SEP Services RFP_Chaffee and Lake Counties.pdf

Colorado Department of

Health Care Policy and Financing

HCPF Solicitation #: RFP UHAA 2015000076

Administration of the Long Term Care Programs for the

Colorado Home and Community Based Services

Population: Chaffee and Lake Counties

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CONTENTS

SECTION 1.0 INTRODUCTION

1.1. GENERAL INFORMATION

1.2. CONFLICTS OF INTEREST

1.3. ANTICIPATED CONTRACT TERM

SECTION 2.0 TERMINOLOGY

2.1. ACRONYMS, ABBREVIATIONS AND OTHER TERMINOLOGY

SECTION 3.0 BACKGROUND INFORMATION

3.1. THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING

3.2. PROJECT BACKGROUND

SECTION 4.0 OFFEROR’S QUALIFICATIONS AND EXPERIENCE

4.1. MANDATORY QUALIFICATION

4.2. ORGANIZATIONAL EXPERIENCE

SECTION 5.0 STATEMENT OF WORK

5.1. CONTRACTOR’S GENERAL REQUIREMENTS

5.2. CONTRACTOR PERSONNEL

5.3. CONTRACTOR’S OBLIGATIONS

5.4. BUSINESS FUNCTION

5.5. SCREENING AND REFERRAL

5.6. ELIGIBILITY DETERMINATION

5.7. CASE MANAGEMENT

5.8. TRAINING, COMPLAINTS, APPEALS, CRITICAL INCIDENTS AND

ADMINISTRATIVE OVERSIGHT REQUIREMENTS

5.9. COMMUNITY TRANSITION SERVICES (CTS)

5.10. CERTIFICATION

5.11. PERFORMANCE STANDARDS

5.12. COLORADO QUALITY OF LIFE INTERVIEWS

5.13. START-UP AND CLOSEOUT PERIODS

SECTION 6.0 COMPENSATION AND INVOICING

6.1. COMPENSATION

6.2. INVOICING AND PAYMENT PROCEDURES

6.3. BUDGET

SECTION 7.0 EVALUATION METHODOLOGY

7.1. EVALUATION PROCESS

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7.2. EVALUATION COMMITTEE

7.3. COMPLIANCE

7.4. PROPOSAL EVALUATION CRITERIA

APPENDIX A - ADMINISTRATIVE INFORMATION DOCUMENT

APPENDIX B - DRAFT CONTRACT

APPENDIX C - CASE MANAGEMENT AGENCY (CMA) ADMINISTRATIVE

REVIEW TOOL

APPENDIX D - CASE MANAGER TRAINING REPORT TEMPLATE

APPENDIX E - COMPLAINT TRENDS/REMEDIAL ACTION REPORT

TEMPLATE

APPENDIX F - PRICING WORKSHEET

APPENDIX G - W-9

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SECTION 1.0 INTRODUCTION

1.1. GENERAL INFORMATION

1.1.1. The Colorado Department of Health Care Policy and Financing (Department) is soliciting competitive, responsive proposals from experienced and financially sound organizations to serve as a Single Entry Point (SEP) Agency for Chaffee and Lake

Counties. The SEP Agency will serve within a local area where a current or potential long-term care client can obtain long-term care information, screening, assessment of need, and referral to appropriate long-term care program and case management services for all Coloradoans within their designated district.

1.1.2. General solicitation information, timelines and proposal submission requirements are available in Appendix A, Administrative Information Document. To be considered responsive, an Offeror shall comply with all of the requirements and timelines contained in Appendix A.

1.2. CONFLICTS OF INTEREST

1.2.1. The federal Centers for Medicare and Medicaid Services (CMS) recently passed new federal rules, 42 CFR § 441.301(c)(1), requiring conflict-free case management. The

CMS rules can be found at http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-

00487.pdf.

1.2.2. The State and subcontractors who provide case management services shall avoid any conflict of interests, real or perceived, in accordance with federal rules and guidance.

1.2.3. Pursuant to the CMS rules, the Department will consider an Offeror to be conflict free if the Offeror meets all of the following:

1.2.3.1. There is separation of case management and utilization review from direct service provisions: structurally or operationally. This includes all of the following:

1.2.3.1.1. Case Manager(s) are not employees of any organization that provides direct services to the HCBS clients. This prevents financial pressure for case manager(s) to make referrals to their own organization and the “trading” of referrals.

1.2.3.1.2. Individuals performing evaluations, assessments and plans of care cannot be any of the following:

1.2.3.1.2.1. Financially responsible for the client.

1.2.3.1.2.2. Empowered to make financial or health-related decisions on behalf of the client.

1.2.3.1.2.3. Case managers and evaluators of a client’s need for services are not related by blood or marriage to the client, their paid caregivers, or anyone financially responsible for the client.

1.2.3.1.3. Providers of Home and Community Based Services (HCBS), or those who have an interest in or are employed by a provider of HCBS for a specified client, shall not provide case management or develop the person-centered service plan, except when the State demonstrates that the only willing and qualified entity to provide case management and/or develop person-centered service plans in a geographic area also provides HCBS.

http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf http://www.gpo.gov/fdsys/pkg/FR-2014-01-16/pdf/2014-00487.pdf

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1.2.4. If an Offeror is not conflict free and is awarded a contract, that Contractor shall request a waiver under 10 C.C.R. 2505-10, Section 8.393.6 prior to the Effective Date. The

Department may grant a waiver to the Offeror to provide direct services, if the Contractor meets all requirements under 10 C.C.R. 2505-10, Section 8.393.6. In the event that the

Department is unable to grant a waiver to the awarded Offeror, the Department may cancel its award to that Offeror and award to the next Offeror whose proposal will be most advantageous to the State of Colorado.

1.2.4.1. In these cases, the Contractor shall work with the Department to devise conflict of interest protections including separation of entity and provider functions within provider entities. Any mitigation plans shall include a clear and accessible alternative dispute resolution process for clients. The Department shall seek CMS approval for conflict of interest mitigation plans.

OFFEROR'S RESPONSE 1. Provide a statement as to whether Offeror is conflict free as defined in Section 1.2. If conflict free, provide details that demonstrate how Offeror meets the definition of conflict free. If not conflict free, provide a detailed plan of how Offeror intends to mitigate all conflicts of interest.

1.3. ANTICIPATED CONTRACT TERM

1.3.1. Dependent on the time necessary for the evaluation of proposals, the Department estimates that the Contractor’s start-up period is to begin on December 15, 2014. The

Department anticipates that the start-up period will end on January 15, 2015.

1.3.2. The initial operational period of the Contract is anticipated to begin at the end of the start-up period and will last until June 30, 2015.

1.3.3. The total duration of this Contract including the Department’s exercise of any options, is not anticipated to extend beyond June 30, 2018. The Department may extend the

Contract beyond the anticipated term in this subsection, 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.

SECTION 2.0 TERMINOLOGY

2.1. ACRONYMS, ABBREVIATIONS AND OTHER TERMINOLOGY

2.1.1. Acronyms, abbreviations and other terminology are defined at their first occurrence in this Request for Proposals (RFP). The following list is provided to assist the reader in understanding acronyms, abbreviations and terminology used throughout this document.

2.1.1.1. Benefits Utilization System (BUS) – The online data system maintained by the

Department for recording case management activities associated with Long-Term

Care services.

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2.1.1.2. Business Day – Any day in which the Department is open and conducting business, but shall not include weekend days or any day on which one of the Department’s holidays are observed. The Department observes all holidays listed in C.R.S. § 24-11-

101(1).

2.1.1.3. Business Interruption – Any event that disrupts the Contractor’s ability to complete the Work for a period of time, and may include, but is not limited to a Disaster, power outage, strike, loss of necessary personnel or computer virus.

2.1.1.4. Case Management – Case Management as defined at 10 C.C.R. 2505-10, Section

8.390.1. Case Management includes but is not limited to:

2.1.1.4.1. Assessment of an individual for long-term care eligibility.

2.1.1.4.2. Circulation and receipt of the Professional Medical Information Page.

2.1.1.4.3. Review, selection and referral to qualified service providers.

2.1.1.4.4. Initiation, review, approval and submission of Prior Authorization Requests (PAR).

2.1.1.4.5. Development of a client-specific service plan.

2.1.1.4.6. Ongoing review of services provided with PAR with service plan adjustments as necessary.

2.1.1.4.7. Representing the Department in all appeals relevant to service authorizations.

2.1.1.5. Case Management Agency – The organization obligated to fulfill the responsibilities and requirements of this Contract.

2.1.1.6. Case Manager – An individual who meets the qualifications to perform case management activities.

2.1.1.7. Closeout Period – The period from the earlier of ninety (90) days prior to the end of the last renewal year of the Contract or notice by the Department of non-renewal until the day that the Department has accepted the final deliverable for the Closeout Period and has determined that the final transition is complete.

2.1.1.8. CMS – The federal Centers for Medicare and Medicaid Services.

2.1.1.9. Community Transition Services (CTS) – Activities essential to move a client from a skilled nursing facility and establish a community-based residence. Services are provided by a Transition Coordination Agency (TCA) and include at least two (2)

Independent Living Core Services.

2.1.1.10. Conflict-free Case Management – The assessment of a long-term care client’s needs, the development and implementation of a service plan for such client, the coordination and monitoring of long-term care service delivery, the evaluation of service effectiveness, and the periodic reassessment of such client’s needs.

2.1.1.11. Contract – The agreement that is entered into as a result of this solicitation.

2.1.1.12. Contractor – The individual or entity selected as a result of this solicitation to complete the Work contained in the Contract.

2.1.1.13. Department – The Colorado Department of Health Care Policy and Financing, a department of the government of the State of Colorado.

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2.1.1.14. Disaster – An event that makes it impossible for the Contractor to perform the Work out of its regular facility, and may include, but is not limited to, natural disasters, fire or terrorist attacks.

2.1.1.15. Effective Date – The effective date defined in the Contract.

2.1.1.16. Eligibility Determination – Eligibility Determination includes, but is not limited to:

2.1.1.16.1. Verification of Medicaid eligibility or Medicaid application submission.

2.1.1.16.2. Review of the Professional Medical Information Page to determine enrollment appropriateness.

2.1.1.16.3. Reviewing all supportive information (documentation and interviews) related to the functional capacity of the applicant or participant.

2.1.1.16.4. Communicating functional eligibility status to the appropriate Eligibility site.

2.1.1.16.5. Representing the Department in all appeals relevant to functional eligibility determinations.

2.1.1.17. HCBS – Home and Community Based Services waiver.

2.1.1.18. HIPAA – The Health Insurance Portability and Accountability Act of 1996.

2.1.1.19. Independent Living Core Services – Information and referral services; independent living skills training; peer counseling, including cross-disability peer counseling; and individual and systems advocacy.

2.1.1.20. Key Personnel – The position or positions that are specifically designated as such in the Contract.

2.1.1.21. LTHH – Long Term Home Health.

2.1.1.22. Offeror – Any individual or entity that submits a proposal, or intends to submit a proposal, in response to this solicitation.

2.1.1.23. Operational Start Date – When the Department authorizes the Contractor to begin fulfilling its obligations under the Contract.

2.1.1.24. Other Personnel – Individuals and Subcontractors, in addition to Key Personnel, assigned to positions to complete tasks associated with the Work outlined in this solicitation.

2.1.1.25. PARs – Prior Authorization Requests.

2.1.1.26. Prior Authorization Request (PAR) – A request authorized by the Department or the

Case Management Agency (CMA) prior to obtaining certain services, supplies, equipment or other waiver benefit items.

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2.1.1.27. Program – A publicly funded program including, but not limited to, Home and

Community Based Services Waiver for Persons with Brain Injury (HCBS-BI), Home and Community Based Services Waiver for Persons who are Elderly, Blind and

Disabled (HCBS-EBD), Community Mental Health Supports Waiver (HCBS-CMHS), Home and Community Based Services Waiver for Persons Living with Acquired

Immune Deficiency Syndrome (HCBS-PLWA), Home and Community Based

Services Waiver for Persons with Spinal Cord Injury (HCBS-SCI), Waiver for

Children with a Life Limiting Illness (HCBS-CLLI), Medicaid nursing facility care, Program for All-Inclusive Care for the Elderly (PACE) and Long Term Home Health

(LTHH).

2.1.1.28. Provider – Any health care professional or entity that has been accepted as a provider in the Colorado Medicaid program, Colorado’s CHP+ program or the Colorado

Indigent Care Program, as determined by the Department.

2.1.1.29. PHI – Protected Health Information.

2.1.1.30. Region – A distinct geographic area, determined by the Department, which includes

Chaffee and Lake Counties.

2.1.1.31. Resource Development – The analysis, study, establishment and implementation of additional resources or services that extend the capabilities of community based long-term care systems to better serve long-term care clients and those likely to need community based long-term care in the future.

2.1.1.32. Screening and Referral – Screening and Referral includes, but is not limited to:

2.1.1.32.1. Making the initial contact with individuals to include a preliminary screening in the following areas:

2.1.1.32.1.1. Individual’s need for long-term care services.

2.1.1.32.1.2. Individual’s need for referral to other programs or services.

2.1.1.32.1.3. Individual’s eligibility for financial and program assistance.

2.1.1.32.1.4. Need for a comprehensive long-term care client assessment.

2.1.1.32.1.5. Maintaining applicant or client records including documentation of the referrals and outcome utilizing the Department’s prescribed system.

2.1.1.33. Service Plan – The document developed by the Case Manager with the client and/or legal guardian and, if appropriate, collaterals, to document client choice and to establish and identify the services and supports the client needs to successfully live in the community. The Service Plan shall reflect the full scope of the client’s needs and include services from all funding sources including third party and natural supports.

The Service Plan shall document the amount, frequency and duration of each service, the type of provider to furnish each service and the expected outcome of each service.

2.1.1.34. Single Entry Point (SEP) – The availability of a single access or entry point within a local area where a current or potential long-term care client can obtain long-term care information, screening, assessment of need, and referral to appropriate long-term care programs and case management services.

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2.1.1.35. Single Entry Point Agency (SEP Agency) – The organization selected to provide case management functions for persons in need of long-term care services within Chaffee and Lake Counties. Single Entry Point Agencies may function as a Utilization Review

Contractor.

2.1.1.36. Start-Up Period – The period from the Effective Date, until the Operational Start Date.

2.1.1.37. State Fiscal Year (SFY) – The twelve (12) month period beginning on July 1st of a year and ending on June 30th of the following year.

2.1.1.38. Subcontractor – Third-parties, if any, engaged by Contractor to aid in performance of its obligations under the Contract.

2.1.1.39. Uniform Long-Term Care (ULTC) Instrument – The Functional Needs Assessment and professional medical information used to determine Functional Eligibility for

Long-Term Care services.

2.1.1.40. Utilization Review (UR) – A system for prospective, concurrent, and retrospective review of the necessity and appropriateness in the allocation of supports and services to ensure the proper and efficient administration of Medicaid Long-Term Care benefits.

2.1.1.41. Work – The tasks and activities Contractor is required to perform to fulfill its obligations under the Contract, including the performance of any services and delivery of any goods.

SECTION 3.0 BACKGROUND INFORMATION

3.1. THE DEPARTMENT OF HEALTH CARE POLICY AND FINANCING

3.1.1. The Department serves as the Medicaid Single State Agency. The Department develops and implements policy and financing for Medicaid and the Children's Health Insurance

Program, called Child Health Plan Plus (CHP+) in Colorado, as well as a variety of other publicly funded health care programs for Colorado's low-income individuals, families, children, pregnant women, the elderly and people with disabilities. For more information about the Department, visit www.Colorado.gov/HCPF.

3.1.2. The Department is a Covered Entity under the Health Insurance Portability and

Accountability Act of 1996 (HIPAA).

3.2. PROJECT BACKGROUND

3.2.1. In 1990, the Legislative Long Term Health Care Task Force developed a legislative proposal, passed in the 1990 session, which required the Department to study the development of a SEP system for accessing long-term care services (Senate Bill-9). This study, entitled "Improving Client Access to Long-Term Care in Colorado," provided the framework for the legislation passed during the following session in 1991 (House Bill-

1287), which implemented the SEP system for long-term care in Colorado. The purpose of this legislation is to improve access to long-term care services and to facilitate utilization of appropriate services by long-term care clients. The system is to function for both private and publicly funded clients in need of long- term care services.

3.2.2. Per C.R.S. 25.5-6-104 (1) (a) and (b):

http://www.colorado.gov/HCPF

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3.2.2.1. “1) (a) The general assembly hereby finds, determines, and declares that there is an increasing strain on long-term care services in the state; that the number of persons in need of long-term care continues to grow; that community based resources are not integrated into a centralized system for referrals, assessment of needs, development of care plans, and case management; and that persons in need of long-term care services have difficulty accessing and using the current system, which is fragmented and which results in inappropriate placements.

3.2.2.2. (b) The general assembly further finds, determines, and declares that the state is in need of a long-term care system that organizes each long-term care client's entry, assessment of need, and service delivery into a single unified system; and that such system must include, at a minimum, a locally established single entry point administered by a designated entity, a single client assessment instrument and administrative process, targeted case management in order to maximize existing federal, state, and local funding, case management, and an accountability mechanism designed to assure that budget allocations are being effectively managed.”

3.2.3. The three (3) principal sections of this RFP include screening and referral, eligibility determination and case management. The following provides a brief description of each section.

3.2.3.1. Screening and Referral

3.2.3.1.1. Screening and Referral for the purpose of this engagement includes, but is not limited to:

3.2.3.1.1.1. The application of criteria to determine if an individual is appropriate for

Medicaid long-term care assessment.

3.2.3.1.1.2. Referral to other services or programs for which the individual may be eligible.

3.2.3.2. Eligibility Determination (formerly referred to as Utilization Review)

3.2.3.2.1. Eligibility determination for the purpose of this engagement includes, but is not limited to:

3.2.3.2.1.1. Verification of Medicaid eligibility or Medicaid application submission.

3.2.3.2.1.2. Review of the Professional Medical Information Page to determine enrollment appropriateness.

3.2.3.2.1.3. Reviewing all supportive information (documentation and interviews) related to the functional capacity of the applicant or participant.

3.2.3.2.1.4. Communicating functional eligibility status to the appropriate Eligibility site.

3.2.3.2.1.5. Representing the Department in all appeals relevant to functional eligibility determinations.

3.2.3.3. Case Management

3.2.3.3.1. SEP Case management, as defined at 10 C.C.R. 25.5-8.393, is considered administrative for the purposes of this engagement. SEP Case Management includes but is not limited to:

3.2.3.3.1.1. Assessment of an individual for long-term care eligibility.

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3.2.3.3.1.2. Circulation and receipt of the Professional Medical Information Page.

3.2.3.3.1.3. Review, selection and referral to qualified service providers.

3.2.3.3.1.4. Initiation, review, approval and submission of Prior Authorization Requests

(PAR).

3.2.3.3.1.5. Development of a client-specific service plan.

3.2.3.3.1.6. Ongoing review of services provided with PAR with service plan adjustments as necessary.

3.2.3.3.1.7. Representing the Department in all appeals relevant to service authorizations.

3.2.4. The following table displays the average monthly number of clients that received Case

Management services in Chaffee and Lake Counties:

SEP

Agency

SFY 13-14 SFY 12-13 SFY 11-12

Chaffee

County:

136 136 137

Lake

County:

25 30 30

3.2.4.1. The client numbers for this table are for informational purposes only and the

Department does not make any representations of future caseloads or growth rates based on this information. Each Offeror shall be responsible for any estimates of future caseloads and growth rates on which it bases its proposal.

SECTION 4.0 OFFEROR’S QUALIFICATIONS AND EXPERIENCE

4.1. MANDATORY QUALIFICATION

4.1.1. Offeror’s organization shall meet the mandatory qualification requirement in this section

4.1 to be considered for award of a Contract from this solicitation.

4.1.1.1. In accordance with C.R.S. §25.5-6-106, Offeror shall be one (1) of the following:

4.1.1.1.1. A private, nonprofit organization, a county agency, including a county department of social services, a county nursing service, an area agency on aging, or a multicounty agency.

OFFEROR'S RESPONSE 2. Provide details that demonstrate how Offeror meets the mandatory qualification requirement. Offeror’s response should list the qualification requirement separately and follow the listed requirement with the details that demonstrate how Offeror meets that specific requirement.

4.2. ORGANIZATIONAL EXPERIENCE

4.2.1. The Department has determined that it desires specific experience and skills for an

Offeror to possess in order for the Offeror to be able to complete the Work efficiently while meeting the demands and deadlines of the Department.

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4.2.2. The Department will evaluate the Offeror's pertaining to the following:

4.2.2.1. Conducting assessments to determine client/applicant deficits and needed program supports.

4.2.2.2. Securing medical determinations of program supports.

4.2.2.3. Referring to and negotiating with various providers for necessary supportive services.

4.2.2.4. Generating PARs to support provider services and payments.

4.2.2.5. Conducting follow-ups with clients and providers on the quality and effectiveness of services provided and making adjustments as required.

4.2.2.6. Coordinating the provision of a broad array of services to ensure the well-being of medically complex populations.

4.2.2.7. Providing case management services similar to those defined under section 5.7.

OFFEROR'S RESPONSE 3. Provide a detailed description of Offeror’s organizational experience related to the Work. Address the organizational experience listed in Section 4.2. Include a description of the population served, the specific services provided and the timeframes over which the services were provided.

SECTION 5.0 STATEMENT OF WORK

5.1. CONTRACTOR’S GENERAL REQUIREMENTS

5.1.1. The Contractor shall serve as the Single Entry Point Agency for Chaffee and Lake

Counties.

5.1.2. The Department will contract with only one (1) organization, the 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.

5.1.3. The Contractor’s organization shall meet the requirements of C.R.S. § 25.5-6-106.

5.1.4. The Contractor shall coordinate with its local Regional Care Collaborative Organization and Mental Health Center(s) on services provided for the benefit of shared clients.

5.1.5. The Contractor may be privy to internal policy discussions, contractual issues, price negotiations, confidential medical information, Department financial information, and advance knowledge of legislation. In addition to all other confidentiality requirements of the Contract, the Contractor shall also consider and treat any such information as confidential and shall only disclose it in accordance with the terms of the Contract.

5.1.6. The Contractor shall work cooperatively with key Department staff and, if applicable, the staff of other Department contractors or other State agencies 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 the Contractor and any other Department contractor, the Department will resolve the conflict and the

Contractor shall abide by the resolution provided by the Department.

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5.1.7. The Contractor shall inform the Department on current trends and issues in the healthcare marketplace and provide information on new technologies in use that may impact the

Contractor’s responsibilities under this Contract.

5.1.8. The Contractor shall maintain complete and detailed records of all meetings, system development life cycle documents, presentations, project artifacts and any other interactions or deliverables related to the project described in the Contract. The

Contractor shall make such records available to the Department upon request, throughout the term of the Contract.

5.1.9. Deliverables

5.1.9.1. All deliverables shall meet Department-approved format and content requirements.

The Department will specify the number of copies and media for each deliverable.

5.1.9.2. Each deliverable will follow the deliverable submission process as follows:

5.1.9.2.1. The Contractor shall submit each deliverable to the Department for review and approval.

5.1.9.2.2. The Department will review the deliverable and may direct the Contractor to make changes to the deliverable. The Contractor shall make all changes within five (5)

Business Days following the Department’s direction to make the change unless the

Department provides a longer period in writing.

5.1.9.2.2.1. Changes the Department may direct include, but are not limited to, modifying portions of the deliverable, requiring new pages or portions of the deliverable, requiring resubmission of the deliverable or requiring inclusion of information that was left out of the deliverable.

5.1.9.2.2.2. The Department may also direct the Contractor to provide clarification or provide a walkthrough of each deliverable to assist the Department in its review. The

Contractor shall provide the clarification or walkthrough as directed by the

Department.

5.1.9.2.2.3. The Contractor shall document, in writing, and deliver to the Department its responses to the Department’s comments and requests for revisions or clarification of deliverable contents.

5.1.9.2.3. Once the Department has received an acceptable version of the deliverable, including all changes directed by the Department, the Department will notify the

Contractor of its acceptance of the deliverable in writing. A deliverable shall not be deemed accepted prior to the Department’s notice to the Contractor of its acceptance of that deliverable.

5.1.9.3. At the Department’s request, the Contractor shall be required to conduct a walk-through of Department-selected deliverables to facilitate the Department's review and approval process. The walk-through shall consist of an overview of the deliverable, explanation of the organization of the deliverable, presentation of critical issues related to the deliverable and other information as requested by the Department. It is anticipated that the content of the walk-through will vary with the deliverable presented.

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5.1.9.4. The Contractor shall employ an internal quality control process to ensure that all deliverables, documents and calculations are complete, accurate, easy to understand and of high quality. The Contractor shall provide deliverables that, at a minimum, are responsive to the specific requirements for that deliverable, organized into a logical order, contain no spelling or grammatical errors, are formatted uniformly and contain accurate information and correct calculations. The Contractor shall retain all draft and marked-up documents and checklists utilized in reviewing deliverables for reference as directed by the Department.

5.1.9.5. In the event that any due date for a deliverable falls on a day that is not a Business

Day, then the due date shall be automatically extended to the next Business Day, unless otherwise directed by the Department.

5.1.9.6. 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.

5.1.9.7. No deliverable, report, data, procedure or system created by the Contractor for the

Department that is necessary to fulfilling the Contractor's responsibilities under the

Contract, as determined by the Department, shall be considered proprietary.

5.1.9.8. If any deliverable contains ongoing responsibilities or requirements for the Contractor, such as deliverables that are plans, policies or procedures, then the Contractor shall comply with all requirements of the most recently approved version of that deliverable.

The Contractor shall not implement any version of any such deliverable prior to receipt of the Department’s written approval of that version of that deliverable. Once a version of any 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 of this Contract.

5.1.9.8.1. Any deliverable described as an update of another deliverable shall be considered a version of the original deliverable for the purposes of this subsection.

5.1.10. Stated Deliverables and Performance Standards

5.1.10.1. 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 deliverables. The sections with these headings are not intended to expand or limit the requirements or responsibilities related to any deliverable or performance standard.

5.1.11. Communication Requirements

5.1.11.1. Communication with the Department

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5.1.11.1.1. The Contractor shall enable all Contractor staff to exchange documents and electronic files with the Department staff in formats compatible with the

Department’s systems. The Department currently uses Microsoft Office 2013 and/or Microsoft Office 365 for PC. If the Contractor uses a compatible program that is not the system used by the Department, then the Contractor shall ensure that all documents or files delivered to the Department are completely transferrable and reviewable, without error, on the Department’s systems.

5.1.11.1.2. The Department will use a transmittal process to provide the Contractor with official direction within the scope of the Contract. The 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 of the following:

5.1.11.1.2.1. The date the transmittal will be effective.

5.1.11.1.2.2. Direction to the Contractor regarding performance under the Contract.

5.1.11.1.2.3. A due date or timeline by which the Contractor shall comply with the direction contained in the transmittal.

5.1.11.1.2.4. The signature of the Department employee who has been designated to sign transmittals.

5.1.11.1.2.4.1. The Department will provide the Contractor with the name of the 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 the

Contractor with a list of backups 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 the

Contractor through a transmittal.

5.1.11.1.3. The Department may deliver a completed transmittal to the Contractor in hard copy, as a scanned attachment to an email or through a dedicated communication system, if such a system is available.

5.1.11.1.3.1. 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.

5.1.11.1.4. If the Contractor receives conflicting transmittals, the Contractor shall contact the

Department’s primary designee, or backup designees if the 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.

5.1.11.1.5. In the event that the 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.

5.1.11.1.6. Transmittals may not be used in place of an amendment, and may not, under any circumstances be used to modify the term of the Contract or any compensation under the Contract. Transmittals are not intended to be the sole means of communication between the Department and the Contractor, and the Department may provide day-to-day communication to the Contractor without using a transmittal.

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5.1.11.1.7. The Contractor shall retain all transmittals for reference and shall provide copies of any received transmittals upon request by the Department.

5.1.11.2. Communication with Clients, Providers and Other Entities

5.1.11.2.1. The Contractor shall create a Communication Plan that includes, but is not limited to, all of the following:

5.1.11.2.1.1. A description of how the Contractor will communicate to Clients any changes to the services those Clients will receive or how those Clients will receive the services.

5.1.11.2.1.2. A description of the communication methods, including things such as email lists, newsletters and other methods, the Contractor will use to communicate with

Providers and Subcontractors.

5.1.11.2.1.3. The specific means of immediate communication with Clients and a method for accelerating the internal approval and communication process to address urgent communications or crisis situations.

5.1.11.2.1.4. A general plan for how the Contractor will address communication deficiencies or crisis situations, including how the Contractor will increase staff, contact hours or other steps the Contractor will take if existing communication methods for

Clients or Providers are insufficient.

5.1.11.2.1.5. A listing of the following individuals within the Contractor’s organization, that includes cell phone numbers and email addresses:

5.1.11.2.1.5.1. 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.

5.1.11.2.1.5.2. An individual who is responsible for any website or marketing related to the

Work.

5.1.11.2.1.5.3. Back-up communication staff that can respond in the event that the other individuals listed are unavailable.

5.1.11.2.2. The Contractor shall deliver the Communication Plan to the Department for review and approval.

5.1.11.2.2.1. DELIVERABLE: Communication Plan

5.1.11.2.2.2. DUE: Within ten (10) Business Days after the Effective Date

5.1.11.2.3. The Contractor shall review its Communication Plan on an annual basis and determine if any changes are required to account for any changes in the Work, in the Department’s processes and procedures or in the Contractor’s processes and procedures. The Contractor shall submit an Annual Communication Plan Update that contains all changes from the most recently approved prior Communication

Plan, Annual Communication Plan Update or Interim Communication Plan Update or shall note that there were no changes.

5.1.11.2.3.1. DELIVERABLE: Annual Communication Plan Update

5.1.11.2.3.2. DUE: Annually, by June 30th of each year

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5.1.11.2.4. The Department may request a change to the Communication Plan at any time to account for any changes in the Work, in the Department’s processes and procedures or in the Contractor’s processes and procedures, or to address any communication related deficiencies determined by the Department. The Contractor shall modify the

Communication Plan as directed by the Department and submit an Interim

Communication Plan Update containing all changes directed by the Department.

5.1.11.2.4.1. DELIVERABLE: Interim Communication Plan Update

5.1.11.2.4.2. DUE: Within ten (10) Business Days following the receipt of the request from the

Department, unless the Department allows for a longer time in writing

5.1.11.2.5. The Contractor shall not engage in any non-routine communication with any Client, any Provider, the media or the public without the prior written consent of the

Department.

5.1.12. Business Continuity

5.1.12.1. The Contractor shall create a Business Continuity Plan that the Contractor will follow in order to continue operations after a Disaster or a Business Interruption. The

Business Continuity Plan shall include, but is not limited to, all of the following:

5.1.12.1.1. How the Contractor will replace staff that has been lost or is unavailable during or after a Business Interruption so that the Work is performed in accordance with the

Contract.

5.1.12.1.2. How the Contractor will back-up all information necessary to continue performing the Work, so that no information is lost because of a Business Interruption.

5.1.12.1.2.1. In the event of a Disaster, the plan shall also include how the Contractor will make all information available at its back-up facilities.

5.1.12.1.3. How the Contractor will minimize the effects on Clients of any Business

Interruption.

5.1.12.1.4. How the Contractor will communicate with the Department during the Business

Interruption and points of contact within the Contractor’s organization the

Department can contact in the event of a Business Interruption.

5.1.12.1.5. Planned long-term back-up facilities out of which the Contractor can continue operations after a Disaster.

5.1.12.1.6. The time period it will take to transition all activities from the Contractor’s regular facilities to the back-up facilities after a Disaster.

5.1.12.2. The Contractor shall deliver the Business Continuity Plan to the Department for review and approval.

5.1.12.2.1. DELIVERABLE: Business Continuity Plan

5.1.12.2.2. DUE: Within ten (10) Business days after the Effective Date

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5.1.12.3. The Contractor shall review its Business Continuity Plan at least semi-annually and update the plan as appropriate to account for any changes in the Contractor’s processes, procedures or circumstances. The Contractor shall submit an Updated

Business Continuity Plan that contains all changes from the most recently approved prior Business Continuity Plan or Updated Business Continuity Plan or shall note that there were no changes.

5.1.12.3.1. DELIVERABLE: Updated Business Continuity Plan

5.1.12.3.2. DUE: For the initial contract year, by June 30th. For renewal years, semi-annually, by June 30th and December 31st of each year.

5.1.12.4. In the event of any Business Interruption, the Contractor shall implement its most recently approved Business Continuity Plan or Updated Business Continuity Plan immediately after the Contractor becomes aware of the Business Interruption. In that event, the Contractor shall comply with all requirements, deliverables, timelines and milestones contained in the implemented plan.

5.1.13. Federal Financial Participation Related Intellectual Property Ownership

5.1.13.1. In addition to the intellectual property ownership rights in the Contract, the following subsections describe the intellectual property ownership requirements that the

Contractor shall meet during the term of the Contract in relation to federal financial participation.

5.1.13.2. To facilitate obtaining the desired amount of federal financial participation under 42

CFR §433.112, the Department shall have all ownership rights, not superseded by other licensing restrictions, in all materials, programs, procedures, etc., designed, purchased, or developed by the Contractor and funded by the Department. The

Contractor shall use contract funds to develop all necessary materials, programs, products, procedures, etc., and data and software to fulfill its obligations under the

Contract. Department funding used in the development of these materials, programs, procedures, etc. shall be documented by the Contractor. The Department shall have all ownership rights in data and software, or modifications thereof and associated documentation and procedures designed and developed to produce any systems, programs reports and documentation and all other work products or documents created under the Contract. The Department shall have these ownership rights, regardless of whether the work product was developed by the Contractor or any Subcontractor for work product created in the performance of this Contract. The Department reserves, on behalf of itself, the Federal Department of Health and Human Services and its contractors, a royalty-free, non-exclusive and irrevocable license to produce, publish or otherwise use such software, modifications, documentation and procedures. Such data and software includes, but is not limited to, the following:

5.1.13.2.1. All computer software and programs, which have been designed or developed for the Department, or acquired by the Contractor on behalf of the Department, which are used in performance of the Contract.

5.1.13.2.2. All internal system software and programs developed by the Contractor or subcontractor, including all source codes, which result from the performance of the

Contract; excluding commercial software packages purchased under the

Contractor’s own license.

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5.1.13.2.3. All necessary data files.

5.1.13.2.4. User and operation manuals and other documentation.

5.1.13.2.5. System and program documentation in the form specified by the Department.

5.1.13.2.6. Training materials developed for Department staff, agents or designated representatives in the operation and maintenance of this software.

5.1.14. Performance Reviews

5.1.14.1. The Department may conduct performance reviews or evaluations of the Contractor in relation to the Work performed under the Contract.

5.1.14.2. The Department may work with the 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.

5.1.14.3. The 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. The Contractor shall provide this information regardless of whether the Department decides to work with the Contractor on any aspect of the performance review or evaluation.

5.1.14.4. The Department may conduct these performance reviews or evaluations at any point during the term of the Contract, or after termination of the Contract for any reason.

5.1.14.5. The Department may make the results of any performance reviews or evaluations available to the public, or may publicly post the results of any performance reviews or evaluations.

5.1.15. Renewal Options

5.1.15.1. 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 of the Work in its sole discretion.

5.1.16. Department System Access

5.1.16.1. In the event that the Contractor requires access to any Department computer system to complete the Work, the Contractor shall have and maintain all hardware, software and interfaces necessary to access the system without requiring any modification to the

Department’s system. The Contractor shall follow all Department policies, processes and procedures necessary to gain access to the Department’s systems.

5.2. CONTRACTOR PERSONNEL

5.2.1. Personnel General Requirements

5.2.1.1. The Contractor shall provide qualified Key Personnel and Other Personnel as necessary to perform the Work throughout the term of the Contract. The Contractor shall provide the Department with a final list of individuals assigned to the Contract.

5.2.1.1.1. DELIVERABLE: Final list of names of the individuals assigned to the Contract

5.2.1.1.2. DUE: Within five (5) Business Days following the Effective Date

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5.2.1.2. The Contractor shall obtain written approval from the Department for individuals proposed for assignment to Key Personnel positions prior to those individuals beginning the performance of any Work under the Contract. The Department reserves the right to approve or disapprove all of the Contractor’s staff assigned to the Contract or to require the reassignment of any Contractor employee found unacceptable by the

Department. The Department has the right to request that any personnel be removed or replaced at any time, for any reason, if it is determined to be in the best interest of the Department.

5.2.1.3. The Contractor shall not voluntarily change individuals in Key Personnel positions without the prior written approval of the Department. The Contractor shall supply the

Department with the name(s), resume and references for any proposed replacement whenever there is a change to Key Personnel. Any individual replacing Key Personnel shall have qualifications that are equivalent to or exceed the qualifications of the individual that previously held the position, unless otherwise approved, in writing, by the Department.

5.2.1.3.1. DELIVERABLE: Name(s), resume(s) and references for the person(s) replacing anyone in a Key Personnel position during a voluntary change

5.2.1.3.2. DUE: At least five (5) Business Days prior to the change in Key Personnel

5.2.1.4. In the event that any individual filling a Key Personnel position leaves employment with the Contractor, the Contractor shall propose a replacement person to the

Department. The replacement person shall have qualifications that are equivalent to or exceed the qualifications of the individual that previously held the position, unless otherwise approved, in writing, by the Department.

5.2.1.4.1. DELIVERABLE: Name(s), resume(s) and references for the person(s) replacing anyone in a Key Personnel position who leaves employment with the Contractor

5.2.1.4.2. DUE: Within ten (10) Business Days following the Contractor’s receipt of notice that the person is leaving employment.

5.2.1.5. The Contractor’s Case Manager(s) and any Case Management Supervisor(s) who maintains a case management caseload shall perform the majority of their work and responsibilities on this project in the Region in which the Clients whose cases they manage reside, unless the Department grants permission otherwise.

5.2.1.6. If any of the 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 the Contractor shall submit copies of such current licenses and certifications to the Department.

5.2.1.6.1. DELIVERABLE: All current professional licensure and certification documentation as specified for Key Personnel or Other Personnel

5.2.1.6.2. DUE: Within five (5) Business Days of receipt of updated licensure or upon request by the Department

5.2.2. Personnel Availability

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5.2.2.1. The 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. The Contractor shall also make these personnel available outside of the Department’s normal business hours and on weekends with prior notice from the Department.

5.2.2.2. The Contractor’s Key Personnel and Other Personnel shall be available for all regularly scheduled meetings between the Contractor and the Department, unless the

Department has granted prior, written approval otherwise.

5.2.2.3. The Contractor shall ensure that the Key Personnel and Other Personnel attending all…