedures.

B. Applicants and Program Clients served shall have ninety (90) calendar days from the date of the incident to file a grievance or appeal expressing a complaint or dissatisfaction with any matter.

C. The Contractor shall accept oral and written grievances and appeals and shall document them in writing.

D. The Contractor shall give Applicants and Program Clients reasonable assistance in filing a grievance or appeal when completing procedural steps in the grievance process.

E. The Contractor shall ensure that the persons who make decisions on grievances and appeals are persons who are not subjects of the grievance or appeal and who were not involved in any previous level of review or decision-making regarding the grievance.

F. The Contractor shall provide a reasonable opportunity for Applicants and Program Clients filing a grievance or appeal to present information in person as well as in writing.

G. The Contractor shall resolve each grievance or appeal and provide written notice within fifteen (15) calendar days from the date the Contractor receives the grievance or appeal. The notice shall include the Contractor’s proposed resolution to the grievance; the rights of the Applicant or Program Client served to further grieve the Contractor’s proposed resolution to the MINDSOURCE Director or designee or her/his/their designee, and information on how to contact the Director or designee.

H. Applicants and Program Clients served shall have ninety (90) calendar days from the date of the Contractor’s notice to submit their grievance to the MINDSOURCE Director or designee or her/his/their designee.

I. The grievance and appeal process shall be an informal dispute resolution process. The decision of the MINDSOURCE Director or designee shall be final.

Second Level Appeal A. Applicants and Program Clients shall have ninety (90) calendar days from the date of the Contractor’s notice to file a second-level appeal with the Department of Human Services, Executive Director, or designee.

B. The Executive Director or his or her designee shall have the right to additional information and may request oral argument or a hearing if it deems necessary.

C. The Applicant or Program Client may represent himself/herself or use legal counsel or other spokesperson at a hearing.

D. The decision of the Executive Director or his/her designee shall constitute final agency action.

E. The Contractor shall participate in the appeals process, provide any documentation required, and implement any decision made by the Executive Director or his/her designee.

F. The appeal process shall be conducted pursuant to Sec. 24-4-105 and 106, C.R.S.

Travel The travel line item shall be utilized for travel relating to Program Client services and training set forth in this contract. Out-of-state conferences may be billed under the travel line item upon request and approval from MINDSOURCE using the budget request spreadsheet.

Meals may be reimbursed at the U.S. General Services Administration per diem rate (different rates apply for breakfast, lunch, and dinner) utilizing the MINDSOURCE Vendor Meal Reimbursement Form in the event that meals are not already provided at the conference or training event. This form should be completed and included as backup documentation with any invoice in which meal reimbursement is being requested.

· The following are examples of expenses that shall not be reimbursed:

· Expenses incurred while not in official travel status.

· Excess and/or overweight baggage, including fees for baggage that is of a personal nature (i.e., not relating to the business purpose of the travel).

· Alcoholic beverages purchased by the traveler.

· Entertainment expenses paid by the traveler.

· Personal expenses incurred during travel, which are primarily for the benefit of the traveler and not directly related to the official purpose of the travel. Examples include the purchase of personal hygiene items, magazines, snacks, movie rentals, and other miscellaneous items.

· Political expenses paid by the traveler (e.g., lobbying, contributions, etc.).

· Costs associated with obtaining a passport.

· Unnecessary automobile rental insurance.

· Value premiums on airline tickets.

· Trip cancellation insurance.

· Additional liability for rental vehicles.

· Personal accident insurance on rental vehicles.

· Supplemental life insurance for airline or common carrier travel.

· The cost of traffic fines and parking tickets.

Budget Revisions and Invoicing A. Budgets shall be submitted along with this Statement of Work using this template.

B. Invoices shall be submitted on a monthly basis and are due to the State within 45 days of work performed by the Contractor unless otherwise stated in the exhibits hereto. Invoices shall be submitted using this template.

C. Invoices shall be submitted to the state on the 1st and 15th of each month. Invoices submitted outside of the billing period will be processed during the next billing cycle.

D. Proper forecasting and projections should limit the number of budget revisions by the Contractor. Up to three budget revisions may be made per year. All three budget revisions, cumulatively, shall be less than or equal to 10% of the total contract amount. The Program shall be notified of these budget revisions in writing and by logging the requested revisions into the budget request spreadsheet. Budget revisions, cumulatively exceeding 10% of the total contract amount, shall require formal written approval of the Program Director and may require a contract amendment. All budget revisions shall follow the guidance outlined in Appendix D.

E. Payments will be made upon submission of an invoice with corresponding documentation demonstrating that the proposed work has been completed and any identified discrepancies have been resolved. All salaried work must include a timesheet or similar documentation verifying the number of hours worked, coinciding with the salary rate.

F. All materials (including, but not limited to: food, beverages, printing, postage, and supplies) must include an itemized receipt. Backup documentation should indicate the corresponding line item to which the payment is being expended.

G. No funds will be paid in advance of work performed.

APPENDIX A: GLOSSARY OF DEFINITIONS

· Appeal: a request to review a decision of the Contractor to deny or revoke program eligibility or to deny, reduce, suspend, or terminate the delivery of program services.

· Applicant: an individual for whom an application for the skill development programming Program services has been completed.

· Brain injury: damage to the brain from an internal or external source, including traumatic and non-traumatic injuries, that occur post-birth and is non-congenital, non degenerative, and non-hereditary, resulting in partial or total functional impairment in one or more areas, including but not limited to: attention, memory, reasoning, problem solving, speed of processing, decision-making, learning, perception, sensory impairment, speech and language, motor and physical functioning, and / or psychosocial behavior. A brain injury and the existence of impairment may be verified through adequate medical history (per Section 26-1-301, C.R.S.) or by screening for a probable lifetime history of brain injury utilizing the Online Brain Injury Screening and Support System (OBISSS). Brain Injury Resource Facilitation and skill-building services require documentation of a brain injury through medical records or a lifetime history screen. Services will be tailored to meet the needs of the Program Client based on their assessed disability and impairments or outcomes of screening for bothersome cognitive symptoms using the OBISSS.

· Brain Injury Advisor: case manager responsible for the delivery of skill development programming services.

· Brain Injury Certification Completion of brain injury training provided by the Brain Injury Association of America, which prepares providers to comprehend and manage situations specific to brain injuries. Case managers may either receive a Brain Injury Specialist (CBIS) or Brain Injury Fundamentals certification as part of their training.

· Brain Injury Resource Facilitator: organization staff trained in best practices of Resource Facilitation for people living with brain injuries, responsible for the delivery of Brain Injury Resource Facilitation services of limited scope and duration.

· Brain Injury Resource Facilitation is a collaborative, research-informed approach designed to help individuals with brain injuries and their families navigate and access the services and supports necessary to manage brain injury. The process involves identifying an individual’s unique needs and strengths to create and implement a personalized plan for community living.

· Case Management means a collaborative process that assesses, plans, implements, coordinates, monitors, and evaluates the options and services required to meet an individual’s needs, using communication and available resources to promote quality, cost-effective outcomes. Case Management services are available to Program Clients across the state, including rural and frontier areas.

· Class: an educational opportunity that meets on a consistent basis to teach a skill or engage in an activity.

· Contractor: organization or entity that is under contract with the State to perform Case Management services awarded by a competitive State Request for Proposal.

· Corrective Action Plan: a written plan that includes the specific actions the Contractor shall take to correct non-compliance with standards and the date by which each action shall be completed.

· Colorado Department of Human Services, hereafter referred to as the “Department”, is housed within the Executive Branch of the Government and houses programs that provide direct client services, including MINDSOURCE Brain Injury Network.

· Failure to Satisfy the Scope of Work: incorrect or improper activities or inactions by the Contractor as defined by its contract with the Department.

· Grievance: oral or written dissatisfaction regarding issues beyond those addressed in appeals, encompassing concerns such as the quality of services rendered, provider performance, service timeliness, accessibility of service locations, or staff availability.

· Group: a structured series of sessions led by a professional, where a specific set of participants learn and practice new skills.

· HIPAA: a federal law known as the Health Insurance Portability and Accountability Act of 1996 that required the creation of national standards to protect sensitive patient health information from being disclosed without the patient's consent or knowledge.

· OBISSS: Online Brain Injury Screening and Support System hosted by the National Association of State Head Injury Administrators.

· Perception of Confidence: pre- and post-self-rating scale of perceived confidence associated with performing a functional task gathered at the beginning and end of skill development program services.

· Power of Attorney: legal authorization for a designated person to make decisions about another person's property, finances, or medical care.

· Protected Health Information: information in a designated record that can be used to identify an individual and that was created, used, or disclosed in the course of providing a health care service, also known as PHI.

· MINDSOURCE Brain Injury Network: lead State agency on Brain Injury, which also operates the Brain Injury Trust Fund as defined in C.R.S. § 26-1-3.

· Program Client: an individual for whom client service eligibility has been determined and is receiving services from a Brain Injury Resource Facilitator, Brain Injury Advisor, or Client Activities and Events Program Manager.

· Protected Health Information (PHI): any information about an Applicant or Program Client that is protected under the Health Insurance Portability and Accountability Act of 1996, Public Law 104-191.

· Release of Information: a document that gives a client the opportunity to decide what records they want released from their medical file, who they want it delivered to, how long the data can be issued, and under what statutes and guidelines it is released.

· Skill development programming Services: a form of skill building focused on the development of compensatory skills and identification of natural supports to increase a Program Client’s capacity to self-manage needs related to brain injury.

· Service Tracking and the associated Service Plan: written documentation specifying a Program Client’s intervention needs along with methods, mutual responsibilities, and timelines.

· Trust Fund Board: the Colorado Brain Injury Trust Fund Board, created pursuant to C.R.S. § 26-1-301

· Trust Fund: the Colorado Brain Injury Trust Fund was created in C.R.S. § Section 26-1-301, which provides financial support for client services, education and outreach, and research for brain injuries.

· Workshop: an educational or wellness opportunity that is a one-time event with a teacher who offers a one-time course.

APPENDIX B: REPORTING DUE DATES