STATE OF COLORADO CONTRACT
COVER PAGE
State Agency
Department of Health Care Policy and Financing
Contract Number
24-183277
Contractor
KPMG LLP
Contract Performance Beginning Date
The later of the Effective Date or July 1, 2023
Contract Maximum Amount
Initial Term
Initial Contract Expiration Date
June 30, 2024
State Fiscal Year 2024
$16,744,782.52
Extension Terms
Contract Authority
Authority to enter into this Contract exists in C.R.S. §25.5-1-
101,
et seq
., C.R.S.
State Fiscal Year 2025
$7,788,717.39
State Fiscal Year 2026
$8,996,328.66
State Fiscal Year 2027
$6,431,470.75
State Fiscal Year 2028
$7,070,708.35
Total for All State Fiscal Years
$47,032,007.66
Contract Purpose
This Contract is entered into for the Contractor to provide Value Based Payment services to the Department and to design a
Colorado Providers of Distinction program. The Contractor was awarded this Contract under Solicitation # UHAA ITN
2022000008.
Exhibits and Order of Precedence
The following Exhibits and attachments are included with this Contract:
1.
Exhibit A – HIPAA Business Associates Addendum
2.
Exhibit B – Statement of Work
3.
Exhibit C – Rates
4.
Exhibit D – Terminology
5.
Exhibit E – Contractor’s Administrative Requirements
6.
Exhibit F – Sample Option Letter
7.
Exhibit G – Federal Provisions
8.
Exhibit H – PII Certification
9.
Exhibit I – Substance Use Data
10.
Exhibit J – Deliverables Payments
11.
Exhibit K – Information Technology Provisions
In the event of a conflict or inconsistency between this Contract and any Exhibit or attachment, such conflict or inconsistency
shall be resolved by reference to the documents in the following order of priority:
1.
Exhibit A, HIPAA Business Associates Addendum
2.
Exhibit G, Federal Provisions
3.
Colorado Special Provisions in §18 of the main body of this Contract
4.
Exhibit K, Information Technology Provisions
5.
The provisions of the other sections of the main body of this Contract
6.
Exhibit B, Statement of Work
7.
Exhibit I, Substance Use Data
8.
Exhibit D, Terminology
9.
Exhibit E, Contractor’s Administrative Requirements
10.
Exhibit C, Rates
11.
Exhibit J, Deliverables Payments
12.
Exhibit H, PII Certification
13.
Exhibit F, Sample Option Letter
Principal Representatives
For the State:
For Contractor:
Trevor Abeyta
Eveline van Beek
Finance Office
KPMG LLC
1570 Grant Street
200 E Randolph Street #5500
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Denver, CO 80203
Chicago, IL 60601
Trevor.Abeyta@state.co.us
evelinevanbeek@kpmg.com
SIGNATURE PAGE
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Each person signing this Contract represents and warrants that he or she is duly authorized to execute this Contract and to
bind the Party authorizing his or her signature.
CONTRACTOR
KPMG LLP
By:______________________________________________
Date: _________________________
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
Kim Bimestefer, Executive Director
By:______________________________________________
Date: _________________________
LEGAL REVIEW
Philip J. Weiser, Attorney General
By:__________________N/A___________________________
Date: _________________________
In accordance with §24-30-202, C.R.S., if this Contract is for
a Major Information Technology Project, this Contract is not
valid until signed and dated below by the Chief Information
Officer or an authorized delegate.
STATE CHIEF INFORMATION OFFICER
Anthony Neal-Graves, Chief Information Officer and
Executive Director
By:___________________________________________
Date:_____________________
In accordance with §24-30-202, C.R.S., this Contract is not
valid until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:___________________________________________
Effective Date:_____________________
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
8/15/2023 | 12:25 EDT
8/15/2023 | 12:18 MDT
8/16/2023 | 16:07 PDT
8/22/2023 | 15:50 MDT
Contract Number: 24-183277
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TABLE OF CONTENTS
1.
PARTIES .............................................................................................................................2
2.
TERM AND EFFECTIVE DATE .......................................................................................2
3.
DEFINITIONS .....................................................................................................................3
4.
STATEMENT OF WORK ..................................................................................................6
5.
PAYMENTS TO CONTRACTOR .....................................................................................6
6.
REPORTING - NOTIFICATION........................................................................................8
7.
CONTRACTOR RECORDS ...............................................................................................9
8.
CONFIDENTIAL INFORMATION-STATE RECORDS ................................................10
9.
CONFLICTS OF INTEREST ............................................................................................12
10.
INSURANCE .....................................................................................................................13
11.
BREACH OF CONTRACT ...............................................................................................14
12.
REMEDIES........................................................................................................................15
13.
DISPUTE RESOLUTION .................................................................................................17
14.
NOTICES AND REPRESENTATIVES ...........................................................................17
15.
RIGHTS IN WORK PRODUCT AND OTHER INFORMATION ..................................18
16.
GENERAL PROVISIONS ................................................................................................20
17.
COLORADO SPECIAL PROVISIONS (COLORADO FISCAL RULE 3-3) .................24
18.
ADDITIONAL TERMS ....................................................................................................26
EXHIBIT A, HIPAA BUSINESS ASSOCIATES ADDENDUM ......................................1
EXHIBIT B, STATEMENT OF WORK .............................................................................1
EXHIBIT C, RATES ...........................................................................................................1
EXHIBIT D, TERMINOLOGY ..........................................................................................1
EXHIBIT E, CONTRACTOR’S ADMINISTRATIVE REQUIREMENTS ......................1
EXHIBIT F, SAMPLE OPTION LETTER .........................................................................1
EXHIBIT G, FEDERAL PROVISIONS .............................................................................1
EXHIBIT H, PII CERTIFICATION....................................................................................1
EXHIBIT I, SUBSTANCE USE DATA .............................................................................1
EXHIBIT J, DELIVERABLES PAYMENTS .....................................................................1
EXHIBIT K, INFORMATION TECHNOLOGY PROVISIONS .......................................1
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1.
PARTIES
This Contract is entered into by and between Contractor named on the Cover Page for this
contract (the “Contractor”), and the STATE OF COLORADO acting by and through the
State agency named on the Cover Page for this Contract (the “State,” the “Department,” or
“HCPF”). Contractor and the State agree to the terms and conditions in this Contract.
2.
TERM AND EFFECTIVE DATE
A.
Effective Date
This Contract shall not be valid or enforceable until the Effective Date. The State shall
not be bound by any provision of this Contract before the Effective Date and shall have
no obligation to pay Contractor for any Work performed or expense incurred before the
Effective Date or after the expiration or sooner termination of this Contract.
B.
Initial Term
The Parties’ respective performances under this Contract shall commence on the
Contract Performance Beginning Date shown on the Cover Page for this Contract and
shall terminate on the Initial Contract Expiration Date shown on the Cover Page for
this Contract (the “Initial Term”) unless sooner terminated or further extended in
accordance with the terms of this Contract.
C.
Extension Terms - State’s Option
The State, at its discretion, shall have the option to extend the performance under this
Contract beyond the Initial Term for a period, or for successive periods, of one year or
less at the same rates and under the same terms specified in the Contract (each such
period an “Extension Term”). In order to exercise this option, the State shall provide
written notice to Contractor in a form substantially equivalent to the Sample Option
Letter attached to this Contract. Except as stated in
§2.D
, the total duration of this
Contract, including the exercise of any options to extend, shall not exceed five years
from its Effective Date absent prior approval from the Chief Procurement Officer in
accordance with the Colorado Procurement Code.
D.
End of Term Extension
If this Contract approaches the end of its Initial Term, or any Extension Term then in
place, the State, at its discretion, upon written notice to Contractor as provided in
§14,
may unilaterally extend such Initial Term or Extension Term for a period not to exceed
two months (an “End of Term Extension”), regardless of whether additional Extension
Terms are available or not. The provisions of this Contract in effect when such notice
is given shall remain in effect during the End of Term Extension. The End of Term
Extension shall automatically terminate upon execution of a replacement contract or
modification extending the total term of this Contract.
E.
Early Termination in the Public Interest
The State is entering into this Contract to serve the public interest of the State of
Colorado as determined by its Governor, General Assembly, or Courts. If this Contract
ceases to further the public interest of the State, the State, in its discretion, may
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terminate this Contract in whole or in part. A determination that this Contract should
be terminated in the public interest shall not be equivalent to a State right to terminate
for convenience. This subsection shall not apply to a termination of this Contract by
the State for Breach of Contract by Contractor, which shall be governed by
§11.
i.
Method and Content
The State shall notify Contractor of such termination in accordance with
§14.
The
notice shall specify the effective date of the termination and whether it affects all
or a portion of this Contract, and shall include, to the extent practicable, the public
interest justification for the termination.
ii.
Obligations and Rights
Upon receipt of a termination notice for termination in the public interest,
Contractor shall be subject to the rights and obligations set forth in
§12
.
iii.
Payments
If the State terminates this Contract in the public interest, the State shall pay
Contractor an amount equal to the percentage of the total reimbursement payable
under this Contract that corresponds to the percentage of Work performed in
accordance with the requirements of this Contract, as determined by the State,
less payments previously made. Additionally, if this Contract is less than 60%
completed, as determined by the State, the State may reimburse Contractor for a
portion of actual out-of-pocket expenses, not otherwise reimbursed under this
Contract, incurred by Contractor which are directly attributable to the
uncompleted portion of Contractor’s obligations, provided that the sum of any
and all reimbursement shall not exceed the maximum amount payable to
Contractor hereunder.
3.
DEFINITIONS
The following terms shall be construed and interpreted as follows:
A.
“
Breach of Contract
” means the failure of a Party to perform any of its obligations in
accordance with this Contract, in whole or in part or in a timely or satisfactory manner.
The institution of proceedings under any bankruptcy, insolvency, reorganization or
similar law, by or against Contractor, or the appointment of a receiver or similar officer
for Contractor or any of its property, which is not vacated or fully stayed within 30
days after the institution of such proceeding, shall also constitute a breach. If Contractor
is debarred or suspended under §24-109-105, C.R.S. at any time during the term of this
Contract, then such debarment or suspension shall constitute a breach.
B.
“
Business Day
” means any day other than Saturday, Sunday, or a Legal Holiday as
listed in §24-11-101(1), C.R.S.
C.
“
Chief Procurement Officer
” means the individual to whom the Executive Director
has delegated his or her authority, pursuant to §24-102-202, C.R.S. to procure or
supervise the procurement of all supplies and services needed by the State.
D.
“
Contract
” means this agreement, including all attached Exhibits, all documents
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incorporated by reference, all referenced statutes, rules and cited authorities, and any
future modifications thereto.
E.
“
Contract Funds
” means the funds that have been appropriated, designated,
encumbered, or otherwise made available for payment by the State under this Contract.
F.
“
Contractor Pre-Existing Material
” means material, code, methodology, concepts,
process, systems, technique, trade or service marks, copyrights, or other intellectual
property developed, licensed or otherwise acquired by Contractor prior to the Effective
Date of this Contract and independent of any services rendered under any other contract
with the State.
G.
“
Colorado Open Records Act (CORA)
” means §24-72-200.1,
et seq
., C.R.S.
H.
“
Criminal Justice Information (CJI)
” means criminal justice information collected
by criminal justice agencies needed for the performance of their authorized functions,
including, without limitation, all information defined as criminal justice information by
the U.S. Department of Justice, Federal Bureau of Investigation, Criminal Justice
Information Services Security Policy, as amended and all Criminal Justice Records as
defined under §24-72-302, C.R.S.
I.
“
Deliverable
” means the outcome to be achieved or output to be provided, in the form
of a tangible object or software that is produced as a result of Contractor’s Work that
is intended to be delivered to the State by Contractor.
J.
“
Effective Date
” means the date on which this Contract is approved and signed by the
Colorado State Controller or designee, as shown on the Signature Page for this
Contract. If this Contract is for a Major Information Technology Project, as defined in
§24-37.5-102(2.6), C.R.S., then the Effective Date of this Contract shall be the later of
the date on which this Contract is approved and signed by the State’s Chief Information
Officer or authorized delegate or the date on which this Contract is approved and signed
by the State Controller or authorized delegate, as shown on the Signature Page for this
Contract.
K.
“
End of Term Extension
” means the time period defined in
§2.D
L.
“
Exhibits
” means the exhibits and attachments included with this Contract as shown
on the Cover Page for this Contract.
M.
“
Extension Term
” means the time period defined in
§2.C
N.
“
Goods
” means any movable material acquired, produced, or delivered by Contractor
as set forth in this Contract and shall include any movable material acquired, produced,
or delivered by Contractor in connection with the Services.
O.
“
Incident
” means any accidental or deliberate event that results in or constitutes an
imminent threat of the unauthorized access, loss, disclosure, modification, disruption,
or destruction of any communications or information resources of the State, which are
included as part of the Work, as described in §24-37.5-401,
et seq.
, C.R.S. Incidents
include, without limitation, (i) successful attempts to gain unauthorized access to a
State system or State Records regardless of where such information is located; (ii)
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unwanted disruption or denial of service; (iii) the unauthorized use of a State system
for the processing or storage of data; or (iv) changes to State system hardware,
firmware, or software characteristics without the State’s knowledge, instruction, or
consent.
P.
“Initial Term”
means the time period defined in
§2.B
Q.
“
Party
” means the State or Contractor, and “Parties” means both the State and
Contractor.
R.
“Payment Card Information (PCI)
” means payment card information including any
data related to credit card holders’ names, credit card numbers, or other credit card
information as may be protected by state or federal law.
S.
“
Personal Health Information (PHI)
” means any protected health information,
including, without limitation any information whether oral or recorded in any form or
medium:
(i)
that relates to the past, present, or future physical or mental condition of
an individual; the provision of health care to an individual; or the past, present, or future
payment for the provision of health care to an individual; and
(ii)
that identifies the
individual or with respect to which there is a reasonable basis to believe the information
can be used to identify the individual. PHI includes, but is not limited to, any
information defined as Individually Identifiable Health Information by the federal
Health Insurance Portability and Accountability Act.
T.
“Personally Identifiable Information (PII)
” means personally identifiable
information including, without limitation, any information maintained by the State
about an individual that can be used to distinguish or trace an individual’s identity, such
as name, social security number, date and place of birth, mother’s maiden name, or
biometric records; and any other information that is linked or linkable to an individual,
such as medical, educational, financial, and employment information. PII includes, but
is not limited to, all information defined as personally identifiable information in §§24-
72-501 and 24-73-101, C.R.S. “PII” shall also mean “personal identifying information”
as set forth at § 24-74-102,
et seq
., C.R.S.
U.
“
Services
” means the services to be performed by Contractor as set forth in this
Contract and shall include any services to be rendered by Contractor in connection with
the Goods.
V.
“
State Confidential Information
” means any and all State Records not subject to
disclosure under CORA. State Confidential Information shall include, but is not limited
to, PII, PHI, PCI, Tax Information, CJI, and State personnel records not subject to
disclosure under CORA. State Confidential Information shall not include information
or data concerning individuals that is not deemed confidential but nevertheless belongs
to the State, which has been communicated, furnished, or disclosed by the State to
Contractor which (i) is subject to disclosure pursuant to CORA; (ii) is already known
to Contractor without restrictions at the time of its disclosure to Contractor; (iii) is or
subsequently becomes publicly available without breach of any obligation owed by
Contractor to the State; (iv) is disclosed to Contractor, without confidentiality
obligations, by a third party who has the right to disclose such information; or (v) was
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independently developed without reliance on any State Confidential Information.
W.
“
State Fiscal Rules
” means the fiscal rules promulgated by the Colorado State
Controller pursuant to §24-30-202(13)(a), C.R.S.
X.
“
State Fiscal Year (SFY)
” means a 12-month period beginning on July 1 of each
calendar year and ending on June 30 of the following calendar year. If a single calendar
year follows the term, then it means the State Fiscal Year ending in that calendar year.
Y.
“
State Records
” means any and all State data, information, and records, regardless of
physical form, including, but not limited to, information subject to disclosure under
CORA.
Z.
“
Subcontractor
” means any third party engaged by Contractor to aid in performance
of the Work.
AA.
“
Tax Information
” means federal and State of Colorado tax information including,
without limitation, federal and State tax returns, return information, and such other tax-
related information as may be protected by federal and State law and regulation. Tax
Information includes, but is not limited to, all information defined as federal tax
information in Internal Revenue Service Publication 1075.
BB.
“
Work
” means the Goods delivered and Services performed pursuant to this Contract.
CC.
“
Work Product
” means the tangible and intangible results of the Work, whether
finished or unfinished, including drafts. Work Product includes, but is not limited to,
documents, text, software (including source code), research, reports, proposals,
specifications, plans, notes, studies, data, images, photographs, negatives, pictures,
drawings, designs, models, surveys, maps, materials, ideas, concepts, know-how, and
any other results of the Work. “Work Product” does not include any material that was
developed prior to the Effective Date that is used, without modification, in the
performance of the Work.
Any other term used in this Contract that is defined in an Exhibit shall be construed and
interpreted as defined in that Exhibit, including the terminology in Exhibit D.
4.
STATEMENT OF WORK
A.
Contractor shall complete the Work as described in this Contract and in accordance
with the provisions of Exhibit B, and Exhibit E. The State shall have no liability to
compensate Contractor for the delivery of any goods or the performance of any services
that are not specifically set forth in this Contract.
B.
The State, at its discretion, shall have the option to increase or decrease the statewide
quantity of Goods and Services based upon rates established in this Contract, and
increase the maximum amount payable accordingly. In order to exercise this option,
the State shall provide written notice to Contractor in a form substantially equivalent
to the Sample Option Letter attached to this contract. Delivery of Goods and
performance of Services shall continue at the same rates and terms as described in this
Contract.
5.
PAYMENTS TO CONTRACTOR
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A.
Maximum Amount
Payments to Contractor are limited to the unpaid, obligated balance of the Contract
Funds. The State shall not pay Contractor any amount under this Contract that exceeds
the Contract Maximum for that State Fiscal Year shown on the Cover Page for this
Contract.
B.
Payment Procedures
i.
Invoices and Payment
a.
The State shall pay Contractor in the amounts and in accordance with the
schedule and other conditions set forth in Exhibit B, Statement of Work and
Exhibit C, Rates.
b.
Contractor shall initiate payment requests by invoice to the State, in a form
and manner approved by the State.
c.
The State shall pay each invoice within 45 days following the State’s receipt
of that invoice, so long as the amount invoiced correctly represents Work
completed by Contractor and previously accepted by the State during the
term that the invoice covers. If the State determines that the amount of any
invoice is not correct, then Contractor shall make all changes necessary to
correct that invoice.
d.
The acceptance of an invoice shall not constitute acceptance of any Work
performed or Deliverables provided under this Contract.
ii.
Interest
Amounts not paid by the State within 45 days of the State’s acceptance of the
invoice shall bear interest on the unpaid balance beginning on the 45
th
day at the
rate of 1% per month, as required by §24-30-202(24)(a), C.R.S., until paid in full;
provided, however, that interest shall not accrue on unpaid amounts that the State
disputes in writing. Contractor shall invoice the State separately for accrued
interest on delinquent amounts, and the invoice shall reference the delinquent
payment, the number of day’s interest to be paid and the interest rate.
iii.
Payment Disputes
If Contractor disputes any calculation, determination or amount of any payment,
Contractor shall notify the State in writing of its dispute within 30 days following
the earlier to occur of Contractor’s receipt of the payment or notification of the
determination or calculation of the payment by the State. The State will review
the information presented by Contractor and may make changes to its
determination based on this review. The calculation, determination or payment
amount that results from the State’s review shall not be subject to additional
dispute under this subsection. No payment subject to a dispute under this
subsection shall be due until after the State has concluded its review, and the State
shall not pay any interest on any amount during the period it is subject to dispute
under this subsection.
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iv.
Available Funds-Contingency-Termination
The State is prohibited by law from making commitments beyond the term of the
current State Fiscal Year. Payment to Contractor beyond the current State Fiscal
Year is contingent on the appropriation and continuing availability of Contract
Funds in any subsequent year (as provided in the Colorado Special Provisions).
If federal funds or funds from any other non-State funds constitute all or some of
the Contract Funds, the State’s obligation to pay Contractor shall be contingent
upon such non-State funding continuing to be made available for payment.
Payments to be made pursuant to this Contract shall be made only from Contract
Funds, and the State’s liability for such payments shall be limited to the amount
remaining of such Contract Funds. If State, federal or other funds are not
appropriated, or otherwise become unavailable to fund this Contract, the State
may, upon written notice, terminate this Contract, in whole or in part, without
incurring further liability. The State shall, however, remain obligated to pay for
Services and Goods that are delivered and accepted prior to the effective date of
notice of termination, and this termination shall otherwise be treated as if this
Contract were terminated in the public interest as described in
§2.E
.
6.
REPORTING - NOTIFICATION
A.
Quarterly Reports.
In addition to any reports required pursuant to this Contract or pursuant to any other
Exhibit, for any contract having a term longer than three months, Contractor shall
submit, on a quarterly basis, a written report specifying progress made for each
specified performance measure and standard in this Contract. Such progress report shall
be in accordance with the procedures developed and prescribed by the State. Progress
reports shall be submitted to the State not later than five Business Days following the
end of each calendar quarter or at such time as otherwise specified by the State.
B.
Litigation Reporting
If Contractor is served with a pleading or other document in connection with an action
before a court or other administrative decision-making body, and such pleading or
document relates to this Contract or may affect Contractor’s ability to perform its
obligations under this Contract, Contractor shall, within 10 Business Days after being
served, notify the State of such action, to the extent not precluded by law, and deliver
copies of such pleading or document to the State’s Principal Representative identified
on the Cover Page of this Contract.
C.
Performance Outside the State of Colorado or the United States, §24-102-206, C.R.S.
To the extent not previously disclosed in accordance with §24-102-206, C.R.S.,
Contractor shall provide written notice to the State, in accordance with
§14
and in a
form designated by the State, within 20 days following the earlier to occur of
Contractor’s decision to perform Services outside of the State of Colorado or the United
States, or its execution of an agreement with a Subcontractor to perform, Services
outside the State of Colorado or the United States. Such notice shall specify the type of
Services to be performed outside the State of Colorado or the United States and the
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reason why it is necessary or advantageous to perform such Services at such location
or locations, and such notice shall be a public record. Knowing failure by Contractor
to provide notice to the State under this section shall constitute a breach of this Contract.
This section
shall not apply if the Contract Funds include any federal funds. The Parties
acknowledge that Contractor’s offshore resources may access Contractor’s billing
records system, which billing records system does not and shall not contain any
confidential information, PHI, or PII related to Work performed for the State.
D.
SOC 1 Type II Annual Report
If Contractor performs Work for any of the State’s IT systems that impact the State’s
Comprehensive Annual Financial Report as determined by the Colorado Office of the
State Controller, Contractor, on an annual basis, shall deliver to the State, at
Contractor’s sole cost and expense, Contractor’s System and Organization Controls 1
Type II Report (“SOC 1 Type II Report”) prepared by a qualified independent audit
firm with respect to the Statement on Standards for Attestation Engagements,
Reporting on Controls at a Service Organization (SSAE) as promulgated by the
Auditing Standards Board of the American Institute of Certified Public Accountants,
as amended, from time to time.
7.
CONTRACTOR RECORDS
A.
Maintenance
Contractor shall maintain a file of all documents, records, communications, notes and
other materials relating to the Work (the “Contractor Records”). Contractor Records
shall include all documents, records, communications, notes and other materials
maintained by Contractor that relate to any Work performed by Subcontractors, and
Contractor shall maintain all records related to the Work performed by Subcontractors
required to ensure proper performance of that Work. Contractor shall maintain
Contractor Records until the last to occur of:
(i)
the date three years after the date this
Contract expires or is terminated,
(ii)
final payment under this Contract is made,
(iii)
the resolution of any pending Contract matters, or
(iv)
if an audit is occurring, or
Contractor has received notice that an audit is pending, the date such audit is completed
and its findings have been resolved (the “Record Retention Period”).
B.
Inspection
Contractor shall permit the State, the federal government, and any other duly authorized
agent of a governmental agency to audit, inspect, examine, excerpt, copy and transcribe
Contractor Records during the Record Retention Period. Contractor shall make
Contractor Records available during normal Business Hours at Contractor’s office or
place of business, or at other mutually agreed upon times or locations, upon no fewer
than two Business Days’ notice from the State, unless the State determines that a shorter
period of notice, or no notice, is necessary to protect the interests of the State.
C.
Monitoring
The State, the federal government, and any other duly authorized agent of a
governmental agency in its discretion, may monitor Contractor’s performance of its
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obligations under this Contract using procedures as determined by the State or that
governmental entity. The State shall monitor Contractor’s performance in a manner
that does not unduly interfere with Contractor’s performance of the Work.
D.
Final Audit Report
Contractor shall promptly submit to the State a copy of any final audit report of an audit
performed on Contractor’s records that relates to or affects this Contract or the Work,
whether the audit is conducted by Contractor or a third party.
8.
CONFIDENTIAL INFORMATION-STATE RECORDS
A.
Confidentiality
Contractor shall keep confidential, and cause all Subcontractors to keep confidential,
all State Records, unless those State Records are publicly available. Contractor shall
not, without prior written approval of the State, use, publish, copy, disclose to any third
party, or permit the use by any third party of any State Records, except as otherwise
stated in this Contract, permitted by law, or approved in writing by the State. Contractor
shall provide for the security of all State Confidential Information in accordance with
all applicable laws, rules, policies, publications, and guidelines. If Contractor or any of
its Subcontractors will or may receive the following types of data, Contractor or its
Subcontractors shall provide for the security of such data according to the following:
(i)
the most recently promulgated IRS Publication 1075 for all Tax Information and in
accordance with the Safeguarding Requirements for Federal Tax Information attached
to this Contract as an Exhibit, if applicable,
(ii)
the most recently updated PCI Data
Security Standard from the PCI Security Standards Council for all PCI,
(iii)
the most
recently issued version of the U.S. Department of Justice, Federal Bureau of
Investigation, Criminal Justice Information Services Security Policy for all CJI, and
(iv)
the federal Health Insurance Portability and Accountability Act for all PHI and the
HIPAA Business Associate Agreement attached to this Contract, if applicable.
Contractor shall immediately forward any request or demand for State Records to the
State’s Principal Representative, to the extent not prohibited by law.
B.
Other Entity Access and Nondisclosure Agreements
Contractor may provide State Records to its agents, employees, assigns and
Subcontractors as necessary to perform the Work, but shall restrict access to State
Confidential Information to those agents, employees, assigns, and Subcontractors who
require access to perform their obligations under or facilitate the performance of this
Contract. Contractor shall ensure all such agents, employees, assigns, and
Subcontractors sign agreements containing nondisclosure provisions at least as
protective as those in this Contract, and that the nondisclosure provisions are in force
at all times the agent, employee, assign, or Subcontractor has access to any State
Confidential Information. Contractor shall provide copies of those signed
nondisclosure provisions to the State upon execution of the nondisclosure provisions if
requested by the State.
C.
Use, Security, and Retention
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Contractor shall use, hold, and maintain State Confidential Information in compliance
with any and all applicable laws and regulations only in facilities located within the
United States, and shall maintain a secure environment that ensures confidentiality of
all State Confidential Information. Contractor shall provide the State with access,
subject to Contractor’s reasonable security requirements, for purposes of inspecting
and monitoring access and use of State Confidential Information and evaluating
security control effectiveness. Upon the expiration or termination of this Contract,
Contractor shall return State Records provided to Contractor or destroy such State
Records and certify to the State that it has done so, as directed by the State. If Contractor
is prevented by law or regulation from returning or destroying State Confidential
Information, Contractor warrants it will guarantee the confidentiality of, and cease to
use, such State Confidential Information, provided that Contractor may retain a copy
of State Records, which shall exclude any and all State Confidential information,
received, developed, or otherwise relating to this Contract in order to comply with its
contractual obligations and professional standards established by the Association of
International Certified Public Accountants (AICPA).
D.
Incident Notice and Remediation
If Contractor becomes aware of any Incident, Contractor shall notify the State
immediately and cooperate with the State regarding recovery, remediation, and the
necessity to involve law enforcement, as determined by the State. If it is established
that Contractor and its Subcontractors are the cause or source of the Incident,
Contractor shall be responsible for the cost of notifying each person who may have
been impacted by the Incident. After an Incident, Contractor shall take steps to reduce
the risk of incurring a similar type of Incident in the future, which may include, but is
not limited to, developing and implementing a remediation plan that is approved by the
State at no additional cost to the State. The State may request modifications to this plan
in its sole discretion, and Contractor shall make all modifications to the plan which are
necessary to reduce the risk of incurring a similar type of Incident. If Contractor cannot
produce its analysis and plan within the allotted time, the State, in its sole discretion,
may perform such analysis and produce a remediation plan, and Contractor shall
reimburse the State for the actual costs thereof. The State may, in its sole discretion and
at Contractor’s sole expense, require Contractor to engage the services of an
independent, qualified, State-approved third party to conduct a security audit of
systems. Contractor shall provide the State with the results of such audit and evidence
of Contractor’s planned remediation in response to any negative findings.
E.
Data Protection and Handling
Contractor shall ensure that all State Records and Work Product in the possession of
Contractor or any Subcontractors are protected and handled in accordance with the
requirements of this Contract, including the requirements of any Exhibits hereto, at all
times.
F.
Safeguarding PII
If Contractor or any of its Subcontractors will or may receive PII under this Contract,
Contractor shall provide for the security of such PII, in a manner and form acceptable
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to the State, including, without limitation, State non-disclosure requirements, use of
appropriate technology, security practices, computer access security, data access
security, data storage encryption, data transmission encryption, security inspections,
and audits. Contractor shall be a “Third-Party Service Provider” as defined in §24-73-
103(1)(i), C.R.S. and shall maintain security procedures and practices consistent with
§§24-73-101
et seq.
, C.R.S. In addition, as set forth in § 24-74-102,
et seq
., C.R.S.,
Contractor, including, but not limited to, Contractor’s employees, agents and
Subcontractors, agrees not to share any PII with any third parties for the purpose of
investigating for, participating in, cooperating with, or assisting with Federal
immigration enforcement. If Contractor is given direct access to any State databases
containing PII, Contractor shall execute, on behalf of itself and its employees, the
certification attached hereto as Exhibit H on an annual basis Contractor’s duty and
obligation to certify as set forth in Exhibit H shall continue as long as Contractor has
direct access to any State databases containing PII. If Contractor uses any
Subcontractors to perform services requiring direct access to State databases containing
PII, the Contractor shall require such Subcontractors to execute and deliver the
certification to the State on an annual basis, so long as the Subcontractor has access to
State databases containing PII.
9.
CONFLICTS OF INTEREST
A.
Actual Conflicts of Interest
Contractor shall not engage in any business or activities or maintain any relationships
that conflict in any way with the full performance of the obligations of Contractor under
this Contract. Such a conflict of interest would arise when a Contractor’s or
Subcontractor’s employee, officer or agent were to offer or provide any tangible
personal benefit to an employee of the State, or any member of his or her immediate
family or his or her partner, related to the award of, entry into or management or
oversight of this Contract.
B.
Apparent Conflicts of Interest
Contractor acknowledges that, with respect to this Contract, even the appearance of a
conflict of interest shall be harmful to the State’s interests. Absent the State’s prior
written approval, Contractor shall refrain from any practices, activities or relationships
that reasonably appear to be in conflict with the full performance of Contractor’s
obligations under this Contract.
C.
Disclosure to the State
If a conflict or the appearance of a conflict arises, or if Contractor is uncertain whether
a conflict or the appearance of a conflict has arisen, Contractor shall submit to the State
a disclosure statement setting forth the relevant details for the State’s consideration.
Failure to promptly submit a disclosure statement or to follow the State’s direction in
regard to the actual or apparent conflict constitutes a breach of this Contract.
D.
Contractor acknowledges that all State employees are subject to the ethical principles
described in §24-18-105, C.R.S. Contractor further acknowledges that State employees
may be subject to the requirements of §24-18-105, C.R.S. with regard to this Contract.
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10.
INSURANCE
Contractor shall obtain and maintain, and ensure that each Subcontractor shall obtain and
maintain, insurance as specified in this section at all times during the term of this Contract.
All insurance policies required by this Contract shall be issued by insurance companies as
approved by the State.
A.
Workers’ Compensation
Workers’ compensation insurance as required by state statute, and employers’ liability
insurance covering all Contractor or Subcontractor employees acting within the course
and scope of their employment.
B.
General Liability
Commercial general liability insurance covering premises operations, fire damage,
independent contractors, products and completed operations, blanket contractual
liability, personal injury, and advertising liability with minimum limits as follows:
i.
$1,000,000 each occurrence;
ii.
$1,000,000 general aggregate;
iii.
$1,000,000 products and completed operations aggregate; and
iv.
$50,000 any one fire.
C.
Automobile Liability
Automobile liability insurance covering any auto (including owned, hired and non-
owned autos) with a minimum limit of $1,000,000 each accident combined single limit.
D.
Professional Liability Insurance, including Cyber Liability
Professional liability insurance covering any damages caused by an error, omission or
any negligent act with minimum limits as follows:
i.
$1,000,000 each claim; and
ii.
$1,000,000 general aggregate.
E.
Crime Insurance
Crime insurance including employee dishonesty coverage with minimum limits as
follows:
i.
$1,000,000 each occurrence; and
ii.
$1,000,000 general aggregate.
F.
Additional Insured
The State shall be named as additional insured on all commercial general liability
policies (leases and construction contracts require additional insured coverage for
completed operations) required of Contractor and Subcontractors.
G.
Primacy of Coverage
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Coverage required of Contractor and each Subcontractor shall be primary and
noncontributory over any insurance or self-insurance program carried by Contractor or
the State.
H.
Cancellation
The above insurance policies shall include provisions preventing cancellation or non-
renewal, except for cancellation based on non-payment of premiums, without at least
30 days prior notice to Contractor and Contractor shall forward such notice to the State
in accordance with
§14
within seven days of Contractor’s receipt of such notice.
I.
Subrogation Waiver
The General Liability policy secured or maintained by Contractor or its Subcontractors
in relation to this Contract shall include clauses stating that each carrier shall waive all
rights of recovery under subrogation or otherwise against Contractor or the State, its
agencies, institutions, organizations, officers, agents, employees, and volunteers.
J.
Public Entities
If Contractor is a “public entity” within the meaning of the Colorado Governmental
Immunity Act, §24-10-101,
et seq.
, C.R.S., (the “GIA”), Contractor shall maintain, in
lieu of the liability insurance requirements stated above, at all times during the term of
this Contract such liability insurance, by commercial policy or self-insurance, as is
necessary to meet its liabilities under the GIA. If a Subcontractor is a public entity
within the meaning of the GIA, Contractor shall ensure that the Subcontractor
maintains at all times during the terms of this Contract, in lieu of the liability insurance
requirements stated above, such liability insurance, by commercial policy or self-
insurance, as is necessary to meet the Subcontractor’s obligations under the GIA.
K.
Certificates
Contractor shall provide to the State certificates evidencing Contractor’s insurance
coverage required in this Contract within seven Business Days following the Effective
Date. Contractor shall provide to the State certificates evidencing Subcontractor
insurance coverage required under this Contract within seven Business Days following
the Effective Date, except that, if Contractor’s subcontract is not in effect as of the
Effective Date, Contractor shall provide to the State certificates showing Subcontractor
insurance coverage required under this Contract within seven Business Days following
Contractor’s execution of the subcontract. No later than 15 days after the expiration
date of Contractor’s or any Subcontractor’s coverage, Contractor shall deliver to the
State certificates of insurance evidencing renewals of coverage. At any other time
during the term of this Contract, upon request by the State, Contractor shall, within
seven Business Days following the request by the State, supply to the State evidence
satisfactory to the State of compliance with the provisions of this section. Contractor
shall provide all certificates electronically to the Department’s designated insurance
certificate submission site, unless the Department has specifically directed otherwise.
11.
BREACH OF CONTRACT
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In the event of a Breach of Contract, the aggrieved Party shall give written notice of breach
to the other Party. If the notified Party does not cure the Breach of Contract, at its sole
expense, within 30 days after the delivery of written notice, the Party may exercise any of
the remedies as described in
§12
for that Party. Notwithstanding any provision of this
Contract to the contrary, the State, in its discretion, need not provide notice or a cure period
and may immediately terminate this Contract in whole or in part or institute any other remedy
in this Contract in order to protect the public interest of the State; or if Contractor is debarred
or suspended under §24-109-105, C.R.S., the State, in its discretion, need not provide notice
or cure period and may terminate this Contract in whole or in part or institute any other
remedy in this Contract as of the date that the debarment or suspension takes effect.
12.
REMEDIES
A.
State’s Remedies
If Contractor is in breach under any provision of this Contract and fails to cure such
breach, the State, following the notice and cure period set forth in
§11,
shall have all of
the remedies listed in this section
,
in addition to all other remedies set forth in this
Contract or at law. The State may exercise any or all of the remedies available to it, in
its discretion, concurrently or consecutively.
i.
Termination for Breach of Contract
In the event of Contractor’s uncured breach, the State may terminate this entire
Contract or any part of this Contract. Contractor shall continue performance of
this Contract to the extent not terminated, if any.
a.
Obligations and Rights
To the extent specified in any termination notice, Contractor shall not incur
further obligations or render further performance past the effective date of
such notice, and shall terminate outstanding orders and subcontracts with
third parties. However, Contractor shall complete and deliver to the State
all Work not cancelled by the termination notice and may incur obligations
as necessary to do so within this Contract’s terms. At the request of the
State, Contractor shall assign to the State all of Contractor’s rights, title, and
interest in and to such terminated orders or subcontracts. Upon termination,
Contractor shall take timely, reasonable and necessary action to protect and
preserve property in the possession of Contractor but in which the State has
an interest. At the State’s request, Contractor shall return materials owned
by the State in Contractor’s possession at the time of any termination.
Contractor shall deliver all completed Work Product and all Work Product
that was in the process of completion to the State at the State’s request.
b.
Payments
Notwithstanding anything to the contrary, the State shall only pay
Contractor for accepted Work received as of the date of termination. If, after
termination by the State, the State agrees that Contractor was not in breach
or that Contractor’s action or inaction was excusable, such termination shall
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be treated as a termination in the public interest, and the rights and
obligations of the Parties shall be as if this Contract had been terminated in
the public interest under
§2.E
.
c.
Damages and Withholding
Notwithstanding any other remedial action by the State, Contractor shall
remain liable to the State for any damages sustained by the State in
connection with any breach by Contractor, and the State may withhold
payment to Contractor for the purpose of mitigating the State’s damages
until such time as the exact amount of damages due to the State from
Contractor is determined. The State may withhold any amount that may be
due Contractor as the State deems necessary to protect the State against loss
including, without limitation, loss as a result of outstanding liens and excess
costs incurred by the State in procuring from third parties replacement Work
as cover.
ii.
Remedies Not Involving Termination
The State, in its discretion, may exercise one or more of the following additional
remedies:
a.
Suspend Performance
Suspend Contractor’s performance with respect to all or any portion of the
Work pending corrective action as specified by the State without entitling
Contractor to an adjustment in price or cost or an adjustment in the
performance schedule. Contractor shall promptly cease performing Work
and incurring costs in accordance with the State’s directive, and the State
shall not be liable for costs incurred by Contractor after the suspension of
performance.
b.
Withhold Payment
Withhold payment to Contractor until Contractor corrects its Work.
c.
Deny Payment
Deny payment for Work not performed, or that due to Contractor’s actions
or inactions, cannot be performed or if they were performed are reasonably
of no value to the State; provided, that any denial of payment shall be equal
to the value of the obligations not performed.
d.
Removal
Demand immediate removal of any of Contractor’s employees, agents, or
Subcontractors from the Work whom the State deems incompetent,
careless, insubordinate, unsuitable, or otherwise unacceptable or whose
continued relation to this Contract is deemed by the State to be contrary to
the public interest or the State’s best interest.
e.
Intellectual Property
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If any Work infringes, or if in the State’s reasonable opinion determines that
any Work is likely to infringe, a patent, copyright, trademark, trade secret
or other intellectual property right, Contractor shall, as approved by the
State
(i)
secure that right to use such Work for the State and Contractor;
(ii)
replace the Work with noninfringing Work or modify the Work so that it
becomes noninfringing; or,
(iii)
remove any infringing Work and refund the
amount paid for such Work to the State.
B.
Contractor’s Remedies
If the State is in breach of any provision of this Contract and does not cure such breach,
Contractor, following the notice and cure period in
§11
and the dispute resolution
process in
§13
shall have all remedies available at law and equity.
13.
DISPUTE RESOLUTION
A.
Initial Resolution
Except as herein specifically provided otherwise, disputes concerning the performance
of this Contract which cannot be resolved by the designated Contract representatives
shall be referred in writing to a senior departmental management staff member
designated by the State and a senior manager designated by Contractor for resolution.
B.
Resolution of Controversies
If the initial resolution described in
§13.A
fails to resolve the dispute within 10
Business Days, Contractor shall submit any alleged breach of this Contract by the State
to the Procurement Official of the State Agency named on the Cover Page of this
Contract as described in §24-102-202(3), C.R.S. for resolution in accordance with the
provisions of C.R.S. §24-106-109, C.R.S., and §§24-109-101.1 through 24-109-505,
C.R.S., (the “Resolution Statutes”), except that if Contractor wishes to challenge any
decision rendered by the Procurement Official, Contractor’s challenge shall be an
appeal to the Executive Director of the Department of Personnel and Administration,
or their delegate, under the Resolution Statutes before Contractor pursues any further
action as permitted by such statutes. Except as otherwise stated in this Section, all
requirements of the Resolution Statutes shall apply including, without limitation, time
limitations.
14.
NOTICES AND REPRESENTATIVES
Each individual identified as a Principal Representative on the Cover Page for this Contract
shall be the principal representative of the designating Party. All notices required or
permitted to be given under this Contract shall be in writing, and shall be delivered
(A)
by
hand with receipt required,
(B)
by certified or registered mail to such Party’s principal
representative at the address set forth on the Cover Page of this Contract or
(C)
as an email
with read receipt requested to the principal representative at the email address, if any, set
forth on the Cover Page of this Contract. If a Party delivers a notice to another through email
and the email is undeliverable, then, unless the Party has been provided with an alternate
email contact, the Party delivering the notice shall deliver the notice by hand with receipt
required or by certified or registered mail to such Party’s principal representative at the
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address set forth on the Cover Page for this Contract. Either Party may change its principal
representative or principal representative contact information by notice submitted in
accordance with this section without a formal amendment to this Contract. Unless otherwise
provided in this Contract, notices shall be effective upon delivery of the written notice.
15.
RIGHTS IN WORK PRODUCT AND OTHER INFORMATION
A.
Work Product
i.
Copyrights
To the extent that the Work Product (or any portion of the Work Product) would
not be considered works made for hire under applicable law, Contractor hereby
assigns to the State, the entire right, title, and interest in and to copyrights in all
Work Product and all works based upon, derived from, or incorporating the Work
Product; all copyright applications, registrations, extensions, or renewals relating
to all Work Product and all works based upon, derived from, or incorporating the
Work Product; and all moral rights or similar rights with respect to the Work
Product throughout the world. To the extent that Contractor cannot make any of
the assignments required by this section, Contractor hereby grants to the State a
perpetual, irrevocable, royalty-free license to use, modify, copy, publish, display,
perform, transfer, distribute, sell, and create derivative works of the Work Product
and all works based upon, derived from, or incorporating the Work Product by
all means and methods and in any format now known or invented in the future.
The State may assign and license its rights under this license.
ii.
Patents
In addition, Contractor grants to the State (and to recipients of Work Product
distributed by or on behalf of the State) a perpetual, worldwide, no-charge,
royalty-free, irrevocable patent license to make, have made, use, distribute, sell,
offer for sale, import, transfer, and otherwise utilize, operate, modify and
propagate the contents of the Work Product. Such license applies only to those
patent claims licensable by Contractor that are necessarily infringed by the Work
Product alone, or by the combination of the Work Product with anything else used
by the State.
iii.
Assignments and Assistance
Whether or not Contractor is under contract with the State at the time, Contractor
shall execute applications, assignments, and other documents, and shall render all
other reasonable assistance requested by the State, to enable the State to secure
patents, copyrights, licenses and other intellectual property rights related to the
Work Product. To the extent that Work Product would fall under the definition of
“works made for hire” under 17 U.S.C.S. §101, the Parties intend the Work
Product to be a work made for hire. Contractor assigns to the State and its
successors and assigns, the entire right, title, and interest in and to all causes of
action, either in law or in equity, for past, present, or future infringement of
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intellectual property rights related to the Work Product and all works based on,
derived from, or incorporating the Work Product.
B.
Exclusive Property of the State
Except to the extent specifically provided elsewhere in this Contract, all State Records,
documents, text, software (including source code), facilities, network, hardware,
systems, research, reports, proposals, specifications, plans, notes, studies, data, images,
photographs, negatives, pictures, drawings, designs, models, surveys, maps, materials,
ideas, concepts, know-how, and information provided by or on behalf of the State to
Contractor are the exclusive property of the State (collectively, “State Materials”) .
Contractor shall not use, willingly allow, cause or permit Work Product or State
Materials to be used for any purpose other than the performance of Contractor’s
obligations in this Contract without the prior written consent of the State. Upon
termination of this Contract for any reason, Contractor shall provide all Work Product
and State Materials to the State in a form and manner as directed by the State.
Contractor shall have the right to retain for its files copies of the Work Product and all
information necessary, excluding any and all State Confidential Information, to comply
with its contractual obligations and professional standards established by the AICPA.
C.
Exclusive Property of Contractor
Contractor retains the exclusive rights, title, and ownership to any and all Contractor
Materials owned or licensed to Contractor, either pre-existing this Contract or created,
acquired or licensed outside this Contract, including any modification, enhancements,
improvements, or derivative works created outside of this Contract. Such Contractor
Materials shall include, but are not limited to, all software, licensed products,
associated source code, machine code, text images, audio and/or video, and third-party
materials, delivered by Contractor under the Contract, whether incorporated in a
Deliverable or necessary to use a Deliverable. Contractor Materials shall be licensed to
the State as set forth in this Contract or a State approved license agreement:
(i)
entered
into as exhibits to this Contract;
(ii)
obtained by the State from the applicable third-
party vendor; or
(iii)
in the case of open source software, the license terms set forth in
the applicable open source license agreement. If not otherwise provided in a State
approved license agreement, if and to the extent that any Contractor Materials is
contained in any of the Work Product, Contractor hereby grants the State, under
Contractor’s intellectual property rights, a license in such Contractor Materials, in
15.A. Notwithstanding anything herein or in the Contract which may be construed to
the contrary, the State agrees that nothing in this Contract shall prevent Contractor from
using any generalized knowledge, experience, know-how, or any of the ideas, concepts,
methodologies, tools, or techniques derived from or discovered during the provision of
the Services performed under the Contract that are not unique to the State (collectively,
“Residual Knowledge”) to perform similar services and develop similar work product,
results, or technology as that performed and developed under the Contract.
D.
License by the State
The State grants Contractor a perpetual non-exclusive, irrevocable, royalty-free, world-
wide license to use, copy, execute, perform, modify, display, distribute, and transmit
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Work Product developed under this Contract, and to prepare derivative works of Work
Product developed under this Contract, and to authorize others to do the same on
Contractor’s behalf, for other government entities. Contractor shall not charge a
development, licensing, or user fee to any state, federal, or local government entity
when distributing copies of, and transferring or sublicensing rights to, the Work
Product to such entity.
16.
GENERAL PROVISIONS
A.
Assignment
Contractor’s rights and obligations under this Contract are personal and may not be
transferred or assigned without the prior, written consent of the State. Any attempt at
assignment or transfer without such consent shall be void. Any assignment or transfer
of Contractor’s rights and obligations approved by the State shall be subject to the
provisions of this Contract
B.
Subcontracts
Contractor shall not enter into any subcontract in connection with its obligations under
this Contract without the prior, written approval of the State. Contractor shall submit
to the State a copy of each such subcontract upon request by the State. All subcontracts
entered into by Contractor in connection with this Contract shall comply with all
applicable federal and state laws and regulations, shall provide that they are governed
by the laws of the State of Colorado, and shall be subject to all applicable provisions
of this Contract.
C.
Binding Effect
Except as otherwise provided in
§16.A.
, all provisions of this Contract, including the
benefits and burdens, shall extend to and be binding upon the Parties’ respective
successors and assigns.
D.
Authority
Each Party represents and warrants to the other that the execution and delivery of this
Contract and the performance of such Party’s obligations have been duly authorized.
E.
Captions and References
The captions and headings in this Contract are for convenience of reference only, and
shall not be used to interpret, define, or limit its provisions. All references in this
Contract to sections (whether spelled out or using the § symbol), subsections, exhibits
or other attachments, are references to sections, subsections, exhibits or other
attachments contained herein or incorporated as a part hereof, unless otherwise noted.
F.
Counterparts
This Contract may be executed in multiple, identical, original counterparts, each of
which shall be deemed to be an original, but all of which, taken together, shall constitute
one and the same agreement.
G.
Entire Understanding
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This Contract represents the complete integration of all understandings between the
Parties related to the Work, and all prior representations and understandings related to
the Work, oral or written, are merged into this Contract. Prior or contemporaneous
additions, deletions, or other changes to this Contract shall not have any force or effect
whatsoever, unless embodied herein.
H.
Digital Signatures
If any signatory signs this Contract using a digital signature in accordance with the
Colorado State Controller Contract, Grant and Purchase Order Policies regarding the
use of digital signatures issued under the State Fiscal Rules, then any agreement or
consent to use digital signatures within the electronic system through which that
signatory signed shall be incorporated into this Contract by reference.
I.
Modification
Except as otherwise provided in this Contract, any modification to this Contract shall
only be effective if agreed to in a formal amendment to this Contract, properly executed
and approved in accordance with applicable Colorado State law and State Fiscal Rules.
Modifications permitted under this Contract, other than contract amendments, shall
conform to the policies issued by the Colorado State Controller.
J.
Statutes, Regulations, Fiscal Rules, and Other Authority
Any reference in this Contract to a statute, regulation, State Fiscal Rule, fiscal policy
or other authority shall be interpreted to refer to such authority then current, as may
have been changed or amended since the Effective Date of this Contract.
K.
External Terms and Conditions
Notwithstanding anything to the contrary herein, the State shall not be subject to any
provision included in any terms, conditions, or agreements appearing on Contractor’s
or a Subcontractor’s website or any provision incorporated into any click-through or
online agreements related to the Work unless that provision is specifically referenced
in this Contract.
L.
Severability
The invalidity or unenforceability of any provision of this Contract shall not affect the
validity or enforceability of any other provision of this Contract, which shall remain in
full force and effect, provided that the Parties can continue to perform their obligations
under this Contract in accordance with the intent of this Contract.
M.
Survival of Certain Contract Terms
Any provision of this Contract that imposes an obligation on a Party after termination
or expiration of this Contract shall survive the termination or expiration of this Contract
and shall be enforceable by the other Party.
N.
Taxes
The State is exempt from federal excise taxes under I.R.C. Chapter 32 (26 U.S.C.,
Subtitle D, Ch. 32) (Federal Excise Tax Exemption Certificate of Registry No. 84-
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730123K) and from State and local government sales and use taxes under §§39-26-
704(1),
et seq.,
C.R.S. (Colorado Sales Tax Exemption Identification Number 98-
02565). The State shall not be liable for the payment of any excise, sales, or use taxes,
regardless of whether any political subdivision of the state imposes such taxes on
Contractor. Contractor shall be solely responsible for any exemptions from the
collection of excise, sales or use taxes that Contractor may wish to have in place in
connection with this Contract.
O.
Third Party Beneficiaries
Except for the Parties’ respective successors and assigns described in
§16.A.
, this
Contract does not and is not intended to confer any rights or remedies upon any person
or entity other than the Parties. Enforcement of this Contract and all rights and
obligations hereunder are reserved solely to the Parties. Any services or benefits which
third parties receive as a result of this Contract are incidental to this Contract, and do
not create any rights for such third parties.
P.
Waiver
A Party’s failure or delay in exercising any right, power, or privilege under this
Contract, whether explicit or by lack of enforcement, shall not operate as a waiver, nor
shall any single or partial exercise of any right, power, or privilege preclude any other
or further exercise of such right, power, or privilege.
Q.
CORA Disclosure
To the extent not prohibited by federal law, this Contract and the performance measures
and standards required under §24-106-107, C.R.S., if any, are subject to public release
through the CORA.
R.
Standard and Manner of Performance
Contractor shall perform its obligations under this Contract in accordance with the
highest standards of care, skill and diligence in Contractor’s industry, trade, or
profession.
S.
Licenses, Permits, and Other Authorizations
Contractor shall secure, prior to the Effective Date, and maintain at all times during the
term of this Contract, at its sole expense, all licenses, certifications, permits, and other
authorizations required to perform its obligations under this Contract, and shall ensure
that all employees, agents and Subcontractors secure and maintain at all times during
the term of their employment, agency or subcontract, all licenses, certifications, permits
and other authorizations required to perform their obligations in relation to this
Contract.
T.
Indemnification
i.
General Indemnification
Contractor shall indemnify, save, and hold harmless the State, its employees,
agents and assignees (the “Indemnified Parties”), against any and all costs,
expenses, claims, damages, liabilities, court awards and other amounts (including
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attorneys’ fees and related costs) incurred by any of the Indemnified Parties in
relation to any negligent and willful act or omission by Contractor, or its
employees, agents, Subcontractors, or assignees in connection with this Contract.
ii.
Confidential Information Indemnification
Disclosure or use of State Confidential Information by Contractor in violation of
§8
may be cause for legal action by third parties against Contractor, the State, or
their respective agents. Contractor shall indemnify, save, and hold harmless the
Indemnified Parties, against any and all claims, damages, liabilities, losses, costs,
expenses (including attorneys’ fees and costs) incurred by the State in relation to
any act or omission by Contractor, or its employees, agents, assigns, or
Subcontractors in violation of
§8
.
iii.
Intellectual Property Indemnification
Contractor shall indemnify, save, and hold harmless the Indemnified Parties,
against any and all costs, expenses, claims, damages, liabilities, and other
amounts (including attorneys’ fees and costs) incurred by the Indemnified Parties
in relation to any claim that any deliverable, Good or Service, software, or Work
Product provided by Contractor under this Contract (collectively, “IP
Deliverables”), or the use thereof, infringes a patent, copyright, trademark, trade
secret, or any other intellectual property right. Contractor’s obligations hereunder
shall not extend to the combination of any IP Deliverables provided by Contractor
with any other product, system, or method, unless the other product, system, or
method is
(a)
provided by Contractor or Contractor’s subsidiaries or affiliates;
(b)
specified by Contractor to work with the IP Deliverables;
(c)
reasonably
required in order to use the IP Deliverables in its intended manner and the
infringement could not have been avoided by substituting another reasonably
available product, system, or method capable of performing the same function;
or
(d)
is reasonably expected to be used in combination with the IP Deliverables.
The preceding indemnification shall not apply to any infringement to the extent
arising out of use of any IP Deliverables in violation of this Contract.
iv. The indemnity provided for in this §16.T shall not apply to any fault attributable
to the State.
v. Accessibility Indemnification
Contractor shall indemnify, save, and hold harmless the Indemnified Parties,
against any and all costs, expenses, claims, damages, liabilities, court awards and
other amounts (including attorneys’ fees and related costs) incurred by any of the
Indemnified Parties in relation to Contractor’s failure to comply with §§24-85-
101,
et seq
., C.R.S., or the Accessibility Standards for Individuals with a
Disability as established by OIT pursuant to Section §24-85-103(2.5), C.R.S.
U.
Accessibility
i.
Contractor shall comply with and the Work Product provided under this Contract
shall be in compliance with all applicable provisions of §§24-85-101,
et seq.
,
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C.R.S., and the
Accessibility Standards for Individuals with a Disability,
as
established by the Governor’s Office Of Information Technology (OIT), pursuant
to Section §24-85-103(2.5), C.R.S. Contractor shall also comply with all State of
Colorado technology standards related to technology accessibility and with Level
AA of the most current version of the Web Content Accessibility Guidelines
(WCAG), incorporated in the State of Colorado technology standards.
ii.
The State may require Contractor’s compliance to the State’s Accessibility
Standards to be determined by a third party selected by the State to attest to
Contractor’s Work Product and software is in compliance with §§24-85-101,
et
seq
., C.R.S., and the
Accessibility Standards for Individuals with a Disability
as
established by OIT pursuant to Section §24-85-103(2.5), C.R.S.
V.
Additional Provisions
Contractor shall comply with all requirements shown Exhibit A and Exhibit G.
W. Cooperative Agreement
In accordance with Section 24-110-201, C.R.S., this agreement is established as a
cooperative purchasing agreement available for use by the State Agency issuing this
agreement and other State and local Agencies and Political Subdivisions, including, but
not limited to, city and county government entities, public utilities, public schools
districts, and State Institutions of Higher Education, under the terms, conditions and
rates set forth in the cooperative purchasing agreement. Each agency or entity ordering
goods or services under the cooperative purchasing agreement will be responsible for
all costs and expenses incurred in connection with its orders, and shall, as necessary,
establish its own contract, place its own orders, issue its own purchase orders, be
invoiced therefrom, make its own payments, issue its own tax exemption certificates as
requested, and resolve any disputes arising from any such order.
17.
COLORADO SPECIAL PROVISIONS (COLORADO FISCAL RULE 3-3)
These Special Provisions apply to all contracts except where noted in italics.
A.
STATUTORY APPROVAL. §24-30-202(1), C.R.S.
This Contract shall not be valid until it has been approved by the Colorado State
Controller or designee. If this Contract is for a Major Information Technology Project,
as defined in §24-37.5-102(2.6), C.R.S., then this Contract shall not be valid until it has
been approved by the State’s Chief Information Officer or designee.
B.
FUND AVAILABILITY. §24-30-202(5.5), C.R.S.
Financial obligations of the State payable after the current State Fiscal Year are
contingent upon funds for that purpose being appropriated, budgeted, and otherwise
made available.
C.
GOVERNMENTAL IMMUNITY.
Liability for claims for injuries to persons or property arising from the negligence of
the State, its departments, boards, commissions committees, bureaus, offices,
employees and officials shall be controlled and limited by the provisions of the
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Colorado Governmental Immunity Act, §24-10-101,
et seq
., C.R.S.; the Federal Tort
Claims Act, 28 U.S.C. Pt. VI, Ch. 171 and 28 U.S.C. 1346(b), and the State’s risk
management statutes, §§24-30-1501,
et seq
. C.R.S. No term or condition of this
Contract shall be construed or interpreted as a waiver, express or implied, of any of the
immunities, rights, benefits, protections, or other provisions, contained in these
statutes.
D.
INDEPENDENT CONTRACTOR.
Contractor shall perform its duties hereunder as an independent contractor and not as
an employee. Neither Contractor nor any agent or employee of Contractor shall be
deemed to be an agent or employee of the State. Contractor shall not have authorization,
express or implied, to bind the State to any agreement, liability or understanding, except
as expressly set forth herein.
Contractor and its employees and agents are not
entitled to unemployment insurance or workers compensation benefits through
the State and the State shall not pay for or otherwise provide such coverage for
Contractor or any of its agents or employees. Contractor shall pay when due all
applicable employment taxes and income taxes and local head taxes incurred
pursuant to this Contract. Contractor shall (i) provide and keep in force workers’
compensation and unemployment compensation insurance in the amounts
required by law, (ii) provide proof thereof when requested by the State, and (iii)
be solely responsible for its acts and those of its employees and agents.
E.
COMPLIANCE WITH LAW.
Contractor shall comply with all applicable federal and State laws, rules, and
regulations in effect or hereafter established, including, without limitation, laws
applicable to discrimination and unfair employment practices.
F.
CHOICE OF LAW, JURISDICTION, AND VENUE.
Colorado law, and rules and regulations issued pursuant thereto, shall be applied in the
interpretation, execution, and enforcement of this Contract. Any provision included or
incorporated herein by reference that conflicts with said laws, rules, and regulations
shall be null and void. All suits or actions related to this Contract shall be filed and
proceedings held in the State of Colorado and exclusive venue shall be in the City and
County of Denver.
G.
PROHIBITED TERMS.
Any term included in this Contract that requires the State to indemnify or hold
Contractor harmless; requires the State to agree to binding arbitration; limits
Contractor’s liability for damages resulting from death, bodily injury, or damage to
tangible property; or that conflicts with this provision in any way shall be void ab initio.
Nothing in this Contract shall be construed as a waiver of any provision of §24-106-
109, C.R.S.
H.
SOFTWARE PIRACY PROHIBITION.
State or other public funds payable under this Contract shall not be used for the
acquisition, operation, or maintenance of computer software in violation of federal
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copyright laws or applicable licensing restrictions. Contractor hereby certifies and
warrants that, during the term of this Contract and any extensions, Contractor has and
shall maintain in place appropriate systems and controls to prevent such improper use
of public funds. If the State determines that Contractor is in violation of this provision,
the State may exercise any remedy available at law or in equity or under this Contract,
including, without limitation, immediate termination of this Contract and any remedy
consistent with federal copyright laws or applicable licensing restrictions.
I.
EMPLOYEE FINANCIAL INTEREST/CONFLICT OF INTEREST. §§24-18-
201 and 24-50-507, C.R.S.
The signatories aver that to their knowledge, no employee of the State has any personal
or beneficial interest whatsoever in the service or property described in this Contract.
Contractor has no interest and shall not acquire any interest, direct or indirect, that
would conflict in any manner or degree with the performance of Contractor’s services
and Contractor shall not employ any person having such known interests.
J.
VENDOR OFFSET AND ERRONEOUS PAYMENTS. §§24-30-202(1) and 24-
30-202.4, C.R.S.
[
Not applicable to intergovernmental agreements
]
Subject to §24-30-202.4(3.5),
C.R.S., the State Controller may withhold payment under the State’s vendor offset
intercept system for debts owed to State agencies for:
(i)
unpaid child support debts or
child support arrearages;
(ii)
unpaid balances of tax, accrued interest, or other charges
specified in §§39-21-101,
et seq.
, C.R.S.;
(iii)
unpaid loans due to the Student Loan
Division of the Department of Higher Education;
(iv)
amounts required to be paid to
the Unemployment Compensation Fund; and
(v)
other unpaid debts owing to the State
as a result of final agency determination or judicial action. The State may also recover,
at the State’s discretion, payments made to Contractor in error for any reason,
including, but not limited to, overpayments or improper payments, and unexpended or
excess funds received by Contractor by deduction from subsequent payments under
this Contract, deduction from any payment due under any other contracts, grants or
agreements between the State and Contractor, or by any other appropriate method for
collecting debts owed to the State.
18.
ADDITIONAL TERMS
A.
Limitation of Liability
The liability of Contractor, its Subcontractors, and their respective personnel to the
State for any claims, liabilities, or damages relating to this Contract shall be limited to
damages, including but not limited to direct losses, consequential, special, indirect,
incidental, punitive or exemplary loss, to the extent lawful, not to exceed three times
the Amount payable by the State over the preceding 12 months, provided that in no
circumstance shall the maximum liability of Contractor equal less than the maximum
amount payable during State Fiscal Year 2024 as shown on the Cover Page and
provided that the provisions of this paragraph apply only in excess of the insurance
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coverage included in this Contract at Section 10. No limitation on Contractor’s liability
to the State under this Section shall limit or affect:
1. Contractor’s indemnification obligations under this Contract.
2. Claims or damages arising out of bodily injury, including death, or damage to
tangible property of the State.
3. Claims or damages resulting from the recklessness, bad faith, or intentional
misconduct of Contractor or its Subcontractors.
4. Contractor’s liability relating to the disclosure of confidential information or data
loss.
The provisions of this paragraph shall apply regardless of the form of action, damage,
claim, liability, cost, expense, or loss asserted, whether in contract, statute, rules,
regulations, or tort (including, but not limited to, negligence) or otherwise and shall
survive this Contract’s termination or expiration. The Parties acknowledge, however,
that nothing herein shall prevent the State from pursuing an action, damage, claim,
liability, cost, expense, or loss up to the actual amount of damages subject to the
limitation on Contractor’s liability described in this Section.
B.
Force Majeure
Neither party shall be liable for failure to fulfill its obligations under this Agreement if
that failure is caused, directly or indirectly, by flood, extreme weather, fire, mud slide,
earthquake, or other natural calamity or act of God, interruption in water, electricity,
heating or air conditioning (depending on the season), acts of terrorism, riots, civil
disorders, rebellions or revolutions, acts of governmental agencies, epidemics,
quarantines, embargoes, malicious acts of third parties, labor disputes affecting vendors
or subcontractors and for which the party claiming force majeure is not responsible, or
any other similar cause beyond the reasonable control of that party.
C.
Use of Technologies
Contractor’s technologies, software productivity tools and certain technology
infrastructure and, necessarily, the State’s confidential information, may be hosted in
cloud environments operated by Contractor Resources, notwithstanding other
requirements of this contract. In addition, Contractor may license certain proprietary
and third-party software tools (“Enabling Tools”) for use by the State to facilitate the
Services. All other use is prohibited. The State may not redistribute, reproduce (except
as necessary to run), modify, commercialize, allow third parties to access (unless
authorized by Contractor in writing), or reverse engineer or decompile (except where
such rights cannot be limited by applicable law) Enabling Tools. Enabling Tools are
not intended to be used as a system of record, repository, or hosting service, and the
State’s access to the Deliverables and other documents will be removed from the
Enabling Tools within a reasonable period of time following the conclusion of the
engagement to which they relate. The State shall download such Deliverables and
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documents for its records. The State acknowledges that use of Enabling Tools may be
used notwithstanding other requirements of this Contract.
D.
Changes and Adjustment Events
i. The Parties acknowledge and agree that the occurrence of any of the following events
(each, an “Adjustment Event”) may require an extension in the schedule, modification
of the scope of the Services, and/or increase in the fees and expenses set forth in the
Contract: (a) a failure by the State and/or the State’s third-party contractors to perform
any of the State or the State’s third-party contractors’ respective responsibilities in a
timely manner, including the supply to Contractor of third-party materials or adequate
resources and information; or (b) the State’s failure to timely obtain all of the consents,
permits, licenses, and other approvals necessary for Contractor to provide the Services.
In the event an Adjustment Event occurs or the Parties agree to change the Statement
of Work, the Parties agree to amend the Contract, if necessary, to reflect such change.
ii. Notwithstanding Section 18.D.i above, if any delays or deficiencies in the Services,
or with respect to the Deliverables, occur as a result of an Adjustment Event, the
scheduled completion date under the Contract for the affected Services and/or
Deliverables shall be extended to the extent of any such delays or deficiencies, and
Contractor shall not incur any liability to the State as a result of such delays or
deficiencies.
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EXHIBIT A, HIPAA BUSINESS ASSOCIATES ADDENDUM
This HIPAA Business Associate Agreement (“Agreement”) between the State and Contractor is agreed to
in connection with, and as an exhibit to, the Contract. For purposes of this Agreement, the State is referred
to as “Covered Entity” and the Contractor is referred to as “Business Associate”. Unless the context clearly
requires a distinction between the Contract and this Agreement, all references to “Contract” shall include
this Agreement.
1.
PURPOSE
Covered Entity wishes to disclose information to Business Associate, which may include Protected Health
Information ("PHI"). The Parties intend to protect the privacy and security of the disclosed PHI in
compliance with the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), Pub. L. No.
104-191 (1996) as amended by the Health Information Technology for Economic and Clinical Health Act
(“HITECH Act”) enacted under the American Recovery and Reinvestment Act of 2009 (“ARRA”) Pub. L.
No. 111–5 (2009), implementing regulations promulgated by the U.S. Department of Health and Human
Services at 45 C.F.R. Parts 160, 162 and 164 (the “HIPAA Rules”) and other applicable laws, as amended.
Prior to the disclosure of PHI, Covered Entity is required to enter into an agreement with Business Associate
containing specific requirements as set forth in, but not limited to, Title 45, Sections 160.103, 164.502(e)
and 164.504(e) of the Code of Federal Regulations (“C.F.R.”) and all other applicable laws and regulations,
all as may be amended.
2.
DEFINITIONS
The following terms used in this Agreement shall have the same meanings as in the HIPAA Rules: Breach,
Data Aggregation, Designated Record Set, Disclosure, Health Care Operations, Individual, Minimum
Necessary, Notice of Privacy Practices, Protected Health Information, Required by Law, Secretary, Security
Incident, Subcontractor, Unsecured Protected Health Information, and Use.
The following terms used in this Agreement shall have the meanings set forth below:
a.
Business Associate. “Business Associate” shall have the same meaning as the term “business
associate” at 45 C.F.R. 160.103, and shall refer to Contractor.
b.
Covered Entity. “Covered Entity” shall have the same meaning as the term “covered entity” at
45 C.F.R. 160.103, and shall refer to the State.
c.
Information Technology and Information Security. “Information Technology” and
“Information Security” shall have the same meanings as the terms “information technology”
and “information security”, respectively, in §24-37.5-102, C.R.S.
Capitalized terms used herein and not otherwise defined herein or in the HIPAA Rules shall have the
meanings ascribed to them in the Contract.
3.
OBLIGATIONS AND ACTIVITIES OF BUSINESS ASSOCIATE
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a.
Permitted Uses and Disclosures.
i.
Business Associate shall use and disclose PHI only to accomplish Business Associate’s
obligations under the Contract.
ii.
To the extent Business Associate carries out one or more of Covered Entity’s
obligations under Subpart E of 45 C.F.R. Part 164, Business Associate shall comply
with any and all requirements of Subpart E that apply to Covered Entity in the
performance of such obligation.
iii.
Business Associate may disclose PHI to carry out the legal responsibilities of Business
Associate, provided, that the disclosure is Required by Law or Business Associate
obtains reasonable assurances from the person to whom the information is disclosed
that:
A.
the information will remain confidential and will be used or disclosed only as
Required by Law or for the purpose for which Business Associate originally
disclosed the information to that person, and;
B.
the person notifies Business Associate of any Breach involving PHI of which
it is aware.
iv.
Business Associate may provide Data Aggregation services relating to the Health Care
Operations of Covered Entity. Business Associate may de-identify any or all PHI
created or received by Business Associate under this Agreement, provided the de-
identification conforms to the requirements of the HIPAA Rules.
b.
Minimum Necessary. Business Associate, its Subcontractors and agents, shall access, use, and
disclose only the minimum amount of PHI necessary to accomplish the
objectives of the
Contract
, in accordance with the Minimum Necessary Requirements of the HIPAA Rules
including, but not limited to, 45 C.F.R. 164.502(b) and 164.514(d).
c.
Impermissible Uses and Disclosures.
i.
Business Associate shall not disclose the PHI of Covered Entity to another covered
entity without the written authorization of Covered Entity.
ii.
Business Associate shall not share, use, disclose or make available any Covered Entity
PHI in any form via any medium with or to any person or entity beyond the boundaries
or jurisdiction of the United States without express written authorization from Covered
Entity.
d.
Business Associate's Subcontractors.
i.
Business Associate shall, in accordance with 45 C.F.R. 164.502(e)(1)(ii) and
164.308(b)(2), ensure that any Subcontractors who create, receive, maintain, or
transmit PHI on behalf of Business Associate agree in writing to the same restrictions,
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conditions, and requirements that apply to Business Associate with respect to
safeguarding PHI.
ii.
Business Associate shall provide to Covered Entity, on Covered Entity’s request, a list
of Subcontractors who have entered into any such agreement with Business Associate.
iii.
Business Associate shall provide to Covered Entity, on Covered Entity’s request,
copies of any such agreements Business Associate has entered into with
Subcontractors.
e.
Access to System. If Business Associate needs access to a Covered Entity Information
Technology system to comply with its obligations under the Contract or this
Agreement
,
Business Associate shall request, review, and comply with any and all policies applicable to
Covered Entity regarding such system including, but not limited to, any policies promulgated
by the Office of Information Technology and available at http://oit.state.co.us/about/policies.
f.
Access to PHI. Business Associate shall, within ten days of receiving a written request from
Covered Entity, make available PHI in a Designated Record Set to Covered Entity as necessary
to satisfy Covered Entity’s obligations under 45 C.F.R. 164.524.
g.
Amendment of PHI.
i.
Business Associate shall within ten days of receiving a written request from Covered
Entity make any amendment to PHI in a Designated Record Set as directed by or agreed
to by Covered Entity pursuant to 45 C.F.R. 164.526, or take other measures as
necessary to satisfy Covered Entity’s obligations under 45 C.F.R. 164.526.
ii.
Business Associate shall promptly forward to Covered Entity any request for
amendment of PHI that Business Associate receives directly from an Individual.
h.
Accounting Rights. Business Associate shall, within ten days of receiving a written request
from Covered Entity, maintain and make available to Covered Entity the information necessary
for Covered Entity to satisfy its obligations to provide an accounting of Disclosure under 45
C.F.R. 164.528.
i.
Restrictions and Confidential Communications.
i.
Business Associate shall restrict the Use or Disclosure of an Individual’s PHI within
ten
days of notice from Covered Entity of:
A.
a restriction on Use or Disclosure of PHI pursuant to 45 C.F.R. 164.522; or
B.
a request for confidential communication of PHI pursuant to 45 C.F.R.
164.522.
ii.
Business Associate shall not respond directly to an Individual’s requests to restrict the
Use or Disclosure of PHI or to send all communication of PHI to an alternate address.
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iii.
Business Associate shall refer such requests to Covered Entity so that Covered Entity
can coordinate and prepare a timely response to the requesting Individual and provide
direction to Business Associate.
j.
Governmental Access to Records. Business Associate shall make its facilities, internal
practices, books, records, and other sources of information, including PHI, available to the
Secretary for purposes of determining compliance with the HIPAA Rules in accordance with
45 C.F.R. 160.310.
k.
Audit, Inspection and Enforcement.
i.
Business Associate shall obtain and update at least annually a written assessment
performed by an independent third party reasonably acceptable to Covered Entity,
which evaluates the Information Security of the applications, infrastructure, and
processes that interact with the Covered Entity data Business Associate receives,
manipulates, stores and distributes. Upon request by Covered Entity, Business
Associate shall provide to Covered Entity the executive summary of the assessment.
ii.
Business Associate, upon the request of Covered Entity, shall fully cooperate with
Covered Entity’s efforts to audit Business Associate’s compliance with applicable
HIPAA Rules. If, through audit or inspection, Covered Entity determines that Business
Associate’s conduct would result in violation of the HIPAA Rules or is in violation of
the Contract or this
Agreement
, Business Associate shall promptly remedy any such
violation and shall certify completion of its remedy in writing to Covered Entity.
l.
Appropriate Safeguards.
i.
Business Associate shall use appropriate safeguards and comply with Subpart C of 45
C.F.R. Part 164 with respect to electronic PHI to prevent use or disclosure of PHI other
than as provided in this Agreement.
ii.
Business Associate shall safeguard the PHI from tampering and unauthorized
disclosures.
iii.
Business Associate shall maintain the confidentiality of passwords and other data
required for accessing this information.
iv.
Business Associate shall extend protection beyond the initial information obtained
from Covered Entity to any databases or collections of PHI containing information
derived from the PHI. The provisions of this section shall be in force unless PHI is de-
identified in conformance to the requirements of the HIPAA Rules.
m.
Safeguard During Transmission.
i.
Business Associate shall use reasonable and appropriate safeguards including, without
limitation, Information Security measures to ensure that all transmissions of PHI are
authorized and to prevent use or disclosure of PHI other than as provided for by this
Agreement.
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ii.
Business Associate shall not transmit PHI over the internet or any other insecure or
open communication channel unless the PHI is encrypted or otherwise safeguarded
with a FIPS-compliant encryption algorithm.
n.
Reporting of Improper Use or Disclosure and Notification of Breach.
i.
Business Associate shall, as soon as reasonably possible, but immediately after
discovery of a Breach, notify Covered Entity of any use or disclosure of PHI not
provided for by this
Agreement,
including a Breach of Unsecured Protected Health
Information as such notice is required by 45 C.F.R. 164.410 or a breach for which
noti
ce is required under §24-73-103, C.R.S.
ii.
Such notice shall include the identification of each Individual whose Unsecured
Protected Health Information has been, or is reasonably believed by Business
Associate to have been, accessed, acquired, or disclosed during such Breach.
iii.
Business Associate shall, as soon as reasonably possible, but immediately after
discovery of any Security Incident that does not constitute a Breach, notify Covered
Entity of such incident.
iv.
Business Associate shall have the burden of demonstrating that all notifications were
made as required, including evidence demonstrating the necessity of any delay.
o.
Business Associate’s Insurance and Notification Costs.
i.
Business Associate shall bear all costs of a Breach response including, without
limitation, notifications, and shall maintain insurance to cover:
A.
loss of PHI data;
B.
Breach notification requirements specified in HIPAA Rules and in
§24-73-
103, C.R.S.
; and
C.
claims based upon alleged violations of privacy rights through improper use
or disclosure of PHI.
ii.
All such policies shall meet or exceed the minimum insurance requirements of the
Contract or otherwise as may be approved by Covered Entity (e.g., occurrence basis,
combined single dollar limits, annual aggregate dollar limits, additional insured status,
and notice of cancellation).
iii.
Business Associate shall provide Covered Entity a point of contact who possesses
relevant Information Security knowledge and is accessible 24 hours per day, 7 days
per week to assist with incident handling.
iv.
Business Associate, to the extent practicable, shall mitigate any harmful effect known
to Business Associate of a Use or Disclosure of PHI by Business Associate in violation
of this Agreement.
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Revised 8/18
p.
Subcontractors and Breaches.
i.
Business Associate shall enter into a written agreement with each of its Subcontractors
and agents, who create, receive, maintain, or transmit PHI on behalf of Business
Associate. The agreements shall require such Subcontractors and agents to report to
Business Associate any use or disclosure of PHI not provided for by this
Agreement
,
including Security Incidents and Breaches of Unsecured Protected Health Information,
on the first day such Subcontractor or agent knows or should have known of the Breach
as required by 45 C.F.R. 164.410.
ii.
Business Associate shall notify Covered Entity of any such report and shall provide
copies of any such agreements to Covered Entity on request.
q.
Data Ownership.
i.
Business Associate acknowledges that Business Associate has no ownership rights
with respect to the PHI.
ii.
Upon request by Covered Entity, Business Associate immediately shall provide
Covered Entity with any keys to decrypt information that the Business Association has
encrypted and maintains in encrypted form, or shall provide such information in
unencrypted usable form.
r.
Retention of PHI. Except upon termination of
this Agreement
as provided in Section 5 below,
Business Associate and its Subcontractors or agents shall retain all PHI throughout the term of
this Agreement, and shall continue to maintain the accounting of disclosures required under
Section 3.h above, for a period of six years.
4.
OBLIGATIONS OF COVERED ENTITY
a.
Safeguards During Transmission. Covered Entity shall be responsible for using appropriate
safeguards including encryption of PHI, to maintain and ensure the confidentiality, integrity,
and security of PHI transmitted pursuant to this Agreement, in accordance with the standards
and requirements of the HIPAA Rules.
b.
Notice of Changes.
i.
Covered Entity maintains a copy of its Notice of Privacy Practices on its website.
Covered Entity shall provide Business Associate with any changes in, or revocation of,
permission to use or disclose PHI, to the extent that it may affect Business Associate’s
permitted or required uses or disclosures.
ii.
Covered Entity shall notify Business Associate of any restriction on the use or disclosure
of PHI to which Covered Entity has agreed in accordance with 45 C.F.R. 164.522, to the
extent that it may affect Business Associate’s permitted use or disclosure of PHI.
5.
TERMINATION
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a.
Breach.
i.
In addition to any Contract provision regarding remedies for breach, Covered Entity
shall have the right, in the event of a breach by Business Associate of any provision of
this Agreement, to terminate immediately the Contract, or this
Agreement,
or both.
ii.
Subject to any directions from Covered Entity, upon termination of the Contract, this
Agreement, or both, Business Associate shall take timely, reasonable, and necessary
action to protect and preserve property in the possession of Business Associate in
which Covered Entity has an interest.
b.
Effect of Termination.
i.
Upon termination of this Agreement for any reason, Business Associate, at the option
of Covered Entity, shall return or destroy all PHI that Business Associate, its agents,
or its Subcontractors maintain in any form, and shall not retain any copies of such PHI.
ii.
If Covered Entity directs Business Associate to destroy the PHI, Business Associate
shall certify in writing to Covered Entity that such PHI has been destroyed.
iii.
If Business Associate believes that returning or destroying the PHI is not feasible,
Business Associate shall promptly provide Covered Entity with notice of the
conditions making return or destruction infeasible. Business Associate shall continue
to extend the protections of Section 3 of this Agreement to such PHI, and shall limit
further use of such PHI to those purposes that make the return or destruction of such
PHI infeasible.
6.
INJUNCTIVE RELIEF
Covered Entity and Business Associate agree that irreparable damage would occur in the event Business
Associate or any of its Subcontractors or agents use or disclosure of PHI in violation of this Agreement, the
HIPAA Rules or any applicable law. Covered Entity and Business Associate further agree that money
damages would not provide an adequate remedy for such Breach. Accordingly, Covered Entity and
Business Associate agree that Covered Entity shall be entitled to injunctive relief, specific performance,
and other equitable relief to prevent or restrain any Breach or threatened Breach of and to enforce
specifically the terms and provisions of this Agreement.
7.
LIMITATION OF LIABILITY
Any provision in the Contract limiting Contractor’s liability shall not apply to Business Associate’s liability
under this Agreement, which shall not be limited.
8.
DISCLAIMER
Covered Entity makes no warranty or representation that compliance by Business Associate with this
Agreement or the HIPAA Rules will be adequate or satisfactory for Business Associate’s own purposes.
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Business Associate is solely responsible for all decisions made and actions taken by Business Associate
regarding the safeguarding of PHI.
9.
CERTIFICATION
Covered Entity has a legal obligation under HIPAA Rules to certify as to Business Associate’s Information
Security practices. Covered Entity or its authorized agent or contractor shall have the right to examine
Business Associate’s facilities, systems, procedures, and records, at Covered Entity’s expense, if Covered
Entity determines that examination is necessary to certify that Business Associate’s Information Security
safeguards comply with the HIPAA Rules or this Agreement.
10.
AMENDMENT
a.
Amendment to Comply with Law. The Parties acknowledge that state and federal laws and
regulations relating to data security and privacy are rapidly evolving and that amendment of
this Agreement may be required to provide procedures to ensure compliance with such
developments.
i.
In the event of any change to state or federal laws and regulations relating to data
security and privacy affecting this Agreement, the Parties shall take such action as is
necessary to implement the changes to the standards and requirements of HIPAA, the
HIPAA Rules and other applicable rules relating to the confidentiality, integrity,
availability and security of PHI with respect to this Agreement.
ii.
Business Associate shall provide to Covered Entity written assurance satisfactory to
Covered Entity that Business Associate shall adequately safeguard all PHI, and obtain
written assurance satisfactory to Covered Entity from Business Associate’s
Subcontractors and agents that they shall adequately safeguard all PHI.
iii. Upon the request of either Party, the other Party promptly shall negotiate in good faith
the terms of an amendment to the Contract embodying written assurances consistent
with the standards and requirements of HIPAA, the HIPAA Rules, or other applicable
rules.
iv. Covered Entity may terminate this Agreement upon 30 days’ prior written notice in the
event that:
A.
Business Associate does not promptly enter into negotiations to amend the
Contract and this Agreement when requested by Covered Entity pursuant to
this Section; or
B.
Business Associate does not enter into an amendment to the Contract and this
Agreement, which provides assurances regarding the safeguarding of PHI
sufficient, in Covered Entity’s sole discretion, to satisfy the standards and
requirements of the HIPAA, the HIPAA Rules and applicable law.
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c.
Amendment of Appendix. The Appendix to this
Agreement
may be modified or amended by
the mutual written agreement of the Parties, without amendment of this Agreement. Any
modified or amended Appendix agreed to in writing by the Parties shall supersede and replace
any prior version of the Appendix.
11.
ASSISTANCE IN LITIGATION OR ADMINISTRATIVE PROCEEDINGS
Covered Entity shall provide written notice to Business Associate if litigation or administrative proceeding
is commenced against Covered Entity, its directors, officers, or employees, based on a claimed violation by
Business Associate of HIPAA, the HIPAA Rules or other laws relating to security and privacy or PHI.
Upon receipt of such notice and to the extent requested by Covered Entity, Business Associate shall, and
shall cause its employees, Subcontractors, or agents assisting Business Associate in the performance of its
obligations under the Contract to, assist Covered Entity in the defense of such litigation or proceedings.
Business Associate shall, and shall cause its employees, Subcontractor’s and agents to, provide assistance,
to Covered Entity, which may include testifying as a witness at such proceedings. Business Associate or
any of its employees, Subcontractors or agents shall not be required to provide such assistance if Business
Associate is a named adverse party.
12.
INTERPRETATION AND ORDER OF PRECEDENCE
Any ambiguity in this Agreement shall be resolved in favor of a meaning that complies and is consistent
with the HIPAA Rules. In the event of an inconsistency between the Contract and this Agreement, this
Agreement shall control. This Agreement supersedes and replaces any previous, separately executed
HIPAA business associate agreement between the Parties.
13.
SURVIVAL
Provisions of this Agreement requiring continued performance, compliance, or effect after termination shall
survive termination of this contract or this agreement and shall be enforceable by Covered Entity.
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Exhibit A, HIPAA BAA, Appendix
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APPENDIX TO HIPAA BUSINESS ASSOCIATE AGREEMENT
This Appendix (“Appendix”) to the HIPAA Business Associate Agreement (“Agreement”) is s an appendix to the
Contract and the Agreement. For the purposes of this Appendix, defined terms shall have the meanings ascribed
to them in the Agreement and the Contract.
Unless the context clearly requires a distinction between the Contract, the Agreement, and this Appendix, all
references to “Contract” or “Agreement” shall include this Appendix.
1.
PURPOSE
This Appendix sets forth additional terms to the Agreement. Any sub-section of this Appendix marked as
“Reserved” shall be construed as setting forth no additional terms.
2. ADDITIONAL TERMS
a.
Additional Permitted Uses. In addition to those purposes set forth in the Agreement, Business
Associate may use PHI for the following additional purposes:
i.
Reserved.
b.
Additional Permitted Disclosures. In addition to those purposes set forth in the Agreement, Business
Associate may disclose PHI for the following additional purposes:
i.
Reserved.
c.
Approved Subcontractors. Covered Entity agrees that the following Subcontractors or agents of
Business Associate may receive PHI under the Agreement:
ii.
Reserved.
d.
Definition of Receipt of PHI. Business Associate’s receipt of PHI under this Contract shall be deemed
to occur, and Business Associate’s obligations under the Agreement shall commence, as follows:
i.
Reserved.
e.
Additional Restrictions on Business Associate. Business Associate agrees to comply with the
following additional restrictions on Business Associate’s use and disclosure of PHI under the
Contract:
i.
Reserved.
f.
Additional Terms. Business Associate agrees to comply with the following additional terms under the
Agreement:
i.
Reserved.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 1 of 116
EXHIBIT B, STATEMENT OF WORK
1.
BACKGROUND INFORMATION AND VISION
1.1.
Accountable Care Collaborative (ACC)
1.1.1.
The Accountable Care Collaborative (ACC) is the primary vehicle for delivering health care
to Health First Colorado Members. The ACC differs from a capitated managed care program
by blending capitated behavioral health services with a managed Fee-for-Service physical
health program. Health First Colorado divided the State of Colorado into seven geographic
regions for the ACC. Each region is served by one Regional Accountable Entity (RAE).
Primary Care Medical Providers (PCMPs) are a core component of the ACC model. The
General Assembly has authorized the Department to establish alternative payment and
delivery models within Health First Colorado. The Department has also undertaken initiatives
to move towards value-based payments by designing two Alternative Payment Models
(APMs) for primary care and a bundled payments methodology for perinatal care.
1.1.2.
The first APM model, APM 1, uses a modification of rates for traditional Fee-for Service
payments with the rate change based on performance in quality measures and a redistribution
of funds from lower performers to higher performers. APM 1 pays qualifying PCMPs in the
ACC higher primary care payments for meeting selected structural or performance measures.
1.1.3.
The second model, APM 2, sends Providers a monthly advance Per Member Per Month
payment (PMPM) for the services expected to be provided, to give more financial flexibility
to PCMPs that are more experienced in advanced primary care. APM 2 is currently voluntary.
APM 2 also includes retrospective upside-only gainsharing for managing Members who have
one or more of 13 different chronic condition episodes of care with benchmark prices
calculated for each episode.
1.1.3.1.
As it stands currently, APM 2 does not differentiate between adult and pediatric medicine.
Through this Contract, the Department requests that Contractor design and implement a
value-based payment model in Contractor’s Technology Solution for primary care that
specifically meets the needs of children.
1.2.
Value-Based Maternity Care
1.2.1.
In November 2020, the Department implemented a maternity bundled payment program with
the goal of improving the cost and quality of perinatal care. This maternity bundled payment
program model retrospectively compares actual expenditures to prospectively calculated
benchmarks and distributes any shared savings to the principal accountable obstetrics
Provider.
1.2.2.
Currently, the maternity bundled payment program is voluntary for Providers and the
maternity bundled payment program is up-side risk only, which means the Provider can earn
shared savings if the Provider meets annual program goals but will not be penalized if the
Provider does not meet the annual program goals.
1.2.3.
In response to maternity advocates in the State of Colorado and decisions from the Colorado
Joint Budget Committee, the Department has decided to work towards implementing a New
Maternity APM Program in Contractor’s Technology Solution in a collaborative effort with
Stakeholders.
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1.3.
Purpose for the following Statement of Work
1.3.1.
There is an opportunity to build upon existing momentum in the value-based payments space
in Colorado and move closer to a more holistic value-based system of health care in Health
First Colorado that meets the needs of more Members and a wider variety of Members across
the continuum of health care. With an appropriation from the Colorado legislature, the
Department has received funding to assist in moving value-based payments from a start-up
environment to a more established system of payments. The funding in this Contract goes
towards establishing new and building upon existing APMs and building a system that brings
value-based payment data into a comprehensive technical solution that can be scaled up to
meet rising demand for these programs and deliver consistent performance feedback to
Providers. Once implemented in Contractor’s Technology Solution, the funding will continue
to assist in the operation of each value-based payment program utilizing Contractor’s
Technology Solution.
1.3.1.1.
Contractor’s Technology Solution will be compliant with Centers for Medicare and
Medicaid Services (CMS) Conditions for Enhanced Funding (CEF) and CMS Standards
and Conditions. To demonstrate compliance, Contractor shall use the Streamlined
Modular Certification (SMC) methodology for designing, developing, and implementing
the APM 2 Program within Contractor’s Technology Solution. Additional Projects
implemented in Contractor’s Technology Solution are considered enhancements to
Contractor’s Technology Solution and will not need a comprehensive certification
process to receive enhanced funding unless specifically requested by CMS. Instead, these
enhancements will need to demonstrate that the enhancements meet the objectives of the
Project, as provided in this Contract and Advanced Planning Documents submitted to
CMS.
1.3.2.
Contractor’s implementation of Projects defined under this Contract are expected to include
the following steps that closely track to the CMS CEF: development within Contractor’s
Technology Solution, which includes the traditional steps of gathering system and business
requirements (including gathering system and business requirements directly from
Stakeholders and Providers through various engagement strategies); system development and
testing; stabilization and initial release phase that occurs prior to a formal implementation to
verify system and business requirements are meeting the Department’s, Stakeholders’, and
Providers’ business needs with the opportunity to make corrections as necessary; a Go-Live
Date and phase that indicates Contractor’s Technology Solution is ready to transition into
formal Operations stage; and an Operations Phase with the option for enhancements to
Contractor’s Technology Solution as the Project needs modifications over the remaining
Term of the Contract.
1.3.2.1.
The Department expects significant and active engagement from Stakeholders and
Providers to implement Projects defined under this Contract. Therefore, the Department
has specified a considerable amount of Stakeholder and Provider engagement under the
Contract. The Department considers this work to be necessary to properly gather system
and business requirements to implement Projects within Contractor’s Technology
Solution and to make enhancements once the Project is in Operations. The Department
expects Contractor to actively and successfully engage in these system and business
requirements Stakeholder engagement activities.
2.
GENERAL REQUIREMENTS
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2.1.
Unless otherwise specified, references to “Section” in this Exhibit B refer to sections within
Exhibit B.
2.2.
Contractor shall work with the Department’s contract manager or designee on Contract
monitoring of Contract responsibilities and performance standards throughout the Term of this
Contract to ensure Contract requirements are met.
2.3.
The Parties intend that each Deliverable shall contain: Contractor’s tasks, obligations, and
responsibilities; be approved by the Department; and those Deliverables’ identified tasks,
obligations, and responsibilities shall be incorporated into this Contract.
2.4.
Contractor shall communicate directly, regularly, and in a transparent manner with the
Department during the Term of this Contract.
2.5.
Contractor shall meet or exceed all operations quality standards as set forth in the Service Level
Agreements (SLAs) identified in this Contract throughout the Term of this Contract.
2.6.
General Requirements for Meetings
2.6.1.
If directed by the Department, Contractor shall create and submit to the Department for
review and approval:
2.6.1.1.
The processes Contractor will use to maintain Meeting Minutes.
2.6.1.2.
The processes Contractor will use to maintain Meeting Records.
2.6.1.3.
All documents and processes to support the System Development Life Cycle (SDLC).
2.6.1.4.
Any other documents related to the scheduled meetings.
2.6.2.
Contractor shall create and deliver all Meeting Agendas to the Department and all other
meeting attendees.
2.6.2.1.
DELIVERABLE: Meeting Agenda
2.6.2.2.
DUE: At least 24 hours before the meeting is scheduled to begin
2.6.3.
Contractor shall take Meeting Minutes and retain Meeting Records for all meetings
Contractor has with the Department or the Department’s contractors, Medicaid Providers, or
Department-identified Stakeholders. Contractor shall create and maintain a Project
Repository (see Sections 3.1.4 through 3.1.4.3) in which all Meeting Minutes and Meeting
Records are stored.
2.6.3.1.
DELIVERABLE: Meeting Minutes and Meeting Records
2.6.3.2.
DUE: No later than the 5:00 p.m. Mountain Standard Time or Mountain Daylight Time,
as applicable, on the Business Day after the meeting occurs
2.6.4.
Contractor shall implement or otherwise perform all tasks, obligations, and responsibilities
set forth in all Meeting Minutes and Meeting Records.
2.7.
As-Needed Meetings
2.7.1.
As requested by the Department, Contractor and the Department shall meet as needed (As-
Needed Meetings).
2.7.2.
As-Needed Meetings shall be conducted as approved in advance by the Department.
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2.7.2.1.
The Department will provide to Contractor Google access if and as needed, or another
platform in the Department’s sole discretion, to facilitate virtual meetings and for other
purposes as agreed upon by the Parties.
2.7.2.2.
The Parties shall hold meetings, including in person or virtual meetings, at times and
locations agreed upon by the Parties.
2.7.3.
Contractor shall ensure that Contractor’s staff who attend the As-Needed Meetings have the
authority to represent and make decisions on behalf of Contractor with respect to Project
issues such as work planning, problem resolution, and Project and program development.
2.8.
Project Status Meetings
2.8.1.
Contractor shall attend, facilitate, and participate, as directed by the Department, in all Project
Status Meetings with the Department, Medicaid Enterprise Solution (MES) Vendors, or any
combination thereof.
2.8.2.
Contractor shall provide guidance and advice to participants in the Project Status Meetings
regarding the enforcement of Department-defined MES Standards.
2.9.
Requirements for Data On-Boarding
2.9.1.
Contractor shall create a Data Exchange Document.
2.9.1.1.
The Data Exchange Document shall, at a minimum, include all of the following:
2.9.1.1.1.
Processes for ingesting claims data, Provider data, and eligibility data into
Contractor’s Technology Solution, which claims data shall include a minimum of
seven years of historical claims data. Claims data, Provider data, and eligibility data
will be provided to Contractor by the Department. As agreed upon by the Parties,
claims data, Provider data, and eligibility data may be provided weekly to Contractor.
2.9.1.1.2.
Processes for ingesting All-Payer Claims data into Contractor’s Technology Solution
from the Center for Improving Value in Health Care (CIVHC). All-Payer Claims data
will be provided to Contractor by the Department. As agreed upon by the Parties, All-
Payer Claims data may be provided quarterly or annually to Contractor.
2.9.1.1.3.
Processes for ingesting Social Determinants of Health (SDoH) data. SDoH data will
be provided to Contractor by the Department. See Exhibit D, Section 1.1.104
regarding the definition, responsibilities, and scope of SDoH data. As agreed upon by
the Parties, SDoH data may be provided quarterly or annually to Contractor.
2.9.1.1.4.
Processes for ingesting specific clinical data to support program design and use case
from the community Health Information Exchanges (HIEs) in Colorado, including
Contexture and Quality Health Network (QHN). Clinical data from the HIEs will be
provided to Contractor by the Department. As agreed upon by the Parties, clinical
data from the HIEs may be provided weekly to the Contractor. The Department will
facilitate conversations with the HIEs, in the Department's sole discretion, for the
purposes of obtaining information and/or data related to data exchange and
messaging.
2.9.1.1.5.
Processes for conducting data quality checks.
2.9.1.1.6.
A schedule for updating the frequency of data updates necessary to support up-to-date
information documented in the Data Exchange Document.
2.9.1.2.
DELIVERABLE: Data Exchange Document
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2.9.1.3.
DUE: As identified in the Project Schedule
2.9.2.
Contractor shall have data quality analyses completed in partnership with the Department on,
at a minimum, a quarterly basis, as identified by the Department.
2.9.2.1.
Based on the data analysis and quality checks performed in partnership with the
Department, Contractor shall create a Data Quality Report.
2.9.2.1.1.
The Data Quality Report shall include, at a minimum, all of the following:
2.9.2.1.1.1.
Quality analyses on, at a minimum, the following areas of data:
2.9.2.1.1.1.1.
Provider data.
2.9.2.1.1.1.2.
Claims data.
2.9.2.1.1.1.3.
Eligibility data.
2.9.2.1.1.1.4.
Pharmacy data.
2.9.2.1.1.1.5.
Demographics of Members.
2.9.2.1.1.1.6.
SDoH data.
2.9.2.1.1.1.7.
Clinical data.
2.9.2.1.1.2.
Required metrics shall include, at a minimum, all of the following:
2.9.2.1.1.2.1.
Record check sums.
2.9.2.1.1.2.2.
Formatting issues.
2.9.2.1.1.2.3.
Missing or blank fields.
2.9.2.1.1.2.4.
Expected values issues.
2.9.2.1.1.2.5.
Hard-coded fields.
2.9.2.1.2.
DELIVERABLE: Data Quality Report
2.9.2.1.3.
DUE: On a quarterly basis or as otherwise identified in the Project Schedule
2.10.
Independent Auditor
2.10.1.
Contractor shall pay for an independent auditor to conduct an annual audit of Contractor’s
Technology Solution utilizing a current version of the Statement on Standards for Attestation
Engagements (SSAE), System and Organization Controls (SOC) 1, Type II. The SOC 1, Type
II audit shall address Work performed by Contractor at Contractor’s facility and data center
suites.
2.10.1.1.
Contractor shall develop an initial draft scope of the SOC 1, Type II audit, and the
Department will review with Contractor and approve the scope of the SOC 1, Type II
audit prior to commencement of review activities by the independent auditor.
2.10.1.1.1.
DELIVERABLE: Initial Draft Scope of the SOC 1, Type II Audit
2.10.1.1.2.
DUE: As identified in the Project Schedule
2.10.1.2.
Review of the scope of SOC 1, Type II audits by the Parties shall include consideration
of prior SOC 1, Type II audits to determine if past findings have been addressed.
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2.10.1.3.
Contractor shall be responsible for facilitating meetings between Contractor and the
Department to determine the scope of SOC 1, Type II audits. At a minimum, the following
topics shall be addressed during this meeting:
2.10.1.3.1.
The process to be used by Contractor and independent auditor to develop, document,
and implement the objectives of the SOC 1, Type II audit.
2.10.1.3.2.
Guidelines Contactor and the independent auditor will follow in communicating
audit-related opinions to the Department.
2.10.1.3.3.
Any changes to the control environment that may impact the SOC 1, Type II audit.
2.10.1.4.
Contractor shall submit the SOC 1, Type II audit reports to the Department along with
the following supplemental documentation:
2.10.1.4.1.
Contractor’s responses to the independent auditor’s findings.
2.10.1.4.2.
A SOC 1, Type II Report Action Plan detailing how Contractor will address and
resolve all findings in the SOC 1, Type II report and the timeline for addressing each
finding. The SOC Report Action Plan shall be subject to Department review and
approval.
2.10.1.5.
Contractor shall address and resolve all findings in the SOC 1, Type II report, and provide
monthly updates in the Monthly Contract Management Report until the Department
agrees that Contractor has demonstrated that all findings have been properly addressed
and resolved.
2.10.1.6.
Contractor Approach: Contractor shall pay an independent auditor to perform a SOC 1,
Type II audit annually. Contractor shall deliver the report to the Department.
2.10.1.6.1.
Contractor shall submit responses to the auditor’s findings and a SOC 1, Type II
Report Action Plan to the Department for review and approval.
2.10.1.6.2.
Contractor shall address and resolve findings in the SOC 1, Type II report and provide
monthly updates in the Monthly Contract Management Report until the Department
agrees that Contractor has demonstrated that all findings have been properly
addressed and resolved.
2.10.1.6.3.
DELIVERABLE: SOC 1, Type II Report
2.10.1.6.4.
DUE: Annually, as identified in the Project Schedule
2.10.1.6.5.
DELIVERABLE: Contractor’s Responses to Findings, SOC 1, Type II Report Action
Plan, and SOC 1, Type II report and provide monthly updates in the Monthly Contract
Management Report until the Department agrees that Contractor has demonstrated
that all findings have been properly addressed and resolved.
2.11.
Third-Party Privacy, Security Audits, and Assessments
2.11.1.
Contractor shall pay for a third-party to perform an annual audit or assessment of Contractor’s
privacy and security control environment.
2.11.2.
Contractor shall utilize one of the three identified third-party audits/assessments, identified
in order of priority:
2.11.2.1.
HITRUST Risk-Based, 2-Year (r2) Validated Assessment + Certification.
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2.11.2.2.
SOC 2, Type II Report on Controls at a Service Organization Relevant to Security,
Availability, Processing Integrity, Confidentiality, or Privacy.
2.11.2.3.
HITRUST Implemented, 1-Year (i1) Validated Assessment + Certification.
2.11.3.
In the absence of one of the recommended audit/assessment types, Contractor may propose
an equivalent audit/assessment for Department review.
2.11.4.
Contractor shall submit Contractor’s Department-approved audit/assessment report to the
Department along with the following supplemental documentation:
2.11.4.1.
A Corrective Action Plan (CAP), Plan of Action and Milestones (POA&M), or other
similar document detailing how Contractor will address and resolve all findings in the
audit/assessment report and the timeline for addressing each finding.
2.11.4.1.1.
DELIVERABLE: Audit/Assessment Report
2.11.4.1.2.
DUE: Annually, as identified in the Project Schedule
3.
PROJECT AND CONTRACT MANAGEMENT
3.1.
General Requirements
3.1.1.
Contractor shall work with the Department to receive access to the Department’s existing and
necessary enterprise-level Project Management plans, processes, standards, and templates.
3.1.2.
The Department will designate executive oversight and a project lead to this effort to serve
as main points of contact for Contractor.
3.1.3.
Contractor shall comply with all Department standards, protocols, and Work-specific
procedures, which the Department will communicate to Contractor with respect to all Project
Management activities conducted or undertaken under this Contract.
3.1.4.
Contractor shall work with the Department for purposes of Contractor establishing the Project
Repository.
3.1.4.1.
Contractor shall define the file structure within the Project Repository to use for all
Project documents and Project Artifacts.
3.1.4.2.
All Project documents, including draft documents and Work Products, and Project
Artifacts shall be saved in the Project Repository.
3.1.4.3.
Contractor shall provide access to approved Department Users, as defined by the
Department and communicated to Contractor, to the Project Repository on demand.
3.2.
Development, Stabilization, and Initial Release of Contractor’s Technology Solution
3.2.1.
Master Project Management Plan
3.2.1.1.
Contractor shall create and maintain a Master Project Management Plan.
3.2.1.1.1.
The Master Project Management Plan shall contain, at minimum, all of the following
Deliverables:
3.2.1.1.1.1.
Project Schedule.
3.2.1.1.1.2.
Schedule Development and Maintenance Procedures.
3.2.1.1.1.3.
Deliverable Management Tracking.
3.2.1.1.1.4.
Communications Management Plan.
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3.2.1.1.1.5.
Documentation Management Plan.
3.2.1.1.1.6.
Resource Management Plan and Organizational Structure.
3.2.1.1.1.7.
Risk and Issue Management Plan.
3.2.1.1.1.8.
Scope and Change Management Plan.
3.2.1.2.
All Deliverables that are included in the Master Project Management Plan and identified
in Section 3.2.1.1.1 are set forth in detail below within this Section 3.2.
3.2.1.3.
Contractor shall incorporate industry standards and best practices, according to the
Project Management Body of Knowledge (PMBOK) standards.
3.2.1.4.
Contractor shall deliver the Master Project Management Plan to the Department for
review and approval. Notwithstanding any other provision in this Contract, Contractor
shall not use any part, document, or Deliverable of the Master Project Management Plan
prior to the Department’s approval of that part, document, or Deliverable, unless the
Department has provided its contingent approval of any part, document, or Deliverable
of the Master Project Management Plan. To support the initial Project Management Plan,
Department Staff, as designated by the Department, will be available to Contractor. All
meetings regarding the Master Project Management Plan between Contractor and
Department Staff will be scheduled on dates and times agreed upon by Contractor and
the Department Staff.
3.2.1.4.1.
DELIVERABLE: Master Project Management Plan
3.2.1.4.2.
DUE: No later than 30 days after the Effective Date
3.2.2.
Project Schedule
3.2.2.1.
Contractor shall develop a Project Schedule for the purpose of identifying and tracking
tasks and activities.
3.2.2.1.1.
The Project Schedule shall include all of the following:
3.2.2.1.1.1.
The identification of all tasks included in the Work set forth in the Contract for
which Contractor is responsible, including tasks to be performed by
Subcontractors.
3.2.2.1.1.2.
The identification of all tasks included in the Work set forth in the Contract for
which the Department is responsible.
3.2.2.1.1.3.
A portfolio-level schedule that includes all Project tasks and activities.
3.2.2.1.1.4.
Baseline schedule dates.
3.2.2.1.1.5.
Anticipated Deliverable due dates.
3.2.2.1.1.6.
Anticipated Milestone completion dates.
3.2.2.1.2.
The Project Schedule shall be created and maintained in a software solution that is
compatible with Microsoft Project and approved by the Department.
3.2.2.1.3.
The Project Schedule shall provide information regarding adherence to all schedule
guidelines necessary to validate the accuracy of timeframes.
3.2.2.1.4.
DELIVERABLE: Project Schedule
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3.2.2.1.5.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.2.2.
Contractor shall baseline the Project Schedule and re-baseline the Project Schedule as
needed, upon review and approval by the Department.
3.2.3.
Schedule Development and Maintenance Procedures
3.2.3.1.
Contractor shall develop Schedule Development and Maintenance Procedures.
3.2.3.1.1.
The Schedule Development and Maintenance Procedures shall include, at a
minimum, all of the following:
3.2.3.1.1.1.
Contractor’s approach to complying with the Department’s schedule maintenance
procedures.
3.2.3.1.2.
Contractor shall develop PMBOK-based and PMBOK-compliant Schedule
Development and Maintenance Procedures for the development and maintenance of
the Project Schedule to be utilized to validate the accuracy and timing of the progress
of the Contract.
3.2.3.1.3.
Contractor shall develop and publish the Schedule Development and Maintenance
Procedures to the Project Repository.
3.2.3.1.4.
Contractor shall apply the Department-approved Schedule Development and
Maintenance Procedures to assure the proper development and maintenance of the
Project Schedule.
3.2.3.1.5.
DELIVERABLE: Schedule Development and Maintenance Procedures Document
3.2.3.1.6.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.4.
Deliverable Management Tracking
3.2.4.1.
Contractor shall develop a Deliverable Management Tracking Document to define
processes and maintenance procedures for the review and approval of all Contract
Deliverables. Contractor shall submit the Deliverable Management Tracking Document
to the Department in an electronic format as directed by the Department.
3.2.4.1.1.
The Deliverable Management Tracking Document shall include, at a minimum, all of
the following:
3.2.4.1.1.1.
Contractor’s Deliverables management approach and process.
3.2.4.1.1.2.
The definition of timely submissions, including review and approval of Contract
Deliverables.
3.2.4.1.1.3.
Version control and tracking of Deliverables.
3.2.4.1.1.4.
Quality assurance.
3.2.4.1.1.5.
Department feedback and recommendations coordination process.
3.2.4.1.1.6.
The Department’s approval and written signoff of Deliverables.
3.2.4.1.1.7.
Change control procedures and the identification of changes, as applicable.
3.2.4.1.2.
DELIVERABLE: Deliverable Management Tracking Document
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3.2.4.1.3.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.5.
Communications Management Plan
3.2.5.1.
Contractor shall deliver to the Department a Communications Management Plan.
3.2.5.1.1.
At a minimum, the Communications Management Plan shall include all of the
following:
3.2.5.1.1.1.
Communication Protocols, which shall include all of the following:
3.2.5.1.1.1.1.
Approach to communicating with PCMPs.
3.2.5.1.1.1.2.
Approach to communicating with Specialty Providers.
3.2.5.1.1.1.3.
Approach to communicating with Internal and External Stakeholders,
including all of the following:
3.2.5.1.1.1.3.1.
Approaches to the identification and approval of information that will be
shared with Internal and External Stakeholders.
3.2.5.1.1.1.3.2.
Approaches to the identification of Internal and External Stakeholders.
3.2.5.1.1.1.4.
Approach to decision management.
3.2.5.1.1.2.
With respect to decision management, the strategy for how Contractor shall
distribute a decision log to the Department and Stakeholders.
3.2.5.1.1.2.1.
The decision log shall track key decisions that may have an impact on the
Project that is inclusive of all Communication Protocols, including updates or
changes over time.
3.2.5.1.1.2.2.
At a minimum, the decision log must include the date, description, rationale,
alternatives, expected impact, contributors, and Department approval
signature.
3.2.5.1.1.3.
An identification of:
3.2.5.1.1.3.1.
The Project Stakeholders and the Project Stakeholders’ roles, whether the
Stakeholders are Internal Stakeholders or External Stakeholders.
3.2.5.1.1.3.2.
The frequency and extent of communications between Contractor and the
Department and the Department’s identified Internal Stakeholders and
External Stakeholders.
3.2.5.1.1.4.
The method of communications between Contractor and the Department’s
identified Stakeholders. The Department will support Contractor’s Stakeholder
outreach and engagement efforts where appropriate (for example, by participating
in key virtual Stakeholder meetings and by enabling use of the Department email
account for invites, the Department’s virtual meeting technology for sessions, and
the Department website for any web publications).
3.2.5.1.1.5.
A listing of the following individuals within Contractor’s organization:
3.2.5.1.1.5.1.
The individuals responsible for Contractor’s communications, including the
identification of valid and after-hour contact information.
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3.2.5.1.1.6.
Approach to maintaining daily contact with the Department during critical
transition and operational readiness, as appropriate as determined by the
Department.
3.2.5.1.1.7.
Identification of compliance with PMBOK Body of Knowledge for
Communication.
3.2.5.1.1.8.
Description of Contractor’s review and approval process, including the process
for facilitating the Department’s review of each Deliverable to have a common
understanding of purpose and content of documentation prior to final delivery.
3.2.5.1.2.
DELIVERABLE: Communications Management Plan
3.2.5.1.3.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.6.
Documentation Management Plan
3.2.6.1.
Contractor shall develop a Documentation Management Plan.
3.2.6.1.1.
The Documentation Management Plan shall include, at a minimum, all of the
following:
3.2.6.1.1.1.
Approach to support Project continuity.
3.2.6.1.1.2.
Retention period for document reference and retrieval, as prescribed in this
Contract.
3.2.6.1.1.3.
Document management standards, procedures, processes, and tools.
3.2.6.1.2.
DELIVERABLE: Documentation Management Plan
3.2.6.1.3.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.7.
Resource Management Plan and Organizational Structure
3.2.7.1.
Contractor shall develop a Resource Management Plan and Organizational Structure.
3.2.7.1.1.
The Resource Management Plan and Organizational Structure shall include, at a
minimum, all of the following:
3.2.7.1.1.1.
Information relating to Contractor’s Subcontractors, as set forth in Exhibit E,
Sections 2.4.4 through 2.4.4.4.2.
3.2.7.1.1.2.
Position descriptions and titles.
3.2.7.1.1.3.
Required education, training, licensure, and certification for all identified
positions.
3.2.7.1.1.4.
Required experience, skills, and knowledge for all identified positions.
3.2.7.1.1.5.
Percentage of time each position is allocated to this Contract.
3.2.7.1.1.6.
Contractor’s process for resource planning and reporting, including current
staffing levels and staffing needs for the Work.
3.2.7.1.1.7.
The identification of any Personnel vacancies among Key Personnel and Other
Personnel.
3.2.7.1.2.
DELIVERABLE: Resource Management Plan and Organizational Structure
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3.2.7.1.3.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.8.
Risk and Issue Management Plan
3.2.8.1.
Contractor shall develop a Risk and Issue Management Plan.
3.2.8.1.1.
The Risk and Issue Management Plan shall include, at a minimum, all of the
following:
3.2.8.1.1.1.
Processes and procedures Contractor uses to identify Risks and Issues.
3.2.8.1.1.2.
Processes and procedures Contractor uses to analyze Risks and Issues.
3.2.8.1.1.3.
Processes and procedures Contractor uses to mitigate Risks and Issues.
3.2.8.1.1.4.
The processes and procedures Contractor uses to manage realized Risks as an
Issue.
3.2.8.1.1.5.
Processes and procedures Contractor uses to monitor and communicate Risks and
Issues to the Department and, as approved, to Department Stakeholders.
3.2.8.1.1.6.
The solutions Contractor utilizes to address identified Risks and Issues.
3.2.8.1.1.7.
A Risk response plan that shall identify:
3.2.8.1.1.7.1.
Risks that should be avoided.
3.2.8.1.1.7.2.
Risks that should be transferred.
3.2.8.1.1.7.3.
Risks that should be mitigated.
3.2.8.1.1.7.4.
Risks that should be accepted.
3.2.8.1.1.8.
Descriptions of the Issue resolution for each Issue.
3.2.8.1.2.
DELIVERABLE: Risk and Issue Management Plan
3.2.8.1.3.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.2.8.1.4.
The Risk and Issue Management Plan, as may be revised or updated from time to
time, shall be in effect for the entire Term of the Contract.
3.2.9.
Scope and Change Management Plan
3.2.9.1.
Contractor shall develop a Scope and Change Management Plan.
3.2.9.1.1.
The Scope and Change Management Plan shall include, at a minimum, all of the
following:
3.2.9.1.1.1.
Change management process, which includes sufficient staffing needed to
implement Technology Solution changes in the event of Defects and Department-
requested modifications.
3.2.9.1.1.2.
A process to communicate recommendations to the Department regarding any
changes to the Technology Solution needed to make improvements and
efficiencies throughout the Term of the Contract.
3.2.9.1.1.3.
A process to update relevant Deliverables.
3.2.9.1.1.4.
A process to resolve any inconsistencies in the Deliverables.
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3.2.9.1.1.5.
Approach to confirm Work requirements are clearly defined and managed.
3.2.9.1.1.6.
Approach to ensure alignment and compliance with and participation in the
Department’s Priority Change Board (PCB) processes and implement any PCB
decisions that impact the Technology Solution.
3.2.9.1.1.7.
Release notes, which shall include, at a minimum, all of the following:
3.2.9.1.1.7.1.
What is being released.
3.2.9.1.1.7.2.
Any known issues related to the Technology Solution that will be released.
3.2.9.1.1.7.3.
Anything held back from the release.
3.2.9.1.1.7.4.
Any special instructions for the release.
3.2.9.1.1.7.5.
Any other notes of importance that are germane to the release.
3.2.9.1.1.8.
Process to monitor, measure, and report scope performance compared to the
Project Schedule.
3.2.9.1.2.
Contractor shall maintain the Scope and Change Management Plan in a searchable
format.
3.2.9.1.3.
Contractor shall participate in Department’s PCB processes by attending meetings as
requested by the Department for changes that impact the Technology Solution.
3.2.9.1.4.
DELIVERABLE: Scope and Change Management Plan
3.2.9.1.5.
DUE: At the due date identified for the Master Project Management Plan (see Section
3.2.1.4.2)
3.3.
Additional Deliverables
3.3.1.
Configuration Management Plan
3.3.1.1.
Contractor shall develop a Configuration Management Plan for Contractor’s Technology
Solution that aligns with standard SDLC processes.
3.3.1.1.1.
Contractor’s Technology Solution Configuration Management Plan shall include all
of the following:
3.3.1.1.1.1.
The identification of the participants and roles in the configuration process.
3.3.1.1.1.2.
Contractor’s Technology Solution configuration processes.
3.3.1.1.1.3.
A configuration change document that identifies all changes made each time a
change is required.
3.3.1.1.1.4.
The identification of when the information contained in the Configuration
Management Plan will be implemented.
3.3.1.1.1.5.
Contractor shall establish a PCB that aligns with the Department’s PCB processes.
3.3.1.1.2.
DELIVERABLE: Contractor’s Technology Solution Configuration Management
Plan
3.3.1.1.3.
DUE: As identified in the Project Schedule
3.3.1.1.4.
Notwithstanding any provision in this Contract to the contrary, Contractor shall
review, update, and submit a Revised Contractor’s Technology Solution
Configuration Management Plan for Department review and approval at least
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annually and before any implementation of a Revised Contractor’s Technology
Solution Configuration Management Plan. If no changes have occurred, Contractor
shall provide a summary report that indicates no changes have occurred.
3.3.1.1.4.1.
If any change is made to the Contractor’s Technology Solution Configuration
Management Plan at any time during the applicable fiscal year, Contractor shall
submit a Revised Contractor’s Technology Solution Configuration Management
Plan to the Department for review and approval prior to implementation of the
Revised Contractor’s Technology Solution Configuration Management Plan.
3.3.1.1.4.2.
DELIVERABLE: Revised Contractor’s Technology Solution Configuration
Management Plan
3.3.1.1.4.3.
DUE: Not later than 10 Business Days after Contractor is aware of the need for a
Change; at least 30 days before Contractor’s Technology Solution’s Go-Live
Date; and at least annually by each annual anniversary of Contractor’s
Technology Solution’s Go-Live Date as identified in the Project Schedule
3.3.2.
Interface Control Documents (ICDs)
3.3.2.1.
Contractor shall complete an ICD with the Department’s Enterprise Solutions Integrator
Contractor, which ICD shall comply with CMS ICD format, which the Department will
provide to Contractor, and the Department’s MES Governance Plan best practices, for
every integration project, with one integration occurring in Design, Development and
Implementation (DDI) and any additional integrations occurring as part of the
Modification Enhancement Hours (see Section 11), that will be implemented throughout
the Term of the Contract.
3.3.2.1.1.
At a minimum, each ICD shall include all of the following:
3.3.2.1.1.1.
The name and purpose of the interface.
3.3.2.1.1.2.
Metrics, including size and frequency.
3.3.2.1.1.3.
The definition of data exchange transactions.
3.3.2.1.1.4.
Source and Target contact information.
3.3.2.1.1.5.
Formatting and valid values.
3.3.2.1.1.6.
Application Programming Interface (API), interface, and batch layout.
3.3.2.1.1.7.
Data dictionary related to the Integration.
3.3.2.1.1.8.
A description of the type of information being transferred.
3.3.2.1.1.9.
A description of triggers that initiate communication.
3.3.2.1.1.10.
The identification of when the information contained in the ICD will be
implemented.
3.3.2.1.2.
DELIVERABLE: ICD for Department-Defined Integration
3.3.2.1.3.
DUE: As identified in the Project Schedule
3.3.2.1.4.
Contractor shall update the ICD for any changes made to the interface for Department
review and approval.
3.3.2.1.4.1.
DELIVERABLE: Updated ICD
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3.3.2.1.4.2.
DUE: As identified in the Project Schedule
3.3.3.
Data Governance
3.3.3.1.
Contractor shall adhere to the Department’s MES Governance as defined by the
Enterprise Governance Council.
3.3.3.2.
Contractor shall adhere to the Department’s MES Governance Plan, which is maintained
by the Department’s Enterprise Solutions Integrator Contractor.
3.3.3.3.
Contractor shall participate in, at a minimum, all of the following:
3.3.3.3.1.
The Enterprise Governance Council
3.3.3.3.1.1.
Contractor shall follow the direction of the Enterprise Governance Council and
MES Governance Plan to determine and provide enterprise data management
business decisions for all relevant MES Vendors and the Department for inclusion
in Contractor’s Technology Solution as a module of the MES.
3.3.3.3.1.2.
Participation in the Enterprise Governance Council shall include Contractor’s
responsibility to identify and communicate potential impacts to the Enterprise
Solution Integrator Contractor for determination of consideration at the Enterprise
Governance Council or referral to the Architecture Review Board (ARB).
3.3.3.3.2.
The Architecture Review Board (ARB)
3.3.3.3.2.1.
Contractor’s participation in the ARB shall include Contractor submitting to the
ARB all data model changes, updating definitions/descriptions of data fields, or
any other modifications to data that impact Contractor Technology Solution’s
integration with the MES.
3.3.3.3.3.
The MES Priority Change Board (PCB)
3.3.3.3.3.1.
Contractor’s participation in the MES PCB shall include Contractor submitting to
the PCB changes to Contractor’s Integration and presenting sufficient information
on changes that impact the Technology Solution’s integration with the MES
Ecosystem to allow ARB voting members the ability to make informed decisions
about prioritization.
3.3.3.4.
Processes and Procedures
3.3.3.4.1.
Contractor shall adhere to Processes and Procedures Documents for the ARB, MES
PCB, and Enterprise Governance Council, which are maintained by the Enterprise
Solutions Integrator Contractor.
3.3.4.
Contract Kickoff Meeting
3.3.4.1.
With input from the Department, Contractor shall schedule and facilitate a Contract
Kickoff Meeting that includes all of the following:
3.3.4.1.1.
Identification and introduction of Key Personnel.
3.3.4.1.2.
Identification and introduction of Department leadership.
3.3.4.1.3.
Identification and introduction of Department Project team members.
3.3.4.1.4.
Identification and introduction of any other relevant and needed persons or
organizations.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 16 of 116
3.3.4.2.
Contractor shall develop Contract Kickoff Meeting materials and an agenda that contains,
at a minimum, the following:
3.3.4.2.1.
A description of all activities, Milestones, and Deliverables necessary for Contractor
to be able to complete the Work.
3.3.4.2.2.
Initial timelines for starting the Work and creating a description of all Deliverables.
3.3.4.2.3.
A discussion of transmission methods and specific Deliverable templates or
requirements.
3.3.4.2.4.
Any other item required to initiate and ensure Work is started and completed on time.
3.3.4.3.
DELIVERABLE: Contract Kickoff Meeting
3.3.4.4.
DUE: Not later than 14 days after the Effective Date
3.3.4.5.
Contractor shall prepare Contract Kickoff Meeting Minutes.
3.3.4.5.1.
DELIVERABLE: Contract Kickoff Meeting Agenda & Materials
3.3.4.5.2.
DUE: Not later than three Business Days after the Contract Kickoff Meeting
3.3.5.
Project Status Reports and Meetings
3.3.5.1.
Contractor shall develop Weekly Project Status Reports throughout the Term of the
Contract.
3.3.5.1.1.
The Weekly Project Status Report shall include, at a minimum, all of the following:
3.3.5.1.1.1.
Current work throughout all SDLC phases of the Contract and regarding all terms
and conditions of the Contract applicable to the Work.
3.3.5.1.1.2.
Status of the Project Schedule against the approved baseline.
3.3.5.1.1.3.
Contract performance, including addressing quality, scope, technical, budget, and
operations requirements.
3.3.5.1.1.4.
Risks, Issues, and Change Requests.
3.3.5.1.1.5.
Staffing changes.
3.3.5.1.1.6.
Written recommendations to improve Work processes and efficiencies, as
identified and observed.
3.3.5.1.1.7.
Identification of all Production Incidents.
3.3.5.1.1.8.
Communication regarding Stakeholder engagement.
3.3.5.1.1.9.
Other pertinent metrics related to the Work.
3.3.5.1.2.
DELIVERABLE: Weekly Project Status Report
3.3.5.1.3.
DUE: 24 hours prior to each meeting between Contractor and the Department,
Sponsor, and invited meeting participants, as defined by the Department, during
Operations
3.3.5.2.
Contractor shall facilitate Weekly Status Meetings with the Department.
3.3.5.2.1.
The Weekly Status Meetings shall be conducted by video conference call, as approved
in advance of the Weekly Status Meeting by the Department.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 17 of 116
3.3.5.2.1.1.
Contractor shall ensure that Contractor staff attending the Weekly Status
Meetings have the authority to represent and commit Contractor.
3.3.5.2.2.
Contractor shall address Contractor’s most recent and any prior Weekly Project Status
Report(s) at the Weekly Status Meetings.
3.3.5.3.
Contract Management Reporting
3.3.5.3.1.
Contractor shall prepare a Monthly Contract Management Report throughout the
Term of the Contract.
3.3.5.3.2.
The Monthly Contract Management Report shall include all of the following:
3.3.5.3.2.1.
A reconciliation of issues, tasks, action items, and activities identified in the
current month’s Weekly Project Status Reports for the purpose of identifying
which issues, tasks, action items, and activities have been completed; how those
issues, tasks, action items, and activities were completed; and when those issues,
tasks, action items, and activities were completed.
3.3.5.3.2.2.
Identification of all Production Incidents that occurred during the month and how
those Production Incidents were resolved.
3.3.5.3.2.3.
Metrics and measures for the tracking of data errors.
3.3.5.3.2.4.
Any Latency issues, reflected on a per-month basis.
3.3.5.3.2.5.
Any new items at issue that have not been identified in a Weekly Project Status
Report.
3.3.5.3.2.6.
Any items on any of the current month’s Weekly Project Status Reports that
remain outstanding or unresolved.
3.3.5.3.2.7.
Activities conducted in the previous month by each functional group or unit
within Contractor’s Project organization.
3.3.5.3.2.8.
The achievement of performance standards during the previous month.
3.3.5.3.2.9.
The identification of all performance standards that Contractor did not achieve
during the previous month.
3.3.5.3.2.10.
All changes Contractor implemented in the previous month.
3.3.5.3.2.11.
A projection of which Change Requests will be implemented in upcoming
months.
3.3.5.3.2.12.
Traceability of actual versus estimated resources, time, and cost associated with
each change and each Change Request.
3.3.5.3.2.13.
An application-level hardware and software change release plan and schedule.
3.3.5.3.2.14.
Information on software updates or changes.
3.3.5.3.2.15.
Reporting on all aspects of the Contract that affect:
3.3.5.3.2.15.1.
Budget.
3.3.5.3.2.15.2.
Schedule.
3.3.5.3.2.15.3.
Technology Solution operation and performance scope.
3.3.5.3.2.15.4.
Performance quality.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 18 of 116
3.3.5.3.2.15.5.
Risk.
3.3.5.3.2.15.6.
Issues.
3.3.5.3.2.15.7.
Change Requests.
3.3.5.3.2.15.8.
Applicable resources.
3.3.5.3.2.16.
A description and analysis of Contractor’s and any and all of Contractor’s
Subcontractors’ compliance with Contractor’s responsibilities and performance
standards as set forth in this Contract.
3.3.5.3.2.17.
Metrics and reports on all SLAs defined in the Contract to show that each SLA
has been satisfied in conformity with the SLA requirement.
3.3.5.3.2.18.
A plan for improvement related to any SLA that is not being met.
3.3.5.3.2.19.
Software and hardware licenses and certificates descriptions and versions.
3.3.5.3.2.20.
Whether the Department is compliant and in good standing with the hardware and
software license vendor or owner.
3.3.5.3.2.21.
Any modifications to the Consultative and Technical Support Services.
3.3.5.3.2.22.
Other activities necessary for the Department to monitor Contractor’s
performance of the Work.
3.3.5.3.3.
Contractor shall provide access to the raw data to the Department for purposes of
permitting the Department to accurately assess Contractor’s work with respect to
performance metrics and SLAs.
3.3.5.3.4.
DELIVERABLE: Monthly Contract Management Report
3.3.5.3.5.
DUE: Not later than seven Business Days after the end of each calendar month during
Operations
3.3.5.3.6.
The Department reserves the right to request to meet with Contractor to discuss
Contractor’s Monthly Contract Management Report. Upon the Department’s meeting
request, the Department and Contractor shall meet on a date and time as identified
and directed by the Department.
3.3.6.
Requirements Management Plan
3.3.6.1.
The Contractor shall develop a Requirements Management Plan.
3.3.6.1.1.
The Requirements Management Plan shall include, at a minimum, all of the
following:
3.3.6.1.1.1.
Definition of the process of requirements management.
3.3.6.1.1.2.
Description of the process to capture and record functional, business, and
technical requirements for the Technology Solution.
3.3.6.1.1.3.
Description of the process to communicate, approve, and deliver functional,
business, and technical requirements to the Department.
3.3.6.1.1.4.
Description of a process to trace requirements throughout the SDLC.
3.3.6.1.1.5.
Description of the online tool Contractor will use to develop, store, monitor, and
trace requirements through the Term of the Contract.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 19 of 116
3.3.6.1.1.6.
Description of requirement processes Contractor will utilize to manage
requirements backlog and requirements traceability.
3.3.6.1.2.
DELIVERABLE: Requirements Management Plan
3.3.6.1.3.
DUE: As identified in the Project Schedule
3.3.7.
Requirements Traceability Matrix
3.3.7.1.
Contractor shall provide a Requirements Traceability Matrix (RTM), which includes, at
a minimum, all of the following:
3.3.7.1.1.
Traceability to the state for each functional, business, and technical requirement
throughout the SDLC.
3.3.7.1.2.
Maintain a current list of requirements throughout the SDLC.
3.3.7.1.3.
Retain historic versions.
3.3.7.1.4.
Traceability to all test results to the corresponding functional, business, and technical
requirement throughout the SDLC.
3.3.7.1.5.
Traceability to Defects and their statuses.
3.3.7.1.6.
Traceability to features, product releases, and release approvals.
3.3.7.1.7.
Contractor shall maintain the RTM on a frequency defined by the Department.
3.3.7.1.8.
DELIVERABLE: Initial RTM
3.3.7.1.9.
DUE: As identified in the Project Schedule
3.3.7.2.
DELIVERABLE: Updated RTM
3.3.7.3.
DUE: Monthly, no later than the 15
th
day of each month
3.3.8.
Training Management Plan
3.3.8.1.
Contractor shall develop a Training Management Plan for Contractor’s Technology
Solution’s software and services.
3.3.8.1.1.
The Training Management Plan shall include, at a minimum, all of the following:
3.3.8.1.1.1.
The identification of when the information in the Training Management Plan will
be implemented.
3.3.8.1.1.2.
Schedule of training, to occur not less than bi-annually, for the Term of the
Contract.
3.3.8.1.1.3.
Training approach.
3.3.8.1.1.4.
Training delivery methodologies, such as face-to-face training, online Instructor-
Led Training (ILT), webinar training, or other training.
3.3.8.1.1.5.
Process for identifying training needs.
3.3.8.1.1.6.
Process for communicating and scheduling training.
3.3.8.1.1.7.
Training deployment.
3.3.8.1.2.
DELIVERABLE: Training Management Plan
3.3.8.1.3.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 20 of 116
3.3.9.
Operational Readiness Plan
3.3.9.1.
Contractor shall develop an Operational Readiness Plan.
3.3.9.1.1.
The Operational Readiness Plan shall include, at a minimum, all of the following:
3.3.9.1.1.1.
Description of operational readiness assessment criteria including, but not limited
to:
3.3.9.1.1.1.1.
A complete list all templates, tools, and procedures to be used during
operational readiness activities.
3.3.9.1.1.1.2.
Contractor’s Technology Solution’s readiness in order to Go-Live.
3.3.9.1.1.1.3.
Contractor’s Technology Solution’s maintenance and downtime schedule.
3.3.9.1.1.1.4.
Provider onboarding schedules and trainings as identified in the Project
Schedule.
3.3.9.1.1.2.
Process for conducting a final Operational Readiness Review with the Department
and as defined by the Department.
3.3.9.1.1.3.
Alignment to the Department’s processes, which the Department will
communicate to Contractor.
3.3.9.1.2.
DELIVERABLE: Operational Readiness Plan
3.3.9.1.3.
DUE: As identified in the Project Schedule
3.3.10.
Final Operational Readiness Assessment Document
3.3.10.1.
Contractor shall develop a Final Operational Readiness Assessment Document for the
implementation of Contractor’s Technology Solution.
3.3.10.1.1.
The Final Operational Readiness Assessment Document and any subsequent updates
shall include, at a minimum, all of the following:
3.3.10.1.1.1.
Test results.
3.3.10.1.1.2.
Risk assessment and contingency plan.
3.3.10.1.1.3.
Documentation of any known Defects that will be moved to Production as part of
the implementation process.
3.3.10.1.1.4.
Contractor’s communication and outreach process to the Department during the
implementation of Contractor’s Technology Solution.
3.3.10.1.2.
DELIVERABLE: Final Operational Readiness Assessment Document
3.3.10.1.3.
DUE: As identified in the Project Schedule
3.3.11.
Operational Readiness Review Meetings
3.3.11.1.
Contractor shall develop and present to the Department Operational Readiness Review
Meetings for the Department’s review and approval for the purpose of identifying where
Contractor, the Department, and Stakeholders are in relation to implementing a Project,
to review each Final Operational Readiness Assessment Document, and for the
Department to make Go/No Go decisions.
3.3.11.2.
Each Operational Readiness Review Meeting shall consist of Contractor conducting an
operational demonstration of Contractor’s Technology Solution.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 21 of 116
3.3.11.3.
DELIVERABLE: Operational Readiness Review Meeting
3.3.11.4.
DUE: As identified in the Project Schedule
3.3.12.
CMS Certification Implementation Plan
3.3.12.1.
Contractor shall create a CMS Certification Implementation Plan related to the DDI of
the APM 2 Program within Contractor’s Technology Solution related to Section 3.3.16.
3.3.12.1.1.
The CMS Certification Implementation Plan shall include, at a minimum, all of the
following:
3.3.12.1.1.1.
Description of Contractor’s Technology Solution’s integration and development
process that includes the identification of any and all integration of data sources,
and which data sources will be provided by the Department the Contractor.
3.3.12.1.1.2.
Identification of tasks and activities for transition from DDI into Maintenance and
Operations (M&O).
3.3.12.1.1.3.
Description of the expectation for Department Staff.
3.3.12.1.1.4.
Transition Milestones.
3.3.12.1.1.5.
Entrance and exit criteria.
3.3.12.1.1.6.
Schedule for transition.
3.3.12.1.1.7.
Production program and documentation update procedures during transition.
3.3.12.1.1.8.
Parallel test procedure.
3.3.12.1.1.9.
Interface testing.
3.3.12.1.1.10.
The identification of when the information contained in the CMS Certification
Implementation Plan will be implemented.
3.3.12.1.2.
DELIVERABLE: CMS Certification Implementation Plan
3.3.12.1.3.
DUE: As identified in the Project Schedule
3.3.13.
Operations and Maintenance Plan
3.3.13.1.
Contractor shall develop an Operations and Maintenance Plan that shall be executed
during M&O, defined as the period of time after Contractor’s Technology Solution goes
live into Production through the end of the Term of the Contract.
3.3.13.2.
Contractor shall perform operations and maintenance of Contractor’s Technology
Solution.
3.3.13.3.
The Operations and Maintenance Plan shall, at a minimum, address all of the following:
3.3.13.3.1.
An Operational Documentation and Guide that shall include, at a minimum, all of the
following:
3.3.13.3.1.1.
A guide that addresses technology and infrastructure.
3.3.13.3.1.2.
A guide that addresses operations and maintenance.
3.3.13.3.1.3.
A guide that addresses End User documentation based on each identified End
User role.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 22 of 116
3.3.13.3.1.4.
A guide that addresses protocols for Providers being terminated as Health First
Colorado Providers when the Provider’s access to Contractor’s Technology
Solution has been revoked.
3.3.13.3.1.5.
Help Desk Management Plan that includes Help Desk activities support services.
3.3.13.3.1.6.
Documentation of components and procedures so that Contractor’s Technology
Solution can be operated by other Users, including the Department or
Department’s contractors.
3.3.13.3.1.7.
Contractor’s operational tasks, activities, and Workflow.
3.3.13.3.1.8.
Standard Operating Procedures (SOPs), as applicable.
3.3.13.3.1.9.
Quality assurance controls to ensure compliance with established Contract
standards, such as SOPs, protocols, and best practices.
3.3.13.3.1.10.
The identification of policies and procedures, ensuring adherence to CMS
Documentation Standards and Conditions, which is part of the CMS Standards
and Conditions.
3.3.13.3.1.11.
A tracking process for Production Incidents and Defects.
3.3.13.3.1.12.
A tracking process for Change Requests.
3.3.13.3.1.13.
Contractor’s approach to communications and Contractor’s support procedures.
3.3.13.3.1.14.
The processes to develop and facilitate a Lessons Learned Report among
Contractor, the Department, and any Stakeholders, as identified by the
Department.
3.3.13.3.1.15.
Project successes and failures.
3.3.13.3.1.16.
Evaluation metrics as approved by the Department.
3.3.13.3.1.17.
User satisfaction.
3.3.13.3.1.18.
Ongoing contingencies or problems.
3.3.13.3.1.19.
Contractor’s Technology Solution acceptance procedures.
3.3.13.3.1.20.
Monitoring of daily performance of Contractor’s Technology Solution.
3.3.13.3.1.21.
Plan for maintaining security on a database, network, and individual Authorized
User level, including maintenance of Authorized User accounts.
3.3.13.3.1.22.
Proposed Contractor staffing model and role and responsibilities for the
Maintenance and Operations Phase.
3.3.13.3.1.23.
Process for submitting operations problem reports to the Department when
operational problems occur, including the following information:
3.3.13.3.1.23.1.
The nature of the problem.
3.3.13.3.1.23.2.
The expected impact of ongoing functions.
3.3.13.3.1.23.3.
A plan to correct the problem.
3.3.13.3.1.23.4.
The expected time of problem resolution.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 23 of 116
3.3.13.3.1.24.
The identification of the methods by which Contractor shall receive reports of
problems, questions, or Technology Solution problems in the Production
Environment.
3.3.13.3.1.25.
The identification of when the information contained in the Operations and
Maintenance Plan will be implemented.
3.3.13.3.2.
DELIVERABLE: Operations and Maintenance Plan
3.3.13.3.3.
DUE: As identified in the Project Schedule
3.3.14.
Lessons Learned Report
3.3.14.1.
Contractor shall document the results of lessons, as defined in the Department’s Lessons
Learned Model, to reduce the occurrence of Defects in future work and processes as part
of a continuous improvement process.
3.3.14.2.
After complying with the Department’s Lessons Learned Model, which Department may
modify in its sole discretion, Contractor shall facilitate debrief meeting sessions to discuss
lessons learned for all Projects and programs included in this Exhibit B and provide a
walkthrough of all final documentation and recommendations.
3.3.14.3.
Contractor shall create a Lessons Learned Report.
3.3.14.3.1.
The Lessons Learned Report shall include all of the requirements set out in the
Department’s Lessons Learned Model.
3.3.14.3.2.
DELIVERABLE: Lessons Learned Report
3.3.14.3.3.
DUE: As identified in the Project Schedule
3.3.15.
Quality Management Plan
3.3.15.1.
Contractor shall develop a Quality Management Plan.
3.3.15.1.1.
The Quality Management Plan shall include, at a minimum, all of the following:
3.3.15.1.1.1.
Methodology/methodologies for maintaining quality Work Products, Project
Schedule, Deliverables, and Subcontractor’s activities, such as: requirements
validation and execution, design and development validation and execution, and
test scenario and test case validation and execution.
3.3.15.1.1.2.
Quality relating to data integration.
3.3.15.1.1.3.
Performance standards development and measurement.
3.3.15.1.1.4.
Customer satisfaction measurement and lessons learned analysis.
3.3.15.1.1.5.
Operational processes and outcomes.
3.3.15.1.1.6.
The identification of when the information contained in the Quality Management
Plan will be implemented.
3.3.15.1.2.
DELIVERABLE: Quality Management Plan
3.3.15.1.3.
DUE: As identified in the Project Schedule
3.3.16.
APM 2 Program CMS Certification Management Plan
3.3.16.1.
Contractor shall develop an APM 2 Program CMS Certification Management Plan.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 24 of 116
3.3.16.1.1.
Contractor shall use the SMC methodology for completing the APM 2 Program CMS
Certification Management Plan.
3.3.16.1.2.
The APM 2 Program Certification Management Plan shall include, at a minimum, all
of the following:
3.3.16.1.2.1.
An outline of the methodology, tools, timeline, and resources required to manage
the CMS Certification process for Contractor’s Technology Solution.
3.3.16.1.2.2.
A plan to attend all Certification-related meetings, as defined by the Department
and communicated to Contractor.
3.3.16.1.2.3.
A plan to produce all Certification documentation, as defined by the Department
and CMS and communicated to Contractor.
3.3.16.1.2.4.
A plan to facilitate a live production demonstration of Contractor’s Technology
Solution during required CMS Certification review meetings.
3.3.16.1.2.5.
A plan to achieve CMS Certification of Contractor’s Technology Solution
backdated to the Go-Live Date.
3.3.16.1.3.
Contractor shall provide Contract-related documentation in compliance with CMS’s
requirements and guidance.
3.3.16.1.4.
DELIVERABLE: APM 2 Program CMS Certification Management Plan
3.3.16.1.5.
DUE: As identified in the Project Schedule
3.3.17.
CMS Certification
3.3.17.1.
Contractor shall provide a Technology Solution that is compliant with CEF and CMS
Standards and Conditions.
3.3.17.2.
Contractor shall ensure that the Technology Solution meets CMS Certification
requirements for the maximum allowable Federal Financial Participation (FFP) and
complies with CMS Certification requirements on the Go-Live Date. The Department
acknowledges that Contractor cannot guarantee any assumed federal matching
percentages.
3.3.17.3.
Contractor shall work with the Department to support existing Department standards and
processes in support of CMS Certification activities for the Technology Solution.
3.3.17.3.1.
Contractor’s support shall include, but is not limited to, all of the following:
3.3.17.3.1.1.
Providing outcomes-based evidence and supporting metrics.
3.3.17.3.1.2.
Providing data, reports, and performance information, pursuant to 42 C.F.R. §§
433.112(b)(15) and 433.116(b), (c), and (i), as applicable.
3.3.17.3.1.3.
Providing applicable design documentation.
3.3.17.3.1.4.
Providing applicable test results documentation.
3.3.17.3.1.5.
Providing plans for organizational change management (e.g., managing
Stakeholders and Users, training, Help Desk).
3.3.17.3.1.6.
Participating in CMS Certification planning meetings with the Department.
3.3.17.3.1.7.
Participating in CMS Certification review meetings with the Department and
CMS, as applicable.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 25 of 116
3.3.17.3.1.8.
Facilitating live demonstrations of Technology Solution functionality, as
requested by the Department or CMS to support CMS Certification review
meetings.
3.3.17.3.1.9.
Participating in a lessons learned review with the Department after the CMS
Certification project is completed.
3.3.17.3.2.
DELIVERABLE: CMS Certification of the Technology Solution as identified by the
Department
3.3.17.3.3.
DUE: As identified in the Project Schedule
3.3.18.
Requirements Specifications Document
3.3.18.1.
Contractor shall develop a Requirements Specifications Document (RSD).
3.3.18.1.1.
The RSD shall include, at a minimum, all of the following:
3.3.18.1.1.1.
An architecture overview of how components will be integrated.
3.3.18.1.1.2.
Detailed Requirements Specification.
3.3.18.1.1.3.
Identification of changes to existing requirements.
3.3.18.1.1.4.
Clarifying information associated with requirements, as needed.
3.3.18.1.1.5.
Identification of new requirements.
3.3.18.1.1.6.
Explanation of how requirements will be met.
3.3.18.1.1.7.
Identification of the entity responsible for meeting the requirement.
3.3.18.1.1.8.
A logical data model that identifies the entities, relationships, attributes, and
access paths.
3.3.18.1.1.9.
Description of the hardware/software configuration that will be used to meet the
requirement.
3.3.18.1.1.10.
The identification of when the information contained in the RSD will be
implemented.
3.3.18.1.2.
DELIVERABLE: RSD
3.3.18.1.3.
DUE: As identified in the Project Schedule
3.3.18.2.
Contractor shall plan, communicate, and facilitate an RSD Requirement Review and
Validation Session Meeting with the Department to discuss the RSD, applicable policies,
and other topics as defined by the Department. At the Department’s discretion, multiple
RSD Requirement Review and Validation Session Meetings may be required.
3.3.18.2.1.
DELIVERABLE: RSD Requirement Review and Validation Session Meeting
3.3.18.2.2.
DUE: As directed by the Department
3.3.19.
Design Specification Document
3.3.19.1.
Contractor shall develop a Design Specification Document (DSD).
3.3.19.1.1.
The DSD shall include, at a minimum, all of the following:
3.3.19.1.1.1.
Process Workflows.
3.3.19.1.1.2.
The identification of interfaces.
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3.3.19.1.1.3.
The identification of applicable Project Artifacts.
3.3.19.1.1.4.
The identification of when the information contained in the DSD will be
implemented.
3.3.19.1.2.
DELIVERABLE: DSD
3.3.19.1.3.
DUE: As identified in the Project Schedule
3.3.20.
Business Continuity and Disaster Recovery Plan
3.3.20.1.
Contractor shall create a Business Continuity and Disaster Recovery (BC/DR) Plan that
Contractor shall follow in order to continue operations after a Disaster or Business
Interruption.
3.3.20.1.1.
The BC/DR Plan shall include, but is not limited to, all of the following:
3.3.20.1.1.1.
How Contractor will replace Contractor’s staff that are lost or unavailable during
or after a Business Interruption so that the Work is performed in accordance with
the Contract.
3.3.20.1.1.2.
How Contractor will back-up all information necessary to continue performing
the Work, so that no information is lost because of a Business Interruption.
3.3.20.1.1.2.1.
The plan shall also include how Contractor will make all information available
at its back-up facilities.
3.3.20.1.1.2.2.
The plan shall also include how Contractor will ensure no greater than five
minutes of Committed Transaction data is lost during a Disaster or Business
Interruption.
3.3.20.1.1.3.
How Contractor will maintain complete back-up copies of all data, databases,
operating programs, files, Technology Solution, and software pertaining to
enrollment information at a Department-approved, off-site location.
3.3.20.1.1.4.
How Contractor will minimize the effects on Members of any Business
Interruption.
3.3.20.1.1.5.
How Contractor will communicate with the Department during the Business
Interruption and points of contact within Contractor’s organization the
Department can contact in the event of a Business Interruption.
3.3.20.1.1.6.
Planned long-term back-up facilities out of which Contractor can continue
operations after a Disaster.
3.3.20.1.1.7.
The time period it will take to transition all activities from Contractor’s regular
facilities to the back-up facilities after a Disaster.
3.3.20.1.2.
DELIVERABLE: BC/DR Plan
3.3.20.1.3.
DUE: As identified in the Project Schedule
3.3.20.2.
Contractor shall annually test its processes and procedures to ensure compliance with the
requirements of the BC/DR Plan and affirm such compliance to the Department.
3.3.20.2.1.
DELIVERABLE: Annual BC/DR Plan Affirmation
3.3.20.2.2.
DUE: Annually, by June 1
3.3.21.
Contract Turnover Plan
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3.3.21.1.
Contractor shall develop a Contract Turnover Plan that addresses all requirements, steps,
timelines, Milestones, and Deliverables, which shall include but not be limited to
Contractor’s Technology Solution subscriptions, such as business logic, and data,
necessary to fully transition the Work described in the Contract from Contractor to the
Department or to another contractor selected by the Department, in the Department’s sole
discretion, to be the contractor after the termination of the Contract.
3.3.21.1.1.
The Contract Turnover Plan shall include, at a minimum, all of the following:
3.3.21.1.1.1.
Approach to transition.
3.3.21.1.1.2.
Approach for conducting a knowledge transfer from Contractor to a new
contractor selected by the Department.
3.3.21.1.1.3.
Approach to consolidate applicable sections from Contractor’s Contract Turnover
Plan into the transition planning activity.
3.3.21.1.1.4.
The identification of an individual to act as Contractor’s closeout coordinator.
3.3.21.1.1.5.
Processes by which Contractor’s closeout coordinator shall complete the
following tasks:
3.3.21.1.1.5.1.
Manage the fulfillment of all requirements of the Contract Turnover Plan for
purposes of verifying that all requirements of the Contract Turnover Plan are
completed in compliance with the Contract Turnover Plan.
3.3.21.1.1.5.2.
Manage the fulfillment of all steps required by the Contract Turnover Plan for
purposes of verifying that all steps required by the Contract Turnover Plan are
completed in compliance with the Contract Turnover Plan.
3.3.21.1.1.5.3.
Manage the fulfillment of and compliance with the timelines set out in the
Contract Turnover Plan for purposes of verifying that all timelines set out in
the Contract Turnover Plan are maintained in compliance with the Contract
Turnover Plan.
3.3.21.1.1.5.4.
Manage the fulfillment of the Milestones identified in the Contract Turnover
Plan for purposes of verifying that the Milestones identified in the Contract
Turnover Plan are achieved.
3.3.21.1.1.5.5.
Manage the development of all Deliverables for the purposes of verification
and compliance with the Contract Turnover Plan. Deliverables identified in
the Contract Turnover Plan shall be completed in compliance with the
Contract Turnover Plan.
3.3.21.1.1.6.
The identification of when the information contained in the Contract Turnover
Plan will be implemented.
3.3.21.1.2.
Contractor shall work with the Department and any other contractor to minimize the
impact of the transition on Stakeholders, Department Staff, and existing MES
Vendors.
3.3.21.1.3.
DELIVERABLE: Contract Turnover Plan
3.3.21.1.4.
DUE: No later than 365 days after the Effective Date
3.3.21.2.
The performance of the tasks identified in the Contract Turnover Plan may extend past
the termination of the Contract. The Department will perform a closeout review to ensure
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that Contractor has completed all requirements of the Contract Turnover Plan. If
Contractor has not completed all of the requirements of the Contract Turnover Plan by
the date of the termination of the Contract, then any incomplete requirements shall survive
termination of the Contract.
3.3.22.
Consultative and Technical Support Services
3.3.22.1.
Contractor shall provide Project Management, technical advisory services, and
consultative services to the Department for purposes of achieving the successful
implementation of the Technology Solution.
3.3.22.2.
Contractor shall be responsible for hiring, onboarding staff newly hired by Contractor,
training staff newly hired by Contractor, or engaging in any other process related to
Contractor’s decision to allocate Contractor’s staff or other agent resources to perform
Work on this Contract, regardless of terminology.
3.3.22.3.
Contractor shall work with the Department at the start of each State Fiscal Year (SFY) to
prioritize the Consultative and Technical Support Services that Contractor shall execute
during that SFY.
3.3.22.3.1.
Skill categories will be defined by Contractor.
3.3.22.3.2.
Contractor’s Project staff allocated to each Technical and Consultative Support
Service effort will be selected for the skills and capabilities necessary to complete
each effort.
3.3.22.3.3.
Modifications to annually planned Consultative and Technical Support Services will
be addressed as part of Monthly Contract Management Report conducted in
conjunction with the Department.
3.4.
Operations
3.4.1.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit a Revised Master Project Management Plan for Department review and
approval. The requirements of the Master Project Management Plan are identified at Sections
3.2.1 through 3.2.9.1.5.
3.4.1.1.
DELIVERABLE: Revised Master Project Management Plan
3.4.1.2.
DUE: Quarterly, as identified in the Project Schedule
3.4.2.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit a Revised Project Schedule for Department review and approval. The
requirements of the Project Schedule are identified at Sections 3.2.2.1 through 3.2.2.1.3.
3.4.2.1.
DELIVERABLE: Project Schedule Update
3.4.2.2.
DUE: At the due date identified for the Revised Master Project Management Plan (see
Section 3.4.1.2)
3.4.3.
Notwithstanding any provision to the contrary in this Contract, Contractor shall review,
update, and submit a Revised Communications Management Plan for Department review and
approval upon the Department’s request. The requirements of the Communications
Management Plan are identified at Sections 3.2.5.1 through 3.2.5.1.1.8.
3.4.3.1.
If any change is made to the Communications Management Plan at any time, Contractor
shall submit a Revised Communications Management Plan to the Department.
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3.4.3.1.1.
DELIVERABLE: Revised Communications Management Plan
3.4.3.1.2.
DUE: Upon any change or as identified and determined by the Department
3.4.4.
Notwithstanding any provision to the contrary in this Contract, Contractor shall review,
update, and submit a Revised Resource Management Plan and Organizational Structure for
Department Review and approval. The requirements of the Resource Management Plan and
Organizational Structure are identified at Sections 3.2.7.1 through 3.2.7.1.1.7.
3.4.4.1.
DELIVERABLE: Revised Resource Management Plan and Organizational Structure
3.4.4.2.
DUE: At the due date identified for the Revised Master Project Management Plan (see
Section 3.4.1.2)
3.4.5.
Notwithstanding any provision to the contrary in this Contract, Contractor shall review,
update, and submit Updated Weekly Project Status Reports for Department’s review and
approval. The requirements of the Weekly Project Status Report are identified at Sections
3.3.5.1 through 3.3.5.1.1.9.
3.4.5.1.
DELIVERABLE: Updated Weekly Project Status Report
3.4.5.2.
DUE: 24 hours prior to each weekly meeting, after the initial weekly meeting, between
Contractor and the Department, Sponsor, and invited meeting participants, as defined by
the Department, ongoing after Operations begin
3.4.6.
Notwithstanding any provision to the contrary in this Contract, Contractor shall review,
update, and submit Updated Monthly Contract Management Reports for the Department’s
review and approval. The requirements of the Monthly Contract Management Report are
identified at Sections 3.3.5.3.1 through 3.3.5.3.3.
3.4.6.1.
DELIVERABLE: Updated Monthly Contract Management Report
3.4.6.2.
DUE: Not later than seven Business Days after the end of each calendar month
3.4.7.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit an Updated Lessons Learned Report for the Department’s review and
approval. The requirements of the Lessons Learned Report are identified at 3.3.14.3 through
3.3.14.3.1.
3.4.7.1.
DELIVERABLE: Updated Lessons Learned Report
3.4.7.2.
DUE: As identified in the Project Schedule
3.4.8.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit a Revised BC/DR Plan for the Department’s review and approval. The
requirements of the BC/DR Plan are identified at Sections 3.3.20.1 through 3.3.20.1.1.7.
3.4.8.1.
DELIVERABLE: Revised BC/DR Plan
3.4.8.2.
DUE: Annually, by June 1
3.4.9.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit a Revised Contract Turnover Plan for the Department’s review and
approval. The requirements of the Contract Turnover Plan are identified at Sections 3.3.21.1
through 3.3.21.1.2.
3.4.9.1.
DELIVERABLE: Revised Contract Turnover Plan
3.4.9.2.
DUE: Annually, by July 1
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4.
TECHNOLOGY SOLUTION REQUIREMENTS
4.1.
Technology Solution Integration
4.1.1.
At a minimum, Contractor’s Technology Solution shall support all of the following
Integration methods:
4.1.1.1.
API provisioning where data is provided via APIs.
4.1.1.2.
Extract Transform Load (ETL) where data is supplied in files, optionally transformed,
and delivered in files. The Department will make data available in Contractor’s requested
formats within the requested timeframes as agreed by the Parties. The Department will
supply to Contractor up to three years of Medicaid data files and any available Colorado
All-Payer Claims Database (CO APCD) data files that contain medical and pharmacy
claims, eligibility files, Provider directory information, and data dictionary. The Parties
agree that if the ETL processing and conversion of the data takes more than four weeks
to process, then the Project Schedule may require revision.
4.1.1.3.
Batching where data is provided via a Real Time API, collected, and periodically
delivered in files.
4.1.1.4.
De-batching where data is provided in files, then parsed, and delivered by calling an
external API.
4.1.2.
Contractor shall provide a service catalog of APIs, if necessary.
4.1.3.
Contractor shall include API metrics to the Department that include, but are not limited to,
all of the following metrics:
4.1.3.1.
Runtime management.
4.1.3.2.
Security monitoring.
4.1.3.3.
Usage monitoring.
4.1.4.
Contractor shall design, develop, and implement Integration solutions through an approved
SDLC process utilizing best practices, as defined by the Department’s MES Governance
Plan, which the Department will provide to Contractor.
4.1.5.
Contractor shall provide mapping and transformation processes for inbound and outbound
Integration and interface transmissions.
4.1.5.1.
Contractor shall document all transformations.
4.1.6.
Contractor shall provide Real Time data monitoring and analysis to monitor the consistency,
quality, integrity, and overall health of the data for the purpose of maintaining accuracy and
completeness of the data within Contractor’s Technology Solution.
4.1.7.
Contractor shall provide ongoing data monitoring and analysis to monitor the consistency,
quality, and overall health of Contractor’s Technology Solution, such as quality and interface
files.
4.1.8.
Contractor’s Technology Solution shall be scalable, configurable, and provide for technical
tools, applications, and data security for implementations.
4.1.9.
Contractor shall provide ETL software and tools to support data management and data
sharing.
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4.1.10.
Contractor’s Technology Solution shall have the ability to exchange data with the following
systems:
4.1.10.1.
Medicaid Management Information System (MMIS)
4.1.10.1.1.
Contractor’s Technology Solution shall have the ability to transmit data elements in
a predefined format as identified by the Department’s Enterprise Solutions Integrator
Contractor and the Department.
4.1.10.1.1.1.
The data elements subject to transmission shall include, at a minimum, all of the
following:
4.1.10.1.1.1.1.
The exchange of Member data.
4.1.10.1.1.1.2.
The exchange of Provider data.
4.1.10.1.1.1.3.
The exchange of claims data.
4.1.10.1.1.1.4.
The exchange of utilization management data.
4.1.10.1.1.1.5.
Other required data, as identified by the Department.
4.1.10.2.
Business Intelligence Data Management (BIDM)
4.1.10.2.1.
Contractor’s Technology Solution shall have the ability to transmit data elements in
a predefined format as identified by the Department’s Enterprise Solutions Integrator
Contractor and the Department.
4.1.10.2.1.1.
The data elements subject to transmission shall include, at a minimum, all of the
following:
4.1.10.2.1.1.1.
The exchange of Member data.
4.1.10.2.1.1.2.
The exchange of Provider data.
4.1.10.2.1.1.3.
The exchange of claims data.
4.1.10.2.1.1.4.
The exchange of utilization management data.
4.1.10.2.1.1.5.
Data generated by Contractor’s Technology Solution.
4.1.10.2.1.1.6.
Other required data, as identified by the Department.
4.1.10.3.
Enterprise Solutions Integrator Platform
4.1.10.3.1.
Contractor’s Technology Solution shall have the ability to transmit data elements in
a predefined format as identified by the Department’s Enterprise Solutions Integrator
Contractor and the Department.
4.1.10.3.1.1.
The data elements subject to transmission shall include, at a minimum, all of the
following:
4.1.10.3.1.1.1.
The exchange of Member data.
4.1.10.3.1.1.2.
The exchange of Provider data.
4.1.10.3.1.1.3.
The exchange of claims data.
4.1.10.3.1.1.4.
The exchange of utilization management data.
4.1.10.3.1.1.5.
Data generated by Contractor’s Technology Solution.
4.1.10.3.1.1.6.
Other required data, as identified by the Department.
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4.1.11.
Contractor’s Technology Solution shall provide all the following functionality:
4.1.11.1.
The ability to send and receive data via a cloud platform data exchange within and
between Department MES Modules using industry proven cloud hosting technologies
(such as Amazon Web Services or Google Cloud Platform).
4.1.12.
Contractor shall establish and maintain an interface through the Department’s Enterprise
Solutions Integrator Contractor to the Department’s defined systems to upload and download
data as required by the Department, as necessary and as defined by the Department-approved
Interface Control Documents identified in Section 3.3.2.
4.1.13.
After implementation of Contractor’s production-ready Technology Solution to the
Department, Contractor shall be responsible for the M&O of Contractor’s Technology
Solution, in conformity with the Operations and Maintenance Plan.
4.1.14.
Contractor’s Technology Solution shall interface with any other system or solution as
directed by the Department through the Department’s Enterprise Solutions Integrator
Contractor.
4.1.15.
The Contractor shall provide integration architecture framework that accomplishes the
following objectives:
4.1.15.1.
Permits continuous digital transformation.
4.1.15.2.
Enables bidirectional Integrations and/or interfaces.
4.1.15.3.
Enables data imports.
4.1.15.4.
Enables data exports.
4.1.15.5.
Supports connectivity to Existing Systems.
4.1.15.6.
Interfaces and/or integrates with new modular solution implementations when not
available through the Department’s Enterprise Solutions Integrator solution.
4.2.
Technology Solution Capabilities
4.2.1.
Contractor’s Technology Solution shall have the ability to:
4.2.1.1.
Generate Provider performance reports and format the data output, including the type of
reports, applications, and data sets.
4.2.1.2.
Deliver timely, accessible, and actionable Provider reports.
4.2.1.3.
Send, receive, and process data inputs incorporated in Contractor’s Technology Solution
on a regular and consistent basis.
4.2.1.4.
For Department Users, integrate with the Department’s Single Sign On (SSO) solution to
allow Department Users to sign on between the Department’s MES systems to
Contractor’s Technology Solution without a separate set of credentials. All input data to
support SSO integration shall be provided in Contractor-specified format.
4.2.1.5.
For Provider Users, integrate with the Department’s SSO solution (the SSO solution may
be the Contractor’s SSO or the SSO used for Providers connecting to the BIDM) to allow
Providers to sign on between the Department’s BIDM Provider Portal, as identified and
provided by the Department and intended to be included as part of the Modification
Enhancement Hours (see Section 11), to Contractor’s Technology Solution without a
separate set of credentials.
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4.2.1.6.
Make data available to Providers’ Electronic Health Records (EHRs) systems through an
interface(s) (e.g., API, HL7). Contractor shall configure one Interface that Providers can
access and potentially a second Interface for the two HIEs in the State (i.e., Contexture
and QHN).
4.2.1.6.1.
The
interface(s) (e.g., APIs, HL7)
shall allow data on a specific individual, rather than
on all individuals attributed to the Provider, to be sent to the Provider’s EHR.
4.2.1.7.
Make data available to HIEs in Colorado so HIEs can design a view of the data and
metrics produced by Contractor’s Technology Solution that is available to Providers
through HIEs’ Provider portals or directly into Providers’ EHRs systems sent through
HIEs.
4.2.1.7.1.
Contractor shall work with HIEs in Colorado to determine which variables in
Contractor’s Technology Solution should be displayed to Providers through the HIE
and how such variables should be displayed to Providers.
4.2.1.7.2.
Make data available to HIEs in Colorado through an
interface(s) (e.g., APIs, HL7)
.
4.2.1.7.2.1.
Contractor shall work with HIEs in Colorado to determine which variables in
Contractor’s Technology Solution will be sent through the interface and the
design of the interface(s).
4.2.1.7.2.1.1.
The interface(s) shall allow data on a specific individual, rather than all
individuals attributed to a Provider, HIE, or network, to be sent to an HIE.
4.2.1.7.3.
Make data available to HIEs in Colorado through a batch file on a schedule
determined by the Parties.
4.2.1.7.3.1.
Contractor shall work with HIEs in Colorado to determine which variables in
Contractor’s Technology Solution will be sent through the batch file, the design
of the batch file exchange, and to create a schedule to send batch files.
4.2.1.8.
Display Provider-specific Dashboards to Providers that can be modified to provide to
focus on specific metrics or services the Provider should consider as a priority (e.g., Gap
in Care reporting to identify a discrepancy between evidence-based recommendations).
4.2.1.9.
Adapt and scale to support Contractor’s Technology Solution’s growth and evolution.
5.
DATA MANAGEMENT
5.1.
Contractor shall be responsible for all of the following:
5.1.1.
Data confidentiality, meaning Contractor shall prevent disclosure of data to unauthorized
persons or systems.
5.1.2.
Data integrity, meaning that Contractor shall not modify data undetectably.
5.1.3.
Data availability, meaning Contractor does not inappropriately block or deny access to an
Authorized User.
5.1.4.
Data authenticity, meaning Contractor shall validate transactions.
5.1.5.
Data security, meaning Contractor shall encrypt and comply with Department-approved
security protocols and processes, as defined in Sections 2.10, 2.11, and 6.
5.1.6.
Non-repudiation of Data, meaning Contractor shall ensure that parties to a transaction cannot
deny the party’s participation in the transaction.
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5.2.
Data Dictionary
5.2.1.
Contractor shall develop a Data Dictionary.
5.2.1.1.
The Data Dictionary shall include, at a minimum, all of the following:
5.2.1.1.1.
A listing of all data elements, including:
5.2.1.1.1.1.
Data element name.
5.2.1.1.1.2.
Data element description.
5.2.1.1.1.3.
Optionality.
5.2.1.1.1.4.
Valid values.
5.2.1.1.1.5.
Linkage to other data structures, such as interface formats and Contractor’s Data
Model (defined as the Data Dictionary and the Mapping Documents).
5.2.1.1.1.6.
A feature to map data elements.
5.2.1.1.1.7.
The definition of data exchange transactions.
5.2.1.1.1.8.
The definition of immutability.
5.2.1.1.1.9.
The definition of traceability.
5.2.1.1.1.10.
The definition of auditability.
5.2.1.1.1.11.
The inclusion of predefined Integration governance protocols.
5.2.1.1.1.12.
Identification of when the information contained in the Data Dictionary will be
implemented.
5.2.1.2.
DELIVERABLE: Data Dictionary
5.2.1.3.
DUE: As identified in the Project Schedule
5.2.1.4.
Notwithstanding any provision in the Contract to the contrary, Contractor shall review,
update, and submit a Revised Data Dictionary for Department review and approval at
least annually and before any implementation of a Revised Data Dictionary. If no changes
have occurred, Contractor shall provide a summary report that indicates no changes have
occurred.
5.2.1.4.1.
If any change is made to the Data Dictionary at any time during the year, Contractor
shall submit a Revised Data Dictionary to the Department for review and approval
prior to implementation of the Revised Data Dictionary.
5.2.1.4.2.
DELIVERABLE: Revised Data Dictionary
5.2.1.4.3.
DUE: As identified in the Project Schedule
5.3.
Mapping Documents
5.3.1.
Contractor shall use mapping document tools that align the planning efforts.
5.3.2.
Contractor shall develop Mapping Documents for all data requiring conversion.
5.3.2.1.
The Mapping Documents shall identify all transformation steps from Source to Target.
5.3.2.1.1.
DELIVERABLE: Mapping Documents
5.3.2.1.2.
DUE: As identified in the Project Schedule
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5.4.
Data Defects
5.4.1.
Contractor shall implement methods to detect Defects and Anomalies within Contractor’s
Technology Solution and provide a notification of the Defect or Anomaly via alert, email,
and any other available means of notification to the End User.
5.4.1.1.
DELIVERABLE: Notification
5.4.1.2.
DUE: Within two hours after Contractor identifies the Defect or Anomaly
6.
SECURITY
6.1.
Compliance with Federal and State Requirements
6.1.1.
At a minimum, Contractor shall ensure that the Technology Solution:
6.1.1.1.
Supports HIPAA-compliant and 42 C.F.R. Part 2-compliant data sharing.
6.1.1.1.1.
Contractor shall not share or make available any Part 2 data with or to any entity other
than the Department unless Contractor has received the Department’s permission to
share or make available Part 2 data to the specific entity.
6.1.1.1.2.
Contractor shall provide and make available to the Department all contracts with
Subcontractors that identify, address, or otherwise affect Part 2 data, upon the
Department’s request.
6.1.1.1.3.
A notification in the Technology Solution that identifies and communicates to all
Users, at a minimum, all of the following information:
6.1.1.1.3.1.
The existence of Part 2 data in the Technology Solution.
6.1.1.1.3.2.
Restrictions and limitations on and disclosure of Part 2 data.
6.1.1.1.3.3.
Information related to permissible authorizations and permissible disclosures of
Part 2 data.
6.1.1.1.3.4.
Information relating to the consequences of a User’s failure to comply with Part
2 legal requirements.
6.1.1.1.4.
Contractor shall ensure that Providers’ Substance Use Data (SUD) is tracked and
saved within the Technology Solution.
6.1.1.1.5.
Contractor may share Part 2 data only with the Department, upon the Department’s
request, for the purposes identified in Exhibit I, Sections 1.2 through 1.2.4.
6.1.1.2.
Meets all federal regulations regarding standards for privacy, security, electronic health
care transaction and individually identifiable health information.
6.1.1.3.
Complies with the privacy regulations found at 42 C.F.R. Part 2, 45 C.F.R. §§ 160, 162
and 164, the Health Insurance Portability and Accountability Act of 1996 (HIPAA) as
amended by the American Recovery and Reinvestment Act of 2009 (ARRA)/HITECH
Act (P.L. 111-005).
6.1.1.4.
Complies with the Colorado Consumer Data Protection Law, §24-73-101, C.R.S. and §6-
1-713, C.R.S.
6.1.1.5.
Complies with the State of Colorado Cyber Security Policies. See Colorado Cyber
Security Policies located at
http://oit.state.co.us/ois/policies
, as revised from time to time.
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6.1.2.
DELIVERABLE: Contractor shall develop a document demonstrating compliance with the
requirements set forth in Sections 6.1.1 through 6.1.1.5.
6.1.3.
DUE: 30 Calendar Days after the Effective Date
6.1.4.
The Department will pass through Part 2 indicators in all relevant data that the Department
provides to Contractor.
6.2.
Contractor shall develop a System Security Plan.
6.2.1.
At a minimum, the System Security Plan shall include all of the following:
6.2.1.1.
Mission Objectives.
6.2.1.2.
Mission Statement.
6.2.1.3.
Concept of Operations.
6.2.1.4.
Roles and responsibilities.
6.2.1.5.
Information Technology Environment.
6.2.1.6.
Network Environment, Enclaves, and Perimeters.
6.2.1.7.
Major Applications and Systems.
6.2.1.8.
General support systems.
6.2.1.9.
Risk Management.
6.2.1.10.
Risk Management methodology, including all of the following:
6.2.1.10.1.
Risk assessment responsibilities.
6.2.1.10.2.
Risk assessment frequency.
6.2.1.10.3.
Project lifecycle.
6.2.1.10.4.
Vendor Management.
6.2.1.11.
Security program, including all of the following:
6.2.1.11.1.
Network and security operations standards.
6.2.1.11.2.
System and application security standards.
6.2.1.11.3.
Access controls.
6.2.1.11.4.
Change control and configuration management.
6.2.1.11.5.
Physical security.
6.2.1.11.6.
Data handling and disposal.
6.2.1.11.7.
Personnel security.
6.2.1.11.8.
Acceptable use.
6.2.1.11.9.
Online privacy.
6.2.1.11.10.
Incident warning, advisory, and response.
6.2.1.11.11.
Evaluating information security warnings and advisories.
6.2.1.11.12.
Information security incident response plan summary.
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6.2.1.12.
Security awareness and training, including all of the following:
6.2.1.12.1.
Security awareness and training methodology.
6.2.1.12.2.
Security awareness and training frequency.
6.2.1.12.3.
Security awareness and training content updates.
6.2.1.13.
Self-Assessment.
6.2.1.14.
Metrics and reporting.
6.2.1.15.
Plan approval and maintenance.
6.2.1.16.
The identification of Contractor’s processes and policies related to the oversight,
assessment, planning, implementation, and compliance with all privacy and security
standards and practices implemented by federal, State, or Contractor to the extent the
privacy and security standards and practices do not conflict.
6.2.1.17.
The identification of Contractor’s processes and policies related to the coordination of
efforts with MES Vendors to monitor for vulnerabilities.
6.2.1.18.
The identification of Contractor’s processes and policies related to assuring that all
penetration testing meets approved security requirements.
6.2.1.19.
The identification of Contractor’s processes and policies related to maintaining core
capabilities that comply with all federal and State security criteria as set forth by OIT and
the U.S Department of Health and Human Services Office for Civil Rights.
6.2.1.20.
The identification of when the information contained in the System Security Plan will be
implemented.
6.2.1.21.
The Contractor shall deliver the System Security Plan to the Department for review and
approval. The Contractor shall not execute activities within the System Security Plan
prior to the Department’s approval of that plan.
6.2.2.
DELIVERABLE: System Security Plan
6.2.3.
DUE: As identified in the Project Schedule
6.2.4.
Notwithstanding any other provision in this Contract, Contractor shall review, update, and
submit a Revised System Security Plan for Department review and approval at least annually
and before any implementation. Contractor’s annual review shall include an estimate and
plan to update Contractor’s Technology Solution to achieve compliance with new
regulations, if applicable. If no changes have occurred, Contractor shall provide a summary
report that indicates no changes have occurred.
6.2.4.1.
If any change is made to the System Security Plan at any time during the year, Contractor
shall submit a Revised System Security Plan to the Department for review and approval
prior to implementation of the Revised System Security Plan.
6.2.4.2.
DELIVERABLE: Revised System Security Plan
6.2.4.3.
DUE: No later than annually on June 30, unless changes are made during the calendar
year
7.
REGULATORY COMPLIANCE
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7.1.
Contractor shall ensure Contractor’s Technology Solution meets federal, State, regulatory, and
Department programmatic requirements, which includes the architectural, technical, security,
and privacy requirements.
7.2.
Contractor’s Technology Solution shall comply with all sections of the Americans with
Disabilities Act (ADA), Section 508 of the Rehabilitation Act, and the most current Web Content
Accessibility Guidelines (WCAG) standard, level AA or above.
7.3.
Contractor shall provide communications that meet the health literacy levels established by
federal (National Institute for Health) and State guidelines for medical terms and descriptions.
7.4.
Contractor shall provide any published content and ensure that it meets 6th grade reading literacy
levels on Provider-facing materials.
8.
TESTING
8.1.
Contractor shall provide and maintain responsibility for Development, Testing, Staging, Data
Conversion, and Production Environments, and an integrated test environment for use with the
Department and other MES Vendors for End-to-End (E2E) testing purposes.
8.1.1.
Contractor shall operate and maintain the Staging Environment as an integrated Test
Environment and shall provide integrated Test Environment improvements and
enhancements.
8.2.
Test Environment Requirements
8.2.1.
Contractor shall provide the following Test Environments or a single Test Environment
capable of supporting the following various testing requirements:
8.2.1.1.
A Test Environment that mirrors production functionality.
8.2.1.2.
User Acceptance Testing (UAT).
8.2.1.3.
System Integration Testing (SIT).
8.2.1.4.
E2E Testing.
8.2.2.
The Test Environments shall have the capability to support, at a minimum, all of the
following:
8.2.2.1.
Testing solution screens.
8.2.2.2.
Reports.
8.2.2.3.
Data.
8.2.2.4.
Integration interfaces.
8.2.2.5.
Contractor’s Technology Solution functionality.
8.2.3.
The Test Environments shall permit the Department and Contractor to monitor the accuracy
that Contractor’s Technology Solution performs according to Department-approved design.
8.2.4.
Contractor shall participate in E2E testing of data exchanges between MES Modules, when
necessary, in an E2E Testing Environment prior to moving data exchanges to Production.
8.2.5.
The Test Environment shall allow for E2E testing including transmission of all data and
Integration between Contractor’s Technology Solution and other Department contractors and
the Department.
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8.2.6.
The Test Environments shall allow for the processing of mock data from Production to
populate APIs and interface files with a volume and distribution similar to that of the
Production Technology Solution.
8.2.7.
The Test Environments shall permit the simultaneous testing within multiple MES Vendor
E2E Test Environments. Simultaneous testing means that, at a minimum, the following tests
can be run at the same time within multiple environments:
8.2.7.1.
Data Integration and API exchanges.
8.2.7.2.
Testing of reporting functionality.
8.2.7.3.
Testing of data, interface, and Integration.
8.2.7.4.
UAT.
8.2.7.5.
SIT.
8.2.7.6.
Unit testing.
8.2.7.7.
Regression testing.
8.2.7.8.
Performance testing.
8.2.7.9.
Security testing.
8.2.7.10.
E2E Testing.
8.2.8.
Contractor shall provide staff, technical expertise, and the tools required to track and report
testing activities, testing outcomes, and testing results.
8.2.9.
Contractor shall test all Technology Solution changes and enhancements prior to
implementing the change or enhancement in the Production Environment.
8.2.10.
Contractor shall provide the Department’s identified Authorized Users with online access to
the Testing Environments.
8.2.11.
Contractor shall ensure that all the testing activities are executed, and each component of
Contractor’s Technology Solution meets or exceeds all the functional, technical, security, and
performance requirements, identified in all of Sections 4 and 7, and Project requirements as
described in Section 13 prior to implementation.
8.3.
Test Results
8.3.1.
All formal testing performed by Contractor shall result in Test Results.
8.3.2.
A summary of testing results shall include all of the following:
8.3.2.1.
Trace to the requirement that is the subject of the testing.
8.3.2.2.
Pass/failure rate.
8.3.2.3.
Defect identifications.
8.3.2.4.
Severity level of failed test cases.
8.3.2.5.
Proposed resolution for identified Defects.
8.3.2.6.
Entrance and exit criteria for each Testing Phase.
8.3.2.7.
Integration testing results.
8.3.2.8.
Regression testing results.
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8.3.2.9.
Performance testing results.
8.3.2.10.
Stress testing results.
8.3.2.11.
Final enhancement test results.
8.3.2.12.
Penetration test results.
8.3.3.
DELIVERABLE: Test Results
8.3.4.
DUE: As identified in the Project Schedule
9.
HELP DESK
9.1.
Contractor shall provide Help Desk and resolution support services for Contractor’s Technology
Solution.
9.2.
Contractor’s Help Desk customer support team shall be available to support Users 24 hours per
day and seven days per week for operational and critical issues via the following methods:
9.2.1.
Toll-free telephonic support.
9.2.2.
Email.
9.2.3.
Web-based customer support portal.
9.3.
Contractor’s Help Desk support toll-free telephone hours of operation for both Tier I and Tier II
support (see definitions in Section 9.5) are defined in Section 15.8.1, which shall exclude federal
and State holidays.
9.4.
Contractor shall provide advance notice to the Department of any known event that may disrupt
any Help Desk services.
9.5.
Upon a User’s contact with Contractor’s Help Desk, a customer support analyst will provide Tier
I support. Tier I support is support for issues that can be resolved immediately, meaning during
the call with Contractor’s Help Desk.
9.5.1.
In the event the underlying issue or question cannot be resolved quickly and requires deeper
research, the issue shall be elevated to Tier II support. Tier II support is support for issues
that cannot be resolved immediately and require escalation.
9.5.2.
Contractor may escalate issues from Tier I to Tier II support via a variety of channels,
including standard Tier I escalation, technical support, and escalation from pulse surveys,
which are surveys generated at ticket closure, or sales/account management contact.
9.5.3.
Contractor shall resolve all Tier II requests within the continental United States. Contractor
shall provide daily updates regarding all Tier II escalations until the Tier II issue is resolved.
10.
REQUESTED ESTIMATES
10.1.
Upon request by the Department, Contractor shall provide Requested Estimates.
10.1.1.
Requested Estimates may include all of the following, as applicable:
10.1.1.1.
Pricing and scheduling estimates related to proposed legislation.
10.1.1.2.
Pricing and scheduling estimates related to proposed budget requests.
10.1.1.3.
Pricing and scheduling estimates related to other initiatives.
10.1.2.
DELIVERABLE: Requested Estimates
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10.1.3.
DUE: Within five Business Days after the Department makes the request to the Contractor,
except if the Department requests a ballpark estimate (-25% to +75%) by identifying a shorter
deadline up to and including a deadline on the same day or within 24 hours after the
Department makes the request
11.
MODIFICATION ENHANCEMENT HOURS
11.1.
Contractor shall provide Modification Enhancement Hours to the Department for the purpose
and utilization of modifications, changes, and enhancements for Contractor to provide Technical
Support Services and Consultative Support Services for Projects and for the creation of
customization and new creation Work.
11.2.
At the beginning of each Contract Year, the Parties shall designate categories of staffing and/or
skill that the Department may access via Modification Enhancement Hours.
11.3.
For Change Requests and enhancements, Contractor will work with the Department to refine the
scope of work during discovery and design, evaluate the Project enhancement, and reprioritize if
determined by the Department.
11.4.
For performance measure customization and new creation Work, Contractor shall work with the
Department to define the scope of work, evaluate the customization and new creation Work, and
reprioritize if determined by the Department.
12.
TRAINING FOR DEPARTMENT STAFF
12.1.
All training programs prepared by Contractor for Department Authorized Users of Contractor’s
Technology Solution shall comply with the Department-approved Training Management Plan.
12.2.
PERFORMANCE STANDARD: For all training sessions conducted by Contractor for
Department Authorized Users, Contractor shall evaluate and conduct quality improvement
relating to training content during the Term of this Contract, such as through the use of surveys.
Contractor shall develop a Survey Report based on the results of each survey that Contractor
uses.
12.2.1.
DELIVERABLE: Survey Reports
12.2.2.
DUE: As identified in the Project Schedule
12.3.
PERFORMANCE STANDARD: Contractor shall communicate updated or new functionality or
business processes during scheduled and Department-approved refresher training sessions for
Department Authorized Users throughout the Term of this Contract.
12.4.
Contractor shall develop Training Materials.
12.4.1.
Contractor’s Training Materials shall include, at a minimum, all of the following:
12.4.1.1.
Identification and training on the items that help the Department to monitor Contractor’s
Technology Solution.
12.4.1.2.
The use of available tools and dashboards.
12.4.1.3.
The use of technical and functional documentation and/or reports.
12.4.2.
Contractor shall save Department-approved Training Materials in the Project Repository.
12.4.3.
DELIVERABLE: Training Materials
12.4.4.
DUE: As identified in the Project Schedule
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12.5.
The Department may utilize a third-party training contractor to complete training activities
related to Contractor’s Technology Solution.
12.5.1.
If requested by the Department, Contractor shall develop materials and train the Department’s
third-party training contractor regarding Contractor’s Technology Solution (“train-the-trainer
training”). In total, Contractor will host up to eight train-the-trainer sessions. The train-the-
trainer sessions will take place in addition to the RAE APM 2 Training Overview specified
in Section 13.
12.5.1.1.
Contractor’s train-the-trainer trainer materials shall include all of the following:
12.5.1.1.1.
The way in which to access timely the relevant parts of Contractor’s Technology
Solution.
12.5.1.1.2.
Appropriate training and explanation on utilizing the APM 2 Model, as defined in the
APM 2 Partial Capitation and Chronic Conditions Episode Model, including all of the
following:
12.5.1.1.2.1.
Information for Users regarding APM 2 enrollment dates or Go-Live of any
operational changes.
12.5.1.1.2.2.
Necessary business changes for participating PCMPs.
12.5.1.1.2.3.
Details regarding any future Stakeholder engagement or Department-hosted
training.
12.5.1.1.2.4.
How to report and track issues or concerns in Contractor’s Technology Solution.
12.5.1.1.3.
DELIVERABLE: Train-the-Trainer Materials
12.5.1.1.4.
DUE: As identified in the Project Schedule
12.5.2.
Contractor shall provide train-the-trainer trainings on dates agreed upon by the Parties.
12.5.3.
Contractor shall work with any Department third-party contractor, as directed by the
Department and mutually agreed upon by the Parties, and the Department to support on a
monthly basis a peer-to-peer learning network for APM 2 Program and Pediatric APM
Program participants.
12.5.4.
Contractor shall assist any Department third-party contractor and mutually agreed upon by
the Parties, as directed by the Department, to disseminate information, business changes, and
other APM 2 Program updates to APM 2 participants.
13.
PROJECTS DEVELOPED WITHIN CONTRACTOR’S TECHNOLOGY SOLUTION
13.1.
Primary Care
13.1.1.
The requirements identified for the APM 2 Program and the Pediatric APM Program outlined
in Sections 13.1.2 and 13.1.3 may have duplicate Deliverables due to the parallel nature of
the Work that cannot be foreseen until later in the design process. The Department will accept
one final Deliverable for any Deliverables determined to be duplicative by the Department.
13.1.2.
APM 2 Program Requirements
13.1.2.1.
Technology Solution Development
13.1.2.1.1.
Contractor shall create an APM 2 Program Operation Transition Plan with the
Department’s existing actuarial contractor that currently operates the Department’s
APM 2 Program (“Department’s Existing Actuarial Contractor”), who the
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Department will introduce to Contractor, to shift the APM 2 Program to Contractor’s
Technology Solution. The Department’s Existing Actuarial Contractor is contracted
to operate the existing APM 2 Programs that are operational until June 30, 2023, with
the need for additional support into the first quarter of SFY 2024 for calculation of
incentive payments. The Department will provide Contractor with detailed
documentation of the current APM 2 Program operations. With the exception of any
proprietary information, this documentation includes, where applicable, access to the
necessary software licenses, data models, calculation models, and reporting formats
and dashboards. If a current Department third-party contractor is currently operating
the APM 2 Program, the Department will make the current Department third-party
contractor and associated materials available to Contractor.
13.1.2.1.1.1.
The APM 2 Program Operation Transition Plan shall include all of the following:
13.1.2.1.1.1.1.
Summary of the current number of APM 2 Program participants, as well as
their level of PMPM and chronic condition participation status.
13.1.2.1.1.1.2.
Summary of the current actuarial methodology based on the Department’s
Existing Actuarial Contractor’s actuarial narrative, which the Department will
provide to Contractor.
13.1.2.1.1.1.3.
Summary of Contractor’s understanding of current day-to-day operations by
both the Department’s Existing Actuarial Contractor and Department Staff
managing the APM 2 Program.
13.1.2.1.1.1.4.
Summary of work to be done within Contractor’s Technology Solution to
develop, implement, and operate the APM 2 program.
13.1.2.1.1.1.5.
Any outstanding questions or action items Contractor must resolve before
taking over current operations.
13.1.2.1.1.1.6.
Target date to shift operations from the Department’s Existing Actuarial
Contractor to Contractor, with a timeline and justification for that date.
13.1.2.1.1.2.
DELIVERABLE: APM 2 Program Operation Transition Plan
13.1.2.1.1.3.
DUE: As identified in the Project Schedule
13.1.2.1.2.
Using the Department-approved APM 2 Program Operation Transition Plan,
Contractor shall perform the following tasks:
13.1.2.1.2.1.
Transition chronic condition episode logic and bundled payment methodology
from the Department’s Existing Actuarial Contractor to Contractor.
13.1.2.1.2.2.
Transition risk adjustment methodology that is in place in the APM 2 Program
from the Department’s Existing Actuarial Contractor to Contractor.
13.1.2.1.2.3.
Transition partial capitation rate development and actuarial methodology for
current and interested Providers from the Department’s Existing Actuarial
Contractor to Contractor.
13.1.2.1.3.
Contractor shall evaluate the Department’s existing primary care alternative payment
models, which are APM 1 and APM 2.
13.1.2.1.3.1.
Contractor shall make recommendations regarding the Department’s strategy of
streamlining the primary care APM Program and of phasing out the APM 1
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Program in favor of the APM 2 Program by conducting all of the following
activities:
13.1.2.1.3.1.1.
Contractor shall analyze the interaction between APM 1 Program and APM 2
Program.
13.1.2.1.3.1.2.
Contractor shall interview identified Department quality, clinical, data, and
payment reform APM 1 Program Subject Matter Experts (SMEs) to learn pain
points and successes.
13.1.2.1.3.1.3.
Contractor shall interview, at minimum, 10 APM 1 Program model
participants, which APM 1 Program model participants will be identified by
the Department, to learn pain points and successes.
13.1.2.1.3.1.3.1.
Contractor shall ensure Contractor’s interviews include representatives in
the following provider types: family practice, pediatrics, obstetrics,
internal medicine, and Federally Qualified Health Centers (FQHC).
13.1.2.1.3.1.4.
Contractor shall interview, at minimum, five APM 1 Program model
participants, identified by the Department, who opted out of the APM 1
Program to gain an understanding of why the interviewed APM 1 Program
model participants did not participate in the APM 1 Program.
13.1.2.1.3.1.5.
Contractor shall host, at minimum, two forums with the RAEs to collect
information about APM 1 Program pain points and successes.
13.1.2.1.3.1.6.
Contractor shall analyze the Department’s current partial capitation
methodology from the Department’s Existing Actuarial Contractor based on
existing methodology narratives and documentation.
13.1.2.1.3.1.7.
Contractor shall analyze all of the following:
13.1.2.1.3.1.7.1.
Member utilization and attribution relative to partial capitation rate
development.
13.1.2.1.3.1.7.2.
Provider leakage and billing patterns.
13.1.2.1.3.1.8.
Contractor shall analyze differences in the episode logic and episode costs of
existing APM 2 Program chronic conditions and costs of chronic conditions
from alternative episode groupers. Contractor’s analysis shall assess
differences in all of the following:
13.1.2.1.3.1.8.1.
Episode triggers.
13.1.2.1.3.1.8.2.
Selection of relevant services.
13.1.2.1.3.1.8.3.
Patient and service exclusions.
13.1.2.1.3.1.8.4.
Variation in episode costs and sources of variation.
13.1.2.1.3.1.9.
Contractor shall analyze episodes for the purpose of changing the logic of the
existing episodes and/or changing available chronic episodes.
13.1.2.1.3.1.10.
Contractor shall examine the ways in which Members with chronic conditions
are attributed to APM 2 Program Providers, including Members with existing
and newly diagnosed chronic conditions.
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13.1.2.1.3.1.11.
Contractor shall evaluate the current risk adjustment model, which shall
include an analysis of the risk adjustment methodology created by the
Department’s Existing Actuarial Contractor. Contractor shall include a
breakdown of methodology based on patient demographics, such as age, sex,
and level of care.
13.1.2.1.4.
Based on Contractor’s work done as part of Sections 13.1.2.1.3 through
13.1.2.1.3.1.11, Contractor shall create an APM Program Evaluation and Feedback
Report.
13.1.2.1.4.1.
The APM Program Evaluation and Feedback Report shall include all of the
following information:
13.1.2.1.4.1.1.
A summary of the APM 1 Program’s performance to date.
13.1.2.1.4.1.2.
A summary of the APM 2 Program’s performance to date.
13.1.2.1.4.1.3.
Recommendations for updates to current methodology based on Contractor’s
analyses of Member data, leakage, and billing patterns.
13.1.2.1.4.1.4.
Recommendations regarding the quality model for a combined program based
on the Department’s lessons learned from APM 1 Program’s quality
measurement.
13.1.2.1.4.1.5.
Recommendations for a streamlined APM 2 Program quality model based on
the recommendations from Stakeholder feedback from Sections 13.1.2.1.3.1.2
through 13.1.2.1.3.1.5 and evaluation of Colorado CMS Core Measure
performance.
13.1.2.1.4.1.6.
An explanation regarding the differences in the episode logic and episode
costs of existing APM 2 Program chronic conditions and costs of chronic
conditions in alternative episode groupers, including information on all of the
following:
13.1.2.1.4.1.6.1.
Episode triggers.
13.1.2.1.4.1.6.2.
Selection of relevant services.
13.1.2.1.4.1.6.3.
Patient and service exclusions.
13.1.2.1.4.1.6.4.
Variation in episode costs and sources of variation.
13.1.2.1.4.1.7.
An analysis that compares episode grouping logic models (as defined in
Sections 13.1.2.1.4.1.6.1 through 13.1.2.1.4.1.6.4).
13.1.2.1.4.1.8.
An evaluation of the financial impacts of different choices among existing
episodes and changing available chronic episodes.
13.1.2.1.4.1.9.
Financial impact to participating APM 2 Program Providers and to the
Department that may occur through modification of the episode definitions.
13.1.2.1.4.1.10.
Recommendations for changes based on Contractor’s analysis of the current
episode attribution methodology for the APM 2 Program and resulting
utilization patterns and Provider leakage.
13.1.2.1.4.1.11.
Recommendations for updates to the risk adjustment methodology based on
Contractor’s evaluation of the current risk adjustment model and associated
analysis.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 46 of 116
13.1.2.1.4.1.12.
Summary of any positives and negatives identified by Contractor based on
Contractor’s analyses and evaluations of APM 2 Program participants, the
Department, and other Stakeholders impacted by APM 2 Program operations.
13.1.2.1.4.1.13.
An identification of benefits to APM 2 Program participation and APM 2
Program operations, as well as possible areas for improvement.
13.1.2.1.4.1.14.
Recommendations for how to improve the existing APM 2 Program based on
a synthesis of all of the information Contractor developed in Sections
13.1.2.1.3 through 13.1.2.1.3.1.11.
13.1.2.1.4.1.15.
Recommendations regarding any additional opportunities for multi-payer
alignment with other payer value-based payment programs in primary care.
13.1.2.1.4.2.
DELIVERABLE: APM Program Evaluation and Feedback Report
13.1.2.1.4.3.
DUE: As identified in the Project Schedule
13.1.2.1.5.
Contractor shall integrate Department-approved recommendations and changes to the
APM 2 program from the APM Program Evaluation and Feedback Report to
Contractor’s Technology Solution. Integration of any changes will be confirmed with
Contractor’s submission of the APM 2 Program Modeling Changes Plan and
Implementation Strategy outlined below in Sections 13.1.2.1.7 through 13.1.2.1.7.4.
13.1.2.1.6.
Upon the Department’s request or upon Contractor’s request and the Department’s
approval, Contractor shall conduct ad hoc analyses utilizing Contractor’s Technology
Solution of the following data:
13.1.2.1.6.1.
Total PMPM spending.
13.1.2.1.6.2.
Spending by chronic condition.
13.1.2.1.6.3.
PCMP leakage.
13.1.2.1.6.4.
Quality measurement performance.
13.1.2.1.6.5.
Contractor shall utilize the ad hoc analyses identified in Sections 13.1.2.1.6
through 13.1.2.1.6.4 to inform recommendations about practice patterns and
opportunities for improvement in quality and health equity within the primary care
APMs.
13.1.2.1.6.6.
DELIVERABLE: Ad Hoc Analyses
13.1.2.1.6.7.
DUE: As identified in the Project Schedule
13.1.2.1.7.
Contractor shall create a proposed APM 2 Program Modeling Changes Plan and
Implementation Strategy based on the APM Program Evaluation and Feedback
Report.
13.1.2.1.7.1.
The APM 2 Program Modeling Changes Plan and Implementation Strategy shall
include all of the following information:
13.1.2.1.7.1.1.
A plan for automatic enrollment of all PCMPs into the APM 2 Program by
January 1, 2024, or an alternative date provided by the Department to
Contractor. Automatic enrollment shall only begin if and as directed by the
Department.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 47 of 116
13.1.2.1.7.1.2.
A plan for how to increase the partial capitation payments with the funds
allotted by the Colorado Joint Budget Committee in the Department’s
submitted budget request, “R-6 Supporting PCMPs with Value Based
Payments,” if Contractor is directed to perform this work by the Department.
13.1.2.1.7.2.
DELIVERABLE: APM 2 Program Modeling Changes Plan and Implementation
Strategy
13.1.2.1.7.3.
DUE: As identified in the Project Schedule
13.1.2.1.7.4.
Contractor shall revise the APM 2 Program Modeling Changes Plan and
Implementation Strategy as part of the Department’s operational processes. See
Sections 13.1.2.5.1 through 13.1.2.5.1.2.
13.1.2.1.8.
Upon the Department’s request, Contractor shall develop and maintain an APM 2
Partial Capitation and Chronic Condition Episodes Model, which shall be used for
each APM 2 Program Year.
13.1.2.1.8.1.
The APM 2 Partial Capitation and Chronic Conditions Episode Model shall
incorporate Department-approved updates to the partial capitation rate setting and
episode incentive payment methodologies, as identified in the Department-
approved APM Program Evaluation and Feedback Report and in the Department-
approved APM 2 Program Modeling Changes Plan and Implementation Strategy,
including all Revised APM 2 Program Modeling Changes Plan and
Implementation Strategy documents, based on analysis and feedback from the
Primary Care Background Research & Onboarding Requirements, Primary Care
Program Design Requirements, and Primary Care Stakeholder Engagement
sections.
13.1.2.1.8.2.
The APM 2 Partial Capitation and Chronic Conditions Episode Model shall
include, at a minimum, all of the following:
13.1.2.1.8.2.1.
Baseline chronic condition thresholds for all participating APM 2 Program
Providers and identified interested Providers for current and subsequent APM
2 Program Years.
13.1.2.1.8.2.2.
A risk-adjusted chronic condition thresholds for all participating APM 2
Program Providers and interested Providers for current and subsequent APM
2 Program Years.
13.1.2.1.8.2.3.
Partial capitation rates all participating APM 2 Program Providers and
interested Providers for current and subsequent APM 2 Program Years.
13.1.2.1.8.3.
DELIVERABLE: APM 2 Partial Capitation and Chronic Condition Episodes
Threshold Model
13.1.2.1.8.4.
DUE: 30 days after the Department approves the APM 2 Program and Modeling
Changes Plan and Implementation Strategy
13.1.2.1.8.5.
Contractor shall revise the APM 2 Partial Capitation and Chronic Condition
Episodes Threshold Model as part of the Department’s operational processes. See
Sections 13.1.2.5.2 through 13.1.2.5.2.1.2.
13.1.2.1.9.
Upon the Department’s request, Contractor shall develop an APM 2 Program
Provider Guidebook.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 48 of 116
13.1.2.1.9.1.
The APM 2 Program Provider Guidebook shall include all of the following:
13.1.2.1.9.1.1.
Descriptions of the payment methodology.
13.1.2.1.9.1.2.
The ways in which the quality model and performance thresholds were
developed.
13.1.2.1.9.1.3.
Information regarding the timelines related to reconciliation and timing of
performance reports.
13.1.2.1.9.1.4.
Information on data analytics development and instructions on how to access
supplemental data.
13.1.2.1.9.1.5.
The business rules for the APM 2 Program.
13.1.2.1.9.2.
DELIVERABLE: APM 2 Program Provider Guidebook
13.1.2.1.9.3.
DUE: Not later than 30 days after the Department approves the APM 2 Program
Modeling Changes Plan and Implementation Strategy
13.1.2.1.9.4.
Contractor shall revise the APM 2 Program Provider Guidebook as part of the
Department’s operational processes. See Sections 13.1.2.5.3 through 13.1.2.5.3.2.
13.1.2.1.10.
Contractor shall build a Primary Care Data Sharing Analytics Solution for the APM
2 Program.
13.1.2.1.10.1.
The Primary Care Data Sharing Analytics Solution for the APM 2 Program shall
include, at a minimum, all of the following:
13.1.2.1.10.1.1.
The ability to access summaries of PCMP performance.
13.1.2.1.10.1.2.
The ability to conduct drill down analyses to identify cost drivers and
interventions to improve cost, quality, and health equity.
13.1.2.1.10.1.3.
Accessibility via a secure portal.
13.1.2.1.10.1.4.
Accessibility via defined role-based access points.
13.1.2.1.10.1.5.
The ability to evaluate and visualize key service utilization measures by
PCMP that can be used to identify interventions to improve cost of care. Key
service utilization measures shall include all of the following:
13.1.2.1.10.1.5.1.
Overall and Member-specific primary care evaluation and management
(E&M).
13.1.2.1.10.1.5.2.
Interventions to increase pediatric primary and preventive care.
13.1.2.1.10.1.5.3.
Patient-specific primary care E&M visit rate.
13.1.2.1.10.1.5.4.
Primary care visits for sickness versus well care visits.
13.1.2.1.10.1.5.5.
Relevant specialty care visit rates.
13.1.2.1.10.1.5.6.
Chronic condition medication adherence.
13.1.2.1.10.1.5.7.
Utilization rates for services that are key cost drivers.
13.1.2.1.10.1.5.8.
Related CMS Core Measures, clinical quality measures, where poor
performance may contribute to high costs.
13.1.2.1.10.1.5.9.
Vaccination rates.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 49 of 116
13.1.2.1.10.1.5.10.
Emergency room (ER) utilization.
13.1.2.1.10.1.5.11.
Developmental screening rates.
13.1.2.1.10.1.5.12.
Registry function at the patient level for identified quality measures.
13.1.2.1.10.1.6.
The ability to evaluate Members by one or more key attributes for the purpose
of analyzing their impacts on costs, quality, and key service utilization
measurements. Key attributes shall include, at a minimum:
13.1.2.1.10.1.6.1.
Risk level.
13.1.2.1.10.1.6.2.
Comorbidities.
13.1.2.1.10.1.6.3.
Demographic and SDoH characteristics (see Exhibit D, Section 1.1.104).
13.1.2.1.10.1.7.
The ability to conduct the following types of Primary Care Data Sharing
Analytics:
13.1.2.1.10.1.7.1.
Monthly PMPM and Fee-for-Service payments for PCMPs taking any
level of partial capitation, including the ability to see PMPM payments
over time relative to the amount billed fee for service.
13.1.2.1.10.1.7.2.
APM 2 Program-eligible beneficiaries.
13.1.2.1.10.1.7.3.
Evaluation of how the PCMP compares to peers in terms of total risk-
adjusted PMPM costs and risk-adjusted costs by service category (e.g.,
inpatient, outpatient (physician visits, ER, tests, procedures, and
pharmacy).
13.1.2.1.10.1.7.4.
Drill down analyses to evaluate how the PCMP compares to peers in terms
of risk adjusted costs, sortable by chronic disease, that can be used for the
purpose of identifying chronic diseases that drive costs within Health First
Colorado claims data. Claim data shall include costs and associated
descriptions that fully detail the care the Member received, including, at a
minimum:
13.1.2.1.10.1.7.4.1.
Claim type.
13.1.2.1.10.1.7.4.2.
Diagnosis.
13.1.2.1.10.1.7.4.3.
Procedure (e.g., CPT-4, ICD-10, revenue codes).
13.1.2.1.10.1.7.4.4.
Prescription drug prescribed.
13.1.2.1.10.1.7.4.5.
Location where services were provided.
13.1.2.1.10.1.7.4.6.
Provider of services.
13.1.2.1.10.1.7.5.
Drill down analyses to identify Members with high risk and high
utilization that drive costs.
13.1.2.1.10.1.7.6.
Grouping Members by one or more key attributes, including risk level,
comorbidities, and demographic and SDoH characteristics (see Exhibit D,
Section 1.1.104) for the purpose of analyzing the key attributes’ impacts
on PCMP total cost of care.
13.1.2.1.10.1.8.
The ability to conduct the following types of analyses:
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 50 of 116
13.1.2.1.10.1.8.1.
At a minimum, for each chronic condition as defined in the APM 2 Partial
Capitation and Chronic Condition Episodes Threshold Model, the Primary
Care Data Sharing Analytics Solution for the APM 2 Program shall allow
the Department, care coordinators, and Providers to conduct the following
types of analyses:
13.1.2.1.10.1.8.1.1.
Evaluation of how the PCMP compares to peers in terms of total risk-
adjusted costs and risk-adjusted costs by service category (e.g.,
inpatient, outpatient (physician visits, ER, tests, procedures),
pharmacy) for each chronic condition.
13.1.2.1.10.1.8.1.2.
Drill down analyses of individual claims within each service category
defined with the Department’s input to ensure completeness of claims
data for the purpose of reviewing and identifying specific claims that
drive costs, including relevant diagnosis, procedure, location, and
other codes.
13.1.2.1.10.1.9.
The ability to conduct drill down analyses with visualizations to guide PCMP
improvement interventions for Members with high risk and high utilization
that drive costs, which shall include all of the following information:
13.1.2.1.10.1.9.1.
Overall primary care E&M utilization.
13.1.2.1.10.1.9.2.
Member-specific primary care E&M utilization.
13.1.2.1.10.1.9.3.
Relevant specialty care visit rates.
13.1.2.1.10.1.9.4.
Utilization rates for services that are key cost drivers.
13.1.2.1.10.1.10.
The ability to identify and display CMS Core Measures where poor
performance may contribute to high costs.
13.1.2.1.10.1.11.
The ability to deliver any form of incentive payment information.
13.1.2.1.10.1.12.
The ability to use HIE data to identify when an episode is triggered if that data
is made available by the Department.
13.1.2.1.10.1.13.
Any additional requirements as agreed upon by the Department and
Contractor.
13.1.2.1.10.2.
DELIVERABLE: Primary Care Data Sharing Analytics Solution for the APM 2
Program
13.1.2.1.10.3.
DUE: As identified in the Project Schedule
13.1.2.1.11.
Contractor shall update the Primary Care Data Sharing Analytics Solution for the
APM 2 Program monthly with the latest claims data for Users to monitor recent
changes in Member health care costs and utilization.
13.1.2.1.12.
Contractor shall aggregate Primary Care Data Sharing Analytics Solution for the
APM 2 Program data to the RAE level and shall disseminate RAE-level Dashboards
to each of the corresponding RAEs.
13.1.2.1.13.
Contractor shall interview the Department’s identified SMEs to define the content,
functionality, and format of the Primary Care Data Sharing Analytics Solution for the
APM 2 Program and the Primary Care Data Sharing Analytics Solution for the APM
2 Program’s associated data.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 51 of 116
13.1.2.1.14.
For each PCMP, and aggregated by RAE Region for each RAE, Contractor shall
provide the following performance feedback reports in the Primary Care Data Sharing
Analytics Solution for the APM 2 Program:
13.1.2.1.14.1.
A Dashboard updated on a monthly basis, with the capability to generate a report
for the Department upon the Department’s request. At a minimum, the Dashboard
shall include all of the following information:
13.1.2.1.14.1.1.
Simple and intuitive graphics that include clear labels and explanations of
source data of cost and quality of care performance for each chronic condition
and quality of care for Members, compared to peers.
13.1.2.1.14.1.2.
Actionable information to facilitate improvement interventions, including a
summary of the drivers of performance measurement results for each chronic
condition, which include overutilization or underutilization of services and
SDoH.
13.1.2.1.14.1.3.
Access to a report of gaps in care for each chronic condition.
13.1.2.1.14.1.4.
Member leakage rate with demographic characteristics of Members that left
the PCMP practice.
13.1.2.1.14.1.5.
Gain/risk share amounts with supporting calculations for management of
chronic conditions.
13.1.2.2.
Stabilization and Initial Release of Contractor’s Technology Solution
13.1.2.2.1.
Contractor shall create an APM 2 Program Implementation Plan.
13.1.2.2.1.1.
The APM 2 Program Implementation Plan shall include all of the following:
13.1.2.2.1.1.1.
The identification of all necessary steps required to bring the Primary Care
Data Sharing Analytics Solution for the APM 2 Program to Go-Live within
Contractor’s Technology Solution.
13.1.2.2.1.1.2.
A plan to manage the Primary Care Data Sharing Analytics Solution for the
APM 2 Program implementation.
13.1.2.2.1.1.3.
A plan to manage the Primary Care Data Sharing Analytics Solution for the
APM 2 Program operations as defined in the APM 2 Program Modeling
Changes Plan and Implementation Strategy.
13.1.2.2.1.1.4.
A plan to implement a soft launch that may include all Providers and during
which payments may be made.
13.1.2.2.1.2.
DELIVERABLE: APM 2 Program Implementation Plan
13.1.2.2.1.3.
DUE: As identified in the Project Schedule
13.1.2.2.2.
Contractor shall create a methodology for PCMPs that drop out of the APM 2 Program
automatic enrollment, provided that the Department approves an automatic
enrollment plan.
13.1.2.2.2.1.
Contractor shall develop an APM 2 Opt-Out Plan, which shall include all the
following:
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 52 of 116
13.1.2.2.2.1.1.
A way in which to capture information about PCMPs that drop out of the APM
2 Program or shift to partial participation and participate in only the chronic
conditions episodes with no PMPM.
13.1.2.2.2.1.2.
A way in which to process enrollment changes, including communication with
RAEs who receive opt-out notifications from PCMPs.
13.1.2.2.2.1.3.
Identification of a methodology for PMCPs that opt out of receiving any
PMPM in the APM 2 Program but continue to participate in the chronic
condition episodes.
13.1.2.2.2.1.4.
Recommended updates to APM 2 Program Member attribution, Provider
leakage, and Provider billing changes to more accurately capture Member
utilization patterns.
13.1.2.2.2.2.
DELIVERABLE: APM 2 Opt-Out Plan
13.1.2.2.2.3.
DUE: As identified in the Project Schedule
13.1.2.2.3.
Contractor shall create Chronic Condition Episode Logic and Business Rules for
purposes of the Department publishing the Chronic Condition Episode Logic and
Business Rules on the Department’s external APM 2 Program website.
13.1.2.2.3.1.
The Chronic Condition Episode Logic and Business Rules shall include all of the
following:
13.1.2.2.3.1.1.
The use of existing specifications developed by the Department’s Existing
Actuarial Contractor as a model for the requirements identified in Sections
13.1.2.2.3.1.2 and 13.1.2.2.3.1.3.
13.1.2.2.3.1.2.
The episode specifications developed in the Department-approved APM 2
Partial Capitation and Chronic Condition Episodes Threshold Model, which
shall be documented and which measures that require risk adjustment
identified.
13.1.2.2.3.1.3.
Specifications developed in the Department-approved APM 2 Partial
Capitation and Chronic Condition Episodes Threshold Model, which shall be
delivered in a Department-approved format that is compatible with the
Department’s website and other electronic distribution methods.
13.1.2.2.3.2.
DELIVERABLE: Chronic Condition Episode Logic and Business Rules
13.1.2.2.3.3.
DUE: As identified in the Project Schedule
13.1.2.2.3.4.
Contractor shall revise the Chronic Condition Episode Logic and Business Rules
as part of the Department’s operational processes. See Sections 13.1.2.5.4 through
13.1.2.5.4.2.
13.1.2.2.4.
Upon the Department’s request, Contractor shall create an APM 2 Program
Reconciliation Plan relating to reimbursement and incentive payment model
reconciliation for the existing APM 2 Program and for any future modeling changes
to the APM 2 Program.
13.1.2.2.4.1.
The APM 2 Program Reconciliation Plan shall include all of the following:
13.1.2.2.4.1.1.
A timeline for the reimbursement and incentive payment model reconciliation
process.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 53 of 116
13.1.2.2.4.1.2.
Necessary outputs to be provided to the Department based on the APM 2
Program Modeling Changes Plan and Implementation Strategy.
13.1.2.2.4.2.
DELIVERABLE: APM 2 Program Reconciliation Plan
13.1.2.2.4.3.
DUE: As identified in the Project Schedule
13.1.2.2.5.
Upon the Department’s request, Contractor shall provide recommendations to the
Department when the Department updates the Department’s State Plan or Medical
Services Board Rule.
13.1.2.2.5.1.
Requested recommendations may include, but are not limited to, reviewing and
editing Department-authored and Department-provided documents to ensure the
Department’s documents match the APM 2 Partial Capitation and Chronic
Condition Episodes Threshold Model.
13.1.2.2.5.2.
DELIVERABLE: Department-Requested Recommendations
13.1.2.2.5.3.
DUE: At a time identified by the Department as identified in the Project Schedule
13.1.2.2.6.
Contractor shall create an Updated APM 2 Actuarial Narrative in a format similar to
the original APM 2 Actuarial Narrative submitted by the Department’s Existing
Actuarial Contractor, which original APM 2 Actuarial Narrative the Department will
provide to Contractor.
13.1.2.2.6.1.
The Updated APM 2 Actuarial Narrative shall describe all current and revised
actuarial assumptions for the APM 2 Partial Capitation and Chronic Condition
Episodes Threshold Model.
13.1.2.2.6.2.
DELIVERABLE: Updated APM 2 Actuarial Narrative
13.1.2.2.6.3.
DUE: As identified in the Project Schedule
13.1.2.2.6.4.
Contractor shall revise the Updated APM 2 Actuarial Narrative as part of the
Department’s operational processes. See Sections 13.1.2.5.5 through 13.1.2.5.5.2.
13.1.2.2.7.
Contractor shall create an APM 2 Stakeholder Engagement Plan.
13.1.2.2.7.1.
The APM 2 Stakeholder Engagement Plan shall include all of the following:
13.1.2.2.7.1.1.
Recommendations for collecting feedback about proposed changes identified
in the Department-approved APM 2 Partial Capitation and Chronic Condition
Episodes Threshold Model.
13.1.2.2.7.1.2.
Timeline for engaging in and completing Stakeholder engagement tasks, as
identified in the APM 2 Stakeholder Engagement Plan.
13.1.2.2.7.1.3.
Marketing plan for engaging in and completing Stakeholder engagement
tasks, as identified in the APM 2 Stakeholder Engagement Plan.
13.1.2.2.7.1.4.
A plan regarding the communication of changes to the APM 2 Program that
are included in the Department-approved APM Program Evaluation and
Feedback Report and in the Department-approved APM 2 Program Modeling
Changes Plan and Implementation Strategy.
13.1.2.2.7.2.
DELIVERABLE: APM 2 Stakeholder Engagement Plan
13.1.2.2.7.3.
DUE: Annually, as identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 54 of 116
13.1.2.2.7.4.
Stakeholder engagement activities outlined in the APM 2 Stakeholder
Engagement Plan shall start no later than August 1 of each APM 2 Program Year.
13.1.2.2.8.
Contractor shall create a RAE APM 2 Program Training Overview, which the RAEs
and potentially other Department-selected third-party contractors (see Sections 12.5
through 12.5.4) are anticipated to share with PCMPs.
13.1.2.2.8.1.
The RAE APM 2 Program Training Overview shall include all of the following:
13.1.2.2.8.1.1.
Information about the APM 2 Program Modeling Changes Plan and
Implementation Strategy.
13.1.2.2.8.1.2.
Information about how to opt out of the APM 2 Program as outlined in the
Department-approved APM 2 Opt-Out Plan.
13.1.2.2.8.1.3.
An APM 2 Program model overview.
13.1.2.2.8.1.4.
Financial impact information for PCMPs.
13.1.2.2.8.1.5.
A quality model summary for purposes of smoothing the transition to the new
payment model after updates to the APM 2 Program are made by the
Department and Contractor.
13.1.2.2.8.2.
DELIVERABLE: RAE APM 2 Training Overview
13.1.2.2.8.3.
DUE: As identified in the Project Schedule
13.1.2.2.9.
Upon the Department’s request, Contractor shall create Rate Workbooks for the
anticipated use of prospective and existing Providers.
13.1.2.2.9.1.
At a minimum, the Rate Workbooks shall include all of the following:
13.1.2.2.9.1.1.
Changes to PMPM or Fee-for-Service rates that include, but are not limited
to:
13.1.2.2.9.1.1.1.
Updated fee schedule changes.
13.1.2.2.9.1.1.2.
Methodology updates.
13.1.2.2.9.1.1.3.
APM 2 Program Year operational changes.
13.1.2.2.9.1.1.4.
PMPM calculations.
13.1.2.2.9.1.1.5.
Supplemental partial capitation data.
13.1.2.2.9.1.1.6.
Chronic condition thresholds.
13.1.2.2.9.1.1.7.
Supplemental episode data.
13.1.2.2.9.1.2.
DELIVERABLE: Rate Workbooks
13.1.2.2.9.1.3.
DUE: As identified in the Project Schedule
13.1.2.2.9.2.
Rate Workbooks may change in format and/or decrease in volume based on the
development of a statewide or tiered PMPM and other changes as outlined in the
APM 2 Program Modeling Changes Plan and Implementation Strategy.
13.1.2.3.
Operations of Contractor’s Technology Solution
13.1.2.3.1.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised Rate Workbooks. The requirements of the Rate
Workbooks are identified at Sections 13.1.2.2.9.1 through 13.1.2.2.9.1.1.7.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 55 of 116
13.1.2.3.1.1.
DELIVERABLE: Revised Rate Workbooks
13.1.2.3.1.2.
DUE: Annually, as identified in the Project Schedule
13.1.2.3.2.
Upon the Department’s request, Contractor shall support the Department in Rate
Workbooks Reviews meetings with interested Providers or practice representatives.
13.1.2.3.2.1.
Rate Workbooks Reviews meetings shall include a high-level overview of the
Rate Workbooks, any Provider-specific data, and an opportunity for the Provider
to ask questions about the APM 2 Program.
13.1.2.3.2.2.
Contractor’s support in Rate Workbooks Reviews meetings shall include, at a
minimum, all of the following:
13.1.2.3.2.2.1.
Contractor’s review of Provider data, including PMPM rates and chronic
condition thresholds.
13.1.2.3.2.2.2.
Contractor’s attendance at all Rate Workbooks Reviews meetings.
13.1.2.3.2.2.3.
Contractor’s input regarding questions or concerns that arise during any Rate
Workbooks Review meeting.
13.1.2.3.2.2.4.
Scheduling all Rate Workbooks Reviews meetings with third-party
individuals and third-party organizations.
13.1.2.3.2.2.5.
Contractor’s follow up to any topics addressed during any Rate Workbooks
Review meeting, as directed by the Department.
13.1.2.3.2.3.
DELIVERABLE: Rate Workbooks Reviews
13.1.2.3.2.4.
DUE: Annually, as identified in the Project Schedule
13.1.2.3.3.
Contractor shall create an ongoing Enrollment Summary Report.
13.1.2.3.3.1.
At a minimum, the Enrollment Summary Report shall include all of the following:
13.1.2.3.3.1.1.
Provider name.
13.1.2.3.3.1.2.
Relevant identifications (IDs), including Provider Medicaid ID, National
Provider Identifier, and Tax ID Number.
13.1.2.3.3.1.3.
PMPM rate.
13.1.2.3.3.1.4.
PMPM percentage selected by the Provider.
13.1.2.3.3.1.5.
Corresponding Fee-for-Service percentage, which indicates remaining non-
capitated APM 2 Program payments and is the inverse of the PMPM
percentage.
13.1.2.3.3.1.6.
Chronic condition episode thresholds.
13.1.2.3.3.1.7.
APM 2 Program Enrollment Start Date selected by the Provider.
13.1.2.3.3.1.8.
Indicator for any Providers who have opted out of the APM 2 Program.
13.1.2.3.3.2.
DELIVERABLE: Enrollment Summary Report
13.1.2.3.3.3.
DUE: On a quarterly basis, no later than two weeks before each APM 2 Program
Enrollment Start Date, as identified in the Project Schedule
13.1.2.3.4.
Contractor shall conduct an annual reconciliation process in accordance with the
Department-approved APM 2 Program Reconciliation Plan.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 56 of 116
13.1.2.3.5.
Contractor shall create a Final Aggregated APM 2 Performance Report.
13.1.2.3.5.1.
The Final Aggregated APM 2 Performance Report shall include all of the
following:
13.1.2.3.5.1.1.
The measurements of APM 2 Program Provider performance against the APM
2 Program’s quality model, as developed in the Department-approved APM
Program Evaluation and Feedback Report.
13.1.2.3.5.1.2.
Summary results of how Providers performed against the quality model
thresholds using Health First Colorado claims and Electronic Clinical Quality
Measure (eCQM) information from clinical data, if applicable. Any eCQM
results will be provided by the Department and will not be calculated by the
Contractor.
13.1.2.3.5.1.3.
Reconciliation of any advanced payment amount to the Fee-for-Service billed
amount using Health First Colorado claims data, including a summarization
of any overpayments or underpayments.
13.1.2.3.5.1.4.
Recommendations for upwards or downwards reconciliation for Providers
receiving under or overpayments based on the results of the APM 2 Program
reconciliation process and the measurements of APM 2 Program Provider
performance in the quality model.
13.1.2.3.5.1.5.
Calculations for the correct level of federal funding that applies to the APM 2
Program population.
13.1.2.3.5.1.6.
The reconciliation of any form of shared savings using Health First Colorado
claims data against cost and quality performance, including a summary of
APM 2 Program Provider performance.
13.1.2.3.5.2.
DELIVERABLE: Final Aggregated APM 2 Performance Report
13.1.2.3.5.3.
DUE: Annually, not later than 10 Business Days after the reconciliation process
is complete, as identified in the Project Schedule
13.1.2.3.6.
Contractor shall create a version of the Final Aggregated Performance Report in a
format approved by the Department, which the Department will post on the
Department’s external website.
13.1.2.3.6.1.
The External Facing APM 2 Model Performance Report shall include all of the
following:
13.1.2.3.6.1.1.
A summary of APM 2 Program performance relating to the impact on Member
outcomes.
13.1.2.3.6.1.2.
A summary of APM 2 Program performance relating to the aggregate Provider
quality performance.
13.1.2.3.6.1.3.
A summary of APM 2 Program performance relating to the positive or
negative financial impacts, including dollar amounts, of the APM 2 Program.
13.1.2.3.6.2.
DELIVERABLE: External Facing APM 2 Model Performance Report
13.1.2.3.6.3.
DUE: Annually, not later than 10 Business Days after the Department approves
the Final Aggregated APM 2 Performance Report, as identified in the Project
Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 57 of 116
13.1.2.3.7.
Contractor shall create Final APM 2 Provider Performance Reports for each Provider
that participates in the APM 2 Program during the APM 2 Program Year.
13.1.2.3.7.1.
Each Provider’s Final APM 2 Provider Performance Reports shall include all of
the following:
13.1.2.3.7.1.1.
Total financial compensation to and reconciliations related to the APM 2
Program Provider.
13.1.2.3.7.1.2.
APM 2 Program Provider’s quality performance compared to the APM 2
Program Provider’s quality threshold, which quality thresholds will be
provided by the Department to Contractor.
13.1.2.3.7.1.3.
Comparison of where the APM 2 Program Provider’s Final Aggregated APM
2 Performance Report stands in relation to other APM 2 Program Providers’
quality performance.
13.1.2.3.7.1.4.
Identified areas where the APM 2 Program Provider’s quality performance
can improve.
13.1.2.3.7.1.5.
Comparison of what the APM 2 Program Provider was paid in the APM 2
Program compared to what the APM 2 Program Provider would have been
paid under Fee-for-Service.
13.1.2.3.7.1.6.
Any shared savings for the APM 2 Program Provider generated by
participation in the APM 2 program.
13.1.2.3.7.2.
DELIVERABLE: Final Provider Performance Reports
13.1.2.3.7.3.
DUE: Annually, not later than 10 Business Days after the Department approves
the Final Aggregated APM 2 Performance Report, as identified in the Project
Schedule
13.1.2.3.7.4.
Contractor shall send by regular mail and by electronic mail the Department-
approved Final Provider Performance Report to each identified APM 2 Program
Provider. Contractor shall notify the Department when Contractor has completed
sending each Final Provider Performance Report to each identified APM 2
Program Provider.
13.1.2.3.7.4.1.
DELIVERABLE: Notice of Final Provider Performance Report Sending
13.1.2.3.7.4.2.
DUE: Not later than two Business Days after sending, as identified in the
Project Schedule
13.1.2.3.8.
Contractor shall develop an APM 2 Program Management and Tracking Report.
13.1.2.3.8.1.
The APM 2 Program Management and Tracking Report shall include all of the
following:
13.1.2.3.8.1.1.
Provider communications and concerns.
13.1.2.3.8.1.2.
Rate appeals.
13.1.2.3.8.1.3.
Claims payment issues.
13.1.2.3.8.1.4.
Attribution issues.
13.1.2.3.8.1.5.
Proposed solutions to identified concerns, appeals, claims payment issues, and
attribution issues.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 58 of 116
13.1.2.3.8.1.6.
Validation of the payment accuracy being made to APM 2 Program Providers
by confirming PMPM payments are made as scheduled and in the amount
expected based on rate and number of attributed Members.
13.1.2.3.8.1.7.
Tracking to resolution or completion all Technology Solution Change
Requests.
13.1.2.3.8.2.
DELIVERABLE: APM 2 Program Management and Tracking Report
13.1.2.3.8.3.
DUE: Monthly, not later than the last day of each month, beginning after the APM
2 Program operations are transitioned to Contractor as identified in the APM 2
Operation Transition Plan
13.1.2.3.9.
Contractor shall, at minimum, host six public webinars each APM 2 Program Year to
advertise the Department-approved APM 2 Program changes as outlined in the APM
2 Program Modeling Changes Plan and Implementation Strategy as well as
forthcoming APM 2 Program enrollment.
13.1.2.3.9.1.
Contractor shall ensure that all webinars include an opportunity for Stakeholder
feedback and responses to proposed changes.
13.1.2.3.9.2.
Contractor shall create unique slide presentations and agenda to present at each
webinar.
13.1.2.3.9.2.1.
Each unique slide presentation and agenda shall include all of the following:
13.1.2.3.9.2.1.1.
An overview of APM 2 Program details.
13.1.2.3.9.2.1.2.
A question-and-answer session related to methodology, Rate Workbooks,
and enrollment.
13.1.2.3.9.2.1.3.
A discussion about any recommendations and updates to the APM 2
Program that the Department has approved.
13.1.2.3.9.2.1.4.
A list of agenda topics to discuss at each webinar.
13.1.2.3.9.2.2.
DELIVERABLE: Slide Presentation and Agenda.
13.1.2.3.9.2.3.
DUE: Three Business Days prior to each webinar
13.1.2.3.9.3.
Contractor shall take Meeting Minutes during each webinar.
13.1.2.3.9.3.1.
Each Meeting Minutes document shall include all of the following:
13.1.2.3.9.3.1.1.
List of attendees.
13.1.2.3.9.3.1.2.
Summary of agenda items.
13.1.2.3.9.3.1.3.
Question-and-answer and comment log for any Stakeholder questions or
comments, as well as answers made by webinar presenters.
13.1.2.3.9.3.1.4.
Chat log for written comments.
13.1.2.3.9.3.1.5.
Action items or next steps identified during the webinar.
13.1.2.3.9.3.2.
DELIVERABLE: Webinar Meeting Minutes
13.1.2.3.9.3.3.
DUE: Three Business Days after each webinar
13.1.2.3.9.4.
Contractor shall record each webinar. The Department will post the webinar
recordings to the Department’s external website.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 59 of 116
13.1.2.3.9.4.1.
DELIVERABLE: Webinar Recording
13.1.2.3.9.4.2.
DUE: Three Business Days after each webinar
13.1.2.3.10.
Contractor shall host and facilitate, at minimum, semi-annual trainings for RAE staff
and potentially other Department-selected third-party contractors (see Sections 12.5
through 12.5.4) that work with Provider practices.
13.1.2.3.10.1.
Each training shall include all of the following:
13.1.2.3.10.1.1.
Information from the Department-approved RAE APM 2 Training Overview
or Revised RAE APM 2 Training Overview, as applicable, that RAEs must
communicate to PCMPs.
13.1.2.3.10.1.2.
Information regarding up-to-date Department and Contractor points of contact
for follow up questions.
13.1.2.3.10.2.
DELIVERABLE: RAE Practice Facilitator Trainings
13.1.2.3.10.3.
DUE: Semi-annually, as identified in the Project Schedule
13.1.2.3.11.
On-Going Primary Care Data Sharing Analytics Solution for the APM 2 Program
M&O
13.1.2.3.11.1.
Contractor shall update analytics shared with Providers through the Primary Care
Data Sharing Analytics Solution for the APM 2 Program at minimum on a
monthly basis, or as otherwise requested by the Department, to provide regular,
consistent updates on care delivery and to support Provider success in the APM 2
Program. Contractor shall deliver a Data Update Provider Status Report to the
Department upon completion of the data update.
13.1.2.3.11.1.1.
The Data Update Provider Status Report shall include all of the following:
13.1.2.3.11.1.1.1.
A summary of all changes made to the data and analytics in the Primary
Care Data Sharing Analytics Solution for the APM 2 Program.
13.1.2.3.11.1.1.2.
A table of updated or refreshed source data included in the Primary Care
Data Sharing Analytics Solution for the APM 2 Program.
13.1.2.3.11.1.2.
DELIVERABLE: Data Update Provider Status Report
13.1.2.3.11.1.3.
DUE: Monthly, as identified in the Project Schedule
13.1.2.3.11.2.
Contractor shall create a Primary Care Data Sharing Analytics Solution for the
APM 2 Program Change Report.
13.1.2.3.11.2.1.
The Primary Care Data Sharing Analytics Solution for the APM 2 Program
Change Report shall summarize all technical changes, including Defects and
other Department-requested changes, made to the Primary Care Data Sharing
Analytics Solution for the APM 2 Program.
13.1.2.3.11.2.2.
DELIVERABLE: Primary Care Data Sharing Analytics Solution for the APM
2 Program Change Report
13.1.2.3.11.2.3.
DUE: Monthly, as identified in the Project Schedule
13.1.2.4.
APM 2 Program Close-Out and Transition Requirements of Contractor’s Technology
Solution
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 60 of 116
13.1.2.4.1.
Contractor shall develop a Primary Care Close-Out Report for the APM 2 Program.
13.1.2.4.1.1.
The Primary Care Close-Out Report for the APM 2 Program shall include all of
the following:
13.1.2.4.1.1.1.
Methodology changes.
13.1.2.4.1.1.2.
Updates that have been implemented to date.
13.1.2.4.1.1.3.
Current APM 2 Program model designs and methodologies.
13.1.2.4.1.1.4.
A summary of Stakeholder feedback and lessons learned.
13.1.2.4.1.2.
DELIVERABLE: Primary Care Close-Out Report for the APM 2 Program
13.1.2.4.1.3.
DUE: As identified in the Project Schedule
13.1.2.4.2.
Contractor shall develop a Primary Care Transition Plan for the APM 2 Program for
purposes of shifting the APM 2 Program’s ongoing and future operations to the
Department and/or to a different contractor of the Department’s choosing, in the
Department’s sole discretion.
13.1.2.4.2.1.
The Primary Care Transition Plan for the APM 2 Program shall include all of the
following:
13.1.2.4.2.1.1.
Procedural documentation timelines for updates.
13.1.2.4.2.1.2.
Data analytics and Dashboard maintenance schedules and monitoring
strategies, summarized from the Updated Provider Data Status Report and the
Updated Primary Care Data Sharing Analytics Solution for the APM 2
Program Data Report.
13.1.2.4.2.1.3.
Provider enrollment monitoring summarized from the Enrollment Summary
Report, including methods of tracking Provider enrollment and current status
of the APM 2 Program.
13.1.2.4.2.1.4.
Descriptions of how to maintain the Primary Care Data Analytics Solution for
the APM 2 Program, including a step-by-step process guide.
13.1.2.4.2.1.5.
Descriptions of how to monitor Member attribution to the APM 2 Program
and the Primary Care Data Analytics Solution for the APM 2 Program.
13.1.2.4.2.1.6.
Quality Threshold and Payment Rate reconciliation.
13.1.2.4.2.1.7.
Any elements that require sunset or otherwise will cease operations.
13.1.2.4.2.2.
DELIVERABLE: Primary Care Transition Plan for the APM 2 Program
13.1.2.4.2.3.
DUE: As identified in the Project Schedule
13.1.2.5.
Enhancements to Contractor’s Technology Solution
13.1.2.5.1.
Notwithstanding any provision in this Contract to the contrary, Contractor shall
review, update, and submit a revised APM 2 Program Modeling Changes Plan and
Implementation Strategy annually to reflect additional changes from legislative or
budget action. The requirements of the APM 2 Program Modeling Changes Plan and
Implementation Strategy are identified at Sections 13.1.2.1.7.1 through
13.1.2.1.7.1.2.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 61 of 116
13.1.2.5.1.1.
DELIVERABLE: Revised APM 2 Program Modeling Changes Plan and
Implementation Strategy
13.1.2.5.1.2.
DUE: Annually, as identified in the Project Schedule
13.1.2.5.2.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised APM 2 Partial Capitation and Chronic
Condition Episodes Threshold Model at least annually and before any implementation
of a Revised APM 2 Partial Capitation and Chronic Condition Episodes Threshold
Model. If no changes have occurred, Contractor shall provide a summary report that
indicates no changes have occurred. The requirements of the APM 2 Partial
Capitation and Chronic Condition Episodes Threshold Model are identified at
Sections 13.1.2.1.8.1 through 13.1.2.1.8.2.3.
13.1.2.5.2.1.
If any change is made to the APM 2 Partial Capitation and Chronic Condition
Episodes Threshold Model at any time during the applicable State Fiscal Year,
Contractor shall submit a Revised APM 2 Partial Capitation and Chronic
Condition Episodes Threshold Model to the Department.
13.1.2.5.2.1.1.
DELIVERABLE: Revised APM 2 Partial Capitation and Chronic Condition
Episodes Threshold Model
13.1.2.5.2.1.2.
DUE: At least annually and after a change is made as identified in the Project
Schedule
13.1.2.5.3.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised APM 2 Program Provider Guidebook if any
changes in the Revised APM 2 Partial Capitation and Chronic Condition Threshold
Model require corresponding changes to the content in the APM 2 Program Provider
Guidebook. The requirements of the APM 2 Program Provider Guidebook are
identified at Sections 13.1.2.1.9.1 through 13.1.2.1.9.1.5.
13.1.2.5.3.1.
DELIVERABLE: Revised APM 2 Program Provider Guidebook
13.1.2.5.3.2.
DUE: As identified in the Project Schedule
13.1.2.5.4.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised Chronic Condition Episode Logic and Business
Rules as business rules change. The requirements of the Chronic Condition Episode
Logic and Business Rules are identified at Sections 13.1.2.2.3.1 through
13.1.2.2.3.1.3.
13.1.2.5.4.1.
DELIVERABLE: Revised Chronic Condition Episode Logic and Business Rules
13.1.2.5.4.2.
DUE: Within 10 Business Days after a business rule change
13.1.2.5.5.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised Updated APM 2 Actuarial Narrative when
changes occur to the rate model. The requirements of the Updated APM 2 Actuarial
Narrative are identified at Sections 13.1.2.2.6 through 13.1.2.2.6.1.
13.1.2.5.5.1.
DELIVERABLE: Revised Updated APM 2 Actuarial Narrative
13.1.2.5.5.2.
DUE: Within 10 Business Days after a rate model change
13.1.3.
Pediatric APM Program Requirements
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 62 of 116
13.1.3.1.
Development within Contractor’s Technology Solution
13.1.3.1.1.
To develop requirements for implementation in Contractor’s Technology Solution,
Contractor shall create a recommendation regarding the best way to perform an
analysis and report of the proportion of Health First Colorado or CHP+ Member
pediatric health care access via an assessment of Provider workforce.
13.1.3.1.1.1.
DELIVERABLE: Pediatric Recommendation of Analysis and Report
13.1.3.1.1.2.
DUE: As identified in the Project Schedule
13.1.3.1.2.
To develop requirements for implementation in Contractor’s Technology Solution,
Contractor shall create a Comprehensive Literature Review Report for the
Department to use as background research for the Pediatric APM Program.
13.1.3.1.2.1.
Contractor’s Comprehensive Literature Review Report shall include, but is not
limited to, all of the following:
13.1.3.1.2.1.1.
A summary of existing pediatric APMs in the United States and results from
the APMs if they are publicly available.
13.1.3.1.2.1.2.
Methods of risk adjustment based on the SDoH.
13.1.3.1.2.1.3.
Demographics from Health First Colorado claims (e.g., 0-2 years old; 3-5
years old; 6-10 years old; 11-18 years-old).
13.1.3.1.2.1.4.
Prominent morbidities.
13.1.3.1.2.1.5.
Types of Providers that see pediatric patients (e.g., pediatrician, family
practice).
13.1.3.1.2.1.6.
Types of practices that see pediatric patients (e.g., private family practice,
FQHC, hospital-based clinics, pediatric practice, school-based health center).
13.1.3.1.2.1.7.
Clinic geography (e.g., Urban, Rural, Frontier).
13.1.3.1.2.1.8.
A projection of the impact of federal Health First Colorado policy changes
(e.g., Health First Colorado expansion, the end of the Public Health
Emergency) and population forecasts (e.g., growing population) to estimate
future Health First Colorado Fee-for-Service enrollment for children. The
sub-demographics shall include, but are not limited to:
13.1.3.1.2.1.8.1.
Colorado’s Medicaid expansion that went into effect on January 1, 2014.
13.1.3.1.2.1.8.2.
COVID-19 Public Health Emergency.
13.1.3.1.2.1.8.3.
General population growth in Colorado.
13.1.3.1.2.1.8.4.
Any other sub-demographics defined by the Department.
13.1.3.1.2.1.9.
Analysis of trends within Health First Colorado claims related to Health First
Colorado churn and the common types of health coverage for children aged 0
to 18 years old.
13.1.3.1.2.1.10.
Analysis of and report regarding the proportion of Health First Colorado or
CHP+ Member pediatric health care access via an assessment of Provider
workforce
supply,
in
compliance
with
the
Department-approved
Recommendation of Analysis and Report.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 63 of 116
13.1.3.1.2.1.11.
Estimate of the financial health of pediatric practices across Colorado based
on Health First Colorado claims data and the publicly available data such as
the census estimated number of children in Colorado, profitability, liquidity,
and patient panel mix.
13.1.3.1.2.2.
DELIVERABLE: Pediatric Comprehensive Literature Review Report
13.1.3.1.2.3.
DUE: As identified in the Project Schedule
13.1.3.1.3.
To develop requirements for implementation in Contractor’s Technology solution,
Contractor shall create a Pre-Design Research Report supported by the Department-
approved Comprehensive Pediatric Literature Review, Health First Colorado claims
data, and clinical practice guidelines for the Department to use to design the Pediatric
APM Program.
13.1.3.1.3.1.
The Pre-Design Research Report shall include, at a minimum, all of the following:
13.1.3.1.3.1.1.
The identification of best practices in pediatric care related to clinical care,
including but not limited to: well care, immunization, developmental
screenings, and dental care.
13.1.3.1.3.1.2.
An analysis of Health First Colorado claims data for Provider performance for
Health First Colorado Members in the CMS Child Core Measures Set and
identify focus areas for improvement.
13.1.3.1.3.1.3.
An analysis of trends in pediatric utilization in Health First Colorado claims
data to find cost drivers to recommend opportunities for a Pediatric APM
Program.
13.1.3.1.3.1.4.
An analysis of Provider attribution in Health First Colorado claims to make
recommendations for the base pediatric payment model.
13.1.3.1.3.1.4.1.
Contractor shall analyze Health First Colorado’s current attribution
methodology, which the Department will share with Contractor, and
evaluate Health First Colorado’s current attribution methodology for
accuracy at the PCMP level based on Member utilization patterns.
13.1.3.1.3.1.5.
An analysis of Health First Colorado claims using the Department’s current
attribution methodology for leakage of Pediatric Members seeking care
outside of Pediatric Members’ PCMP and Pediatric Members that move out
of Colorado.
13.1.3.1.3.1.6.
The development of a tiered analysis of current APM 2 practices by practice
type (e.g., family practice, pediatric practices, FQHCs, school-based health
clinics) who see more than 50 Pediatric Members and recommend how the
Pediatric APM Program and the APM 2 Program model will interact given
that some children will receive care in a different setting than an exclusive
pediatric setting.
13.1.3.1.3.1.7.
Recommend an incentive payment specific to the pediatric population based
on best practices and Pediatric Member spending drivers in Health First
Colorado claims.
13.1.3.1.3.1.8.
If requested by the Department, implementation recommendations based on
the Department’s submitted budget request, “R-6 Supporting PCMPs with
Value Based Payments.”
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 64 of 116
13.1.3.1.3.2.
DELIVERABLE: Pediatric Pre-Design Research Report
13.1.3.1.3.3.
DUE: As identified in the Project Schedule
13.1.3.1.4.
To develop requirements for implementation within Contractor’s Technology
Solution, Contractor shall have a Stakeholder-Driven Design Process.
13.1.3.1.4.1.
Contractor shall interview Stakeholders identified by the Department for purposes
of determining pediatric care opportunities and learning pain points for Pediatric
APM Program design.
13.1.3.1.4.1.1.
Per direction from the Department on whom to interview, Contractor shall
interview, at a minimum, individuals in all of the following groups:
13.1.3.1.4.1.1.1.
Department SMEs.
13.1.3.1.4.1.1.2.
10 pediatric Providers (e.g., pediatrician, family physician, nurse
practitioner, physician assistant).
13.1.3.1.4.1.1.3.
Three consumer advocates.
13.1.3.1.4.1.1.4.
RAEs.
13.1.3.1.4.1.1.5.
The parent(s)/guardian(s) of five Health First Colorado Pediatric Members
(current or former).
13.1.3.1.4.2.
Contractor shall summarize every Stakeholder engagement meeting.
13.1.3.1.4.2.1.
Each Stakeholder engagement meeting summary shall include:
13.1.3.1.4.2.1.1.
An overview of information discussed during the meeting.
13.1.3.1.4.2.1.2.
The identification of common themes discussed by Stakeholders during
the meeting.
13.1.3.1.4.2.1.3.
An analysis of conflicting thoughts regarding one theme between
Stakeholders during a meeting or between Stakeholder groups.
13.1.3.1.4.2.2.
DELIVERABLE: Pediatric Stakeholder Engagement Meeting Summary
13.1.3.1.4.2.3.
DUE: As identified in the Project Schedule
13.1.3.1.4.3.
The Department will invite the Stakeholders and relevant SMEs to participate in
the Design Team (“the Design Team”).
13.1.3.1.4.3.1.
Contractor shall host a maximum of 12 working group meetings via webinars
with the Design Team to design the Pediatric APM Program.
13.1.3.1.4.4.
Contractor shall create unique slide presentations and agenda to present at each
webinar for the Design Team working group meetings.
13.1.3.1.4.4.1.
Each unique slide presentation and agenda shall include all of the following:
13.1.3.1.4.4.1.1.
An overview of Pediatric APM Program details.
13.1.3.1.4.4.1.2.
A question-and-answer session related to methodology and enrollment.
13.1.3.1.4.4.1.3.
A discussion about any recommendations and updates to the Pediatric
APM Program that the Department has approved.
13.1.3.1.4.4.1.4.
A list of agenda topics to discuss at each webinar.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 65 of 116
13.1.3.1.4.4.2.
DELIVERABLE: Slide Presentation and Agenda
13.1.3.1.4.4.3.
DUE: Three Business Days prior to each webinar
13.1.3.1.5.
Contractor shall take Meeting Minutes during each webinar.
13.1.3.1.5.1.
Each Meeting Minutes document shall include all of the following:
13.1.3.1.5.1.1.
List of attendees.
13.1.3.1.5.1.2.
Summary of agenda items.
13.1.3.1.5.1.3.
Question-and-answer and comment log for any Stakeholder questions or
comments, as well as answers made by webinar presenters.
13.1.3.1.5.1.4.
Chat log for written comments.
13.1.3.1.5.1.5.
Action items or next steps identified during the webinar.
13.1.3.1.5.2.
DELIVERABLE: Webinar Meeting Minutes
13.1.3.1.5.3.
DUE: Three Business Days after each webinar
13.1.3.1.6.
When requested by the Department, Contractor shall provide ad-hoc data reports to
the Department.
13.1.3.1.6.1.
DELIVERABLE: Ad-Hoc Data Reports
13.1.3.1.6.2.
DUE: As instructed by the Department
13.1.3.1.7.
Contractor shall create a Pediatric APM Program Model Design Document based on
the results of the Design Team, Department-approved Comprehensive Pediatric
Literature Review, and Department-approved Pre-Design Research Report.
13.1.3.1.7.1.
The Pediatric APM Program Model Design Document shall include all of the
following:
13.1.3.1.7.1.1.
Pediatric APM Program detailed model specifications, which shall include:
13.1.3.1.7.1.1.1.
Payment model design.
13.1.3.1.7.1.1.2.
Incentive payment structure.
13.1.3.1.7.1.1.3.
Risk adjustment methodology
13.1.3.1.7.1.1.4.
Operational details.
13.1.3.1.7.1.2.
A Pediatric APM Program quality model.
13.1.3.1.7.1.3.
Pediatric APM Program business rules.
13.1.3.1.7.1.4.
Decision items and consensus decisions reached by the Design Team.
13.1.3.1.7.2.
DELIVERABLE: Pediatric APM Program Model Design Document
13.1.3.1.7.3.
DUE: As identified in the Project Schedule
13.1.3.1.8.
Pediatric APM Program Expansion and Enhancement of Contractor’s Technology
Solution Through Stakeholder Engagement
13.1.3.1.8.1.
Contractor shall host at least five public meetings in different regions of Colorado
to educate and discuss with Providers the Pediatric APM Program Model, which
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 66 of 116
is expected to provide requirements to enhance Contractor’s Technology
Solution.
13.1.3.1.8.2.
Contractor shall propose public meeting locations for each of the five public
meetings.
13.1.3.1.8.2.1.
DELIVERABLE: Pediatric APM Program Expansion and Enhancement:
Proposed Public Meeting Locations
13.1.3.1.8.2.2.
DUE: As identified in the Project Schedule
13.1.3.1.8.3.
Contractor shall create unique slide presentations and agenda to present at each
meeting.
13.1.3.1.8.3.1.
Each unique slide presentation and agenda shall include all of the following:
13.1.3.1.8.3.1.1.
An overview of Pediatric APM Program details.
13.1.3.1.8.3.1.2.
Information from the Department-approved Pediatric APM Program
Model Design Document.
13.1.3.1.8.3.1.3.
The proposed rate increase, if directed by the Department.
13.1.3.1.8.3.1.4.
Upcoming Pediatric APM Program enrollment.
13.1.3.1.8.3.1.5.
A question-and-answer session related to methodology and enrollment.
13.1.3.1.8.3.1.6.
A discussion about any recommendations and updates to the Pediatric
APM Program that the Department has approved.
13.1.3.1.8.3.1.7.
A list of agenda topics to discuss at each webinar.
13.1.3.1.8.3.2.
DELIVERABLE: Slide Presentation and Agenda
13.1.3.1.8.3.3.
DUE: Three Business Days prior to each webinar
13.1.3.1.8.4.
Contractor shall take Meeting Minutes during each webinar.
13.1.3.1.8.4.1.
Each Meeting Minutes document shall include all of the following:
13.1.3.1.8.4.1.1.
List of attendees.
13.1.3.1.8.4.1.2.
Summary of agenda items.
13.1.3.1.8.4.1.3.
Question-and-answer and comment log for any meeting participant’s
questions or comments, as well as answers made by webinar presenters.
13.1.3.1.8.4.1.4.
Chat log for written comments.
13.1.3.1.8.4.1.5.
Action items or next steps identified during the webinar.
13.1.3.1.8.4.2.
DELIVERABLE: Webinar Meeting Minutes
13.1.3.1.8.4.3.
DUE: Three Business Days after each webinar
13.1.3.1.9.
Contractor shall develop RAE Communication Materials for the RAEs, and
potentially other Department-selected third-party contractors (see Sections 12.5
through 12.5.4), to share with Providers, which is expected to provide requirements
to enhance Contractor’s Technology Solution.
13.1.3.1.9.1.
The RAE Communications Materials shall include all of the following:
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 67 of 116
13.1.3.1.9.1.1.
If requested by the Department, the upcoming Pediatric APM Program
enrollment.
13.1.3.1.9.1.2.
How to drop out of the Pediatric APM Program.
13.1.3.1.9.1.3.
Information containing an estimated financial impact to Providers if they are
automatically enrolled into the Pediatric APM Program.
13.1.3.1.9.2.
DELIVERABLE: RAE Communications Materials
13.1.3.1.9.3.
DUE: As identified in the Project Schedule
13.1.3.1.10.
If requested by the Department, Contractor shall host at minimum five trainings for
RAE staff that work with Provider practices to communicate the legislative or budget
action(s).
13.1.3.1.10.1.
DELIVERABLE: RAE Trainings
13.1.3.1.10.2.
DUE: As identified in the Project Schedule
13.1.3.1.11.
Contractor shall develop Initial Payment Rates for Providers.
13.1.3.1.11.1.
The Initial Payment Rates shall comply with all of the following:
13.1.3.1.11.1.1.
The Initial Payment Rates shall be based on the specifications in the
Department-approved Pediatric APM Program Model Design Document.
13.1.3.1.11.1.2.
The Initial Payment Rates shall be in compliance with Actuarial Standards of
Practice.
13.1.3.1.11.1.3.
The Initial Payment Rates shall be risk adjusted to ensure payment matches
the Providers’ risk and include adjustment based on the SDoH.
13.1.3.1.11.2.
DELIVERABLE: Initial Payment Rates
13.1.3.1.11.3.
DUE: As identified in the Project Schedule
13.1.3.1.12.
Contractor shall develop Initial Quality Thresholds set relative to national standards
for Providers participating in the Pediatric APM Program for Department approval.
13.1.3.1.12.1.
DELIVERABLE: Initial Quality Thresholds
13.1.3.1.12.2.
DUE: As identified in the Project Schedule
13.1.3.1.12.3.
After receiving the Department’s approval of the Initial Quality Thresholds,
Contractor shall send the Department-approved Initial Quality Thresholds to
Providers enrolled in Health First Colorado.
13.1.3.1.13.
Contractor shall develop Provider Payment Rate Communications Materials.
13.1.3.1.13.1.
The Provider Payment Rate Communications Materials shall include all of the
following:
13.1.3.1.13.1.1.
The Providers’ Payment Rates.
13.1.3.1.13.1.2.
The Providers’ Quality Thresholds.
13.1.3.1.13.2.
DELIVERABLE: Provider Payment Rate Communications Materials
13.1.3.1.13.3.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 68 of 116
13.1.3.1.13.4.
After receiving the Department’s approval of the Provider Payment Rate
Communications Materials, Contractor shall send the Department-approved
Provider Payment Rate Communications Materials to Providers.
13.1.3.1.14.
Contractor shall create a Pediatric APM Program Provider Guidebook.
13.1.3.1.14.1.
The Pediatric APM Program Provider Guidebook shall include all of the
following:
13.1.3.1.14.1.1.
Specifications of the payment methodology from the Department-approved
Pediatric APM Program Model Design Document.
13.1.3.1.14.1.2.
Business rules for the Pediatric APM Program from the Department-approved
Pediatric APM Program Model Design Document.
13.1.3.1.14.1.3.
Rules for incentive payment eligibility from the Department-approved
Pediatric APM Program Model Design Document.
13.1.3.1.14.1.4.
The identification of Pediatric Members that are included in the Pediatric
APM Program from the Department-approved Pediatric APM Program Model
Design Document.
13.1.3.1.14.1.5.
How payments in the Pediatric APM Program are processed and timelines for
when payments in the Pediatric APM Program are processed from the
Department-approved Pediatric APM Program Model Design Document.
13.1.3.1.14.1.6.
Quality measures specifications from the Department-approved Pediatric
APM Program Model Design Document.
13.1.3.1.14.2.
DELIVERABLE: Pediatric APM Program Provider Guidebook
13.1.3.1.14.3.
DUE: As identified in the Project Schedule
13.1.3.1.14.4.
Notwithstanding any other provision in this Contract, Contractor shall update the
Pediatric APM Program Provider Guidebook when any of the following occur
independently or together: (1) at least on an annual basis; (2) when a
programmatic change is implemented; (3) when an operational change is
implemented; and/or (4) after the annual Stakeholder engagement process.
13.1.3.1.14.4.1.
DELIVERABLE: Updated Pediatric APM Program Provider Guidebook
13.1.3.1.14.4.2.
DUE: At least annually or as otherwise requested and identified in the Project
Schedule
13.1.3.1.15.
Contractor shall create a Pediatric APM Program Reconciliation Plan.
13.1.3.1.15.1.
The Pediatric APM Program Reconciliation Plan shall include all of the
following:
13.1.3.1.15.1.1.
A process regarding prospective payment and incentive payment model
reconciliation to Fee-for-Service payment after the Pediatric APM Program is
implemented.
13.1.3.1.15.1.2.
A timeline for the annual process and necessary outputs to be provided to the
Department based on the Department-approved Pediatric APM Program
Model Design Document.
13.1.3.1.15.2.
DELIVERABLE: Pediatric APM Program Reconciliation Plan
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 69 of 116
13.1.3.1.15.3.
DUE: On an annual basis, as identified in the Project Schedule
13.1.3.2.
Primary Care Data Sharing Analytics Solution for the Pediatric APM Program
Requirements
13.1.3.2.1.
Contractor shall build a Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program as part of Contractor’s Technology Solution.
13.1.3.2.1.1.
The Primary Care Data Sharing Analytics Solution for the Pediatric APM
Program shall include, at a minimum, all of the following:
13.1.3.2.1.1.1.
The ability to access summaries of Provider performance.
13.1.3.2.1.1.2.
The ability to conduct drill down analyses to identify cost drivers and
interventions to improve cost, quality, and health equity.
13.1.3.2.1.1.3.
Accessibility via a secure portal.
13.1.3.2.1.1.4.
Accessibility via defined role-based access points.
13.1.3.2.1.1.5.
The ability to evaluate and visualize key service utilization measures by
Providers that can be used to identify interventions to improve cost of care.
Key service utilization measures shall include all of the following:
13.1.3.2.1.1.5.1.
Overall and Member-specific primary care E&M.
13.1.3.2.1.1.5.2.
Interventions to increase pediatric primary and preventive care.
13.1.3.2.1.1.5.3.
Patient-specific primary care E&M visit rate.
13.1.3.2.1.1.5.4.
Primary care visits for sickness versus well care visits.
13.1.3.2.1.1.5.5.
Relevant specialty care visit rates.
13.1.3.2.1.1.5.6.
Chronic condition medication adherence.
13.1.3.2.1.1.5.7.
Utilization rates for services that are key cost drivers.
13.1.3.2.1.1.5.8.
Related CMS Child Core Measures Set, clinical quality measures, where
poor performance may contribute to high costs.
13.1.3.2.1.1.5.9.
Vaccination rates.
13.1.3.2.1.1.5.10.
ER utilization.
13.1.3.2.1.1.5.11.
Developmental screening rates.
13.1.3.2.1.1.5.12.
Registry function at the patient level for identified quality measures.
13.1.3.2.1.1.6.
The ability to evaluate Pediatric Members by one or more key attributes for
the purpose of analyzing the key attributes’ impacts on costs, quality, and key
service utilization measurements. Key attributes shall include, at a minimum:
13.1.3.2.1.1.6.1.
Risk level.
13.1.3.2.1.1.6.2.
Comorbidities.
13.1.3.2.1.1.6.3.
Demographic and SDoH characteristics (see Exhibit D, Section 1.1.104).
13.1.3.2.1.1.7.
The ability to conduct the following types of Data Sharing Analytics for the
Pediatric APM Program:
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Exhibit B, SOW
Page 70 of 116
13.1.3.2.1.1.7.1.
Monthly PMPM and Fee-for-Service payments for Providers taking any
level of partial capitation, including the ability to see PMPM payments
over time relative to the amount billed Fee-for-Service.
13.1.3.2.1.1.7.2.
Pediatric APM Program-eligible Members, as defined in the Department-
approved Pediatric APM Program Model Design Document, for use in
comparing payments to actual Pediatric Member attribution by month.
13.1.3.2.1.1.7.3.
Evaluation of how the Provider compares to peers in terms of total risk-
adjusted PMPM costs and risk-adjusted costs by service category (e.g.,
inpatient, outpatient (physician visits, ER), tests, procedures, and
pharmacy).
13.1.3.2.1.1.7.4.
Drill down analyses to evaluate how the Provider compares to peers in
terms of risk adjusted costs, sortable by chronic disease that can be used
for the purpose of identifying chronic diseases that drive costs within
Health First Colorado claims data. Claim data shall include costs and
associated descriptions that fully detail the care the Pediatric Member
received, including, at a minimum:
13.1.3.2.1.1.7.4.1.
Claim type.
13.1.3.2.1.1.7.4.2.
Diagnosis.
13.1.3.2.1.1.7.4.3.
Procedure (e.g., CPT-4, ICD-10, revenue codes).
13.1.3.2.1.1.7.4.4.
Prescription drug prescribed.
13.1.3.2.1.1.7.4.5.
Location where services were provided.
13.1.3.2.1.1.7.4.6.
Provider of services.
13.1.3.2.1.1.7.5.
Drill down analyses to identify Pediatric Members with high risk and high
utilization that drive costs.
13.1.3.2.1.1.7.6.
Grouping Pediatric Members by one or more key attributes, including risk
level, comorbidities, and demographic and SDoH characteristics (see
Exhibit D, Section 1.1.104) for the purpose of analyzing their impacts on
PCMP total cost of care.
13.1.3.2.1.1.8.
The ability to conduct the following types of analyses:
13.1.3.2.1.1.8.1.
At a minimum, the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program shall allow the Department, care coordinators,
and Providers to conduct the following types of analyses:
13.1.3.2.1.1.8.1.1.
Evaluation of how the Provider compares to peers in terms of total
risk-adjusted costs and risk-adjusted costs by service category (e.g.,
inpatient, outpatient (physician visits, ER), tests, procedures,
pharmacy) for each chronic condition.
13.1.3.2.1.1.8.1.2.
Drill down analyses of individual claims within each service category
defined with the Department’s input to ensure completeness of claims
data for the purpose of reviewing and identifying specific claims that
drive costs, including relevant diagnosis, procedure, location, and
other codes.
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Exhibit B, SOW
Page 71 of 116
13.1.3.2.1.1.9.
The ability to conduct drill down analyses with visualizations to guide
Provider improvement interventions for Pediatric Members with high risk and
high utilization that drive costs, which shall include all of the following
information:
13.1.3.2.1.1.9.1.
Overall primary care E&M utilization.
13.1.3.2.1.1.9.2.
Pediatric Member-specific primary care E&M utilization.
13.1.3.2.1.1.9.3.
Relevant specialty care visit rates.
13.1.3.2.1.1.9.4.
Medication adherence, if included in the Department-approved Pediatric
APM Program Design Document.
13.1.3.2.1.1.9.5.
Utilization rates for services that are key cost drivers.
13.1.3.2.1.1.10.
The ability to identify and display CMS Child Core Measures Set where poor
performance may contribute to high costs.
13.1.3.2.1.1.11.
The ability to deliver any form of incentive payment information.
13.1.3.2.1.1.12.
The ability to use clinical data to identify when an episode is triggered if made
available by the Department.
13.1.3.2.1.1.13.
Any additional requirements as agreed upon by the Department and
Contractor.
13.1.3.2.1.2.
DELIVERABLE: Primary Care Data Sharing Analytics Solution for the Pediatric
APM Program
13.1.3.2.1.3.
DUE: As identified in the Project Schedule
13.1.3.2.2.
Contractor shall update the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program monthly with the latest claims data for Users to monitor
recent changes in Pediatric Member health care costs and utilization.
13.1.3.2.3.
Contractor shall aggregate Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program data to the RAE level and shall disseminate these RAE-level
Dashboards to each of the corresponding RAEs.
13.1.3.2.4.
Contractor shall interview the Department’s identified SMEs to define the content,
functionality, and format of the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program and the Primary Care Data Sharing Analytics Solution for
the Pediatric APM Program’s associated data.
13.1.3.2.5.
For each Provider, and aggregated by RAE Region for each RAE, Contractor shall
provide performance feedback reports in the Primary Care Data Sharing Analytics
Solution for the Pediatric APM Program:
13.1.3.2.5.1.
Each report for Pediatric Members shall contain all of the following information:
13.1.3.2.5.1.1.
Simple and intuitive graphics that include clear labels and explanations of
source data of cost and quality of care performance for each chronic condition
and quality of care for Pediatric Members, compared to peers.
13.1.3.2.5.1.2.
Actionable information to facilitate improvement interventions, including a
summary of the drivers of performance measurement results for each chronic
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Exhibit B, SOW
Page 72 of 116
condition and for pediatric care, which include overutilization or
underutilization of services and SDoH.
13.1.3.2.5.1.3.
Access to a report of gaps in care for each chronic condition and for Pediatric
Members.
13.1.3.2.5.1.4.
Member leakage rate with demographic characteristics of patients that left the
Provider practice.
13.1.3.2.5.1.5.
Gain/risk share amounts with supporting calculations for management of
chronic conditions.
13.1.3.3.
Stabilization within Contractor’s Technology Solution
13.1.3.3.1.
Contractor shall support the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program implementation and Go-Live within the Contractor’s
Technology Solution.
13.1.3.3.2.
Contractor shall create a Pediatric APM Program Implementation Plan.
13.1.3.3.2.1.
The Pediatric APM Program Implementation Plan shall include all of the
following:
13.1.3.3.2.1.1.
The identification of all necessary steps required to bring the Primary Care
Data Sharing Analytics Solution for the Pediatric APM Program to Go-Live
within the Contractor’s Technology Solution.
13.1.3.3.2.1.2.
A plan to manage the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program implementation.
13.1.3.3.2.1.3.
A plan to manage the Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program operations as defined in the Department-approved
Pediatric Model Design Document.
13.1.3.3.2.1.4.
A plan to implement a pilot program that may include all Providers, during
which payments may be made, and which pilot program shall not exceed one
year in duration.
13.1.3.3.2.2.
DELIVERABLE: Pediatric APM Program Implementation Plan
13.1.3.3.2.3.
DUE: As identified in the Project Schedule
13.1.3.3.3.
If requested by the Department, Contractor shall attend meetings as requested with
CMS to negotiate State Plan and provide clarifying language about the methodology
to support the Department in obtaining approval for a State Plan Amendment or
Medical Services Board rule to operate the Pediatric APM Program.
13.1.3.3.3.1.
DELIVERABLE: CMS Meeting Attendance
13.1.3.3.3.2.
DUE: As identified in the Department’s request for Contractor to attend each
meeting
13.1.3.3.4.
Contractor shall create a Pediatric APM Program Management Tracker.
13.1.3.3.4.1.
The Pediatric APM Program Management Tracker shall include all of the
following:
13.1.3.3.4.1.1.
Identification of Provider communications and concerns.
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Exhibit B, SOW
Page 73 of 116
13.1.3.3.4.1.2.
Identification of claims payment issues.
13.1.3.3.4.1.3.
Proposed solutions to all identified Provider communications and concerns
and Primary Care Data Sharing Analytics Solution for the Pediatric APM
Program issues required in order to achieve the Primary Care Data Sharing
Analytics Solution for the Pediatric APM Program Go-Live.
13.1.3.3.4.1.4.
Validation and reporting on the Pediatric APM Program claims payment
accuracy of payments made to Providers.
13.1.3.3.4.2.
DELIVERABLE: Pediatric APM Program Management Tracker
13.1.3.3.4.3.
DUE: Monthly, as identified in the Project Schedule
13.1.3.4.
Operations within Contractor’s Technology Solution
13.1.3.4.1.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised Provider Payment Rate Communications
Materials for Department review and approval. The requirements of the Provider
Payment Rate Communications Materials are identified at Sections 13.1.3.1.13.1
through 13.1.3.1.13.1.2.
13.1.3.4.1.1.
DELIVERABLE: Revised Provider Payment Rate Communications Materials
13.1.3.4.1.2.
DUE: Annually, as identified in the Project Schedule
13.1.3.4.1.3.
After receiving the Department’s approval of the Revised Provider Payment Rate
Communications Materials, Contractor shall send the Department-approved
Revised Provider Payment Rate Communications Materials to Providers.
13.1.3.4.2.
Contractor shall create a Final Aggregated Performance Report.
13.1.3.4.2.1.
The Final Aggregated Performance Report shall include all of the following:
13.1.3.4.2.1.1.
The measurements of Provider performance against the most recent
Department-approved Quality Thresholds and summarize results of how
Providers performed against the most recent Department-approved Quality
Thresholds using Health First Colorado claims and Electronic Clinical Quality
Measure information from clinical data and provided by the Department, if
applicable.
13.1.3.4.2.1.2.
The reconciliation of any prospective payment amount to the Fee-for-Service
billed amount using Health First Colorado claims data, including a
summarization of any overpayments or underpayments.
13.1.3.4.2.1.3.
The reconciliation of any form of incentive payments or shared savings using
Health First Colorado claims data against cost and quality performance,
including a summary of Provider performance in financial savings.
13.1.3.4.2.1.4.
Analysis of Health First Colorado claims regarding the causes that drive
Health First Colorado Pediatric Member outcomes, and the identification of
levers Providers are using to be successful in the Pediatric APM Program.
13.1.3.4.2.2.
DELIVERABLE: Final Aggregated Performance Report
13.1.3.4.2.3.
DUE: Annually, as identified in the Project Schedule
13.1.3.4.3.
Contractor shall create Final Provider Performance Reports.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 74 of 116
13.1.3.4.3.1.
The Final Provider Performance Reports shall include all of the following:
13.1.3.4.3.1.1.
Show the total financial impact to the Provider.
13.1.3.4.3.1.2.
Show the Provider’s quality performance compared to the Provider’s Quality
Threshold.
13.1.3.4.3.1.3.
Show the Provider where the Provider stands compared to other Providers.
13.1.3.4.3.1.4.
Identify how the Provider can improve the Provider’s performance.
13.1.3.4.3.1.5.
Show the Provider what the Provider was paid in the Pediatric APM Program
compared to what the Provider would have been paid under a Fee-for-Service.
13.1.3.4.3.1.6.
Any shared savings generated in the Pediatric APM Program.
13.1.3.4.3.2.
DELIVERABLE: Final Provider Performance Reports
13.1.3.4.3.3.
DUE: Annually, as identified in the Project Schedule
13.1.3.4.3.4.
Contractor shall deliver all Department-approved Final Provider Performance
Reports directly to Providers enrolled in the Pediatric APM Program.
13.1.3.4.4.
Contractor shall create a version of the Final Aggregated Performance Report which
the Department will post on the Department’s external website.
13.1.3.4.4.1.
The External Facing Model Performance Report shall summarize in writing and
numerically model performance in terms of impact on Pediatric Member
outcomes, Provider quality metric performance, and the positive or negative
financial impacts of the Pediatric APM Program.
13.1.3.4.4.1.1.
DELIVERABLE: External Facing Model Performance Report
13.1.3.4.4.1.2.
DUE: Annually, no later than as identified in the Project Schedule
13.1.3.5.
On-Going Pediatric APM Program Stakeholder Engagement to Determine Enhancements
within Contractor’s Technology Solution
13.1.3.5.1.
Contractor shall hold an annual Stakeholder engagement process to seek feedback
from Stakeholders regarding improving the Pediatric APM Program. At a minimum,
Contractor shall host four webinars each SFY throughout the Term of the Contract.
13.1.3.5.1.1.
Contractor shall create unique slide presentations and agenda to present at each
webinar.
13.1.3.5.1.1.1.
Each unique slide presentation and agenda shall include all of the following:
13.1.3.5.1.1.1.1.
An overview of Pediatric APM Program details.
13.1.3.5.1.1.1.2.
A question-and-answer session.
13.1.3.5.1.1.1.3.
A discussion about any recommendations and updates to the Pediatric
APM Program that the Department has approved.
13.1.3.5.1.1.1.4.
A list of agenda topics to discuss at each webinar.
13.1.3.5.1.1.2.
DELIVERABLE: Slide Presentation and Agenda
13.1.3.5.1.1.3.
DUE: Three Business Days prior to each webinar
13.1.3.5.1.2.
Contractor shall take Meeting Minutes during each webinar.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 75 of 116
13.1.3.5.1.2.1.
Each Meeting Minutes document shall include all of the following:
13.1.3.5.1.2.1.1.
List of attendees.
13.1.3.5.1.2.1.2.
Summary of agenda items.
13.1.3.5.1.2.1.3.
Question-and-answer and comment log for any Stakeholder questions or
comments, as well as answers made by webinar presenters.
13.1.3.5.1.2.1.4.
Chat log for written comments.
13.1.3.5.1.2.1.5.
Action items or next steps identified during the webinar.
13.1.3.5.1.2.2.
DELIVERABLE: Webinar Meeting Minutes
13.1.3.5.1.2.3.
DUE: Three Business days after each webinar
13.1.3.5.1.3.
Contractor shall summarize the results of the annual Stakeholder engagement
process in a Pediatric APM Program Annual Stakeholder Engagement Report.
The Pediatric APM Program Annual Stakeholder Engagement Report shall
include, at a minimum, all of the following:
13.1.3.5.1.3.1.
Summarize Stakeholder feedback and perform thematic analysis of trends in
Stakeholder feedback.
13.1.3.5.1.3.2.
Identify areas of potential improvement for the Pediatric APM Program based
on Stakeholder feedback.
13.1.3.5.1.3.3.
Identify areas where Stakeholders give positive feedback on the Pediatric
APM Program.
13.1.3.5.1.3.4.
DELIVERABLE: Pediatric APM Program Annual Stakeholder Engagement
Report
13.1.3.5.1.3.5.
DUE: As identified in the Project Schedule
13.1.3.6.
Pediatric APM Program Close-Out and Transition Requirements within Contractor’s
Technology Solution
13.1.3.6.1.
Contractor shall develop a Primary Care Close-Out Report for the Pediatric APM
Program.
13.1.3.6.1.1.
The Primary Care Close-Out Report for the Pediatric APM Program shall include
all of the following:
13.1.3.6.1.1.1.
Methodology changes.
13.1.3.6.1.1.2.
Updates that have been implemented to date.
13.1.3.6.1.1.3.
Current Pediatric APM Program model designs and methodologies.
13.1.3.6.1.1.4.
A summary of Stakeholder feedback and lessons learned.
13.1.3.6.1.2.
DELIVERABLE: Primary Care Close-Out Report
13.1.3.6.1.3.
DUE: As identified in the Project Schedule
13.1.3.6.2.
Contractor shall develop a Primary Care Transition Plan for the Pediatric APM
Program for purposes of shifting the Pediatric APM Program’s ongoing and future
operations to the Department and/or to a different contractor of the Department’s
choosing, in the Department’s sole discretion.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 76 of 116
13.1.3.6.2.1.
The Primary Care Transition Plan for the Pediatric APM Program shall include
all of the following:
13.1.3.6.2.1.1.
Procedural documentation timelines for updates.
13.1.3.6.2.1.2.
Data analytics and Dashboard maintenance schedules and monitoring
strategies, summarized from the most recent Department-approved Updated
Provider Data Status Report and the most recent Department-approved
Updated Primary Care Data Sharing Analytics Solution for the Pediatric APM
Program Data Report.
13.1.3.6.2.1.3.
Provider enrollment monitoring summarized from the Department-approved
Enrollment Summary Report, including methods of tracking Provider
enrollment and current status of the Pediatrics APM.
13.1.3.6.2.1.4.
Descriptions of how to maintain the Primary Care Data Analytics Solution for
the Pediatric APM Program, including a step-by-step process guide.
13.1.3.6.2.1.5.
Descriptions of how to monitor Pediatric Member attribution to the Pediatric
APM Program and the Primary Care Data Analytics Solution for the Pediatric
APM Program.
13.1.3.6.2.1.6.
Quality Threshold and Payment Rate reconciliation.
13.1.3.6.2.1.7.
Any elements that require sunset or otherwise will cease operations.
13.1.3.6.2.2.
DELIVERABLE: Primary Care Transition Plan for the Pediatric APM Program
13.1.3.6.2.3.
DUE: As identified in the Project Schedule
13.1.3.7.
Enhancements within Contractor’s Technology Solution
13.1.3.7.1.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit a Revised Payment Rates for Department review and
approval.
13.1.3.7.1.1.
Each Revised Payment Rates shall include all of the following:
13.1.3.7.1.1.1.
An update based on the results of the Pediatric APM Program Annual
Stakeholder Engagement Report.
13.1.3.7.1.1.2.
Changes to the Payment Rates based on the latest available calendar year
claims data.
13.1.3.7.1.1.3.
An update based on changes in Pediatric Member utilization of services.
13.1.3.7.1.1.4.
A population risk adjustment model based on Pediatric Member utilization
and diagnosis information, in which SDoH shall be used to update the Revised
Payment Rates.
13.1.3.7.1.1.5.
Inclusion of updated Quality Thresholds based on quality performance in the
Final Aggregated Performance Report.
13.1.3.7.1.2.
DELIVERABLE: Revised Payment Rates
13.1.3.7.1.3.
DUE: Annually, as identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 77 of 116
13.1.3.7.2.
Notwithstanding any provision in the Contract to the contrary, Contractor shall
review, update, and submit Revised Quality Thresholds for Department review and
approval.
13.1.3.7.2.1.
Each Revised Quality Thresholds shall include all of the following:
13.1.3.7.2.1.1.
An update based on the result of the Pediatric APM Program Annual
Stakeholder Engagement Report.
13.1.3.7.2.1.2.
An update based on Provider performance against the previous year’s Quality
Thresholds.
13.1.3.7.2.1.3.
An update based on the most recently released nationally recognized quality
measures or CMS Child Core Measures.
13.1.3.7.2.1.4.
Inclusion of updated Quality Thresholds based on quality performance in the
Final Aggregated Performance Report.
13.1.3.7.2.2.
DELIVERABLE: Revised Quality Thresholds
13.1.3.7.2.3.
DUE: Annually, as identified in the Project Schedule
13.1.3.7.2.4.
After receiving the Department’s approval of each Revised Quality Thresholds,
Contractor shall send the Revised Quality Thresholds to Providers enrolled in
Health First Colorado.
13.1.3.8.
On-Going Primary Care Data Sharing Analytics Solution for the Pediatric APM Program
M&O
13.1.3.8.1.
Contractor shall update analytics shared with Providers through the Primary Care
Data Sharing Analytics Solution for the Pediatric APM Program at minimum on a
monthly basis, or as otherwise requested by the Department, to provide regular,
consistent updates on care delivery and to support Provider success in the Pediatric
APM Program. Contractor shall deliver an Updated Provider Data Report to the
Department upon completion of the data update.
13.1.3.8.1.1.
The Updated Provider Data Report shall include all of the following:
13.1.3.8.1.1.1.
A summary of all changes made to the data and analytics in the Primary Care
Data Sharing Analytics Solution for the Pediatric APM Program.
13.1.3.8.1.1.2.
A table of updated or refreshed source data included in the Primary Care Data
Sharing Analytics Solution for the Pediatric APM Program.
13.1.3.8.1.2.
DELIVERABLE: Updated Provider Data Status Report
13.1.3.8.1.3.
DUE: As identified in the Project Schedule
13.1.3.8.2.
Contractor shall create a Primary Care Data Sharing Analytics Solution for the
Pediatric APM Program Change Report.
13.1.3.8.2.1.
The Primary Care Data Sharing Analytics Solution for the Pediatric APM
Program Change Report shall summarize all technical changes, including Defects
and other Department-requested changes, made to the Primary Care Data Sharing
Analytics Solution for the Pediatric APM Program.
13.1.3.8.2.2.
DELIVERABLE: Primary Care Data Sharing Analytics Solution Change Report
for the Pediatric APM Program
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 78 of 116
13.1.3.8.2.3.
DUE: As identified in the Project Schedule
13.2.
Maternity Bundled Payment Program Requirements
13.2.1.
Development within Contractor’s Technology Solution
13.2.1.1.
Background Research and On-boarding
13.2.1.1.1.
Contractor shall create a Maternity Bundled Payment Program Operational Transition
Plan with the Department’s Existing Actuarial Contractor. The Department will
provide Contractor with detailed documentation of the current Maternity Bundled
Payment Program operations. With the exception of any proprietary information, this
documentation includes, where applicable, access to the necessary software licenses,
data models, calculation models, and reporting formats and dashboards. If a current
Department third-party contractor is currently operating the Maternity Bundled
Payment Program, the Department will make the current Department third-party
contractor and associated materials available to Contractor.
13.2.1.1.1.1.
The Maternity Bundled Payment Program Operational Transition Plan shall
include all of the following:
13.2.1.1.1.1.1.
Identify knowledge areas that require transition from the Department’s
Existing Actuarial Contractor to Contractor.
13.2.1.1.1.1.2.
Identify all data files and Maternity Bundled Payment Program
documentation that require transition from the Department’s Existing
Actuarial Contractor to Contractor.
13.2.1.1.1.1.3.
An implementation process to take over the Department’s Existing Actuarial
Contractor’s work through Contractor’s Technology Solution, which shall
include all of the following:
13.2.1.1.1.1.3.1.
Threshold setting and updating methodology.
13.2.1.1.1.1.3.2.
Quality measure goal setting and updating methodology.
13.2.1.1.1.1.3.3.
Performance reporting methodology.
13.2.1.1.1.1.3.4.
Payment reconciliation methodology.
13.2.1.1.1.1.4.
A timeline to complete all activities in the Maternity Bundled Payment
Program Operational Transition Plan.
13.2.1.1.1.2.
DELIVERABLE: Maternity Bundled Payment Program Operation Transition
Plan
13.2.1.1.1.3.
DUE: As identified in the Project Schedule
13.2.1.2.
Maternity Bundled Payment Program Evaluation and Improvement
13.2.1.2.1.
Contractor shall create a Maternity Bundled Payment Program Evaluation Plan.
13.2.1.2.1.1.
The Maternity Bundled Payment Program Evaluation Plan shall include, at a
minimum, all of the following:
13.2.1.2.1.1.1.
The identification of the steps required to determine how effectively and
efficiently the Maternity Bundled Payment Program has been in meeting its
goals over a period of time that is not less than Maternity Bundled Payment
Program Year 1 and Maternity Bundled Payment Program Year 2.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 79 of 116
13.2.1.2.1.1.2.
The identification of the goals of the evaluation identified in Section
13.2.1.2.1.1.1.
13.2.1.2.1.1.3.
The development of the evaluation methodology that Contractor will use to
conduct the evaluation identified in Section 13.2.1.2.1.1.1.
13.2.1.2.1.1.4.
The identification of the data, information, and Providers required to conduct
the evaluation identified in Section 13.2.1.2.1.1.1.
13.2.1.2.1.1.5.
A timeline of developing and executing the evaluation identified in Section
13.2.1.2.1.1.1.
13.2.1.2.1.2.
DELIVERABLE: Maternity Bundled Payment Program Evaluation Plan
13.2.1.2.1.3.
DUE: As identified in the Project Schedule
13.2.1.2.2.
Contractor shall evaluate the Maternity Bundled Payment Program in compliance
with the Maternity Bundled Payment Program Evaluation Plan after obtaining the
Department’s approval of the Maternity Bundled Payment Program Evaluation Plan.
13.2.1.2.3.
Contractor shall create a Maternity Bundled Payment Program Evaluation Report.
13.2.1.2.3.1.
The Maternity Bundled Payment Program Evaluation Report shall include, at a
minimum, all of the following:
13.2.1.2.3.1.1.
Improvement recommendations based on Contractor’s evaluation results
obtained per Section 13.2.1.2.2.
13.2.1.2.3.1.2.
An evaluation of the current components of the Maternity Bundled Payment
Program, including:
13.2.1.2.3.1.2.1.
Existing cost thresholds setting and quality measure goal-setting
methodologies.
13.2.1.2.3.1.2.2.
Existing quality measure set, including health equity measures, keeping
Maternity Bundled Payment Program focus on CMS Core Measures
where appropriate.
13.2.1.2.3.1.2.3.
Existing episode definition and Maternity Bundled Payment Program
scope.
13.2.1.2.3.1.2.4.
Existing incentive payment methodology.
13.2.1.2.3.1.3.
An evaluation of the outcomes of the Maternity Bundled Payment Program,
including:
13.2.1.2.3.1.3.1.
Maternity Bundled Payment Program outcomes regarding health and cost,
which compares the Maternity Bundled Payment Program’s outcomes to
comparable programs run by other state Medicaid departments or agencies
and with private payers.
13.2.1.2.3.1.3.2.
Maternity Bundled Payment Program outcomes regarding quality
outcomes, which compares the Maternity Bundled Payment Program’s
outcomes to comparable programs run by other state Medicaid
departments or agencies and with private payers.
13.2.1.2.3.1.3.3.
Maternity Bundled Payment Program outcomes regarding equity-related
outcomes, which compares the Maternity Bundled Payment Program’s
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 80 of 116
outcomes to comparable programs run by other state Medicaid
departments or agencies and with private payers.
13.2.1.2.3.2.
DELIVERABLE: Maternity Bundled Payment Program Evaluation Report
13.2.1.2.3.3.
DUE: As identified in the Project Schedule
13.2.1.2.3.4.
Contractor shall make improvements in Contractor’s Technology Solution to the
Maternity Bundled Payment Program methodology based on the Department-
approved Maternity Bundled Payment Program Evaluation Report.
13.2.1.3.
Data Analytics within Contractor’s Technology Solution
13.2.1.3.1.
Contractor shall develop a customizable Maternity Bundled Payment Program Data
Sharing and Analytics Solution (“Portal/Dashboard”).
13.2.1.3.1.1.
The Portal/Dashboard shall include, at a minimum, all of the following:
13.2.1.3.1.1.1.
A secured portal that provides an interactive data analytic Dashboard for each
participating Provider.
13.2.1.3.1.1.2.
A secured portal that provides an interactive data analytic Dashboard for the
Department.
13.2.1.3.1.1.3.
Ability to provide timely and actionable performance data on episode volume.
13.2.1.3.1.1.4.
Ability to provide timely and actionable performance data on episode cost.
13.2.1.3.1.1.5.
Ability to provide timely and actionable performance data on quality metrics.
13.2.1.3.1.1.6.
Ability to provide timely and actionable performance data on avoidable
clinical events (e.g., volume and value).
13.2.1.3.1.1.7.
Episode and service volume analytics and reporting ability.
13.2.1.3.1.1.8.
Episode cost analytics and reporting ability.
13.2.1.3.1.1.9.
Quality metrics analytics and reporting ability.
13.2.1.3.1.1.10.
Health equity metrics analytics and reporting ability (e.g., racial group
breakdown).
13.2.1.3.1.1.11.
Claim data breakdown (e.g., analytics and reporting) ability and clinical data
integration ability.
13.2.1.3.1.1.12.
Gap analysis and performance comparison ability (e.g., episode cost and care
quality).
13.2.1.3.1.1.13.
Transferability by Contractor to the Department and/or another contractor
selected by the Department, in the Department’s sole discretion, to be the
contractor after the termination of the Contract.
13.2.1.3.1.1.14.
Transferability to a future maternity APM to the extent possible.
13.2.1.3.1.1.15.
The ability to provide training, operational, and technical support to Providers
and the Department.
13.2.1.3.1.2.
DELIVERABLE: Maternity Bundled Payment Program Data Sharing Solution
(“Portal/Dashboard”)
13.2.1.3.1.3.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 81 of 116
13.2.2.
Stabilization and Initial Release within Contractor’s Technology Solution
13.2.2.1.
Contractor shall update existing public-facing Maternity Bundled Payment Program
documentation
and
information
(currently
available
at:
https://hcpf.colorado.gov/bundled-payments
) with the latest Maternity Bundled Payment
Program updates, including: Program Specifications; Maternity Definition; and
Frequently Asked Questions.
13.2.2.1.1.
Contractor’s updates to the existing public-facing Maternity Bundled Payment
Program documentation and information shall match the program methodology
improvement (identified in Section 13.2.1.2.3.4) made through Contractor’s
Technology Solution.
13.2.2.1.2.
DELIVERABLE: Updated Public-Facing Maternity Bundled Payment Program
Documentation and Information
13.2.2.1.3.
DUE: As identified in the Project Schedule
13.2.2.2.
Maternity Bundled Payment Program Stakeholder Engagement
13.2.2.2.1.
Contractor shall create a Provider Recruitment Outreach Strategy for the purpose of
recruiting additional eligible Providers to join the Maternity Bundled Payment
Program and to make enhancements to the Contractor’s Technology Solution.
13.2.2.2.1.1.
The Provider Recruitment Outreach Strategy shall include all of the following:
13.2.2.2.1.1.1.
Proposed outreach methods.
13.2.2.2.1.1.2.
Proposed outreach activities.
13.2.2.2.1.1.3.
Proposed list of outreach materials.
13.2.2.2.1.1.4.
A timeline of implementation.
13.2.2.2.1.1.5.
The identification of targeted audiences.
13.2.2.2.1.1.6.
The identification of expected recruitment outcomes.
13.2.2.2.1.2.
DELIVERABLE: Provider Recruitment Outreach Strategy
13.2.2.2.1.3.
DUE: As identified in the Project Schedule
13.2.2.2.2.
Contractor shall create Provider Recruitment Outreach Materials based on the list
identified in the Department-approved Provider Recruitment Outreach Strategy that
will be used in Contractor’s outreach activities.
13.2.2.2.2.1.
Provider Recruitment Outreach Materials shall include, at a minimum, all of the
following:
13.2.2.2.2.1.1.
Key Maternity Bundled Payment Program information, including a
description of the Maternity Bundled Payment Program, the minimum
requirements to participate in the Maternity Bundled Payment Program, and
the mechanics of enrolling in the Maternity Bundled Payment Program.
13.2.2.2.2.1.2.
Key recruitment messaging, including the benefits to the Provider for
participating in the Maternity Bundled Payment Program.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 82 of 116
13.2.2.2.2.1.3.
An overview of how Contractor’s Technology Solution, how utilizing
Contractor’s Technology Solution benefits provides, and how providers can
make recommendations to enhance Contractor’s Technology Solution.
13.2.2.2.2.2.
Provider Recruitment Outreach Material shall be created using media that
matches the channel by which it will be distributed (e.g., email or print) or
otherwise made available (e.g., downloadable documents or viewable videos).
13.2.2.2.2.3.
DELIVERABLE: Provider Recruitment Outreach Materials
13.2.2.2.2.4.
DUE: As identified in the Project Schedule
13.2.2.2.3.
Contractor shall plan and facilitate at least two Maternity Bundled Payment Program-
promoting webinars per Maternity Bundled Payment Program Year.
13.2.2.2.3.1.
Each webinar shall provide all of the following information:
13.2.2.2.3.1.1.
Explanations about the most recent Maternity Bundled Payment Program
achievements.
13.2.2.2.3.1.2.
Maternity Bundled Payment Program updates.
13.2.2.2.3.1.3.
Explanations about Maternity Bundled Payment Program details.
13.2.2.2.3.1.4.
Discussion about the Maternity Bundled Payment Program participation
process.
13.2.2.2.3.1.5.
An overview of how Contractor’s Technology Solution, how utilizing
Contractor’s Technology Solution benefits provides, and how providers can
make recommendations to enhance Contractor’s Technology Solution.
13.2.2.2.3.1.6.
DELIVERABLE: Maternity Bundled Payment Program Webinars
13.2.2.2.3.1.7.
DUE: As identified in the Project Schedule
13.2.2.2.3.2.
Contractor shall create presentation slides and agenda to present at each webinar.
13.2.2.2.3.2.1.1.
Each unique slide presentation and agenda shall include all of the
following:
13.2.2.2.3.2.1.1.1.
An overview of the Maternity Bundled Payment Program details.
13.2.2.2.3.2.1.1.2.
A question-and-answer session.
13.2.2.2.3.2.1.1.3.
A discussion about any recommendations, updates to the Maternity
Bundled Payment Program and updates to the Contractor’s
Technology Solution that the Department has approved.
13.2.2.2.3.2.1.1.4.
A list of agenda topics to discuss at each webinar.
13.2.2.2.3.2.1.2.
DELIVERABLE: Presentation Slides and Agenda
13.2.2.2.3.2.1.3.
DUE: No later than five Business Days prior to each webinar
13.2.2.2.3.3.
Contractor shall take Meeting Minutes during each webinar.
13.2.2.2.3.3.1.
Each Meeting Minutes document shall include all of the following:
13.2.2.2.3.3.1.1.
List of attendees.
13.2.2.2.3.3.1.2.
Summary of agenda items.
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13.2.2.2.3.3.1.3.
Question-and-answer and comment log for any Stakeholder questions or
comments, as well as answers made by webinar presenters.
13.2.2.2.3.3.1.4.
Chat log for written comments.
13.2.2.2.3.3.1.5.
Action items or next steps identified during the webinar.
13.2.2.2.3.3.2.
DELIVERABLE: Webinar Meeting Minutes
13.2.2.2.3.3.3.
DUE: No later than Three Business Days after each webinar
13.2.2.2.4.
Contractor shall conduct, at a minimum, a total of four Stakeholder engagement
activities, including, at minimum, two engagement activities with Internal
Stakeholders, which Internal Stakeholders will be identified by the Department and
communicated to Contractor, and, at minimum, two engagement activities with
External Stakeholders., which External Stakeholders will be identified by the
Department and communicated to Contractor. Stakeholder engagement activities can
be a combination of interviews and surveys.
13.2.2.2.4.1.
DELIVERABLE: Maternity Bundled Payment Program Feedback Collection
Activities for both Internal Stakeholders and External Stakeholders
13.2.2.2.4.2.
DUE: As identified in the Project Schedule
13.2.2.2.4.3.
DELIVERABLE: Summary of Stakeholder Feedback for both Internal
Stakeholders and External Stakeholders
13.2.2.2.4.4.
DUE: As identified in the Project Schedule
13.2.3.
Operations of Contractor’s Technology Solution
13.2.3.1.
Contractor shall create Quarterly Provider Performance Reports for each Provider by
using the existing reporting methodology created by the Department’s Existing Actuarial
Contractor through Contractor’s Technology Solution for each existing Provider
.
The
Department will provide to Contractor the Provider list that Contractor shall use as part
of the Quarterly Provider Performance Report.
13.2.3.1.1.
Each Quarterly Provider Performance Report for each Provider shall include all of
the following:
13.2.3.1.1.1.
Quarterly episode cost performance.
13.2.3.1.1.2.
Quarterly quality measure performance.
13.2.3.1.1.3.
Quarterly equity measure performance.
13.2.3.1.2.
DELIVERABLE: Quarterly Provider Performance Report
13.2.3.1.3.
DUE: Once each quarter during every Maternity Bundled Payment Program Year, as
identified in the Project Schedule
13.2.3.2.
Contractor shall develop Initial Cost Thresholds and Quality Goals for each Provider that
is interested in joining the Maternity Bundled Payment Program by using the existing
program methodology created by the Department’s Existing Actuarial Contractor. The
Department will provide the data from the Department’s data warehouse that is required
for Contractor to develop Initial Cost Thresholds and Quality Goals.
13.2.3.2.1.
DELIVERABLE: Initial Cost Thresholds and Quality Goals
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13.2.3.2.2.
DUE: Annually, as identified in the Project Schedule
13.2.3.3.
For all Providers enrolled in the Maternity Bundled Payment Program, Contractor shall
update the cost thresholds annually by using the existing threshold setting methodology
created by the Department’s Existing Actuarial Contractor. The Department will provide
the data file required for each Maternity Bundled Payment Program Year’s annual cost
thresholds update.
13.2.3.3.1.
DELIVERABLE: Annual Provider Episode Cost Thresholds Update
13.2.3.3.2.
DUE: Annually, as identified in the Project Schedule
13.2.3.4.
For all Providers enrolled in the Maternity Bundled Payment Program, Contractor shall
update the quality goals annually by using the existing quality goal setting methodology
created by the Department’s Existing Actuarial Contractor. The Department will provide
the data file required for each year’s annual quality goals update.
13.2.3.4.1.
DELIVERABLE: Annual Provider Quality Goals Update
13.2.3.4.2.
DUE: Annually, as identified in the Project Schedule
13.2.3.5.
Contractor shall reconcile all claims for each participating Provider annually and provide
an Annual Maternity Bundled Payment Program Reconciliation Report for each
participating Provider.
13.2.3.5.1.
Each Annual Maternity Bundled Payment Program Reconciliation Report shall
include, at a minimum, all of the following information:
13.2.3.5.1.1.
Annual episode utilization data with quarterly data breakdown.
13.2.3.5.1.2.
Each Provider’s standing in relation to each Provider’s quarterly cost performance
and to each Provider’s annual thresholds, as identified in Section 13.2.3.3 through
13.2.3.3.1.
13.2.3.5.1.3.
Each Provider’s standing regarding the difference in episode cost and number of
services provided among racial groups with aggregated difference in episode cost
and number of services provided between white and non-white patients.
13.2.3.5.1.4.
Analysis of cost drivers and identification of possible avoidable complications
(such as hospitalizations and readmissions) with recommendations on areas to
improve.
13.2.3.5.1.5.
Final annual shared savings and cost calculation based on cost and midwifery care
usage.
13.2.3.5.2.
DELIVERABLE: Annual Maternity Bundled Payment Program Reconciliation
Report for each Provider
13.2.3.5.3.
DUE: Annually, as identified in the Project Schedule
13.2.3.6.
Maternity Bundled Payment Program Close-Out and Transition Requirement within
Contractor’s Technology Solution
13.2.3.6.1.
Provided that the New Maternity APM Program is not yet developed and
implemented by the end of the Term of the Contract, Contractor shall develop a
Maternity Bundled Payment Program Operation Transition Plan to shift Maternity
Bundled Payment Program operations from Contractor to the Department and/or
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another contractor selected by the Department, in the Department’s sole discretion, to
be the contractor after the termination of the Contract.
13.2.3.6.1.1.
The Maternity Bundled Payment Program Operation Transition Plan shall include
all of the following:
13.2.3.6.1.1.1.
Identification of knowledge areas that need to be transferred.
13.2.3.6.1.1.2.
Identification of data or Maternity Bundled Payment Program files that need
to be transferred.
13.2.3.6.1.1.3.
Implementation timeline of the transition.
13.2.3.6.1.2.
DELIVERABLE: Maternity Bundled Payment Program Operation Transition
Plan
13.2.3.6.1.3.
DUE: As identified in the Project Schedule
13.2.3.6.2.
Provided that the New Maternity APM Program is developed during the Term of the
Contract, the Contractor shall develop a Maternity Bundled Payment Program to New
Maternity APM Program Transition Plan prior to the New Maternity APM Program’s
launch date.
13.2.3.6.2.1.
The Maternity Bundled Payment Program to New Maternity APM Program
Transition Plan shall include, at a minimum of the following:
13.2.3.6.2.1.1.
Training materials that address the goals and operation details of the New
Maternity APM Program.
13.2.3.6.2.1.2.
New Maternity APM Program participation requirements and process.
13.2.3.6.2.2.
DELIVERABLE: Maternity Bundled Payment Program to New Maternity APM
Program Transition Plan
13.2.3.6.2.3.
DUE: As identified in the Project Schedule
13.3.
New Maternity APM Program Requirements within Contractor’s Technology Solution
13.3.1.
Stakeholder Engagement to Establish Requirements to Modify Contractor’s Technology
Solution
13.3.1.1.
Contractor shall develop an Existing Maternity APM Scoping Review Report regarding
the existing APMs for maternity care in all other state Medicaid departments or agencies
to identify options for model design.
13.3.1.1.1.
The Existing Maternity APM Scoping Review and Report shall include, at minimum,
all of the following:
13.3.1.1.1.1.
The design features of each existing maternity APM administered by all other
state Medicaid departments or agencies, including the stated goal of each existing
maternity APM.
13.3.1.1.1.2.
The timeline of each maternity APM development in all other states, where
available.
13.3.1.1.1.3.
Recommendations about successful and unsuccessful design features in achieving
the stated goal of the maternity APM in each existing maternity APM in other
states.
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13.3.1.1.1.4.
Recommendations about how the design features of each existing maternity APM
in all other states could assist or inhibit achieving the stated goal of the
Department’s New Maternity APM Program as identified in the Department-
approved Workgroup Summary Report.
13.3.1.1.2.
DELIVERABLE: Existing Maternity APM Scoping Review Report
13.3.1.1.3.
DUE: As identified in the Project Schedule
13.3.1.2.
Contractor shall conduct research via publicly available sources and via the Department’s
claims data ingested pursuant to Sections 2.9 through 2.9.1.1.6 for the purpose of creating
a Health Disparities Research Report on current disparities in maternal outcomes and
maternal care service delivery among Health First Colorado Members.
13.3.1.2.1.
The Health Disparities Research Report shall include all of the following:
13.3.1.2.1.1.
Information about outcome and access disparities by race.
13.3.1.2.1.2.
Information about outcome and access disparities by ethnicity.
13.3.1.2.1.3.
Information about outcome and access disparities by geographic location.
13.3.1.2.1.4.
Areas of avoidable costs in maternal care for Health First Colorado Members.
13.3.1.2.2.
DELIVERABLE: Health Disparities Research Report
13.3.1.2.3.
DUE: As identified in the Project Schedule
13.3.1.3.
Contractor shall facilitate a minimum of eight and a maximum of 12 virtual meetings with
Stakeholders (“Stakeholder meetings”) selected by the Department.
13.3.1.3.1.
Contractor shall schedule each Stakeholder meeting with Stakeholders selected by the
Department and communicated to Contractor.
13.3.1.3.2.
The Stakeholder meetings shall review the Department-approved Health Disparities
Research Report and the Department-approved Existing Maternity APM Scoping
Review Report.
13.3.1.3.3.
As a group, all Stakeholder meetings will work to establish no more than three goals
for the New Maternity APM Program.
13.3.1.3.4.
Provided that new or revised content will be presented, Contractor shall create a Draft
Stakeholder Meeting Presentation prior to each Stakeholder meeting.
13.3.1.3.4.1.
The Draft Stakeholder Meeting Presentation shall include all of the following:
13.3.1.3.4.1.1.
Meeting Agenda and objectives.
13.3.1.3.4.1.2.
Meeting content.
13.3.1.3.4.1.3.
Questions for the Stakeholders for purposes of directing and guiding areas of
Stakeholder feedback.
13.3.1.3.4.2.
DELIVERABLE: Draft Stakeholder Meeting Presentation
13.3.1.3.4.3.
DUE: At least seven days before each scheduled Stakeholder meeting
13.3.1.3.4.4.
Provided that Contractor prepares a Draft Stakeholder Meeting Presentation as
identified in Sections 13.3.1.3.4 through 13.3.1.3.4.1.3, Contractor shall
incorporate all edits and changes to the Draft Stakeholder Meeting Presentation,
as directed by the Department, into the Final Stakeholder Meeting Presentation.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
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13.3.1.3.4.4.1.
DELIVERABLE: Final Stakeholder Meeting Presentation
13.3.1.3.4.4.2.
DUE: At least three days before each Stakeholder meeting
13.3.1.3.5.
Contractor shall facilitate each meeting in compliance with the Department-approved
Final Stakeholder Meeting Presentation.
13.3.1.3.6.
Contractor shall record Stakeholder Meeting Minutes for each Stakeholder meeting.
13.3.1.3.6.1.
Each Stakeholder Meeting Minutes shall include all of the following:
13.3.1.3.6.1.1.
The identification of meeting attendees.
13.3.1.3.6.1.2.
All feedback from meeting attendees.
13.3.1.3.6.1.3.
A description of action items, including responsible entity and target close
date.
13.3.1.3.6.2.
DELIVERABLE: Stakeholder Meeting Minutes
13.3.1.3.6.3.
DUE: No later than seven Business Days after each Stakeholder meeting
13.3.1.4.
Contractor shall create a Workgroup Summary Report that covers all Stakeholder
meetings identified in Section 13.3.1.3.
13.3.1.4.1.
The Workgroup Summary Report shall include all of the following:
13.3.1.4.1.1.
A thematic analysis that identifies and assesses patterns in qualitative data.
13.3.1.4.1.2.
An identification of action items from all Stakeholders meetings that require
follow up.
13.3.1.4.1.3.
The agreed-upon goal of the New Maternity APM Program.
13.3.1.4.2.
DELIVERABLE: Workgroup Summary Report
13.3.1.4.3.
DUE: As identified in the Project Plan
13.3.1.5.
Contractor shall facilitate a minimum of six virtual Model Design Team meetings to
discuss proposed model design, which Model Design Team will include Department-
selected Department Staff and Department-selected Stakeholders, which selected
Department Staff and Stakeholders the Department will communicate to Contractor.
13.3.1.5.1.
Contractor shall develop and deliver each presentation, schedule each meeting, and
summarize dialogue and action items from each meeting.
13.3.1.5.2.
Provided that new or revised content will be presented, Contractor shall create a Draft
Model Design Team Meeting Presentation prior to each Model Design Team meeting.
13.3.1.5.2.1.
The Draft Model Design Team Meeting Presentation shall include the following:
13.3.1.5.2.1.1.
Meeting Agenda and objectives.
13.3.1.5.2.1.2.
Meeting content.
13.3.1.5.2.1.3.
Questions for the meeting participants to direct areas of feedback.
13.3.1.5.2.2.
DELIVERABLE: Draft Model Design Team Meeting Presentation
13.3.1.5.2.3.
DUE: At least seven Business Days before the first scheduled model design
meeting
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 88 of 116
13.3.1.5.2.4.
Provided that Contractor prepares a Draft Model Design Team Meeting
Presentation as identified in Sections 13.3.1.5.2 through 13.3.1.5.2.4, Contractor
shall incorporate all edits and changes to the Draft Model Design Team Meeting
Presentation, as directed by the Department, into the Final Model Design Team
Meeting Presentation.
13.3.1.5.2.4.1.
DELIVERABLE: Final Model Design Team Meeting Presentation
13.3.1.5.2.4.2.
DUE: At least three Business Days before the first scheduled Model Design
Team meeting
13.3.1.5.3.
Contractor shall facilitate each Model Design Team meeting in compliance with the
Department-approved Final Meeting Presentation.
13.3.1.5.4.
Contractor shall record Meeting Minutes for each Model Design Team meeting.
13.3.1.5.4.1.
Each Model Design Team Meeting Minutes shall include all of the following:
13.3.1.5.4.1.1.
The identification of meeting attendees.
13.3.1.5.4.1.2.
All feedback from meeting attendees.
13.3.1.5.4.1.3.
A description of action items, including responsible entity and target close
date.
13.3.1.5.4.2.
DELIVERABLE: Model Design Team Meeting Minutes
13.3.1.5.4.3.
DUE: No later than seven Business Days after each Model Design Team meeting.
13.3.2.
New Maternity APM Program Design within Contractor’s Technology Solution
13.3.2.1.
Model Design
13.3.2.1.1.
Contractor shall make recommendations to the Department relating to the
achievement of the goal identified in the Department-approved Workgroup Summary
Report (“Design Recommendations”).
13.3.2.1.1.1.
The Design Recommendations shall include, at a minimum, all of the following:
13.3.2.1.1.1.1.
Member attribution.
13.3.2.1.1.1.2.
Risk adjustment.
13.3.2.1.1.1.3.
Performance measures and thresholds.
13.3.2.1.1.1.4.
Episode trigger codes.
13.3.2.1.1.1.5.
Included services.
13.3.2.1.1.1.6.
Episode windows.
13.3.2.1.1.1.7.
SDoH.
13.3.2.1.1.1.8.
CMS Core Measure Set for Maternal and Perinatal Health.
13.3.2.1.1.1.9.
Feedback from the Stakeholder meetings.
13.3.2.1.1.1.10.
Feedback from the Model Design Team meetings.
13.3.2.1.1.1.11.
Findings from the Department-approved Stakeholder Interview Summary
Report.
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Page 89 of 116
13.3.2.1.1.1.12.
Findings from the Department-approved Existing Maternity APM Scoping
Review Report.
13.3.2.1.1.1.13.
Findings from the Department-approved Health Disparities Research Report.
13.3.2.1.1.2.
DELIVERABLE: Design Recommendations
13.3.2.1.1.3.
DUE: As identified in the Project Schedule
13.3.2.1.2.
Contractor shall create a New Maternity APM Program Pilot Testing Plan.
13.3.2.1.2.1.
The New Maternity APM Program Pilot Testing Plan shall include all of the
following information:
13.3.2.1.2.1.1.
Details regarding the process for piloting the Department-approved Design
Recommendations using simulations informed by real cost and Member
outcome data.
13.3.2.1.2.1.2.
Criteria for determining shortcomings and issues in the Department-approved
Design Recommendations.
13.3.2.1.2.2.
DELIVERABLE: New Maternity APM Program Pilot Testing Plan
13.3.2.1.2.3.
DUE: As identified in the Project Schedule
13.3.2.1.3.
Contractor shall pilot the proposed New Maternity APM Program design prior to
implementation in compliance with the Department-approved New Maternity APM
Program Pilot Testing Plan.
13.3.2.1.4.
After conducting the pilot process, Contractor shall create a Model Design Report.
13.3.2.1.4.1.
The Model Design Report shall include all of the following:
13.3.2.1.4.1.1.
The final New Maternity APM Program design.
13.3.2.1.4.1.2.
The process of the New Maternity APM Program design, including alternative
decisions and the reasons for dismissing those alternatives.
13.3.2.1.4.1.3.
Stakeholder feedback on the model design that arises during Model Design
Team meetings and is recorded in the Model Design Team Meeting Meetings.
13.3.2.1.4.1.4.
The findings from the implementation of the pilot process, including any
issues that may arise from the proposed design.
13.3.2.1.4.1.5.
Recommendations for addressing any issues that arise from implementation
of the pilot process.
13.3.2.1.4.1.6.
Requirements for implementation.
13.3.2.1.4.2.
DELIVERABLE: Model Design Report
13.3.2.1.4.3.
DUE: As identified in the Project Schedule
13.3.3.
New Maternity APM Program Data Sharing and Analytics within Contractor’s Technology
Solution
13.3.3.1.
Contractor shall develop Pilot Provider-Facing Reports for Department-selected
Providers to share actionable information.
13.3.3.1.1.
The Pilot Provider-Facing Reports shall contain, at minimum, all of the following:
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Exhibit B, SOW
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13.3.3.1.1.1.
Areas
of
avoidable
costs
under
the
Department-approved
Design
Recommendations.
13.3.3.1.1.2.
Data on Members’ health outcomes and service access, stratified by race,
ethnicity, and ZIP code.
13.3.3.1.1.3.
Actionable and valid data on differences among Member cost and health
outcomes by race, ethnicity, and ZIP code.
13.3.3.1.1.3.1.
In order for data to be actionable, Contractor shall use several Providers, as
defined by the Department and communicated to Contractor, that have below-
average performance, as defined by the Department, and identify data-driven
interventions to improve those Providers’ performance.
13.3.3.1.1.3.2.
In order for data to be valid, Contractor shall conduct all of the following:
13.3.3.1.1.3.2.1.
Quality assurance test of the computer programs used to generate
performance measurements.
13.3.3.1.1.3.2.2.
Face validity tests.
13.3.3.1.1.3.2.3.
Comparison of measurement results to those of related Provider
performance measures published by the CMS or other nationally
recognized organizations within the United States.
13.3.3.1.2.
DELIVERABLE: Pilot Provider-Facing Reports
13.3.3.1.3.
DUE: As identified in the Project Schedule
13.3.3.1.4.
Provided that the Department obtains CMS approval of a State Plan Amendment,
Contractor shall review, update, and submit Revised Pilot Provider-Facing Reports.
If no changes are necessary based on the CMS approval, Contractor shall provide a
summary report that indicates no changes are required.
13.3.3.1.4.1.
DELIVERABLE: Revised Pilot Provider-Facing Reports
13.3.3.1.4.2.
DUE: As identified in the Project Schedule
13.4.
Colorado (CO) Providers of Distinction for Facilities Program
13.4.1.
CO Providers of Distinction for Facilities Program Development within Contractor’s
Technology Solution
13.4.1.1.
Evaluate and Select Procedure Episode Grouper
13.4.1.1.1.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare a document that addresses differences in procedure episode definitions from
up to five different episode groupers available to Contractor, which shall be those
utilized by Tennessee, Ohio, or Arkansas Medicaid and Prometheus, as well as other
open-source episode groupers identified by the Department or Contractor that satisfy
selection criteria that are agreed upon by the Department and Contractor, for five
procedures that are commonly performed for Health First Colorado Members,
including cholecystectomy.
13.4.1.1.1.1.
Documented differences shall include, at a minimum, all of the following:
13.4.1.1.1.1.1.
Episode procedure trigger codes.
13.4.1.1.1.1.2.
Episode time windows.
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Exhibit B, SOW
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13.4.1.1.1.1.3.
Episode service and patient exclusions.
13.4.1.1.1.2.
DELIVERABLE: Differences in Episode Groupers Document
13.4.1.1.1.3.
DUE: As identified in the Project Schedule
13.4.1.1.2.
To define requirements for Contractor’s Technology Solution, Contractor shall use
Health First Colorado data to create a document that compares outputs from available
episode groupers for each of the same five procedures identified in Section 13.4.1.1.1.
13.4.1.1.2.1.
Comparison of output for each of the five procedures shall include, at a minimum,
all of the following:
13.4.1.1.2.1.1.
Episode volume.
13.4.1.1.2.1.2.
Episode costs.
13.4.1.1.2.1.3.
Episode cost variation.
13.4.1.1.2.1.4.
Reasons for differences in output.
13.4.1.1.2.2.
DELIVERABLE: Episode Grouper Output Comparison Report
13.4.1.1.2.3.
DUE: As identified in the Project Schedule
13.4.1.1.3.
To define requirements for Contractor’s Technology Solution, Contractor shall meet
with the Department to discuss the Differences in Episode Groupers Document and
the Episode Grouper Output Comparisons Report Deliverables. Contractor shall take
Meeting Minutes at the meeting with the Department. The Department will be the
sole decisionmaker with respect to choosing the episode grouper for procedure
episodes, which selection will be made at a time of the Department’s choosing.
13.4.1.1.3.1.
DELIVERABLE: Episode Grouper Meeting Minutes
13.4.1.1.3.2.
DUE: As identified in the Project Schedule
13.4.1.1.4.
Contractor shall develop a Rural Facility Evaluation Plan to implement and operate a
Rural Providers of Distinction Program with two separate tracks. The tracks are as
follows:
13.4.1.1.4.1.
Rural Providers referring high value services which cannot be performed at the
Rural Provider’s facility to designated CO Providers of Distinction sites.
13.4.1.1.4.2.
Rural Providers referring high value services among one another (i.e., among
Rural Providers) based on the availability of the service within geographic
constraints.
13.4.1.1.5.
Contractor shall facilitate the following Stakeholder engagement to inform the design
of the Rural Facility Evaluation Plan:
13.4.1.1.5.1.
Contractor shall facilitate a maximum of three Department leadership visioning
sessions, which will include meetings with Department-designated leadership
staff, for the Rural CO Providers of Distinction Program.
13.4.1.1.5.2.
Contractor shall facilitate a maximum of six Stakeholder engagement meetings
with Rural Providers and other Department-selected Rural Stakeholders to inform
the plans design.
13.4.1.1.6.
Contractor shall create a Rural Facility Evaluation Plan.
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Exhibit B, SOW
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13.4.1.1.6.1.
The Rural Facility Evaluation Plan shall include all of the following:
13.4.1.1.6.1.1.
Recommended method of evaluating cost, quality, safety, and equity
performance of Rural facilities that have small procedure volumes.
13.4.1.1.6.1.2.
Recommendations for high value services to be included in the Rural CO
Providers of Distinction Program.
13.4.1.1.6.1.3.
Analysis of services provided by Rural facilities within geographic regions,
which geographic regions will be determined by the Department and
communicated to Contractor.
13.4.1.1.6.1.4.
Time and distance analysis for travel time between Rural facilities and Urban
facilities.
13.4.1.1.6.1.5.
Time and distance analysis for travel time between Rural facilities and other
Rural facilities that provide the high value services.
13.4.1.1.6.1.6.
Options for establishing a system to provide care for Rural residents at either
CO Providers of Distinction-designated facilities or Rural facilities that
provide the high value service within a similar geographic region. “CO
Providers of Distinction-designated facilities” shall be notated via a proxy
indicator.
13.4.1.1.6.1.7.
A proposed implementation and operational plan for the two tracks of the
Rural Providers of Distinction Program.
13.4.1.1.6.2.
DELIVERABLE: Rural Facility Evaluation Plan
13.4.1.1.6.3.
DUE: As identified in the Project Schedule
13.4.1.2.
Design Program Analytics within Contractor’s Technology Solution
13.4.1.2.1.
To define requirements for Contractor’s Technology Solution, Contractor shall
develop a Procedure Episodes Plan and use data from the CO APCD for the purposes
of producing procedure episodes and measuring hospital, ambulatory surgery center,
and, if feasible, surgeon performance for non-Members.
13.4.1.2.1.1.
The Procedure Episodes Plan shall include, at a minimum, all of the following:
13.4.1.2.1.1.1.
Steps to assess feasibility of using the CO APCD to create episodes for non-
Members.
13.4.1.2.1.1.2.
List of challenges expected by combining procedure episodes and
performance measurement results from different data sources for Members
and non-Members.
13.4.1.2.1.1.3.
Options to overcome challenges of combining procedure episodes and
performance measurement results from different data sources.
13.4.1.2.1.2.
DELIVERABLE: Procedure Episodes Plan
13.4.1.2.1.3.
DUE: As identified in the Project Schedule
13.4.1.2.2.
Contractor shall conduct analyses of CO APCD data for the purpose of determining
the feasibility of producing procedure episodes using commercial and Medicare data
in Contractor’s Technology Solution. To define requirements for Contractor’s
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 93 of 116
Technology Solution, Contractor shall prepare a Report of Feasibility to summarize
Contractor’s analysis.
13.4.1.2.2.1.
The Report of Feasibility shall include all of the following:
13.4.1.2.2.1.1.
List of data elements required to produce procedure episodes.
13.4.1.2.2.1.2.
List of required data elements that are missing, if any, from commercial and
Medicare data.
13.4.1.2.2.1.3.
Results of tests of the quality of required data elements for commercial and
Medicare data.
13.4.1.2.2.1.4.
Conclusion about the feasibility of producing procedure episodes using
commercial and Medicare data.
13.4.1.2.2.2.
DELIVERABLE: Report of Feasibility
13.4.1.2.2.3.
DUE: As identified in the Project Schedule
13.4.1.2.3.
Utilizing Contractor’s Technology Solution, Contractor shall create or provide all
procedure episodes from the episode grouper selected by the Department for Health
First Colorado and for commercial and Medicare payers, where feasible, as defined
in the Department-approved Report of Feasibility.
13.4.1.2.3.1.
DELIVERABLE: Procedure Episodes
13.4.1.2.3.2.
DUE: As identified in the Project Schedule
13.4.1.2.4.
Utilizing Contractor’s Technology Solution, Contractor shall develop measurement
criteria for selecting two procedure episodes, in addition to cholecystectomy, for a
total of three procedure episodes, which three procedure episodes will be determined
by the Department.
13.4.1.2.4.1.
At a minimum, the measurement criteria shall be based on the following measures
using Health First Colorado data:
13.4.1.2.4.1.1.
High volume as compared to different procedure episodes.
13.4.1.2.4.1.2.
Measures that demonstrate opportunity for improvement in cost.
13.4.1.2.4.1.3.
Measures that demonstrate opportunity for improvement in quality.
13.4.1.2.4.1.4.
Measures that demonstrate opportunity for improvement in safety.
13.4.1.2.4.1.5.
Measures that demonstrate opportunity for improvement in equity based on
comparisons of measurement results by Members’ gender, language, race,
ethnicity, and income.
13.4.1.2.4.2.
DELIVERABLE: Procedure Episode Selection Criteria
13.4.1.2.4.3.
DUE: As identified in the Project Schedule
13.4.1.2.5.
After the Department accepts and approves Contractor’s Procedure Episode Selection
Criteria, utilizing Contractor’s Technology Solution, Contractor shall produce
measurements from the Procedure Episode Selection Criteria using Health First
Colorado data.
13.4.1.2.5.1.
Contractor shall prepare a Procedure Episode Selection Report, which shall
include, at a minimum, all of the following:
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 94 of 116
13.4.1.2.5.1.1.
Measurement results for all procedure episodes evaluated.
13.4.1.2.5.1.2.
Selection of two procedure episodes, in addition to cholecystectomy, that
includes the rationale for each selection.
13.4.1.2.5.2.
DELIVERABLE: Procedure Episode Selection Report
13.4.1.2.5.3.
DUE: As identified in the Project Schedule
13.4.1.2.6.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall create an Analysis of Cost
Variation and Recommendations Report.
13.4.1.2.6.1.
The Analysis of Cost Variation and Recommendations Report shall include, at a
minimum, all of the following:
13.4.1.2.6.1.1.
An analysis of cost variation for each selected procedure episode identified in
the Department-approved Procedure Episode Selection Report, which shall
include all of the following:
13.4.1.2.6.1.1.1.
The identification of variation due to heterogeneity of trigger procedures,
as applicable.
13.4.1.2.6.1.1.1.1.
The identification of the reasons for the heterogeneity, as applicable.
13.4.1.2.6.1.1.2.
The identification of variation due to heterogeneity of the included
Member population, as applicable.
13.4.1.2.6.1.1.2.1.
The identification of the reasons for the heterogeneity, as applicable.
13.4.1.2.6.1.2.
Options for modifying the definition of each procedure episode to reduce cost
variation due to heterogeneity in trigger procedures and/or in included
Member population, as applicable, while maintaining a sufficient volume of
episodes.
13.4.1.2.6.2.
DELIVERABLE: Analysis of Cost Variation and Recommendations Report
13.4.1.2.6.3.
DUE: As identified in the Project Schedule
13.4.1.2.6.4.
Contractor shall meet with the Department to discuss Contractor’s Analysis of
Cost Variations and Recommendations Report for the purpose of the Department
selecting procedure episode definition modification(s), if any.
13.4.1.2.6.4.1.
DELIVERABLE: Analysis of Cost Variation and Recommendations Meeting
13.4.1.2.6.4.2.
DUE: As identified in the Project Schedule
13.4.1.2.7.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare a Report of Unassigned Episodes and Recommendations.
13.4.1.2.7.1.
The Report of Unassigned Episode and Recommendations shall include, at a
minimum, all of the following:
13.4.1.2.7.1.1.
A recommendation regarding a method of selecting a principal accountable
hospital or ambulatory surgery center for each procedure episode.
13.4.1.2.7.1.2.
A recommendation regarding a method of selecting a principal accountable
surgeon for each procedure episode.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 95 of 116
13.4.1.2.7.1.3.
The number of and the reasons for unassigned procedure episodes for each of
the total of three procedure episodes.
13.4.1.2.7.1.4.
A recommendation of steps or processes to reduce the number of unassigned
procedure episodes.
13.4.1.2.7.2.
DELIVERABLE: Report of Unassigned Episodes and Recommendations
13.4.1.2.7.3.
DUE: As identified in the Project Schedule
13.4.1.2.8.
Utilizing Contractor’s Technology Solution, Contractor shall prepare a Report of
Volume of Episodes.
13.4.1.2.8.1.
The Report of Volume of Episodes shall include, at a minimum, all of the
following:
13.4.1.2.8.1.1.
The volume of episodes for each selected procedure episode by payer and in
total, organized by all of the following:
13.4.1.2.8.1.1.1.
Each hospital and ambulatory surgery center.
13.4.1.2.8.1.1.2.
Each surgeon within a hospital or ambulatory surgery center.
13.4.1.2.8.1.1.3.
The characteristics of hospitals and ambulatory surgery centers, including:
13.4.1.2.8.1.1.3.1.
Location (i.e., Urban, Frontier, and Rural).
13.4.1.2.8.1.1.3.2.
Hospital teaching status.
13.4.1.2.8.1.1.3.3.
Health system affiliation.
13.4.1.2.8.2.
DELIVERABLE: Report of Volume of Episodes
13.4.1.2.8.3.
DUE: As identified in the Project Schedule
13.4.1.2.9.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Feasibility of
Measuring Surgeon Performance Report.
13.4.1.2.9.1.
The Feasibility of Measuring Surgeon Performance Report shall include, at a
minimum, all of the following:
13.4.1.2.9.1.1.
Statistical testing that evaluates procedure episodes by volume, by surgeon
within each hospital or ambulatory surgery center for the purpose of
determining whether procedure episode volumes are sufficient to reliably
assess each surgeon’s performance.
13.4.1.2.9.1.2.
If applicable, recommended options for measuring surgeon performance that
are statistically reliable and clinically meaningful.
13.4.1.2.9.2.
DELIVERABLE: Feasibility of Measuring Surgeon Performance Report
13.4.1.2.9.3.
DUE: As identified in the Project Schedule
13.4.1.2.9.4.
Contractor shall meet with the Department to discuss Contractor’s Feasibility of
Measuring Surgeon Performance Report. The Department will be the sole
decisionmaker with respect to implementing any measurements of surgeon
performance, and a decision will be made at a time of the Department’s choosing.
13.4.1.2.9.4.1.
DELIVERABLE: Feasibility and Surgeon Performance Report Meeting
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 96 of 116
13.4.1.2.9.4.2.
DUE: As identified in the Project Schedule
13.4.1.2.10.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Document of
Recommended Performance Measures based on research of performance
measurements currently used in the United States, except that up to nine performance
measures may be customized or created new in compliance with Section 11.4.
13.4.1.2.10.1.
The Document of Recommended Performance Measures shall include, at a
minimum, all of the following:
13.4.1.2.10.1.1.
Recommendations for quality, safety, and equity performance measures for
each selected procedure episode based on, at a minimum, all of the following:
13.4.1.2.10.1.1.1.
Analyses of Health First Colorado and other payer claims.
13.4.1.2.10.1.1.2.
Analyses of clinical data from the HIEs.
13.4.1.2.10.1.1.3.
Analyses of care quality for populations with differences in SDoH of
gender, language, race, ethnicity, and income.
13.4.1.2.10.1.1.4.
Review of health services literature.
13.4.1.2.10.1.1.5.
Review of medical specialty society performance measurement
benchmarking systems.
13.4.1.2.10.1.1.6.
Review of public sources of performance measures for procedures and
procedure episodes.
13.4.1.2.10.1.1.7.
Review of public sources of hospital performance measurement results.
13.4.1.2.10.1.1.8.
Review of public sources of ambulatory surgery center performance
measurement results.
13.4.1.2.10.1.1.9.
Review of public sources of surgeon performance measurement results.
13.4.1.2.10.1.2.
Recommendations for quality, safety, and equity performance measures for
each selected procedure episode that satisfy all of the following:
13.4.1.2.10.1.2.1.
Demonstration of opportunity for improvement.
13.4.1.2.10.1.2.2.
Demonstration of being meaningful to Providers by virtue of being
supported in the health services literature or by medical specialty societies.
13.4.1.2.10.1.2.3.
Demonstration of the satisfaction of the goal of identifying hospitals,
ambulatory surgery centers, and surgeons that merit a Provider of
Distinction designation (see Risk Adjustment Methods Document at
Sections 13.4.1.4.2 through 13.4.1.4.2.1.4).
13.4.1.2.10.2.
DELIVERABLE: Document of Recommended Performance Measures
13.4.1.2.10.3.
DUE: As identified in the Project Schedule
13.4.1.2.10.4.
Contractor shall meet with the Department to discuss the Department-approved
Document of Recommended Performance Measures for the purpose of selecting
measures of quality, safety, and equity for each procedure episode.
13.4.1.2.10.4.1.
DELIVERABLE: Performance Measures Selection Meeting
13.4.1.2.10.4.2.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 97 of 116
13.4.1.2.11.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Performance Measures
Specification Document.
13.4.1.2.11.1.
The Performance Measures Specification Document shall include detailed
specifications that describe the method of calculating each performance measure
using claims or other data sources and shall include, at a minimum, all of the
following:
13.4.1.2.11.1.1.
Measure name or label.
13.4.1.2.11.1.2.
Measure description.
13.4.1.2.11.1.3.
Numerator description and definition.
13.4.1.2.11.1.4.
Denominator description and definition.
13.4.1.2.11.1.5.
Numerator exclusions.
13.4.1.2.11.1.6.
Denominator exclusions.
13.4.1.2.11.1.7.
Time interval.
13.4.1.2.11.1.8.
Calculation algorithm.
13.4.1.2.11.1.9.
Data sources.
13.4.1.2.11.1.10.
Data elements and codes (e.g., diagnosis, procedure, claim type, place of
service, revenue).
13.4.1.2.11.2.
DELIVERABLE: Performance Measure Specifications Document
13.4.1.2.11.3.
DUE: As identified in the Project Schedule
13.4.1.3.
Stakeholder Driven Technology Solution Requirements #1
13.4.1.3.1.
To define requirements for Contractor’s Technology Solution, Contractor shall
develop a Stakeholder Working Group Plan #1 for the purpose of soliciting feedback
about the definitions and performance measures for each of the three procedure
episodes.
13.4.1.3.1.1.
The Stakeholder Working Group Plan #1 shall include all of the following:
13.4.1.3.1.1.1.
A description of the goals of the Stakeholder Working Group’s meetings.
13.4.1.3.1.1.2.
A description of the feedback sought from the Stakeholder Working Group.
13.4.1.3.1.1.3.
A description of the information to be presented to and discussed with the
Stakeholder Working Group, which shall include all of the following:
13.4.1.3.1.1.3.1.
Episode definitions.
13.4.1.3.1.1.3.2.
Performance measures selected.
13.4.1.3.1.1.3.3.
Number of Stakeholder Working Group meetings.
13.4.1.3.1.1.3.4.
Proposed agenda for each Stakeholder Working Group meeting.
13.4.1.3.1.2.
DELIVERABLE: Stakeholder Working Group Plan #1
13.4.1.3.1.3.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 98 of 116
13.4.1.3.2.
Contractor shall meet with the Department for the purpose of selecting members of
the Stakeholder Working Group. The Stakeholder Working Group shall consist of no
more than 20 individual Stakeholders and Opinion Leaders representing:
13.4.1.3.2.1.
Surgeons/proceduralists that perform procedures for selected episodes.
13.4.1.3.2.2.
Hospitals/ambulatory surgery centers from Urban and Rural/Frontier counties.
13.4.1.3.2.3.
Members.
13.4.1.3.2.4.
Consumer advocates.
13.4.1.3.2.5.
RAEs.
13.4.1.3.3.
The Department will administer Stakeholder Working Group meetings and will host
each meeting. Contractor shall facilitate each Stakeholder Working Group meeting.
13.4.1.3.3.1.
Prior to each Stakeholder Working Group meeting that occurs after the
Department approves Stakeholder Working Group Plan #1 and prior to the
Department’s approval of the Stakeholder Working Group Plan #2, Contractor
shall prepare Stakeholder Working Group Documents #1, which shall include, at
a minimum, all of the following:
13.4.1.3.3.1.1.
Meeting Agenda that Contractor will use during the identified Stakeholder
Working Group meeting.
13.4.1.3.3.1.2.
Definition of each procedure episode presented at a high level, including a
description of the patients and services that are included and excluded.
13.4.1.3.3.1.3.
List of selected performance measures and the rationale for selection.
13.4.1.3.3.1.4.
List of questions for Stakeholders to consider.
13.4.1.3.3.1.5.
DELIVERABLE: Stakeholder Working Group Documents #1
13.4.1.3.3.1.6.
DUE: As identified in the Project Schedule
13.4.1.3.4.
Contractor shall prepare a Stakeholder Working Group Feedback and
Recommendations Document #1 after each Stakeholder Working Group meeting that
occurs prior to the Department’s approval of the Stakeholder Working Group Plan
#2.
13.4.1.3.4.1.
Each Stakeholder Working Group Feedback and Recommendations Document #1
shall include all of the following:
13.4.1.3.4.1.1.
Stakeholder Working Group feedback regarding:
13.4.1.3.4.1.1.1.
The definition of each procedure episode.
13.4.1.3.4.1.1.2.
The performance measures for each procedure episode.
13.4.1.3.4.1.2.
Contractor’s recommended revisions to episode definitions or performance
measures based on the Stakeholder Working Group’s feedback.
13.4.1.3.4.2.
DELIVERABLE: Stakeholder Working Group Feedback and Recommendations
Document #1
13.4.1.3.4.3.
DUE: As identified in the Project Schedule
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 99 of 116
13.4.1.3.5.
After the Department approves the Stakeholder Working Group Feedback and
Recommendations Document #1, Contractor shall prepare an Impact of
Recommended Revisions Document #1.
13.4.1.3.5.1.
The Impact of Recommended Revisions Document #1 shall include, at a
minimum, all of the following:
13.4.1.3.5.1.1.
The potential impact of revisions to episode definitions and performance
measures on:
13.4.1.3.5.1.1.1.
Episode volumes.
13.4.1.3.5.1.1.2.
Episode costs and cost variation.
13.4.1.3.5.1.1.3.
Homogeneity of episode definition of procedures and patients.
13.4.1.3.5.1.1.4.
Opportunities for improvement in quality, safety, and equity.
13.4.1.3.5.2.
DELIVERABLE: Impact of Recommended Revisions Document #1
13.4.1.3.5.3.
DUE: As identified in the Project Schedule
13.4.1.3.6.
Contractor shall meet with the Department to discuss the Department-approved
Stakeholder Working Group Feedback and Recommendations Document #1 and the
Department-approved Impact of Recommended Revisions Document #1. The
Department will be the sole decisionmaker with respect to any revisions to episode
definitions and performance measures, which will be made at a time of the
Department’s choosing.
13.4.1.3.6.1.
DELIVERABLE: Recommended Revisions Meeting
13.4.1.3.6.2.
DUE: As identified in the Project Schedule
13.4.1.3.7.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare a Stakeholder Working Group Communication #1 about revisions approved
by the Department that resulted from the Stakeholder Working Group’s feedback and
the impact of the revisions on the assessment of facility performance. The Department
will send all Department-approved communication(s).
13.4.1.3.7.1.
DELIVERABLE: Stakeholder Working Group Communication #1
13.4.1.3.7.2.
DUE: As identified in the Project Schedule
13.4.1.4.
Produce and Test Initial Results within Contractor’s Technology Solution
13.4.1.4.1.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Measurement and
Validation Report.
13.4.1.4.1.1.
The Measurement and Validation Report shall include, at a minimum, all of the
following:
13.4.1.4.1.1.1.
Episode cost by payer for each hospital, ambulatory surgery center, and, if
feasible, each surgeon.
13.4.1.4.1.1.2.
Measurement results of quality, safety, and equity across payers for each
hospital, ambulatory surgery center, and, if feasible, each surgeon.
13.4.1.4.1.1.3.
Validation of all measurement results conducted by:
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 100 of 116
13.4.1.4.1.1.3.1.
Quality assurance test of computer programs.
13.4.1.4.1.1.3.2.
Test of face validity.
13.4.1.4.1.1.3.3.
Comparison of measurement results to those of related hospital,
ambulatory surgery center, or surgeon performance measures published
by CMS and other nationally recognized organizations within the U.S.
13.4.1.4.1.2.
DELIVERABLE: Measurement and Validation Report
13.4.1.4.1.3.
DUE: As identified in the Project Schedule
13.4.1.4.2.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Risk Adjustment
Methods Document.
13.4.1.4.2.1.
The Risk Adjustment Methods Document shall include, at a minimum, all of the
following:
13.4.1.4.2.1.1.
List of measures requiring risk adjustment.
13.4.1.4.2.1.2.
Method of identifying Member and non-Member characteristics to adjust for
risk, including Member and non-Member comorbidities.
13.4.1.4.2.1.3.
Time period during which Member and non-Member comorbidities will be
identified in relation to the trigger procedure date.
13.4.1.4.2.1.4.
Method of developing and testing risk adjustment models.
13.4.1.4.2.2.
DELIVERABLE: Risk Adjustment Methods Document
13.4.1.4.2.3.
DUE: As identified in the Project Schedule
13.4.1.4.2.4.
Contractor shall meet with the Department to discuss the Risk Adjustment
Methods Document. The Department will be the sole decisionmaker with respect
to the suitability of any risk adjustment methods, which decision(s) will be made
which will be made at a time of the Department’s choosing.
13.4.1.4.2.4.1.
DELIVERABLE: Risk Adjustment Methods Document Meeting
13.4.1.4.2.4.2.
DUE: As identified in the Project Schedule
13.4.1.4.3.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Risk Adjustment Model
Document.
13.4.1.4.3.1.
The Risk Adjustment Model Document shall include, at a minimum, all of the
following for each performance measure identified in the Department-approved
Risk Adjustment Methods Document that requires risk adjustment:
13.4.1.4.3.1.1.
Independent variables and coefficients of the model.
13.4.1.4.3.1.2.
Goodness of fit tests.
13.4.1.4.3.2.
DELIVERABLE: Risk Adjustment Model Document
13.4.1.4.3.3.
DUE: As identified in the Project Schedule
13.4.1.4.3.4.
Contractor shall meet with the Department to discuss the Risk Adjustment Model
Document. The Department will be the sole decisionmaker with respect to the
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 101 of 116
suitability of any risk adjustment models, which decision(s) will be made at a time
of the Department’s choosing.
13.4.1.4.3.4.1.
DELIVERABLE: Risk Adjustment Model Document Meeting
13.4.1.4.3.4.2.
DUE: As identified in the Project Schedule
13.4.1.4.4.
Utilizing Contractor’s Technology Solution and to define requirements for
Contractor’s Technology Solution, Contractor shall prepare a Risk-Adjusted
Measurement and Validation Report.
13.4.1.4.4.1.
The Risk-Adjusted Measurement and Validation Report shall include, at a
minimum, all of the following:
13.4.1.4.4.1.1.
Risk-adjusted measurement results for each procedure episode organized by
each hospital, ambulatory surgery center, and if feasible, by each surgeon.
13.4.1.4.4.1.2.
Validation of risk adjusted measurement results conducted by:
13.4.1.4.4.1.2.1.
Quality assurance test of computer programs.
13.4.1.4.4.1.2.2.
Face validity test.
13.4.1.4.4.1.2.3.
Assessing differences in characteristics of hospitals and ambulatory
surgery centers with high versus low risk-adjusted measurement results,
including:
13.4.1.4.4.1.2.3.1.
Location (i.e., Urban, Rural, and Frontier).
13.4.1.4.4.1.2.3.2.
Hospital teaching status.
13.4.1.4.4.1.2.3.3.
Health system affiliation.
13.4.1.4.4.1.3.
Conclusion about the validity of risk-adjusted measurement results.
13.4.1.4.4.2.
DELIVERABLE: Risk-Adjusted Measurement and Validation Report
13.4.1.4.4.3.
DUE: As identified in the Project Schedule
13.4.1.4.4.4.
Contractor shall meet with the Department to discuss the Risk-Adjusted
Measurement and Validation Report. The Department will be the sole
decisionmaker with respect to sharing the report with Department-selected
Stakeholders, which decision(s) will be made at the time of the Department’s
choosing.
13.4.1.4.4.4.1.
DELIVERABLE: Risk-Adjusted Measurement and Validation Report
Meeting
13.4.1.4.4.4.2.
DUE: As identified in the Project Schedule
13.4.1.5.
Stakeholder Driven Technology Solution Requirements #2
13.4.1.5.1.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare a Stakeholder Working Group Plan #2 to solicit feedback from the
Stakeholder Working Group about the initial results and future design of the CO
Providers of Distinction for Facilities Program.
13.4.1.5.1.1.
The Stakeholder Working Group Plan #2 shall include, at a minimum, all of the
following:
13.4.1.5.1.1.1.
A description of the goals of the Stakeholder Working Group’s meetings.
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Exhibit B, SOW
Page 102 of 116
13.4.1.5.1.1.2.
A description of the feedback sought from the Stakeholder Working Group.
13.4.1.5.1.1.3.
A description of the information to be presented and discussed with the
Stakeholder Working Group, which shall include all of the following:
13.4.1.5.1.1.3.1.
Performance measurement results.
13.4.1.5.1.1.3.2.
Risk adjustment models.
13.4.1.5.1.1.3.3.
Number of Stakeholder Working Group meetings.
13.4.1.5.1.1.3.4.
Proposed agenda for each Stakeholder Working Group meeting.
13.4.1.5.1.2.
DELIVERABLE: Stakeholder Working Group Plan #2
13.4.1.5.1.3.
DUE: As identified in the Project Schedule
13.4.1.5.2.
The Department will administer and convene Stakeholder Working Group meetings
and shall host each meeting. Contractor shall facilitate each Stakeholder Working
Group meeting.
13.4.1.5.3.
Contractor shall prepare Stakeholder Working Group Documents #2 for each
Stakeholder Working Group meeting that occurs after the Department approves the
Stakeholder Working Group Plan #2.
13.4.1.5.3.1.
The Stakeholder Working Group Documents #2 shall include, at a minimum, all
of the following:
13.4.1.5.3.1.1.
Meeting Agenda that Contractor will use during the identified Stakeholder
Working Group meeting.
13.4.1.5.3.1.2.
Blinded unadjusted and risk-adjusted performance measurement results by
individual facility and by surgeon, if feasible.
13.4.1.5.3.1.3.
Risk adjustment model variables and coefficients.
13.4.1.5.3.1.4.
List of questions for Stakeholders to consider, including a question about the
impact of public release of hospital, ambulatory surgery facility, and, if
feasible, surgeon performance.
13.4.1.5.3.2.
DELIVERABLE: Stakeholder Working Group Documents #2
13.4.1.5.3.3.
DUE: As identified in the Project Schedule
13.4.1.5.4.
Contractor
shall
prepare
Stakeholder
Working
Group
Feedback
and
Recommendations Document #2 following each meeting held after the Department
approves the Stakeholder Working Group Documents #2.
13.4.1.5.4.1.
The Stakeholder Working Group Feedback and Recommendations Document #2
shall include, at a minimum, all of the following:
13.4.1.5.4.1.1.
Stakeholder Working Group feedback about:
13.4.1.5.4.1.1.1.
Hospital, ambulatory surgery center, and, if applicable, surgeon
performance measurement results.
13.4.1.5.4.1.1.2.
Risk adjustment model.
13.4.1.5.4.1.2.
Consequences of publishing reports of hospital, ambulatory surgery center,
and, if applicable, surgeon performance measurement results.
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Exhibit B, SOW
Page 103 of 116
13.4.1.5.4.1.3.
Contractor’s recommended revisions to performance measurement and risk
adjustment based on the Stakeholder Working Group’s feedback.
13.4.1.5.4.2.
DELIVERABLE: Stakeholder Working Group Feedback and Recommendations
Document #2
13.4.1.5.4.3.
DUE: As identified in the Project Schedule
13.4.1.5.5.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare an Impact of Recommended Revisions Document #2 after the Department
approves Contractor’s Stakeholder Working Group Feedback and Recommendations
Document #2.
13.4.1.5.5.1.
Impact of Recommended Revisions Document #2 shall include, at a minimum,
all of the following:
13.4.1.5.5.1.1.
The potential impact of revisions to performance measures and risk
adjustment models on:
13.4.1.5.5.1.1.1.
Hospital, ambulatory surgery center, and, if applicable, surgeon
performance measurement results.
13.4.1.5.5.1.1.2.
Publication of hospital, ambulatory surgery center, and, if applicable,
surgeon reports of performance.
13.4.1.5.5.2.
DELIVERABLE: Impact of Recommended Revisions Document #2
13.4.1.5.5.3.
DUE: As identified in the Project Schedule
13.4.1.5.6.
Contractor shall meet with the Department regarding the Department-approved
Stakeholder Working Group Feedback and Recommendations Document #2 and the
Department-approved Impact of Recommended Revisions Document #2. The
Department will be the sole decisionmaker with respect to any revisions to
performance measures and risk adjustment models, which decision will be made at a
time of the Department’s choosing.
13.4.1.5.6.1.
DELIVERABLE: Stakeholder Working Group Feedback and Recommendations
#2 and Impact of Recommended Revisions Document #2 Meeting
13.4.1.5.6.2.
DUE: As identified in the Project Schedule
13.4.1.5.7.
To define requirements for Contractor’s Technology Solution, Contractor shall
prepare a Stakeholder Working Group Communication #2 regarding revisions that
resulted from Contractor’s feedback and Contractor’s impact on reported
performance
measurement
results.
Department
will
send
the
approved
communication.
13.4.1.5.7.1.
DELIVERABLE: Stakeholder Working Group Communication #2
13.4.1.5.7.2.
DUE: As identified in the Project Schedule
13.4.1.6.
Broad Stakeholder Engagement to Collect Requirements for Contractor’s Technology
Solution
13.4.1.6.1.
To define requirements for Contractor’s Technology Solution, Contractor shall create
a Regional Stakeholder Plan for Contractor’s Technology Solution to inform
Stakeholders from each of five different Regions of Colorado (“Regional
Stakeholders”) of the purpose of the CO Providers of Distinction for Facilities
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
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Program. Five meetings, one meeting with each Regional Stakeholder group, will
occur. The five Regions are defined as RAE Region 1; RAE Region 2; RAE Region
4; RAE Region 7; and a combination of RAE Regions 3, 5, and 6 representing the
metropolitan areas of Denver and Boulder.
13.4.1.6.1.1.
The Regional Stakeholder Plan for Contractor’s Technology Solution shall
include all of the following:
13.4.1.6.1.1.1.
A description of the goals of meeting with Regional Stakeholders.
13.4.1.6.1.1.2.
A description of the information to be presented and discussed with the
Regional Stakeholders, including how Rural facilities can participate in the
CO Providers of Distinction for Facilities Program.
13.4.1.6.1.1.3.
Proposed agenda for Regional Stakeholder meetings.
13.4.1.6.1.2.
DELIVERABLE: Regional Stakeholder Plan for Contractor’s Technology
Solution
13.4.1.6.1.3.
DUE: As identified in the Project Schedule
13.4.1.6.2.
Contractor shall meet with the Department for the purpose of determining the
composition of each of the five Regional Stakeholder groups.
13.4.1.6.2.1.
The Department will administer and convene all five Regional Stakeholder
meetings and will host each meeting. Contractor shall facilitate each of the five
meetings.
13.4.1.6.2.2.
Contractor shall prepare Regional Stakeholder Meeting Documents, which shall
include, at a minimum, all of the following:
13.4.1.6.2.2.1.
Meeting Agenda that Contractor will use during the identified Regional
Stakeholder Working Group meeting.
13.4.1.6.2.2.2.
The purpose and description of the CO Providers of Distinction Program.
13.4.1.6.2.2.3.
High-level design and methods for measuring performance of hospitals,
ambulatory surgery centers, and, if feasible, surgeons.
13.4.1.6.2.2.4.
Initial blinded cost, quality, safety, and equity performance measurement
results.
13.4.1.6.2.3.
DELIVERABLE: Regional Stakeholder Meeting Documents
13.4.1.6.2.4.
DUE: As identified in the Project Schedule
13.4.1.6.3.
Contractor shall prepare a Regional Stakeholder Meeting Summary following each
Regional Stakeholder meeting.
13.4.1.6.3.1.
The Regional Stakeholder Meeting Summary shall include all of the following:
13.4.1.6.3.1.1.
Regional Stakeholder feedback about the CO Providers of Distinction for
Facilities Program, including feedback regarding all of the following:
13.4.1.6.3.1.1.1.
Purpose of the CO Providers of Distinction for Facilities Program.
13.4.1.6.3.1.1.2.
CO Providers of Distinction for Facilities Program design and methods.
13.4.1.6.3.1.1.3.
Initial cost, quality, safety, and equity performance measurement results.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 105 of 116
13.4.1.6.3.1.1.4.
Potential unintended consequences of public release of hospital,
ambulatory surgery center, and, if applicable, surgeon performance
reports.
13.4.1.6.3.2.
DELIVERABLE: Regional Stakeholder Meeting Summary
13.4.1.6.3.3.
DUE: As identified in the Project Schedule
13.4.1.6.4.
Contractor shall meet with the Department to discuss the Department-approved
Regional Stakeholder Meeting Summary.
13.4.1.6.4.1.
DELIVERABLE: Regional Stakeholder Meeting Summary Meeting
13.4.1.6.4.2.
DUE: As identified in the Project Schedule
13.4.1.7.
Design for Possible Future Program Development with Contractor’s Technology
Solution
13.4.1.7.1.
To define requirements for Contractor’s Technology Solution based on input from the
Department in Stakeholder Working Group Feedback and Recommendations
Document #1 (see Sections 13.4.1.3.4 through 13.4.1.3.3.1.4) and the Regional
Stakeholder Meeting Summary (see
Sections 13.4.1.6.3 through 13.4.1.6.3.1.1.4),
Contractor shall develop a Rural Facilities Technology Evaluation Plan for the CO
Providers of Distinction for Facilities Program.
13.4.1.7.1.1.
The Rural Facilities Technology Evaluation Plan shall include all of the
following:
13.4.1.7.1.1.1.
Recommended method of evaluating cost, quality, safety, and equity
performance of Rural facilities that have small procedure volumes.
13.4.1.7.1.1.2.
Options for establishing a system to provide care for Rural residents locally
when facilities in Rural residents’ communities do not achieve a Provider of
Distinction designation (see CO Providers of Distinction for Facilities
Methods Document at Sections 13.4.1.7.2 through 13.4.1.7.2.1.5).
13.4.1.7.1.2.
DELIVERABLE: Rural Facilities Technology Evaluation Plan
13.4.1.7.1.3.
DUE: As identified in the Project Schedule
13.4.1.7.2.
To define requirements for Contractor’s Technology Solution, Contractor shall create
a CO Providers of Distinction Program Methods Document.
13.4.1.7.2.1.
The CO Providers of Distinction Program Methods Document shall include, at a
minimum, all of the following:
13.4.1.7.2.1.1.
Methods for:
13.4.1.7.2.1.1.1.
Calculating a composite score to summarize performance for each hospital
and ambulatory surgery center across all applicable procedure episode
performance measures. The composite score methodology shall include
all of the following components, at a minimum:
13.4.1.7.2.1.1.2.
Normalization of performance measurement results.
13.4.1.7.2.1.1.3.
Exclusion of outlier performance measurement results.
13.4.1.7.2.1.1.4.
Weighting of constituent performance measures to reflect Department
priorities and opportunities for performance improvement.
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Exhibit B, SOW
Page 106 of 116
13.4.1.7.2.1.2.
Defining geographic areas within Colorado from which to select CO Providers
of Distinction for Facilities.
13.4.1.7.2.1.3.
Selecting (or designating) hospitals and ambulatory surgery centers as
Providers of Distinction within Contractor’s proposed geographic areas based
on achievement of a standard of performance or based on superior
performance compared to hospital and ambulatory surgery center peers.
13.4.1.7.2.1.4.
Ensuring that designated hospitals and ambulatory surgery centers have
sufficient capacity to treat additional Members.
13.4.1.7.2.1.5.
Reducing potential barriers to Member access to designated hospitals and
ambulatory surgery centers.
13.4.1.7.2.2.
DELIVERABLE: CO Providers of Distinction for Facilities Program Methods
Document
13.4.1.7.2.3.
DUE: As identified in the Project Schedule
13.4.1.7.3.
To define requirements for Contractor’s Technology Solution, Contractor shall create
an Incentives for the CO Providers of Distinction for Facilities Program Proposal.
13.4.1.7.3.1.
The Incentives for the CO Providers of Distinction for Facilities Program Proposal
shall include all of the following:
13.4.1.7.3.1.1.
A detailed description of methods for:
13.4.1.7.3.1.1.1.
Rewarding designated facilities for accepting additional Members.
13.4.1.7.3.1.1.2.
Motivating and helping Providers that were not designated as CO
Providers of Distinction to improve those Providers’ performances.
13.4.1.7.3.2.
DELIVERABLE: Incentives for CO Providers of Distinction for Facilities
Program Proposal
13.4.1.7.3.3.
DUE: As identified in the Project Schedule
13.4.1.7.4.
To define requirements for Contractor’s Technology Solution, Contractor shall
develop a Facility Performance Report Publication Plan.
13.4.1.7.4.1.
The Facility Performance Report Publication Plan shall include, at a minimum,
all of the following:
13.4.1.7.4.1.1.
A summary of health services literature regarding effective ways to
communicate information to influence Member selection of a care provider.
13.4.1.7.4.1.2.
Steps to engage Members to help the Department make decisions about the
design and dissemination of information about the performances of individual
facilities.
13.4.1.7.4.1.3.
Options for the design of information about the performances of individual
facilities that encourages Members to use the information to select their care
providers.
13.4.1.7.4.2.
DELIVERABLE: Facility Performance Report Publication Plan
13.4.1.7.4.3.
DUE: As identified in the Project Schedule
13.4.2.
Program Initial Release within Contractor’s Technology Solution
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 107 of 116
13.4.2.1.
Utilizing Contractor’s Technology Solution, Contractor shall create Updated
Performance Reports for the initial three procedure episodes, sortable by hospital,
ambulatory surgery center, and surgeon, if applicable.
13.4.2.1.1.
The Updated Performance Reports shall, at a minimum, include all of the following:
13.4.2.1.1.1.
Quarterly updates of unadjusted and risk-adjusted cost, quality, safety, and equity
performance measurement results.
13.4.2.1.1.2.
Statistical tests of stability and reliability of:
13.4.2.1.1.2.1.
Procedure episode volume.
13.4.2.1.1.2.2.
Episode costs by payer.
13.4.2.1.1.2.3.
Quality, safety, and equity measurement results across payers.
13.4.2.1.2.
DELIVERABLE: Updated Performance Reports
13.4.2.1.3.
DUE: On a quarterly basis, as identified in the Project Schedule
13.4.2.2.
Utilizing Contractor’s Technology Solution, Contractor shall create a Technology
Solution Expansion Plan for the CO Providers of Distinction for Facilities Program,
which may be to be implemented, if at all, through future Contract amendments.
13.4.2.2.1.
The Technology Solution Expansion Plan for the CO Providers of Distinction for
Facilities Program shall include, at a minimum, all of the following:
13.4.2.2.1.1.
Selection of five additional procedure episodes that meet requirements listed in
Sections 13.4.1.2.4.1 through 13.4.1.2.4.1.5.
13.4.2.2.1.2.
Step-by-step plan to implement requirements previously defined and developed
for Contractor’s Technology Solution for additional procedure episodes, which
shall include all of the following g:
13.4.2.2.1.2.1.
Modification of procedure episode definitions.
13.4.2.2.1.2.2.
Selection of performance measures of quality, safety, and equity.
13.4.2.2.1.2.3.
Documentation of performance measure specifications.
13.4.2.2.1.2.4.
Development of risk adjustment methods.
13.4.2.2.2.
DELIVERABLE: Technology Solution Expansion Plan for the CO Providers of
Distinction for Facilities Program
13.4.2.2.3.
DUE: As identified in the Project Schedule
14.
OPTIONAL NEW WORK
14.1.
Provided that the Department obtains future funding appropriations or other funding sources, the
Department may include any or all New Work identified in this Section as part of this Contract.
None of the New Work described in this Section 14 is guaranteed to be implemented at any time
during the Term of the Contract.
14.1.1.
All New Work, if any, shall be implemented via a Contract Amendment. No New Work shall
begin prior to execution of an applicable Contract Amendment.
14.1.1.1.
Any Contract Amendment shall include, at least in part, the applicable rates identified in
Exhibit C.
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Exhibit B, SOW
Page 108 of 116
14.2.
The New Work identified in this Section 14 is new to the extent that it is not duplicative of
Contractor’s responsibilities in this Exhibit B.
14.3.
New Work may include any or all of following that is not already identified in this Exhibit B:
14.3.1.
The provisions identified as “FUTURE OPTION” in ITN UHAA 2022000008, Modification
#1.
14.3.2.
The strategic planning of the APM 2 Program operations process and the management of all
involved activities, including but not limited to Stakeholder engagement, evaluation, scaling
up, Provider enrollment, and Provider training.
14.4.
The Department may elect, in its sole discretion, not to have Contractor perform any or all of the
New Work.
14.5.
All Deliverables resulting from New Work shall comply with all requirements identified in
Exhibit E, Section 1.6.
15.
SERVICE LEVEL AGREEMENTS (SLAs)
15.1.
System Management SLAs
15.1.1.
The following Systems Management SLAs shall apply to Contractor’s Technology Solution.
15.1.1.1.
Priority 1 Production Incidents
15.1.1.1.1.
Notice of Priority 1 Production Incidents
15.1.1.1.1.1.
Contractor shall provide to the Department Notice of each Priority 1 Production
Incident within 30 minutes after Contractor discovers the Priority 1 Production
Incident.
15.1.1.1.1.1.1.
The Notice of a Priority 1 Production Incident shall include all of the
following:
15.1.1.1.1.1.1.1.
Identification of the Production Incident priority.
15.1.1.1.1.1.1.2.
Date of the Priority 1 Production Incident.
15.1.1.1.1.1.1.3.
Time of the Priority 1 Production Incident.
15.1.1.1.1.1.1.4.
If the Production Incident is resolved prior to providing the Notice of a
Priority 1 Production Incident, when the Production Incident was resolved
and ended.
15.1.1.1.1.1.2.
Contractor shall deliver each Notice of a Priority 1 Production Incident to the
Department for review and approval.
15.1.1.1.1.1.3.
DELIVERABLE: Notice of a Priority 1 Production Incident
15.1.1.1.1.1.4.
DUE: Not later than 30 minutes after Contractor discovers the Production
Incident
15.1.1.1.2.
Preliminary Root Cause Analysis (RCA) and Resolution Plan for Priority 1
Production Incidents
15.1.1.1.2.1.
Contractor shall prepare a Preliminary RCA and Resolution Plan for each Priority
1 Production Incident, which shall include all SOPs written for each Priority 1
Production Incident type, based on error type.
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15.1.1.1.2.1.1.
Contractor shall deliver each Preliminary RCA and Resolution Plan to the
Department for review and approval. Contractor shall not use any Preliminary
RCA and Resolution Plan prior to the Department’s approval of that
document.
15.1.1.1.2.1.1.1.
DELIVERABLE: Preliminary RCA and Resolution Plan
15.1.1.1.2.1.1.2.
DUE: Not later than two hours after Contractor provided the Notice of a
Priority 1 Production Incident to the Department
15.1.1.1.3.
Reports for and Resolution of Priority 1 Production Incidents
15.1.1.1.3.1.
Contractor shall provide an Incident Resolution Report for all Priority 1
Production Incidents.
15.1.1.1.3.1.1.
The Incident Resolution Report shall include all of the following:
15.1.1.1.3.1.1.1.1.
Confirmation of restoration of service or of the remediation plan.
15.1.1.1.3.1.1.1.2.
Timeline for resolution of the Priority 1 Production Incident.
15.1.1.1.3.1.2.
Contractor shall deliver each Incident Resolution Report to the Department
for review and approval. Contractor shall not use any Incident Resolution
Report prior to the Department’s approval of that document.
15.1.1.1.3.1.3.
DELIVERABLE: Incident Resolution Report
15.1.1.1.3.1.4.
DUE: Not later than 24 hours after the Department approves the Preliminary
RCA and Resolution Plan for the Priority 1 Production Incident
15.1.1.1.4.
Contractor shall deliver each Final Production Incident Report for each Priority 1
Production Incident to the Department for review and approval.
15.1.1.1.4.1.
DELIVERABLE: Final Production Incident Report
15.1.1.1.4.2.
DUE: Not later than 30 days after resolution of the Priority 1 Production Incident
15.1.1.1.5.
Contractor shall prepare Progress Reports for each Priority 1 Production Incident until
the Priority 1 Production Incident is resolved.
15.1.1.1.5.1.
Contractor shall deliver each Progress Report to the Department for review and
approval.
15.1.1.1.5.1.1.
DELIVERABLE: Progress Report
15.1.1.1.5.1.2.
DUE: Every four hours, calculated from the time Contractor provides the
Notice of a Priority 1 Production Incident to the Department
15.1.1.1.6.
Contractor shall resolve all Priority 1 Production Incident(s) within 24 hours after
Contractor identifies the Priority 1 Production Incident.
15.1.1.1.6.1.
PERFORMANCE STANDARD: All Priority 1 Production Incident(s) resolved
within 24 hours after Contractor’s identification of the Priority 1 Production
Incident.
15.1.1.2.
Priority 2 Production Incidents
15.1.1.2.1.
Notice of Priority 2 Production Incidents
15.1.1.2.1.1.
Contractor shall provide to the Department Notice of each Priority 2 Production
Incident.
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Exhibit B, SOW
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15.1.1.2.1.1.1.
The Notice of a Priority 2 Production Incident shall include all of the
following:
15.1.1.2.1.1.1.1.
Identification of the Production Incident priority.
15.1.1.2.1.1.1.2.
Date of the Priority 2 Production Incident.
15.1.1.2.1.1.1.3.
Time of the Priority 2 Production Incident.
15.1.1.2.1.1.1.4.
If the Production Incident is resolved prior to providing the Notice of a
Priority 2 Production Incident, when the Production Incident was resolved
and ended.
15.1.1.2.1.1.2.
Contractor shall deliver each Notice of a Priority 2 Production Incident to the
Department for review and approval.
15.1.1.2.1.1.3.
DELIVERABLE: Notice of a Priority 2 Production Incident
15.1.1.2.1.1.4.
DUE: Not later than 60 minutes after Contractor discovers the Production
Incident
15.1.1.2.2.
Preliminary RCA and Resolution Plan for Priority 2 Production Incidents
15.1.1.2.2.1.
Contractor shall prepare a Preliminary RCA and Resolution Plan for each Priority
2 Production Incident, which shall include all SOPs written for each Priority 2
Production Incident type, based on error type.
15.1.1.2.2.1.1.
Contractor shall deliver each Preliminary RCA and Resolution Plan to the
Department for review and approval. Contractor shall not use any Preliminary
RCA and Resolution Plan prior to the Department’s approval of that
document.
15.1.1.2.2.1.2.
DELIVERABLE: Preliminary RCA and Resolution Plan
15.1.1.2.2.1.3.
DUE: Not later than eight Business Hours after Contractor provided the
Notice of a Priority 2 Production Incident to the Department
15.1.1.2.3.
Reports for and Resolution of Priority 2 Production Incidents
15.1.1.2.3.1.
Contractor shall provide an Incident Resolution Report for all Priority 2
Production Incidents.
15.1.1.2.3.1.1.
The Incident Resolution Report shall include all of the following:
15.1.1.2.3.1.1.1.
Confirmation of restoration of service or of the remediation plan.
15.1.1.2.3.1.1.2.
Timeline for resolution of the Priority 2 Production Incident.
15.1.1.2.3.1.2.
Contractor shall deliver each Incident Resolution Report to the Department
for review and approval. Contractor shall not use any Incident Resolution
Report prior to the Department’s approval of that document.
15.1.1.2.3.1.3.
DELIVERABLE: Incident Resolution Report
15.1.1.2.3.1.4.
DUE: Not later than 14 days after Contractor identifies the Incident
15.1.1.2.4.
Contractor shall deliver a Daily Status Update for each Priority 2 Production Incident
to the Department for review and approval.
15.1.1.2.4.1.
DELIVERABLE: Daily Status Update
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15.1.1.2.4.2.
DUE: Not later than noon every day
15.1.1.2.5.
Contractor shall resolve all Priority 2 Production Incident(s) within 36 hours after the
Department approves the Preliminary RCA and Resolution Plan for the Priority 2
Production Incident(s).
15.1.1.2.5.1.
PERFORMANCE STANDARD: All Priority 2 Production Incident(s) resolved
within 36 hours after the Department approves the Preliminary RCA and
Resolution Plan for the Priority 2 Production Incident(s).
15.1.1.3.
Priority 3 Production Incidents
15.1.1.3.1.
Contractor shall provide to the Department Notice of each Priority 3 Production
Incident.
15.1.1.3.1.1.
The Notice of a Priority 3 Production Incident must include all of the following:
15.1.1.3.1.1.1.
Identification of Production Incident priority.
15.1.1.3.1.1.2.
Date of the Priority 3 Production Incident.
15.1.1.3.1.1.3.
Time of the Priority 3 Production Incident.
15.1.1.3.1.1.4.
If the Production Incident is resolved prior to providing the Notice of a Priority
3 Production Incident, when the Production Incident was resolved and ended.
15.1.1.3.1.2.
Contractor shall deliver each Notice of a Priority 3 Production Incident to the
Department for review and approval.
15.1.1.3.1.3.
DELIVERABLE: Notice of a Priority 3 Production Incident
15.1.1.3.1.4.
DUE: Not later than one Business Day after Contractor discovers the Production
Incident.
15.1.1.4.
Contractor shall prepare a Preliminary RCA and Resolution Plan for each Priority 3
Production Incident, which shall include all SOPs written for each Priority 3 Production
Incident type, based on error type.
15.1.1.4.1.
Contractor shall deliver each Preliminary RCA and Resolution Plan to the Department
for review and approval. Contractor shall not use any Preliminary RCA and
Resolution Plan prior to the Department’s approval of that document.
15.1.1.4.2.
DELIVERABLE: Preliminary RCA and Resolution Plan
15.1.1.4.3.
DUE: Not later than 48 hours after Contractor provided the Notice of a Priority 3
Production Incident to the Department.
15.1.1.5.
Contractor shall provide an Incident Resolution Report for each Priority 3 Production
Incident.
15.1.1.5.1.
The Incident Resolution Report shall include all of the following:
15.1.1.5.1.1.
Confirmation of the remediation deployment.
15.1.1.5.1.2.
Confirmation of the timeline for implementation previously agreed upon by the
Parties in the Preliminary RCA and Resolution Plan.
15.1.1.5.2.
Contractor shall deliver each Incident Resolution Report to the Department for review
and approval. Contractor shall not use any Incident Resolution Report prior to the
Department’s approval of that document.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 112 of 116
15.1.1.5.3.
DELIVERABLE: Incident Resolution Report
15.1.1.5.4.
DUE: Not later than one month after the Department approves the Preliminary RCA
and Resolution Plan for each Priority 3 Production Incident
15.1.1.6.
Contractor shall deliver a Final Production Incident Report for each Priority 3 Production
Incident to the Department for review and approval.
15.1.1.6.1.
DELIVERABLE: Final Production Incident Report
15.1.1.6.2.
DUE: Not later than 30 days after resolution of each Priority 3 Production Incident
15.1.1.7.
Contractor shall prepare a Weekly Progress Report for each Priority 3 Production Incident
until the Priority 3 Production Incident is resolved.
15.1.1.7.1.
Contractor shall deliver each Weekly Progress Report to the Department for review
and approval.
15.1.1.7.2.
DELIVERABLE: Weekly Progress Report
15.1.1.7.3.
DUE: Not later than every Friday by 5:00 p.m.
15.1.1.8.
Contractor shall resolve all Priority 3 Production Incident(s) within one month after
Contractor identifies the Priority 3 Production Incident.
15.1.1.8.1.
PERFORMANCE STANDARD: All Priority 3 Production Incident(s) resolved
within one month after Contractor’s identification of the Priority 3 Production
Incident.
15.2.
Testing SLAs
15.2.1.
Testing Environments
15.2.1.1.
Contractor shall ensure that the UAT environment is available to be used 99.9% of the
time during Scheduled Testing Activities.
15.2.1.1.1.
PERFORMANCE STANDARD: The UAT testing environment shall be available
99.9% of the time when Scheduled Testing Activities are planned.
15.2.1.2.
Contractor shall ensure that all testing environments that are defined in the Sections 8.2.1
through 8.2.1.4.
15.2.1.3.
Contractor shall resolve any unscheduled testing environment downtime within one
Business Hour after Contractor identifies the downtime.
15.2.1.3.1.
PERFORMANCE STANDARD: All unscheduled downtime in all testing
environments shall be resolved, with access to the testing environment restored,
within one hour after Contractor identifies the downtime.
15.2.1.4.
Contractor shall ensure that all testing environments are available during the hours of
7:00 a.m. and 11:00 p.m. Mountain Time, as adjusted for Daylight Saving Time, on all
days on which Scheduled Testing Activities are planned.
15.3.
Deployment of Code/Functionality SLAs
15.3.1.
Contractor shall deploy code and/or functionality to the Production Environment after
Contractor receives the Department’s written approval to implement the code/functionality
during an Operational Readiness Review Meeting.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 113 of 116
15.3.1.1.
PERFORMANCE STANDARD: All Department-approved code and/or functionality
shall be implemented after the Department has provided written approval to implement
the code functionality.
15.4.
Licensing SLAs
15.4.1.
Contractor shall have responsibility for obtaining, controlling, and ensuring the working
order of all hardware and software licenses and certificates necessary to complete the Work.
15.4.1.1.
Contractor shall manage the production hardware and software licenses.
15.4.2.
PERFORMANCE STANDARD: Contractor shall renew all hardware and software licenses
and certificates on time so that no hardware or software license expires.
15.5.
System Performance SLAs
15.5.1.
Contractor shall ensure that the Production Environment is available 24 hours per day and
seven days per week, with a monthly availability of 99.9% uptime, excluding Department-
approved planned downtime.
15.5.1.1.
PERFORMANCE STANDARD: The Production Environment shall be available 24
hours per day and seven days per week. The Production Environment shall have a
monthly availability of 99.9% uptime, excluding Department-approved planned
downtime.
15.5.1.2.
Monthly availability is calculated as follows:
15.5.1.2.1.
Availability Percentage = Unplanned Unavailability or Downtime (Total Downtime
– Approved Downtime – Department approval time for Preliminary RCAs and
Resolution Plans) divided by Total Time (24x7) over a month period
15.5.1.3.
Unplanned Unavailability shall not include cloud platform unplanned outages.
15.5.1.3.1.
If a cloud platform unplanned outage occurs, Contractor shall notify the Department
within one Business Hour after learning of the cloud platform unplanned outage.
15.5.1.3.2.
If a cloud platform unplanned outage occurs, Contractor shall contact the cloud
platform throughout the duration of the cloud platform unplanned outage to learn
more information about resolution of the unplanned outage and communicate all
information from the cloud platform to the Department.
15.5.1.3.3.
An unplanned cloud platform outage shall be considered “approved downtime.”
15.5.1.4.
Contractor shall request approval of all planned downtime, and the Department will not
unreasonably withhold planned downtime approval.
15.5.2.
Contractor shall deliver the Monthly System Performance Availability Report to the
Department for review and approval.
15.5.2.1.
DELIVERABLE: Monthly System Performance Availability Report
15.5.2.2.
DUE: Not later than seven Business Days after the end of each calendar month
15.5.3.
Contractor shall provide API native service performance that meets 90% Latency of less than
10,000 milliseconds as measured by the API provider time per message request, in relation
to online transaction processing (OLTP) functions and not in relation to online analytical
processing (OLAP) functions.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 114 of 116
15.5.3.1.
PERFORMANCE STANDARD: The API native service performance shall have 90%
Latency of less than 10,000 milliseconds.
15.5.4.
Contractor shall provide the Department with access to the API Gateway native service
performance Dashboard for purposes of the Department utilizing the API Gateway native
service performance Dashboard to perform real-time monitoring of system performance, in
the Department’s discretion.
15.6.
Personnel SLA
15.6.1.
Contractor shall comply Exhibit E, Section 2.1.2 through 2.1.2.2.
15.6.1.1.
PERFORMANCE STANDARD: Contractor shall not voluntarily change individuals in
Key Personnel positions without the prior written approval of the Department.
15.7.
Data Production SLA
15.7.1.
Notice and Resolution Plan of Data Production Errors for those Deliverables identified in the
Monthly Contract Management Report
15.7.1.1.
Contractor shall provide the Department Notice and a Resolution Plan for any identified
errors in calculation of rates or methodology within 24 hours after Contractor identifies
the error.
15.7.1.1.1.
The Notice and Resolution Plan of a Data Production Error shall include all of the
following:
15.7.1.1.1.1.
The name of the Deliverable that contains the Data Production Error.
15.7.1.1.1.2.
Other Deliverables effected by the Data Production Error.
15.7.1.1.1.3.
Manner by which or reason the Data Production Error was generated, created, or
established.
15.7.1.1.1.4.
Steps and timeline of actions that need to be taken to resolve the Data Production
Error.
15.7.1.1.2.
Contractor shall deliver each Notice and Resolution Plan of a Data Production Error
to the Department for review and approval.
15.7.1.1.3.
DELIVERABLE: Notice and Resolution Plan of a Data Production Error
15.7.1.1.4.
DUE: Not later than 24 hours after Contractor discovers the Data Production Error
15.8.
Help Desk SLAs
15.8.1.
Contractor shall provide Help Desk support functions that enables User support to be
requested via Tier I and Tier II support at a minimum on all Business Days from 6:00 a.m.
Mountain Time to 6:00 p.m. Mountain Time, as adjusted for Daylight Saving Time.
15.8.1.1.
PERFORMANCE STANDARD: The Help Desk shall be available and working to
resolve Tier I and Tier II requests between the hours of 6:00 a.m. Mountain Time and
6:00 p.m. Mountain Time, as adjusted for Daylight Saving Time, on all Business Days.
15.8.2.
Contractor shall provide a non-automated response to all requests to the Help Desk requests
during Business Hours within 60 minutes, 99.99% of the time, measured weekly Sunday
through Saturday.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 115 of 116
15.8.2.1.
PERFORMANCE STANDARD: Non-automated responses shall be provided to 99.99%
of all Help Desk requests within 60 minutes during Business Hours, when the percentage
is measured weekly from Sunday through Saturday.
15.8.3.
Contractor shall implement and utilize a mutually agreed-upon trouble-ticket system that
supports the production/development/all environments and resolves defects in a timely
manner.
16.
COMPENSATION AND INVOICING
16.1.
Compensation
16.1.1.
The Contractor will receive payment as specified in Exhibit C, Rates.
16.2.
Detailed Invoicing and Payment Procedures
16.2.1.
Contractor shall invoice the Department on a quarterly basis, by the 15
th
Business Day of the
month following the end of calendar quarter for which the invoice covers. Contractor shall
not invoice the Department for a calendar quarter prior to the last day of that calendar quarter.
For purposes of invoicing, work completed over a partial calendar quarter shall be treated the
same as work completed over a full calendar quarter.
16.2.2.
For the avoidance of doubt, calendar quarters shall be measured as follows:
16.2.2.1.
January through March.
16.2.2.2.
April through June.
16.2.2.3.
July through September.
16.2.2.4.
October through December.
16.2.3.
The invoice shall contain all of the following for the calendar quarter for which the invoice
covers:
16.2.3.1.
The Contract Number shown on the cover page for this Contract to facilitate invoice
processing.
16.2.3.2.
A clear description of the time period the invoice covers.
16.2.3.3.
The Fixed Quarterly Payment, shown in Exhibit C, related to the invoiced calendar
quarter.
16.2.3.4.
The Quarterly SLA Performance Payment Amount(s), shown in Exhibit C, related to the
invoiced calendar quarter, corresponding to those SLAs that Contractor successfully
achieved.
16.2.3.5.
The total amount due for all achieved SLAs during that calendar quarter.
16.2.3.6.
Each Implementation Payment, shown in Exhibit C, for implementation(s) that was
accepted by the Department during that calendar quarter.
16.2.3.7.
The total amount due for all Implementation Payments for implementation(s) accepted
by the Department during that calendar quarter.
16.2.3.8.
Each Deliverable, shown in Exhibit C and Exhibit J that was accepted by the Department
during that calendar quarter.
16.2.3.9.
The total amount due for all Deliverables accepted by the Department during that calendar
quarter.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit B, SOW
Page 116 of 116
16.2.3.10.
All Work attributable to Modification Enhancement Hours, in compliance with Exhibit
C, Sections 5.1 through Section 5.3, accepted by the Department during that calendar
quarter.
16.2.3.11.
The Total amount due with respect to the Fixed Quarterly Payment, achieved SLAs,
accepted Implementation Payments, accepted Deliverables, and accepted Modification
Enhancement Hours during that calendar quarter.
16.3.
Closeout Payments
16.3.1.
Notwithstanding anything to the contrary in this Contract, all payments for the final month
of this Contract shall be paid to Contractor no sooner than 10 days after the Department has
determined that Contractor has completed all of the requirements of the Closeout Period.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 1 of 7
EXHIBIT C, RATES
1.
RATE INCLUSION AND RATE MODIFICATION
1.1.
The pricing provided in this Exhibit C encompasses the entire scope of work described in Exhibit
B. If any Deliverables are intended to be eliminated or reduced in scope, then Contractor and the
Department agree to negotiate an amendment to the payments due and Work defined under this
Contract in good faith to account for reduced work corresponding to one or payment(s) and
increased work corresponding to other payment(s).
2.
QUARTERLY PAYMENTS
2.1.
Calendar quarters shall be measured as described in Exhibit B, Sections 16.2.2 through 16.2.2.4.
2.2.
Fixed Quarterly Payments
2.2.1.
The Department shall pay Contractor a Fixed Quarterly Payment each calendar quarter for
Contractor providing all work included in this Contract other than the additional payments
outlined below. The work includes access to Contractor’s Technology Solution. This
payment is shown in the following table:
PERIOD
FIXED QUARTERLY
PAYMENT
TOTAL YEARLY
PAYMENT
July 2025 through
September 2025
$149,652.09
October 2025 through
December 2025
$149,652.09
January 2026 through
March 2026
$149,652.09
April 2026 through
June 2026
$149,652.09
$598,608.36 in SFY26
July 2026 through
September 2026
$276,280.77
October 2026 through
December 2026
$276,280.77
January 2027 through
March 2027
$276,280.77
April 2027 through
June 2027
$276,280.77
$1,105,123.08 in SFY27
July 2027 through
September 2027
$276,280.77
October 2027 through
December 2027
$276,280.77
January 2028 through
March 2028
$276,280.77
April 2028 through
June 2028
$276,280.77
$1,105,123.08 in SFY28
2.3.
Quarterly SLA Performance Payment Amounts
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 2 of 7
2.3.1.
The Department shall pay Contractor each of the Quarterly SLA Performance Payment
Amounts described in this section for each calendar quarter in which Contractor meets all
requirements associated with each identified SLA and upon the Department’s acceptance of
Contractor’s invoice for the month in which the applicable calendar quarter ends.
2.3.2.
Compliance with Uptime SLA at Exhibit B, Sections 15.5.1 through 15.5.1.1
2.3.2.1.
The Department shall pay Contractor a Quarterly Uptime SLA Performance Payment
described in this section for each calendar quarter in which Contractor fully and
successfully completes the Uptime SLA identified in Exhibit B, Sections 15.5.1 through
15.5.1.1 and upon the Department’s acceptance of Contractor’s invoice for the month in
which the applicable calendar quarter ends.
2.3.2.1.1.
Provided Contractor fully and successfully completes the Uptime SLA identified in
Exhibit B, Sections 15.5.1 through 15.5.1.1, the amount of each Quarterly Uptime
SLA Performance Payment is shown in the following table:
PERIOD
QUARTERLY UPTIME
SLA PERFORMANCE
PAYMENT AMOUNT
MAXIMUM SFY
AMOUNT
July 2025 through
September 2025
$4,401.53
October 2025 through
December 2025
$4,401.53
January 2026 through
March 2026
$4,401.53
April 2026 through
June 2026
$4,401.53
$17,606.12 in SFY26
July 2026 through
September 2026
$8,125.91
October 2026 through
December 2026
$8,125.91
January 2027 through
March 2027
$8,125.91
April 2027 through
June 2027
$8,125.91
$32,503.64 in SFY27
July 2027 through
September 2027
$8,125.91
October 2027 through
December 2027
$8,125.91
January 2028 through
March 2028
$8,125.91
April 2028 through
June 2028
$8,125.91
$32,503.64 in SFY28
2.3.3.
Compliance with Latency SLA at Exhibit B, Sections 15.5.3 through 15.5.3.1
2.3.3.1.
The Department shall pay Contractor a Quarterly Latency SLA Performance Payment
described in this section for each calendar quarter in which Contractor fully and
successfully completes the Latency SLA identified in Exhibit B, Sections 15.5.3 through
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 3 of 7
15.5.3.1 and upon Department’s acceptance of Contractor’s invoice for the month in
which the applicable calendar quarter ends.
2.3.3.1.1.
Provided Contractor fully and successfully completes the Latency SLA identified in
Exhibit B, Sections 15.5.3 through 15.5.3.1, the amount of each Quarterly Latency
SLA Performance Payment is shown in the following table:
PERIOD
QUARTERLY LATENCY
SLA PERFORMANCE
PAYMENT AMOUNT
MAXIMUM SFY
AMOUNT
July 2025 through
September 2025
$4,401.53
October 2025 through
December 2025
$4,401.53
January 2026 through
March 2026
$4,401.53
April 2026 through
June 2026
$4,401.53
$17,606.12 in
SFY26
July 2026 through
September 2026
$8,125.91
October 2026 through
December 2026
$8,125.91
January 2027 through
March 2027
$8,125.91
April 2027 through
June 2027
$8,125.91
$32,503.64 in
SFY27
July 2027 through
September 2027
$8,125.91
October 2027 through
December 2027
$8,125.91
January 2028 through
March 2028
$8,125.91
April 2028 through
June 2028
$8,125.91
$32,503.64 in
SFY28
2.3.4.
Compliance with Personnel SLA at Exhibit B, Sections 15.6 through 15.6.1.1
2.3.4.1.
The Department shall pay Contractor a Quarterly Personnel SLA Performance Payment
described in this section for each calendar quarter in which Contractor fully and
successfully completes the Personnel SLA identified in Exhibit B, Sections 15.6 through
15.6.1.1 and upon the Department’s acceptance of Contractor’s invoice for the month in
which the applicable calendar quarter ends.
2.3.4.1.1.
Provided Contractor fully and successfully completes the Personnel SLA identified
in Exhibit B, Sections 15.6 through 15.6.1.1, the amount of each Quarterly Personnel
SLA Performance Payment is shown in the following table:
PERIOD
QUARTERLY
PERSONNEL SLA
PERFORMANCE
PAYMENT AMOUNT
MAXIMUM SFY
AMOUNT
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 4 of 7
July 2025 through
September 2025
$8,803.07
October 2025 through
December 2025
$8,803.07
January 2026 through
March 2026
$8,803.07
April 2026 through
June 2026
$8,803.07
$35,212.28 in
SFY26
July 2026 through
September 2026
$16,251.81
October 2026 through
December 2026
$16,251.81
January 2027 through
March 2027
$16,251.81
April 2027 through
June 2027
$16,251.81
$65,007.24 in
SFY27
July 2027 through
September 2027
$16,251.81
October 2027 through
December 2027
$16,251.81
January 2028 through
March 2028
$16,251.81
April 2028 through
June 2028
$16,251.81
$65,007.24 in
SFY28
2.3.5.
Compliance with Help Desk Operations Time SLA at Exhibit B, Sections 15.8.1 through
15.8.1.1
2.3.5.1.
The Department shall pay Contractor a Quarterly Help Desk Operations Time SLA
Performance Payment described in this section for each calendar quarter in which
Contractor fully and successfully completes the Help Desk Operations Time SLA
identified in Exhibit B, Sections 15.8.1 through 15.8.1.1 and upon the Department’s
acceptance of Contractor’s invoice for the month in which the applicable calendar quarter
ends.
2.3.5.1.1.
Provided Contractor fully and successfully completes the Help Desk Operations Time
SLA identified in Exhibit B, Sections 15.8.1 through 15.8.1.1, the amount of each
Quarterly Help Desk Operations Time SLA Performance Payment is shown in the
following table:
PERIOD
QUARTERLY HELP
DESK OPERATIONS
TIME SLA
PERFORMANCE
PAYMENT AMOUNT
MAXIMUM SFY
AMOUNT
July 2025 through
September 2025
$4,401.53
October 2025 through
December 2025
$4,401.53
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 5 of 7
January 2026 through
March 2026
$4,401.53
April 2026 through
June 2026
$4,401.53
$17,606.12 in
SFY26
July 2026 through
September 2026
$8,125.91
October 2026 through
December 2026
$8,125.91
January 2027 through
March 2027
$8,125.91
April 2027 through
June 2027
$8,125.91
$32,503.64 in
SFY27
July 2027 through
September 2027
$8,125.91
October 2027 through
December 2027
$8,125.91
January 2028 through
March 2028
$8,125.91
April 2028 through
June 2028
$8,125.91
$32,503.64 in
SFY28
2.3.6.
Compliance with Help Desk Response Time SLA at Exhibit B, Sections 15.8.2 through
15.8.2.1
2.3.6.1.
The Department shall pay Contractor a Quarterly Help Desk Response Time SLA
Performance Payment described in this section for each calendar quarter in which
Contractor fully and successfully completes the Help Desk Response Time SLA
identified in Exhibit B, Sections 15.8.2 through 15.8.2.1and upon the Department’s
acceptance of Contractor’s invoice for the month in which the applicable calendar quarter
ends.
2.3.6.1.1.
Provided Contractor fully and successfully completes the Help Desk Response Time
SLA identified in Exhibit B, Sections 15.8.2 through 15.8.2.1, the amount of each
Quarterly Help Desk Response Time SLA Performance Payment is shown in the
following table:
PERIOD
QUARTERLY HELP
DESK RESPONSE TIME
SLA PERFORMANCE
PAYMENT AMO]UNT
MAXIMUM SFY
AMOUNT
July 2025 through
September 2025
$4,401.53
October 2025 through
December 2025
$4,401.53
January 2026 through
March 2026
$4,401.53
April 2026 through
June 2026
$4,401.53
$17,606.12 in
SFY26
July 2026 through
September 2026
$8,125.91
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit C, Rates
Page 6 of 7
October 2026 through
December 2026
$8,125.91
January 2027 through
March 2027
$8,125.91
April 2027 through
June 2027
$8,125.91
$32,503.64 in
SFY27
July 2027 through
September 2027
$8,125.91
October 2027 through
December 2027
$8,125.91
January 2028 through
March 2028
$8,125.91
April 2028 through
June 2028
$8,125.91
$32,503.64 in
SFY28
3.
ONE-TIME IMPLEMENTATION PAYMENTS
3.1.
The Department shall pay Contractor a Fixed Implementation Payment for each of the following
implementations that are accepted by the Department:
IMPLEMENTATION
DUE DATE
FIXED
IMPLEMENTATION
PAYMENT
APM 2 Program Soft Launch SFY24
$422,547.08
Initial Launch Operations of
Contractor’s
Technology
Solution
SFY24
$1,300,144.87
4.
ONE-TIME DELIVERABLE PAYMENTS
4.1.
The Department shall pay Contractor a Fixed Deliverable Payment for all Deliverables in Exhibit
J that are accepted by the Department.
4.2.
Unless otherwise identified in Exhibit J, each Deliverable payment shall be paid once to
Contractor.
4.3.
To the extent that any conflict exists between the “Exhibit B Section Number” column and the
“Deliverable Name” column in Exhibit J, information in the “Deliverable Name” column shall
control.
5.
MODIFICATION ENHANCEMENT HOURS
5.1.
The chart in this section describes the hourly rates that Contractor shall use to calculate the
reasonable Deliverable or milestone completion payment amounts for all projects described
under the Modification Enhancement Work in Exhibit B, Section 11. This chart is for calculation
purposes only to determine the Deliverable or milestone completion payment amounts, based on
a blended rate of the hourly rates described below, and the Department shall not pay hourly rates
for any Work performed under Exhibit B, Section 11.
5.1.1.
The Parties also agree to use these rates as a guide to help determine a reasonable price for
all amendments to this Contract that increase or decrease work.
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Exhibit C, Rates
Page 7 of 7
5.2.
The hourly rates to be used for the calculations described in this section for each SFY are shown
on the table below:
ROLE
RATE (THROUGH THE TERM
OF THE CONTRACT)
Senior Clinician
$325.00
Partner/Subject Matter Professional
$300.00
Technical Lead
$250.00
Senior Data Engineer/Senior (Project) Manager
$200.00
Data Engineer/Project Manager
$175.00
Senior Analyst
$150.00
(Data) Analyst
$130.00
Junior Analyst
$100.00
Blended Rate: Annual System Enhancement Hours
$150.00
Blended Rate: New Quality and Performance
Measure Development
$220.00
5.3.
The total amount of funding available for projects described in Exhibit B, Section 11 for each
fiscal year is as follows:
SFY
MODIFICATION AND ENHANCEMENT
FUNDING AVAILABLE
SFY 2024
$0.00
SFY 2025
$600,000.00
SFY 2026
$800,000.00
SFY 2027
$700,000.00
SFY 2028
$700,000.00
5.3.1.
The Department may increase or decrease the funding amount available in this Section 5.3,
and add additional work related to Modification Enhancement Hours, through the use of an
Option Letter substantially similar to Exhibit F.
5.4.
The Parties agree to use the rates identified in Section 5.2 as guides to help determine reasonable
prices for all amendments to this Contract that increase or decrease Work.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit D, Terminology
Page 1 of 11
EXHIBIT D, TERMINOLOGY
1.
TERMINOLOGY
1.1.
In addition to the terms defined in
§3
of this Contract, the following list of terms shall be
construed and interpreted as follows:
1.1.1.
Actuarial Standards of Practice – The procedures an actuary should follow when performing
actuarial services and identifies what the actuary should disclose when communicating the
results of those services.
1.1.2.
American Recovery and Reinvestment Act (ARRA) – The American Recovery and
Reinvestment Act of 2009.
1.1.3.
Anomaly – Data is flowing in the ESI Integration Platform but there is no data integrity
between the ODS and the Source System or System, Integration processes, or Integration
components and data are incomplete in their transmission.
1.1.4.
API Gateway – A programming layer that accepts and processes concurrent API calls, which
happen when APIs submit requests to a server. An API Gateway manages traffic, authorizes
End Users, and monitors performance.
1.1.5.
APM 2 Program Enrollment Start Date – The quarterly dates on which the APM 2 Program
accepts new enrollees, which dates are January 1, April 1, July 1, and October 1 of each
calendar year.
1.1.6.
APM 2 Program Year(s) – One or more calendar years in which each calendar year is
measured from January 1 through December 31.
1.1.7.
Application Program Interface (API) – A set of routines, protocols, and tools for building
software applications.
1.1.8.
Business Hour – The hours of the day during which business is transacted. The open and
close schedule that a business determines for its operations. Office working hours are
weekdays from 8:00 a.m. to 5:00 p.m. Mountain Time.
1.1.9.
Business Interruption – Any event that disrupts 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.
1.1.10.
Change Request – A formal proposal to modify a document, Deliverable, or baseline; a
formal proposal to make a System change; or a formal proposal to make any other System
modification.
1.1.11.
Child Health Plan Plus (CHP+) – Colorado’s public low-cost health insurance for certain
children and pregnant women. It is for people who earn too much to qualify for Health First
Colorado (Colorado's Medicaid Program), but not enough to pay for private health insurance.
1.1.12.
CMS Child Core Measures Set – The quality measures set by CMS to strengthen the quality
of care provided, encompassing both physical and mental health.
1.1.13.
CMS Core Measure – CMS Core Measures are developed to promote alignment and
harmonization of measures to identify high-value, high-impact, evidence-based measures that
promote better patient outcomes and provide useful information for improvement, decision
making, and payment.
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Exhibit D, Terminology
Page 2 of 11
1.1.14.
CMS Core Measure Set for Maternal and Perinatal Health – The quality measure set by CMS
for Maternal and Perinatal Health.
1.1.15.
CMS Standards and Conditions – The standards and conditions that pertain to the design and
development of health care systems and are a fundamental cornerstone in the MITA State
Self-Assessment activity. State’s enhanced federal funding depends upon system
modernization that focuses on incorporating industry standards, business rules, and service-
oriented architecture principles to foster improved business results and enhance
interoperability to lower costs and improve health outcomes.
1.1.16.
Colorado All-Payer Claims and All-Payer Claims Database – The database operated by the
Center for Improving Value in Health Care that collects and aggregates claims from all payers
in Colorado.
1.1.17.
Colorado Joint Budget Committee – The part of the Colorado General Assembly responsible
for studying the management, operations, programs, and fiscal needs of agencies and
institutions of Colorado state government.
1.1.18.
Colorado Revised Statutes (C.R.S.) – The legal code of Colorado; the legal codified general
and permanent statutes of the Colorado General Assembly.
1.1.19.
Committed Transaction – An event where the two or more parties involved have submitted
and received a file/batch and acknowledged the transaction as completed.
1.1.20.
Communication Protocols – A set of formal rules describing how to transmit or exchange
data, especially across a network.
1.1.21.
Consultative Support Services – Services used to integrate and optimize Colorado’s MES
Business, Technical, and Information Architectures. Consultative Support Services provide
services to support the Department with strategic planning and decision making that will
impact re-planning of the MES Modernization Roadmap.
1.1.22.
Consumer Price Index- Urban (CPI-U) – The Consumer Price Index for All Urban
Consumers published by the US Department of Labor, Bureau of Labor Statistics.
1.1.23.
Contract Year – Each period of 12 consecutive months during the Initial Term of this
Agreement, with the first Contract Year commencing on the Effective Date, and with each
subsequent Contract Year commencing on the anniversary of the Effective Date.
1.1.24.
Dashboard – A visual display of various recognized data within a software system, designed
to provide information at a glance.
1.1.25.
Data – State Confidential Information and other State information resources transferred to
the Contractor for the purpose of completing a task or Project assigned in the Statement of
Work.
1.1.26.
Data Governance – The exercise of authority, control, and shared decision making (e.g.,
planning, monitoring and enforcement) over the management of data assets.
1.1.27.
Data Production Error – Errors found in Deliverables that require Contractor to calculate or
extract data.
1.1.28.
Defect – A genuine error, malfunction, fault, or failure which prevents the System from
operating as intended. A Defect also includes situations in which a part or component of the
System was operating as intended but at some point stopped working as intended.
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Exhibit D, Terminology
Page 3 of 11
1.1.29.
Department Staff – Colorado Department of Health Care Policy & Financing (HCPF) State
employees or contracted personnel, as determined by the Department.
1.1.30.
Department Stakeholders – A person, Project team member, or participant within the
Department’s organization or system, with an interest or concern in its business or success.
1.1.31.
Department’s Existing Actuarial Contractor – The contractor with whom the Department
contracts as of the Effective Date with respect to the operation of the Department’s APM 2
Program.
1.1.32.
Disaster – An event that makes it impossible for Contractor to perform the Work out of its
regular facility or facilities, and may include, but is not limited to, natural disasters, fire or
terrorist attacks.
1.1.33.
Electronic Clinical Quality Measure (eCQM) – An eCQM is a clinical quality measure that
is expressed and formatted to use data from electronic health records (EHR) and/or Health
Information Technology (HIT) systems to measure healthcare quality, specifically data
captured in structured form during the process of patient care.
1.1.34.
End-to-End Test or Testing – End-to-end testing is a software testing technique that verifies
the functionality and performance of an entire software application from start to finish by
simulating real-world user scenarios and replicating live data. Its objective is to identify bugs
that arise when all components are integrated, ensuring that the application delivers the
expected output as a unified entity.
1.1.35.
Enterprise Governance Council – This is the group formed to ensure alignment across all
projects in the organization to understand impact.
1.1.36.
Enterprise Solutions Integrator Contractor – The Department’s Medicaid Enterprise System
Integration Platform Contractor. Also termed “the Department’s Enterprise Solutions
Integrator Contractor.”
1.1.37.
Existing System – All of the MES systems in existing as of the Effective Date.
1.1.38.
External Stakeholder – An External Stakeholder is a Stakeholder who is neither a Department
employee nor a Department contractor.
1.1.39.
Fee-for-Service – The unassigned population of Health First Colorado Members who get
services from any Provider that accepts Medicaid.
1.1.40.
Fraud – An intentional deception or misrepresentation made by a person with the knowledge
that the deception could result in some unauthorized benefit to that person or some other
person and includes any act that constitutes fraud under any federal or state law.
1.1.41.
Frontier – A county with a population density of six or fewer people per square mile.
1.1.42.
Gap in Care – The discrepancy between the care provided to patients and the recommended
best practices in health care.
1.1.43.
Go/No Go – Go/No Go means being or relating to a required decision to continue or stop a
course of action.
1.1.44.
Go-Live – The time during a Project at which all or a part of Contractors’ Technology
Solution is officially released into production.
1.1.45.
Go-Live Date – The date on which all or a part of Contractor’s Technology Solution is
officially released into production.
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Exhibit D, Terminology
Page 4 of 11
1.1.46.
Health First Colorado – Colorado’s Medicaid Program.
1.1.47.
Health Information Trust Alliance (HITRUST) – HITRIST is a non-profit company that
delivers data protection standards and certification programs to help organizations safeguard
sensitive information, manage information risk, and reach their compliance goals.
1.1.48.
Health Insurance Portability and Accountability Act (HIPAA) – The Health Insurance
Portability and Accountability Act of 1996, as amended.
1.1.49.
Health Information Technology for Economic and Clinical Health Act (HITECH) (P.L. 111-
005)– The Health Information Technology for Economic and Clinical Health Act, enacted as
part of the ARRA.
1.1.50.
Information Architecture – The structure of a system and structural design of shared
information environments. It is the way information is grouped, the navigation methods, and
terminology used within the system.
1.1.51.
Integration – Integration begins with the ingestion process, and includes steps such as
cleansing, extract, transform, and load (ETL) mapping, and transformation. Data Integration
is the process of combining data from different Sources into a single, unified view, and
ultimately enables analytics tools to produce effective, actionable business intelligence.
1.1.52.
Internal Stakeholder – An Internal Stakeholder is a Stakeholder who is also employed or
contracted by the Department.
1.1.53.
Issues – A negative result, outcome, or action that has already occurred.
1.1.54.
Key Personnel – The position or positions that are specifically designated as such in this
Contract.
1.1.55.
Latency – The delay before a transfer of data begins following an instruction for its transfer.
Latency is the time it takes for data to pass from one point on a network to another.
1.1.56.
Maintenance and Operations – Includes the day-to-day activities necessary for the building
or built structure, its systems and equipment, and an occupant or User to perform the
occupant’s or User’s intended function.
1.1.57.
Maintenance and Operations Phase – The period of time after which a Project has moved
from DDI and into production.
1.1.58.
Maternity Bundled Payment Program Year – One or more year-long periods in which each
year-long period is measured from November 1 through October 31.
1.1.59.
Maternity Bundled Payment Program Year 1 – The year-long period from November 1, 2020
through October 31, 2021.
1.1.60.
Maternity Bundled Payment Program Year 2 – The year-long period from November 1, 2021
through October 31, 2022.
1.1.61.
Medicaid Enterprise Solutions – The MMIS, PBMS, CBMS, and BIDM systems.
1.1.62.
Meeting Agenda – Denotes the date, time, and location of the meeting, the invitees, and the
topics to be covered during the meeting with the presenter’s name and discussion duration.
1.1.63.
Meeting Minutes – Captures the attendees, the discussion topics, Action items and next steps,
and decisions made during the meeting.
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Exhibit D, Terminology
Page 5 of 11
1.1.64.
Meeting Records – Are the recorded or written Meeting Agenda, Meeting Minutes, and any
related documentation, videos, or attachments.
1.1.65.
Member – Any individual enrolled in the Colorado Medicaid program, Colorado’s CHP+
program or the Colorado Indigent Care Program, as determined by the Department.
1.1.66.
MES Ecosystem – The technical environment of the MES, consisting of the MIDA
Integration Platform, 233 Interfaces, the Existing Systems, MES Modules, and Source
Systems of Existing Vendors and MES Vendors connected to the MIDA Integration Platform
through APIs.
1.1.67.
MES Governance Plan – MES Governance Plan is a deliverable document of the Enterprise
Solutions Integrator Contractor, that defines the policies, processes, and procedures for
establishing a connection to, implementing changes that impact, and engaging with the
Enterprise Solutions Integrator Platform as a MES Vendor.
1.1.68.
MES Module(s) – All MES components residing within the BIDM, CBMS, MMIS, or PBMS
systems, or that once resided in the BIDM, CBMS, MMIS, or PBMS systems that the
Department reconfigures into its own module to integrate with the MIDA Integration
Platform.
1.1.69.
MES Standards – Aligned with CMS MITA conditions and standards, Colorado OIT,
PMBOK, SAFe, and the Department’s standards, tools, templates, and processes, and
encompassing the Department’s standards and best practices for MES data governance, data
quality controls, Integration file exchange, data model maintenance, and technical and
Consultative Support Services. Contractor will be provided the applicable Colorado OIT
standards with which Contractor’s Technology Solution offering must comply.
1.1.70.
MES Vendor(s) or Medicaid Enterprise Solution Vendor(s) – The contractors selected by the
Department with which the Department has entered into MES Modules-related contracts after
the Effective Date. Also referred to as the Department’s MES Vendor(s).
1.1.71.
MIDA Integration Platform – Medicaid Enterprise System Integration Platform.
1.1.72.
Milestones – A goal to be achieved via a list of tasks. A Milestone is a tool for tracking the
progress of a Project and to measure the performance of teams based on specific
requirements. A Milestone is used to reference a specific progress point in a Project and
describes when the Parties plan to achieve an event, such as on a quarterly timeline.
1.1.73.
Modification Enhancement Hours – Allotments of hours budgeted by Contractor to support
consultative and technical support services specifically related to enhancements that shall be
identified, defined, and scoped during the course of the Projects or for other purposes
identified in the Contract.
1.1.74.
Operations – Performing the requirements of the Department after completing the Design and
Development Phase and when the software and services are being used for their intended
uses for the End User.
1.1.75.
Opinion Leader – An expert in a specific niche or market and has established trust in a
community.
1.1.76.
Other Personnel – Individuals and Subcontractors, in addition to Key Personnel, assigned to
positions to complete tasks associated with the Work.
1.1.77.
Pediatric Member – Any Member who receives care at a pediatric clinic or any Member ages
zero through 18 years of age who receives care at a family practice clinic.
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Exhibit D, Terminology
Page 6 of 11
1.1.78.
Priority 1 Production Incident – Critical Issues, which are defined as Production Incidents in
which User(s) cannot operate a core piece of business due to a deficiency or Defect with no
reasonable workaround.
1.1.79.
Priority 2 Production Incident – High or Major Issues, which are defined as operations
impacted, slowed, or hampered by a deficiency or Defect for which there is a viable
workaround that permits the continued use of the MES Ecosystem.
1.1.80.
Priority 3 Production Incident – The overall production is operational with no major impact
on the Department’s business operation and a reasonable workaround is available.
1.1.81.
Production – A real-time setting where programs are run and hardware setups are installed
and relied on for organization or daily operations. The environment where software and
products are put into operation for their intended uses.
1.1.82.
Production Environment – The setting where software and other products are put into
operation for their intended uses, where programs are run, and where hardware setups are
installed and relied on for daily operations.
1.1.83.
Production Incident – A service disruption that requires a response from the Contractor
according to Project SLAs.
1.1.84.
Project – A Project encompasses, at a minimum, COPOD for Facilities, APM 2, Maternity
Bundled Payments, New Maternity APM, and Pediatric APM. Additional Projects may be
added to this Contract, and all Projects may be amended.
1.1.85.
Project Artifact – Anything the Contractor produces during the performance of the Work.
1.1.86.
Project Management – The use of specific knowledge, skills, tools, and techniques to deliver
something of value to people and the process of leading the work of a team to achieve all
Project goals within the given constraints. Project Management standards are based on the
PMBOK.
1.1.87.
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. Providers may or may not also be associated with
another type of provider such as a PCMP, a Specialty Provider, or another type of Provider.
1.1.88.
RAE Region – Regional Accountable Entity regions are the Medicaid contractors who
provide primary care case management for the delivery system across seven regions of
Colorado.
1.1.89.
RAE Region 1 – Regional Accountable Entity – Rocky Mountain Health Plans.
1.1.90.
RAE Region 2 – Regional Accountable Entity – Northeast Health Partners.
1.1.91.
RAE Region 3 – Regional Accountable Entity – Colorado Access.
1.1.92.
RAE Region 4 – Regional Accountable Entity – Health Colorado, Inc.
1.1.93.
RAE Region 5 – Regional Accountable Entity – Colorado Access.
1.1.94.
RAE Region 6 – Regional Accountable Entity – Colorado Community Health Alliance.
1.1.95.
Real Time – The actual time it takes a process to occur; of or relating to computer systems
that update information at the same rate they receive information.
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Exhibit D, Terminology
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1.1.96.
Regional Stakeholders – Internal or External Stakeholders who represent each of Colorado’s
seven RAE Regions.
1.1.97.
Requirements Specification – A collection of requirements that are to be imposed on the
design and verification of the product and that also contains other related information
necessary for the design, verification, and maintenance of the product.
1.1.98.
Risk – An uncertain event or condition that, if it occurs, has a positive or negative effect on
a Project’s objectives.
1.1.99.
Root Cause Analysis – A systematic process for identifying “root causes” (the factor that
causes a particular situation) of Production Incidents or events as well as an approach for
responding to each Production Incident or event.
1.1.100.
Rural – A county in Colorado with a total population of less than 100,000 people.
1.1.101.
Scheduled Testing Activities – Testing tasks and testing sub-tasks that are included in the
MES Master Testing Strategy and Management Plan (including Defect Management),
including scheduled testing dates and scheduled testing times for each testing task or testing
sub-task.
1.1.102.
Service Level Agreement (SLA) – An agreement that details performance requirements and
measurement metrics with respect to specific activities or systems.
1.1.103.
Single Sign On (SSO) – Single Sign On is a session and user authentication service that
permits a user to use one set of login credentials.
1.1.104.
Social Determinants of Health (SDOH or SDoH) – The conditions in the environments where
people (individuals or households) are born, live, learn, work, play, worship, and age that
affect a wide range of health, functioning, and quality-of-life outcomes and risks. Under this
Contract, Contractor is expected to utilize SDoH in risk-adjustments, measures, and other
breakouts of data as directed by the Department. SDoH may include, but are not limited to,
the following: age, gender, language, race, ethnicity, income (or as a percent of federal
poverty level), disability status, geographic location, individual or household education (e.g.,
adult without a high school education), safety of neighborhood, receiving public assistance
(e.g., receipt of
Supplemental Nutrition Assistance Program
(SNAP) benefits, receipt of cash
assistance benefits), household/family composition (e.g., single parent household, single
female parent household), employment status, transportation access (e.g., household without
a car), homelessness, previous incarceration, food insecurity, rural residence, maternal mental
health, parent or individual diagnosis of substance use, social venerability index, social
deprivation index, health related risk scores/metrics.
1.1.105.
Source – A place, person, or thing from which something comes or can be obtained, such as
an external system which provides the data to be loaded into the Target system.
1.1.106.
Specialty Provider(s) – A Specialty Provider is a Provider who has education, training, or
qualifications in a specialty field other than primary care.
1.1.107.
Sponsor – A person or group who provides resources and support for the Project and program
and is accountable for enabling success.
1.1.108.
Staging Environment – A pre-production environment that resembles the Production
Environment used for testing before application deployment.
1.1.109.
Stakeholders – A Stakeholder is any person or entity that has an interest or concern in a
business or Project, in which all the members or participants are seen as having an interest in
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Exhibit D, Terminology
Page 8 of 11
its success. The term Stakeholder includes both Internal and External Stakeholders.
Stakeholders may include, but are not bound by nor limited to, Members and Providers.
1.1.110.
Stakeholder Working Group – A group of people brought together to inform the processes
and desired outcomes of the Work Products.
1.1.111.
Streamlined Modular Certification (SMC) – Streamlined Modular Certification is a CMS
mandated process for certifying modular Information Technology solutions per State
Medicaid Director Letter #22-001.
1.1.112.
System Development Lifecycle (SDLC) – System Development Lifecycle is the entire
process of technology innovation and support.
1.1.113.
System Integration Testing (SIT) – System Integration Testing is the overall testing of a
whole system which is composed of many sub-systems.
1.1.114.
Target – An object or goal that is being aimed at, such as a target system or destination place
where something is being sent, taken, going, or directed.
1.1.115.
Technical Support Services – Technical Support Services inform the Department’s decision-
making, provide solution design and delivery, and guide the Integration effort through
continuous alignment with the design and architecture of the MES Integration Platform.
Technical Support Services also support MES Vendors’ onboarding needs for completing the
Integrations and data conversions using best practices to support the Department’s goals.
1.1.116.
Technology Solution – One or all of the technical components, including the Primary Care
Data Sharing Analytics Solution and the Maternity Bundled Payment Data Sharing Solution
(also known as the Portal/Dashboard), that comprise the system built for the Department.
Also called “Contractor’s Technology Solution.”
1.1.117.
Test (or Testing) Environment – The environment where hardware and software components
include configuration settings that are necessary to test and validate that the application meets
design specifications. The environment where hardware and software components include
configuration settings that are necessary to test and validate that the application meets design
specifications.
1.1.118.
Testing Phase – The period of time during which Contractor ensure the Project meets design
specifications.
1.1.119.
Urban – A county in Colorado with a total population equal to or greater than 100,000 people.
1.1.120.
User(s) – A person who utilizes a computer, network service, or other equipment. A User
often has a User account and is identified to the system by a username. Also called End User
for the Target User (employee or customer) or Authorized User.
1.1.121.
User Acceptance Testing (UAT) – User Acceptance Testing is a phase of software
development in which the software is tested in the real world by its intended audience.
1.1.122.
User Documentation – Explanatory and informational materials concerning the Department’s
documentation or Vendor’s products, company products, in printed or electronic format,
which the Department or Vendor/Contractor has released for distribution to End Users which
may include manuals, descriptions, User and/or installation instructions, diagrams, printouts,
listings, flowcharts, and training materials.
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1.1.123.
Workflow – A Workflow is a sequence of any business or industry tasks that processes a set
of data. Workflows are the paths that describe how something goes from being undone to
done, or raw to processed.
1.2.
ACRONYMS AND ABBREVIATIONS
1.2.1.
The following list is provided to assist the reader in understanding certain acronyms and
abbreviations used in this Contract:
1.2.1.1.
ACC – Accountable Care Collaborative
1.2.1.2.
ADA – Americans with Disabilities Act
1.2.1.3.
API – Application Programming Interface
1.2.1.4.
APM – Alternative Payment Model
1.2.1.5.
ARB – Architecture Review Board
1.2.1.6.
ARRA – American Recovery and Reinvestment Act of 2009
1.2.1.7.
BC/DR – Business Continuity and Disaster Recovery
1.2.1.8.
BIDM – Business Intelligence Data Management System
1.2.1.9.
CAP – Corrective Action Plan
1.2.1.10.
CBMS – Colorado Benefits Management System
1.2.1.11.
CEF – CMS Conditions for Enhanced Funding
1.2.1.12.
CFR – Code of Federal Regulations
1.2.1.13.
CHP+ – Child Health Plan Plus
1.2.1.14.
CISP – Colorado Information Security Policy
1.2.1.15.
CIVHC – Center for Improving Value in Health Care
1.2.1.16.
CMS – Centers for Medicare and Medicaid Services
1.2.1.17.
CO APCD – Colorado All Payer Claims Database
1.2.1.18.
CORA –Colorado Open Records Act, C.R.S. §24–72–200.1, et seq.
1.2.1.19.
CPI – Consumer Price Index
1.2.1.20.
CPI-U – CPI for all urban consumers
1.2.1.21.
CPT-4 – Current Procedural Terminology version 4
1.2.1.22.
C.R.S. – Colorado Revised Statutes
1.2.1.23.
DDI – Design, Development, and Implementation
1.2.1.24.
DSD – Design Specification Document
1.2.1.25.
E2E – End-to-End
1.2.1.26.
E&M – Evaluation and Management
1.2.1.27.
eCQM – Electronic Clinical Quality Measure
1.2.1.28.
EHR – Electronic Health Records
1.2.1.29.
ER – Emergency Room
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Exhibit D, Terminology
Page 10 of 11
1.2.1.30.
ESI – Enterprise Service Integrator
1.2.1.31.
ETL – Extract Transform Load
1.2.1.32.
FFP – Federal Financial Participation
1.2.1.33.
FQHC – Federally Qualified Health Center
1.2.1.34.
HHS – Health and Human Services
1.2.1.35.
HIE – Health Information Exchange
1.2.1.36.
HIPAA – Health Insurance Portability and Accountability Act of 1996, as amended.
1.2.1.37.
HITECH – The Health Information Technology for Economic and Clinical Health Act
1.2.1.38.
HITRUST – Health Information Trust Alliance
1.2.1.39.
HL7 – Health Level Seven International
1.2.1.40.
ICD – Interface Control Document
1.2.1.41.
ICD-10 – Internal Classification of Diseases tenth version.
1.2.1.42.
ILT – Instructor-Led Training
1.2.1.43.
ITN – Invitation to Negotiate
1.2.1.44.
ITSP – Information Technology Service Provider
1.2.1.45.
M&O – Maintenance and Operations
1.2.1.46.
MES – Medicaid Enterprise Solutions
1.2.1.47.
MFCU – The Colorado Medicaid Fraud Control Unit in the Colorado Department of Law
1.2.1.48.
MIDA – MES Integration Data and Alignment
1.2.1.49.
MITA – Medicaid Information Technology Architecture
1.2.1.50.
MMIS – Medicaid Management Information System
1.2.1.51.
ODS – Operational Data Store
1.2.1.52.
OIT – The Governor’s Office of Information Technology
1.2.1.53.
OLAP – Online Analytical Processing
1.2.1.54.
OLTP – Online Transaction Processing
1.2.1.55.
PBMS – Pharmacy Benefit Management System
1.2.1.56.
PCB – Priority Change Board
1.2.1.57.
PCMP – Primary Care Medical Provider
1.2.1.58.
PMBOK – Project Management Body of Knowledge
1.2.1.59.
PMPM – Per Member Per Month
1.2.1.60.
POA&M – Plan of Action and Milestones
1.2.1.61.
QHN – Quality Health Network
1.2.1.62.
RAE – Regional Accountable Entity
1.2.1.63.
RCA – Root Cause Analysis
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Exhibit D, Terminology
Page 11 of 11
1.2.1.64.
RSD – Requirements Specifications Document
1.2.1.65.
RTM – Requirements Traceability Matrix
1.2.1.66.
SAFe – Scaled Agile Framework
1.2.1.67.
SDLC – System Development Lifecycle
1.2.1.68.
SDOH or SDoH – Social Determinants of Health
1.2.1.69.
SIT – System Integration Testing
1.2.1.70.
SLA – Service Level Agreement
1.2.1.71.
SMC – Streamlined Modular Certification
1.2.1.72.
SME – Subject Matter Expert
1.2.1.73.
SOC – System and Organization Controls
1.2.1.74.
SOP – Standard Operating Procedure
1.2.1.75.
SSAE – Statement on Standards for Attestation Engagements
1.2.1.76.
SSO – Single Sign On
1.2.1.77.
SUD – Substance Use Data
1.2.1.78.
U.S.C. – United States Code
1.2.1.79.
UAT – User Acceptance Testing
1.2.1.80.
VARA – Visual Rights Act of 1990
1.2.1.81.
WCAG – Web Content Accessibility Guidelines
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Exhibit E, Contractor’s Administrative Requirements
Page 1 of 15
EXHIBIT E, CONTRACTOR’S ADMINISTRATIVE REQUIREMENTS
1.
CONTRACTOR’S GENERAL REQUIREMENTS
1.1.
Unless otherwise identified, the Department will contract with only one organization, Contractor,
and will work solely with that organization with respect to all tasks and Deliverables to be
completed, services to be rendered and performance standards to be met under this Contract.
1.2.
Contractor may be privy to internal policy discussions, contractual issues, price negotiations,
confidential medical information, Department financial information, advance knowledge of
legislation and other Confidential Information. In addition to all other confidentiality
requirements of the Contract, Contractor shall also consider and treat any such information as
Confidential Information and shall comply with confidentiality requirements of the Contract.
1.3.
Contractor shall work cooperatively with Department Staff and, if applicable, the staff of other
State contractors to ensure the completion of the Work. The Department may, in its sole
discretion, use other contractors to perform activities related to the Work that are not contained
in the Contract or to perform any of the Department’s responsibilities. In the event of a conflict
between Contractor and any other State contractor, the State will resolve the conflict and
Contractor shall abide by the resolution provided by the State.
1.4.
Contractor shall inform the Department on current trends and issues in the health care
marketplace and provide information on new technologies in use that may impact Contractor’s
responsibilities under this Contract.
1.5.
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 Work described in the Contract. Contractor shall make such records available to
the Department upon request throughout the term of the Contract.
1.6.
Deliverables
1.6.1.
All Deliverables shall meet Department-approved format and content requirements. The
Department will specify the number of copies and media for each Deliverable.
1.6.1.1.
Contractor shall submit each Deliverable to the Department for review and approval and
shall adhere to the following Deliverable process such for any documentation creation,
review, and acceptable cycle, Contractor shall:
1.6.1.1.1.
Gather and document requirements for the Deliverable.
1.6.1.1.2.
Create a draft in the Department-approved format for the individual Deliverable.
1.6.1.1.3.
Perform internal quality control review(s) of the Deliverable, including, but not
limited to:
1.6.1.1.3.1.
Readability.
1.6.1.1.3.2.
Spelling.
1.6.1.1.3.3.
Grammar.
1.6.1.1.3.4.
Completion.
1.6.1.1.4.
Adhere to all required templates or development of templates.
1.6.1.1.5.
Perform modifications that include version control and tracked changes.
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Exhibit E, Contractor’s Administrative Requirements
Page 2 of 15
1.6.1.2.
The Department will review the Deliverable and, within 10 Business Days of delivery
(“Acceptance Period”) may direct Contractor in writing to make changes to the
Deliverable, specifying a list of material non-conformities with the specifications set forth
in the Contract (“Rejection Notice”). Contractor shall make all changes within five
Business Days following receipt of the Department’s Rejection Notice unless the
Department provides a longer period in writing. This review process shall continue until
the Deliverable is accepted. The time periods identified in this Section 1.6.1.2 may be
extended by agreement of the Parties.
1.6.1.2.1.
Changes the Department direct include, but are not limited to, modifying portions of
the Deliverable, requiring new pages or portions of the Deliverable, requiring
resubmission of the Deliverable or requiring inclusion of information or components
that were left out of the Deliverable.
1.6.1.2.2.
The Department may also direct Contractor to provide clarification or provide a
walkthrough of any Deliverable to assist the Department in its review. Contractor
shall provide the clarification or walkthrough as directed by the Department.
1.6.1.3.
Once the Department has received an acceptable version of the Deliverable, including all
changes directed by the Department, the Department will notify Contractor of its
acceptance of the Deliverable in writing within a reasonable amount of time. A
Deliverable shall not be deemed accepted prior to the Department’s notice to Contractor
of its acceptance of that Deliverable.
1.6.2.
Contractor shall employ an internal quality control process to ensure that all Deliverables are
complete, accurate, easy to understand and of high quality, as described herein. Contractor
shall provide Deliverables that, at a minimum, are responsive to the specific requirements for
that Deliverable, organized into a logical order, contain accurate spelling and grammar, are
formatted uniformly, and contain accurate information and correct calculations. Contractor
shall retain all draft and marked-up documents and checklists utilized in reviewing
Deliverables for reference as directed by the Department.
1.6.3.
In the event any due date for a Deliverable falls on a day that is not a Business Day, the due
date shall be automatically extended to the next Business Day, unless otherwise directed by
the Department.
1.6.4.
All due dates or timelines that reference a period of days, months or quarters shall be
measured in calendar days, months and quarters unless specifically stated as being measured
in Business Days or otherwise. All times stated in the Contract shall be considered to be in
Mountain Time, adjusted for Daylight Saving Time as appropriate, unless specifically stated
otherwise.
1.6.5.
No Deliverable, report, data, procedure or system created by Contractor for the Department
that is necessary to fulfilling Contractor’s responsibilities under the Contract, as determined
by the Department, shall be considered proprietary.
1.6.6.
If any Deliverable contains ongoing responsibilities or requirements for Contractor, such as
Deliverables that are plans, policies or procedures, then Contractor shall comply with all
requirements of the most recently approved version of that Deliverable. 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
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Exhibit E, Contractor’s Administrative Requirements
Page 3 of 15
Deliverables contained within that Deliverable shall be considered to be requirements,
Milestones and Deliverables of this Contract.
1.6.6.1.
Any Deliverable described as an update of another Deliverable shall be considered a
version of the original Deliverable for the purposes of this subsection.
1.7.
Stated Deliverables and Performance Standards
1.7.1.
Any section within this Statement of Work headed with or including the term
"DELIVERABLE" or "PERFORMANCE STANDARD" is intended to highlight a
Deliverable or performance standard contained in this Statement of Work and provide a clear
due date for the Deliverables. The sections with these headings are for ease of reference not
intended to expand or limit the requirements or responsibilities related to any Deliverable or
performance standard, except to provide the due date for the Deliverables.
1.7.2.
Contractor shall deliver each new and revised Deliverable to the Department for review and
approval. Contractor shall not execute activities, obligations, responsibilities, specifications,
or other requirements prior to the Department’s approval of the new or revised Deliverable.
1.7.3.
Contractor shall implement or otherwise perform all tasks, obligations, tracking information,
roles, schedules, or other responsibilities set forth in all new and revised Deliverables in
conformity with the Deliverable, after obtaining the Department’s approval of each new or
revised Deliverable.
1.7.4.
Unless otherwise specified in this Contract, or unless circumstances require more frequent
reviews or updates, Contractor shall review, update, and submit revised Deliverables no less
often than on a quarterly basis. The due date for quarterly reviews and updates related to each
Deliverable shall be identified in the Project Schedule. If no changes have occurred with
respect to a specific Deliverable, Contractor shall identify that no changes have been made
to the identified Deliverable. The review process identified in Exhibit E, Section 1.6. shall
apply to all revised Deliverables.
1.8.
Communication with the Department
1.8.1.
Contractor shall enable all Contractor staff to exchange documents and electronic files with
the Department Staff in formats compatible with the Department’s systems. The Department
currently uses Microsoft Office 2016 and/or Microsoft Office 365 for PC. If Contractor uses
a compatible program, then Contractor shall ensure that all documents or files delivered to
the Department are completely transferrable and reviewable, without error, on the
Department’s systems.
1.8.2.
The Department will use a transmittal process to provide Contractor with official direction
within the scope of the Contract. Contractor shall comply with all direction contained within
a completed transmittal. For a transmittal to be considered complete, it must include, at a
minimum, all of the following:
1.8.2.1.
The date the transmittal will be effective.
1.8.2.2.
Direction to Contractor regarding performance under the Contract.
1.8.2.3.
A due date or timeline by which Contractor shall comply with the direction contained in
the transmittal.
1.8.2.4.
The signature of the Department employee who has been designated to sign transmittals.
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Exhibit E, Contractor’s Administrative Requirements
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1.8.2.4.1.
The Department will provide 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 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 Contractor through a transmittal.
1.8.3.
The Department may deliver a completed transmittal to Contractor in hard copy, as a scanned
attachment to an email or through a dedicated communication system, if such a system is
available.
1.8.3.1.
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.
1.8.4.
If Contractor receives conflicting transmittals, 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.
1.8.5.
In the event that Contractor receives direction from the Department outside of the transmittal
process, it shall contact the Department’s primary designee, or backup designees if the
primary designee is unavailable, and have the Department confirm that direction through a
transmittal prior to complying with that direction.
1.8.6.
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 Contractor, and the Department may provide day-to-day communication to
Contractor without using a transmittal.
1.8.7.
Contractor shall retain all transmittals for reference and shall provide copies of any received
transmittals upon request by the Department.
1.9.
Performance Reviews
1.9.1.
The Department may conduct performance reviews or evaluations of Contractor in relation
to the Work performed under the Contract.
1.9.2.
The Department may work with Contractor in the completion of any performance reviews or
evaluations or the Department may complete any or all performance reviews or evaluations
independently, at the Department’s sole discretion.
1.9.3.
Contractor shall provide all information necessary for the Department to complete all
performance reviews or evaluations, as determined by the Department, upon the
Department’s request. Contractor shall provide this information regardless of whether the
Department decides to work with Contractor on any aspect of the performance review or
evaluation.
1.9.4.
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.
1.9.5.
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.
1.10.
Renewal Options and Extensions
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1.10.1.
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.
1.10.2.
The Parties may amend the Contract to extend beyond five years, in accordance with the
Colorado Procurement Code and its implementing rules, in the event that the Department
determines the extension is necessary to align the Contract with other Department contracts,
to address state or federal programmatic or policy changes related to the Contract, or to
provide sufficient time to transition the Work.
1.10.3.
In the event that the Contract is extended beyond five years, the annual maximum
compensation for the Contract in any of those additional years shall not exceed the Contract
maximum amount for the prior State Fiscal Year (SFY) plus the annual percent increase in
the Consumer Price Index for All Urban Consumers (CPI-U) for the Denver-Boulder-Greeley
metropolitan area for the calendar year ending during that prior SFY. If the CPI-U for Denver-
Boulder-Greeley is for some reason not available as specified in this subsection, the increase
shall be equal to the percent increase in the CPI-U (U.S.) for the same period.
1.10.4.
The limitation on the annual maximum compensation in this Contract shall not include
increases made specifically as compensation for additional Work added to the Contract.
1.11.
Department System Access
1.11.1.
In the event that Contractor requires access to any Department computer system to complete
the Work, Contractor shall have and maintain all hardware, software, and interfaces necessary
to access the system without requiring any modification to the Department’s system.
Contractor shall adhere to all Department policies, processes, and procedures necessary to
gain access to the Department’s systems, if applicable, and as communicated by the
Department to Contractor.
1.11.2.
Contractor shall be responsible for any costs associated with obtaining and maintaining
access to systems needed to perform the Work under this solicitation, as determined by the
Department. The Department will not reimburse Contractor for any costs associated with
obtaining and maintaining access to Department systems.
1.12.
Provider Fraud
1.12.1.
Contractor shall notify the Department and the Colorado Medicaid Fraud Control Unit of the
Colorado Department of Law (MFCU) if it identifies or suspects possible Provider Fraud as
a result of any activities in its performance of this Contract.
1.12.2.
Upon identification or suspicion of possible Provider Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.12.2.1.
For each incident of identified or suspected Provider Fraud, Contractor shall provide all
of the following, at a minimum:
1.12.2.1.1.
Written documentation of the findings.
1.12.2.1.2.
Information on any verbal or written reports.
1.12.2.1.3.
All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, in a format agreed to by the Department.
1.12.2.1.4.
Information on the identification of any affected claims that have been discovered.
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Page 6 of 15
1.12.2.1.5.
Any claims data associated with its report (in a mutually agreed upon format, if
possible).
1.12.2.1.6.
Any additional information as required by the Department.
1.12.3.
For each incident of identified or suspected Provider Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department and the
MFCU.
1.12.3.1.
DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.12.3.2.
DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.12.4.
Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department or the MFCU.
1.12.4.1.
DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional
Information
1.12.4.2.
DUE: Within three Business Days following the Department’s or the MFCU’s request,
unless the Department or MFCU provides for a different period in its request.
1.13.
Member Fraud
1.13.1.
Contractor shall notify the Department if it identifies or suspects possible Member Fraud as
a result of any activities in its performance of this Contract.
1.13.2.
Upon identification or suspicion of possible Member Fraud, Contractor shall complete
Contractor Suspected Fraud Written Notice Form provided by the Department.
1.13.2.1.
For each incident of identified or suspected Member Fraud, Contractor shall provide all
of the following, at a minimum:
1.13.2.1.1.
All verbal and written reports related to the suspected fraud.
1.13.2.1.2.
All details of the findings and concerns, including a chronology of Contractor actions
which resulted in the reports, and the Member’s State ID number, and Member’s date
of birth if applicable.
1.13.2.1.3.
Information on the identification of any affected claims that have been discovered.
1.13.2.1.4.
Any claims data associated with its report in a format agreed to by the Department.
1.13.2.1.5.
Any additional information as required by the Department.
1.13.3.
For each incident of identified or suspected Member Fraud, Contractor shall deliver the
completed Contractor Suspected Fraud Written Notice Form to the Department at
report.clientfraud@state.co.us
, or at such other email address as provided by the Department
from time to time.
1.13.3.1.
DELIVERABLE: Completed Contractor Suspected Fraud Written Notice Form
1.13.3.2.
DUE: Within three Business Days following the initial discovery of the Fraud or
suspected Fraud
1.13.4.
Contractor shall revise or provide additional information related to Contractor Suspected
Fraud Written Notice Form as requested by the Department.
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1.13.4.1.
DELIVERABLE: Contractor Suspected Fraud Written Notice Revisions and Additional
Information
1.13.4.2.
DUE: Within three Business Days following the Department’s request, unless the
Department provides for a different period in its request.
2.
CONTRACTOR PERSONNEL
2.1.
Personnel General Requirements
2.1.1.
Contractor shall not permit any individual proposed for assignment to Key Personnel or Other
Personnel positions to perform any Work prior to the Department’s approval of that
individual to be assigned as Key Personnel or Other Personnel.
2.1.2.
Contractor shall not voluntarily change individuals in Key Personnel or Other Personnel
positions without the prior written approval of the Department. Contractor shall supply the
Department with the name, resume, and references for any proposed replacement whenever
there is a change to Key Personnel or Other Personnel. Any individual replacing Key
Personnel or Other 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.
2.1.2.1.
DELIVERABLE: Name(s), resume(s) and references for the person(s) replacing anyone
in a Key Personnel or Other Personnel position during a voluntary change
2.1.2.2.
DUE: At least five Business Days prior to the change in Key Personnel or Other Personnel
2.1.3.
If any individual filling a Key Personnel or Other Personnel position identified in this
Contract leaves employment with Contractor, Contractor shall develop a Personnel
Transition document related to the employment vacancy.
2.1.3.1.
The Personnel Transition document shall include but not be limited to all of the following:
2.1.3.1.1.
The identification of the personnel that is transitioning.
2.1.3.1.2.
The date of the personnel’s transition.
2.1.3.1.3.
The identification of the person(s) who will perform the same work as the personnel
that is transitioning on a temporary basis until the position is filled or no longer
required.
2.1.3.2.
DELIVERABLE: Personnel Transition Document
2.1.3.3.
DUE: Five Business Days after Contract is notified of a Key Personnel or Other Personnel
transition
2.1.4.
If any individual filling a Key Personnel position and Other Personnel position identified in
this Contract leaves employment with Contractor, 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.
2.1.4.1.
DELIVERABLE: Name(s), resume(s) and references for the person(s) replacing anyone
in a Key Personnel or Other Personnel position who leaves employment with Contractor
2.1.4.2.
DUE: Within 10 Business Days after Contractor’s receipt of notice that the person is
leaving employment, unless the Department allows for a shorter or longer time in writing
for Contractor to recruit a replacement
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2.1.4.3.
The Contractor shall fill all vacant Key Personnel positions and Other Personnel positions
no later than 60 Business Days after the Contractor receives notice of the vacancy, unless
otherwise approved by the Department.
2.1.4.4.
The Contractor shall not be required to fill any vacant position if alternate staff assigned
by the Contractor to perform Work under this Contract is able to perform the job duties
of the vacant position or if the vacant position is no longer required to perform Work
under this Contract, in accordance with the Project Schedule.
2.1.5.
If any of Contractor’s Key Personnel or Other Personnel are required to have and maintain
any professional licensure or certification issued by any federal, state or local government
agency, then Contractor shall submit copies of such current licenses and certifications to the
Department.
2.1.5.1.
DELIVERABLE: All current professional licensure and certification documentation as
specified for Key Personnel or Other Personnel
2.1.5.2.
DUE: Within five Business Days of receipt of updated licensure or upon request by the
Department
2.2.
Personnel Availability
2.2.1.
Contractor shall ensure Key Personnel and Other Personnel assigned to the Contract are
available for meetings with the Department during the Department’s normal Business Hours,
as determined by the Department. Contractor shall also make these personnel available
outside of the Department’s normal Business Hours and on weekends with prior notice from
the Department.
2.2.2.
Contractor’s Key Personnel and Other Personnel shall be available for all regularly scheduled
meetings between Contractor and the Department, unless the Department has granted prior
written approval otherwise.
2.2.3.
Contractor shall ensure that the Key Personnel and Other Personnel attending all meetings
between the Department and Contractor have the authority to represent and commit
Contractor regarding work planning, problem resolution and program development.
2.2.4.
At the Department’s direction, Contractor shall make its Key Personnel and Other Personnel
available to attend meetings as subject matter experts with stakeholders both within the State
government and external private stakeholders.
2.2.5.
All of Contractor’s Key Personnel and Other Personnel that attend any meeting with the
Department or other Department Stakeholders shall be physically present at the location of
the meeting, unless the Department gives prior, written permission to attend by telephone or
video conference. If Contractor has any personnel attend by telephone or video conference,
Contractor shall provide all additional equipment necessary for attendance, including any
virtual meeting space or telephone conference lines.
2.2.6.
Contractor shall respond to all telephone calls, voicemails, and emails from the Department
within two Business Days of receipt by Contractor.
2.3.
Key Personnel
2.3.1.
Contractor shall designate people to hold the following Key Personnel positions:
2.3.1.1.
Project Lead
2.3.1.1.1.
The Project Lead shall be responsible for all of the following:
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2.3.1.1.1.1.
Serving as Contractor’s primary point of contact for the Department.
2.3.1.1.1.2.
Ensuring the completion of all Work in accordance with the Contract’s
requirements. This includes, but is not limited to, ensuring the accuracy,
timeliness and completeness of all work.
2.3.1.1.1.3.
Overseeing all other Key Personnel and Other Personnel and ensuring proper
staffing levels throughout the term of the Contract.
2.3.1.2.
Additional Key Personnel
2.3.1.2.1.
Project Management Lead
2.3.1.2.1.1.
The Project Management Lead shall be responsible for all of the following:
2.3.1.2.1.1.1.
Managing project tasks and schedule, Contract performance, Change
Requests, and risks and adjusts resources accordingly.
2.3.1.2.1.1.2.
Reporting project status on a weekly basis.
2.3.1.2.2.
APM 2 Program Lead
2.3.1.2.2.1.
The APM 2 Program Lead shall have the following qualifications:
2.3.1.2.2.1.1.
Experience in Project Management, which includes managing project scope,
schedule, risks, and changes.
2.3.1.2.2.1.2.
Experience communicating analytic methods and results and their impact on
program goals to clients and Stakeholders.
2.3.1.2.2.1.3.
Experience in implementing and operating an APM.
2.3.1.2.2.2.
The APM 2 Program Lead shall be responsible for all of the following:
2.3.1.2.2.2.1.
Overseeing Project Management for the APM 2 Program.
2.3.1.2.2.2.2.
Overseeing rates setting.
2.3.1.2.2.2.3.
Overseeing and maintaining the process for engaging with Key Stakeholders.
2.3.1.2.2.2.4.
Assisting the Department in facilitating relationships with Key Stakeholders.
2.3.1.2.2.2.5.
Ensuring the Dashboard and Primary Care Data Sharing Analytics Solution
for the APM 2 Program is functional for the Department and Providers.
2.3.1.2.3.
CO Providers of Distinction for Facilities Lead
2.3.1.2.3.1.
The CO Providers of Distinction for Facilities Lead shall have the following
qualifications:
2.3.1.2.3.1.1.
Experience working with teams of clinicians, statisticians, and health care data
analysts to develop credible measurement and analytic methods.
2.3.1.2.3.1.2.
Experience in Project Management, which includes managing project scope,
schedule, risks, and changes.
2.3.1.2.3.1.3.
Experience communicating analytic methods and results and their impact on
program goals to clients and Stakeholders.
2.3.1.2.3.2.
The CO Providers of Distinction for Facilities Lead shall have the following
Responsibilities:
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Exhibit E, Contractor’s Administrative Requirements
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2.3.1.2.3.2.1.
Responsible for all Work and Deliverables identified in the CO Providers of
Distinction for Facilities Program section of Exhibit B, which starts at Section
13.4. Ensures efficient and effective execution of tasks necessary to achieve
program goals and objectives.
2.3.1.2.3.2.2.
Organizing and managing project teams consisting of individuals with
clinical, statistical, and analytics skills and expertise required to design the CO
Providers of Distinction for Facilities Program.
2.3.1.2.3.2.3.
Ensuring that personnel with necessary skills and expertise are available when
personnel are needed and are effectively communicating and coordinating
with other team members to conduct analyses and complete project tasks and
Deliverables according to the Project Schedule.
2.3.1.2.3.2.4.
Responsible for involving Department in detailed discussions about analytic
methods that will be used to complete each Deliverable and about the results
of the analyses and impact on the CO Providers of Distinction for Facilities
Program design.
2.3.1.2.3.2.5.
Establishing a cadence of meetings and communications with the Department
about project tasks and Deliverables, including progress, problems, and risks,
in relation to the CO Providers of Distinction for Facilities Program.
2.3.1.2.3.2.6.
Reporting project status on a weekly basis.
2.3.1.2.4.
Maternity Bundled Payment and New Maternity APM Lead
2.3.1.2.4.1.
The Maternity Lead shall have the following qualifications:
2.3.1.2.4.1.1.
Experience in Project Management, which includes managing project scope,
schedule, risks, and changes.
2.3.1.2.4.1.2.
Experience communicating analytic methods and results and their impact on
program goals to clients and Stakeholders.
2.3.1.2.4.1.3.
Experience in implementing and operating an APM.
2.3.1.2.4.2.
The Maternity Lead shall be responsible for all of the following:
2.3.1.2.4.2.1.
Overseeing Project Management for the Maternity Bundled Payment
Program.
2.3.1.2.4.2.2.
Overseeing rates setting.
2.3.1.2.4.2.3.
Overseeing and maintaining the process for engaging with Key Stakeholders.
2.3.1.2.4.2.4.
Assisting the Department in facilitating relationships with Key Stakeholders.
2.3.1.2.4.2.5.
Ensuring the Maternity Bundled Payment Program Data Sharing and
Analytics Solution is functional for the Department and Providers.
2.3.1.2.4.2.6.
Synthesizing the findings from Stakeholder meetings, existing Maternity
Bundled Payment Program evaluation, research on existing APMs in
maternity care, and Department input for final program design
recommendations.
2.3.1.2.4.2.7.
Overseeing Project Management for the New Maternity APM Program.
2.3.1.2.4.2.8.
Overseeing and maintaining the process for engaging with Key Stakeholders.
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Exhibit E, Contractor’s Administrative Requirements
Page 11 of 15
2.3.1.2.4.2.9.
Assisting the Department in facilitating relationships with Key Stakeholders.
2.3.1.2.4.2.10.
Ensuring the Pilot New Maternity APM Program Dashboard is functional for
the Department and Providers.
2.3.1.2.5.
Pediatric APM Lead
2.3.1.2.5.1.
The Pediatric APM Lead shall have the following qualifications:
2.3.1.2.5.1.1.
Experience in Project Management, which includes managing project scope,
schedule, risks, and changes.
2.3.1.2.5.1.2.
Experience communicating analytic methods and results and their impact on
program goals to clients and Stakeholders.
2.3.1.2.5.1.3.
Experience in developing, implementing, and operating an APM.
2.3.1.2.5.2.
The Pediatric APM Lead shall be responsible for all of the following:
2.3.1.2.5.2.1.
Overseeing Project Management for the Pediatric APM Program.
2.3.1.2.5.2.2.
Overseeing rates setting.
2.3.1.2.5.2.3.
Overseeing and maintaining the process for engaging with Key Stakeholders.
2.3.1.2.5.2.4.
Assisting the Department in facilitating relationships with Key Stakeholders.
2.3.1.2.5.2.5.
Ensuring the Dashboard and Primary Care Data Sharing Analytics Solution
for the Pediatric APM Program is functional for the Department and
Providers.
2.3.1.2.6.
Analytics Lead
2.3.1.2.6.1.
The Analytics Lead shall have the following qualifications:
2.3.1.2.6.1.1.
A master’s degree (PhD preferred) in data science, computer science,
information technology, economics, information systems, statistics, applied
math, business administration, or any other related field at the Department’s
approval.
2.3.1.2.6.1.2.
Seven years of working experience in a data analyst or data warehousing
position working in a analytical managerial position in a relevant private- or
public-sector setting, or other working experience acceptable to the
Department.
2.3.1.2.6.1.3.
Experience in the execution of data analytics initiatives, leading to the
development of useful insights and the improvement of practices’
performance.
2.3.1.2.6.1.4.
Experience in health care data analytics initiatives that were aimed at
actionable information to help Providers improve quality and cost
performance and aimed at information about Member factors including SDoH
that influence health care quality and outcomes.
2.3.1.2.6.1.5.
Demonstrated experience building and leading quantitative analyses as well
experience building response and risk models for health care organizations.
2.3.1.2.6.2.
The Analytics Lead shall be responsible for all of the following:
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Exhibit E, Contractor’s Administrative Requirements
Page 12 of 15
2.3.1.2.6.2.1.
Ensuring that all analytics tools are delivered to the Department in compliance
with deadline requirements and within budget.
2.3.1.2.6.2.2.
Ensuring that all analytics tools that are developed comply with the
Department’s instructions developed with the advisement of the Stakeholder
engagement process.
2.3.1.2.6.2.3.
Ensuring continuous engagement through Technology Solution development;
stabilization of Contractor’s Technology Solution; initial release of or within
Contractor’s Technology Solution, as applicable; and operations of
Contractor’s Technology Solution.
2.3.1.2.7.
CMS Certification Lead
2.3.1.2.7.1.
The CMS Certification Lead shall have the following qualifications:
2.3.1.2.7.1.1.
Five years or more of project experience.
2.3.1.2.7.1.2.
Five years or more of Health and Human Services or Medicaid experience.
2.3.1.2.7.1.3.
MES certification experience.
2.3.1.2.7.2.
The CMS Certification Lead shall be responsible for all of the following:
2.3.1.2.7.2.1.
Serving as the lead developer of the CMS Certification Implementation Plan.
2.3.2.
An individual may fill more than one of the roles defined as Key Personnel and/or Other
Personnel, provided Contractor identifies the individual to the Department and obtains the
Department’s approval, as identified in Section 2.1.1.
2.4.
Other Personnel Responsibilities
2.4.1.
Contractor shall use its discretion to determine the number of Other Personnel necessary to
perform the Work in accordance with the requirements of this Contract. At a minimum, Other
Personnel shall include personnel to perform the following activities:
2.4.1.1.
Other physician Personnel with specialization in conditions and procedures targeted for
APM, Maternity Bundle and CO Providers of Distinction for Facilities Programs and with
ability to: 1) evaluate episode definitions and recommend changes necessary to ensure
episode definitions are clinically meaningful and useful for measuring differences in
facility and/or Provider performance; 2) recommend episode-specific facility and/or
Provider performance measures for quality, safety, and equity; and 3) evaluate the risk
adjustment models and the risk adjustment models’ explanatory variables for face validity
and clinician acceptance.
2.4.1.2.
Other Personnel with expertise and experience in statistics and experience in conducting
analyses of variation in cost and quality of care for episodes and identifying sources of
variation (e.g., types of procedures included, patient factors, Provider practice).
2.4.1.3.
Other Personnel with expertise and experience in statistics and expertise and recent
experience building linear and logistic regression models to risk adjust procedure
episode-based cost and quality of care measurement results in order to make fair
comparisons of facility and Provider performance.
2.4.1.4.
Other Personnel who have experience in claims and diagnosis/procedure coding to help
write measure specifications for producing custom performance measures and to update
episodes of care and performance measure specifications over time.
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Page 13 of 15
2.4.1.5.
Other Personnel experienced in analyzing procedure episode costs, quality, and safety
and who are able to compare definitions of procedure episodes from different episode
groupers and implement and test modifications to the definitions.
2.4.1.6.
Other Personnel with experience using Medicaid, commercial, and Medicare claims data
to produce episodes or performance measures and who have experience building custom
performance measures from, including, testing measure specifications, writing computer
programs to produce performance measurement results and then testing the validity of
results, and modifying the specifications and programs as necessary.
2.4.1.7.
Other Personnel with experience working with Providers, Medicaid Members, and other
Stakeholders to explain CO Providers of Distinction for Facilities Program goals, design,
and analytic methods, and to solicit feedback about modifications that may be needed to
achieve program goals and acceptance.
2.4.2.
If the Department determines that Contractor has not provided sufficient Other Personnel to
perform the Work in accordance with the requirements of this Contract, Contractor shall
provide all additional Other Personnel necessary to perform the Work in accordance with the
requirements of this Contract at no additional cost to the Department.
2.4.3.
Contractor shall ensure that all Other Personnel have sufficient training and experience to
complete all portions of the Work assigned to them. Contractor shall provide all necessary
training to its Other Personnel, except for State-provided training specifically described in
this Contract.
2.4.4.
Contractor may subcontract to complete a portion of the Work required by the Contract. The
conditions for using a Subcontractor or Subcontractors are as follows:
2.4.4.1.
Contractor shall not subcontract more than 40% of the Work.
2.4.4.2.
Contractor shall provide the organizational name of each Subcontractor and all items to
be worked on by each Subcontractor to the Department.
2.4.4.2.1.
DELIVERABLE: Name of each Subcontractor and items on which each
Subcontractor will work
2.4.4.2.2.
DUE: The later of 30 days prior to the Subcontractor beginning work or the Effective
Date
2.4.4.3.
Contractor shall obtain prior consent and written approval for any use of Subcontractor(s).
2.4.4.4.
If Contractor enters into a subcontract with any Subcontractor, as permitted by this
Contract, then Contractor shall be the Prime Contractor with respect to all subcontracts.
2.4.4.4.1.
As the prime Contractor, Contractor shall be solely responsible for integration of all
Work to be performed under this Contract, whether the Work is performed by
Contractor or any Subcontractor.
2.4.4.4.2.
Contractor shall work solely with the Department to perform all Contract
administration activities of this Contract, including tasks for which the Subcontractor
may be responsible.
3.
INFORMATION TECHNOLOGY RELATED REQUIREMENTS
3.1.
Protection of System Data
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Exhibit E, Contractor’s Administrative Requirements
Page 14 of 15
3.1.1.
For the avoidance of doubt, the terms of this Exhibit shall apply to the extent that any of the
following statements is true in regard to Contractor access, use, or disclosure of State
Records:
3.1.1.1.
Contractor provides physical or logical storage of State Records.
3.1.1.2.
Contractor creates, uses, processes, discloses, transmits, or disposes of State Records.
3.1.1.3.
Contractor is otherwise given physical or logical access to State Records in order to
perform Contractor’s obligations under this Contract.
3.1.2.
Colorado Information Security Policy (CISP) Compliance
3.1.2.1.
Contractor shall assess its compliance with the CISPs, in effect at the time of the
assessment, issued by the Governor’s Office of Information Technology (“OIT”) posted
at
www.oit.state.co.us/about/policies
under Information Security.
3.1.2.2.
For the purposes of reviewing and assessing compliance with the CISPs, Contractor shall
consider itself to be both the Information Technology Service Provider (ITSP) and
Business Owner.
3.1.2.3.
Contractor shall deliver to the State the signed CISP Attestation, on a form provided by
the Department, indicating that Contractor has assessed its compliance with the CISPs
and has developed a plan to correct, in a timely manner, any security vulnerabilities
identified during the assessment.
3.1.2.3.1.
DELIVERABLE: CISP Attestation
3.1.2.3.2.
DUE: Within 30 Business Days after the Effective Date
3.1.2.4.
Notwithstanding any other provision in this Contract, Contractor shall assess its
compliance with the CISPs on an annual basis and deliver to the State the signed CISP
Attestation, on a form provided by the Department.
3.1.2.4.1.
DELIVERABLE: Annual CISP Attestation
3.1.2.4.2.
DUE: Annually, by June 30
th
of each year
3.1.2.5.
Contractor shall cause its Subcontractors to comply with the CISPs and to assess their
compliance on at least an annual basis. If any Subcontractor’s assessment determines that
the Subcontractor is not in compliance, then Contractor shall ensure that Subcontractor
corrects, in a timely manner, any security vulnerabilities identified during the assessment.
3.1.3.
Health and Human Services (HHS) HIPAA Security Rule Risk Assessments
3.1.3.1.
Contractor shall deliver to the State a signed Initial HHS Attestation, on a form provided
by the Department, indicating that Contractor has conducted a risk assessment of its
operations related to the services provided under this Contract that satisfies the
requirement of 45 CFR. §164.308(a)(1)(ii)(A) (the “HIPAA Security Rule”), and that
Contractor has developed a plan to correct, in a timely manner, any vulnerabilities in
administrative, technical, or physical safeguards identified during the assessment.
3.1.3.1.1.
DELIVERABLE: Initial HHS Attestation
3.1.3.1.2.
DUE: Within 30 Business Days after the Effective Date
3.1.3.2.
Contractor shall conduct an annual risk assessment of its operations related to the services
provided under this Contract that satisfies the requirement of the HIPAA Security Rule
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Exhibit E, Contractor’s Administrative Requirements
Page 15 of 15
and deliver to the State the signed Annual HHS Attestation, on a form provided by the
Department.
3.1.3.2.1.
DELIVERABLE: Annual HHS Attestation
3.1.3.2.2.
DUE DATE: Annually, by June 30
th
of each year
3.1.3.3.
Contractor shall cause its Subcontractors to comply with the HIPAA Security Rule and
assess their compliance on at least an annual basis. If any Subcontractor’s assessment
determines that the Subcontractor is not in compliance, then Contractor shall ensure that
Subcontractor corrects, in a timely manner, any vulnerabilities in administrative,
technical, or physical safeguards identified during the assessment.
3.1.4.
With respect to background checks performed in compliance with Exhibit K, Section 1.E,
Contractor shall deliver to the State the signed Background Check Attestation, on a form
provided by the Department, indicating that background checks have been completed on
employees participating in operations related to this Contract.
3.1.4.1.
DELIVERABLE: Background Check Attestation
3.1.4.2.
DUE: Within 30 Business Days of the Effective Date
3.2.
Data Handling
3.2.1.
The State, in its sole discretion, may securely deliver State Records directly to Contractor.
Contractor shall maintain these State Records only within facilities or locations that
Contractor has attested are secure, including for the authorized and approved purposes of
backup and disaster recovery purposes.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit F, Sample Option Letter
Page 1 of 2
EXHIBIT F, SAMPLE OPTION LETTER
OPTION LETTER
State Agency
Department of Health Care Policy and Financing
Option Letter Number
Insert the Option Number (e.g. "1" for the first option)
Contractor
Insert Contractor's Full Legal Name, including
"Inc.", "LLC", etc...
Original Contract Number
Insert CMS number or Other Contract Number of the Original Contract
Current Contract Maximum Amount
Initial Term
Option Contract Number
Insert CMS number or Other Contract Number of this Option
State Fiscal Year 20xx
$0.00
Extension Terms
Contract Performance Beginning Date
The later of the Effective Date or Month Day, Year
State Fiscal Year 20xx
$0.00
State Fiscal Year 20xx
$0.00
State Fiscal Year 20xx
$0.00
Current Contract Expiration Date
Month Day, Year
State Fiscal Year 20xx
$0.00
Total for All State Fiscal Years
$0.00
1.
Options
A.
Option to extend for an Extension Term.
B.
Option to change the quantity of Goods under the Contract.
C.
Option to change the quantity of Services under the Contract.
D.
Option to modify the Contract rates.
2.
Required Provisions
A.
For use with Option 1(A):
In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option for an additional term, beginning Insert start date and ending
on the current contract expiration date shown above, at the rates stated in the Original Contract, as
amended.
B.
For use with Options 1(B and C):
In accordance with Section(s) Number of the Original Contract
referenced above, the State hereby exercises its option to Increase/Decrease the quantity of the
Goods/Services or both at the rates stated in the Original Contract, as amended.
C.
For use with Option 1(D):
In accordance with Section(s) Number of the Original Contract referenced
above, the State hereby exercises its option to modify the Contract rates specified in Exhibit/Section
Number/Letter. The Contract rates attached to this Option Letter replace the rates in the Original Contract
as of the Option Effective Date of this Option Letter.
D.
For use with all Options that modify the Contract Maximum Amount:
The Contract Maximum
Amount table on the Contract’s Signature and Cover Page is hereby deleted and replaced with the Current
Contract Maximum Amount table shown above.
3.
Option Effective Date
a.
The Effective Date of this Option Letter is upon approval of the State Controller or the Effective Date
of this Option Letter, whichever is later.
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Exhibit F, Sample Option Letter
Page 2 of 2
STATE OF COLORADO
Jared S. Polis, Governor
Department of Health Care Policy and Financing
Kim Bimestefer, Executive Director
______________________________________________
By: Kim Bimestefer, Executive Director
Date: _________________________
In accordance with C.R.S. §24-30-202, this Option is not valid
until signed and dated below by the State Controller or an
authorized delegate.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
___________________________________________
By: Jerrod Cotosman, Controller,
Department of Health Care Policy and Financing
Option Effective Date:_____________________
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit G, Federal Provisions
Page 1 of 13
EXHIBIT G, FEDERAL PROVISIONS
1.
APPLICABILITY OF PROVISIONS.
1.1.
The Contract to which these Federal Provisions are attached has been funded, in whole or
in part, with an Award of Federal funds. In the event of a conflict between the provisions
of these Federal Provisions, the Special Provisions, the body of the Contract, or any
attachments or exhibits incorporated into and made a part of the Contract, the provisions
of these Federal Provisions shall control.
2.
FFATA AND UNIFORM GUIDANCE REQUIREMENTS
2.1.
Definitions.
2.1.1.
For the purposes of these Federal Provisions, the following terms shall have the
meanings ascribed to them below.
2.1.1.1.
“Award” means an award of Federal financial assistance, and the Contract setting
forth the terms and conditions of that financial assistance, that a non-Federal Entity
receives or administers.
2.1.1.1.1.
Awards may be in the form of:
2.1.1.1.1.1.
Grants;
2.1.1.1.1.2.
Contracts;
2.1.1.1.1.3.
Cooperative Contracts, which do not include cooperative research and
development Contracts (CRDA) pursuant to the Federal Technology
Transfer Act of 1986, as amended (15 U.S.C. 3710);
2.1.1.1.1.4.
Loans;
2.1.1.1.1.5.
Loan Guarantees;
2.1.1.1.1.6.
Subsidies;
2.1.1.1.1.7.
Insurance;
2.1.1.1.1.8.
Food commodities;
2.1.1.1.1.9.
Direct appropriations;
2.1.1.1.1.10.
Assessed and voluntary contributions; and
2.1.1.1.1.11.
Other financial assistance transactions that authorize the expenditure of
Federal funds by non-Federal Entities.
2.1.1.1.1.12.
Any other items specified by OMB in policy memoranda available at the
OMB website or other source posted by the OMB.
2.1.1.1.2.
Award
does
not
include:
2.1.1.1.2.1.
Technical assistance, which provides services in lieu of money;
2.1.1.1.2.2.
A transfer of title to Federally-owned property provided in lieu of money;
even if the award is called a grant;
2.1.1.1.2.3.
Any award classified for security purposes; or
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Exhibit G, Federal Provisions
Page 2 of 13
2.1.1.1.2.4.
Any award funded in whole or in part with Recovery funds, as defined in
section 1512 of the American Recovery and Reinvestment Act (ARRA) of
2009 (Public Law 111-5).
2.1.1.2.
“Contract” means the Contract to which these Federal Provisions are attached and
includes all Award types in §2.1.1.1.1 of this Exhibit.
2.1.1.3.
“Contractor” means the party or parties to a Contract funded, in whole or in part,
with Federal financial assistance, other than the Prime Recipient, and includes
grantees, subgrantees, Subrecipients, and borrowers. For purposes of Transparency
Act reporting, Contractor does not include Vendors.
2.1.1.4.
“Data Universal Numbering System (DUNS) Number” means the nine-digit
number established and assigned by Dun and Bradstreet, Inc. to uniquely identify
a business entity. Dun and Bradstreet’s website may be found at:
http://fedgov.dnb.com/webform
.
2.1.1.5.
“Entity” means all of the following as defined at 2 CFR part 25, subpart C;
2.1.1.5.1.
A governmental organization, which is a State, local government, or Indian
Tribe;
2.1.1.5.2.
A foreign public entity;
2.1.1.5.3.
A domestic or foreign non-profit organization;
2.1.1.5.4.
A domestic or foreign for-profit organization; and
2.1.1.5.5.
A Federal agency, but only a Subrecipient under an Award or Subaward to a
non-Federal entity.
2.1.1.6.
“Executive” means an officer, managing partner or any other employee in a
management position.
2.1.1.7.
“Federal Award Identification Number (FAIN)” means an Award number assigned
by a Federal agency to a Prime Recipient.
2.1.1.8.
“Federal Awarding Agency” means a Federal agency providing a Federal Award
to a Recipient as described in 2 CFR §200.37
2.1.1.9.
“FFATA” means the Federal Funding Accountability and Transparency Act of
2006 (Public Law 109-282), as amended by §6202 of Public Law 110-252.
FFATA, as amended, also is referred to as the “Transparency Act.”
2.1.1.10.
“Federal Provisions” means these Federal Provisions subject to the Transparency
Act and Uniform Guidance, as may be revised pursuant to ongoing guidance from
the relevant Federal or State of Colorado agency or institutions of higher education.
2.1.1.11.
“OMB” means the Executive Office of the President, Office of Management and
Budget.
2.1.1.12.
“Prime Recipient” means a Colorado State agency or institution of higher education
that receives an Award.
2.1.1.13.
“Subaward” means an award by a Recipient to a Subrecipient funded in whole or
in part by a Federal Award. The terms and conditions of the Federal Award flow
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Exhibit G, Federal Provisions
Page 3 of 13
down to the Award unless the terms and conditions of the Federal Award
specifically indicate otherwise in accordance with 2 CFR §200.38. The term does
not include payments to a contractor or payments to an individual that is a
beneficiary of a Federal program.
2.1.1.14.
“Subrecipient” means a non-Federal Entity (or a Federal agency under an Award
or Subaward to a non-Federal Entity) receiving Federal funds through a Prime
Recipient to support the performance of the Federal project or program for which
the Federal funds were awarded. A Subrecipient is subject to the terms and
conditions of the Federal Award to the Prime Recipient, including program
compliance requirements. The term “Subrecipient” includes and may be referred to
as Subgrantee. The term does not include an individual who is a beneficiary of a
federal program.
2.1.1.15.
“Subrecipient Parent DUNS Number” means the subrecipient parent organization’s
9-digit Data Universal Numbering System (DUNS) number that appears in the
subrecipient’s System for Award Management (SAM) profile, if applicable.
2.1.1.16.
“System for Award Management (SAM)” means the Federal repository into which
an Entity must enter the information required under the Transparency Act, which
may be found at http://www.sam.gov.
2.1.1.17.
“Total Compensation” means the cash and noncash dollar value earned by an
Executive during the Prime Recipient’s or Subrecipient’s preceding fiscal year and
includes the following:
2.1.1.17.1.
Salary and bonus;
2.1.1.17.2.
Awards of stock, stock options, and stock appreciation rights, using the dollar
amount recognized for financial statement reporting purposes with respect to
the fiscal year in accordance with the Statement of Financial Accounting
Standards No. 123 (Revised 2005) (FAS 123R), Shared Based Payments;
2.1.1.17.3.
Earnings for services under non-equity incentive plans, not including group life,
health, hospitalization or medical reimbursement plans that do not discriminate
in favor of Executives and are available generally to all salaried employees;
2.1.1.17.4.
Change in present value of defined benefit and actuarial pension plans;
2.1.1.17.5.
Above-market earnings on deferred compensation which is not tax-qualified;
2.1.1.17.6.
Other compensation, if the aggregate value of all such other compensation (e.g.
severance, termination payments, value of life insurance paid on behalf of the
employee, perquisites or property) for the Executive exceeds $10,000.
2.1.1.18.
“Transparency Act” means the Federal Funding Accountability and Transparency
Act of 2006 (Public Law 109-282), as amended by §6202 of Public Law 110-252.
The Transparency Act also is referred to as FFATA.
2.1.1.19.
“Uniform Guidance” means the Office of Management and Budget Uniform
Administrative Requirements, Cost Principles, and Audit Requirements for Federal
Awards, which supersedes requirements from OMB Circulars A-21, A-87, A-110,
and A-122, OMB Circulars A-89, A-102, and A-133, and the guidance in Circular
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A-50 on Single Audit Act follow-up. The terms and conditions of the Uniform
Guidance flow down to Awards to Subrecipients unless the Uniform Guidance or
the terms and conditions of the Federal Award specifically indicate otherwise.
2.1.1.20.
“Vendor” means a dealer, distributor, merchant or other seller providing property
or services required for a project or program funded by an Award. A Vendor is not
a Prime Recipient or a Subrecipient and is not subject to the terms and conditions
of the Federal award. Program compliance requirements do not pass through to a
Vendor.
2.2.
Compliance.
2.2.1.
Contractor shall comply with all applicable provisions of the Transparency Act, all
applicable provisions of the Uniform Guidance, and the regulations issued pursuant
thereto, including but not limited to these Federal Provisions. Any revisions to such
provisions or regulations shall automatically become a part of these Federal Provisions,
without the necessity of either party executing any further instrument. The State of
Colorado may provide written notification to Contractor of such revisions, but such
notice shall not be a condition precedent to the effectiveness of such revisions.
2.3.
System for Award Management (SAM) and Data Universal Numbering System (DUNS)
Requirements.
2.3.1.
SAM. Contractor shall maintain the currency of its information in SAM until the
Contractor submits the final financial report required under the Award or receives final
payment, whichever is later. Contractor shall review and update SAM information at
least annually after the initial registration, and more frequently if required by changes
in its information.
2.3.2.
DUNS. Contractor shall provide its DUNS number to its Prime Recipient, and shall
update Contractor’s information in Dun & Bradstreet, Inc. at least annually after the
initial registration, and more frequently if required by changes in Contractor’s
information.
2.4.
Total Compensation.
2.4.1.
Contractor shall include Total Compensation in SAM for each of its five most highly
compensated Executives for the preceding fiscal year if:
2.4.1.1.
The total Federal funding authorized to date under the Award is $25,000 or more;
and
2.4.1.2.
In the preceding fiscal year, Contractor received:
2.4.1.2.1.
80% or more of its annual gross revenues from Federal procurement contracts
and subcontracts and/or Federal financial assistance Awards or Subawards
subject to the Transparency Act; and
2.4.1.2.2.
$25,000,000 or more in annual gross revenues from Federal procurement
contracts and subcontracts and/or Federal financial assistance Awards or
Subawards subject to the Transparency Act; and
2.4.1.3.
The public does not have access to information about the compensation of such
Executives through periodic reports filed under section 13(a) or 15(d) of the
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Securities Exchange Act of 1934 (15 U.S.C. 78m(a), 78o(d) or § 6104 of the
Internal Revenue Code of 1986.
2.5.
Reporting.
2.5.1.
Contractor shall report data elements to SAM and to the Prime Recipient as required in
this Exhibit if Contractor is a Subrecipient for the Award pursuant to the Transparency
Act. No direct payment shall be made to Contractor for providing any reports required
under these Federal Provisions and the cost of producing such reports shall be included
in the Contract price. The reporting requirements in this Exhibit are based on guidance
from the US Office of Management and Budget (OMB), and as such are subject to
change at any time by OMB. Any such changes shall be automatically incorporated
into this Contract and shall become part of Contractor’s obligations under this Contract.
2.6.
Effective Date and Dollar Threshold for Reporting.
2.6.1.
Reporting requirements in §2.7 below apply to new Awards as of October 1, 2010, if
the initial award is $25,000 or more. If the initial Award is below $25,000 but
subsequent Award modifications result in a total Award of $25,000 or more, the Award
is subject to the reporting requirements as of the date the Award exceeds $25,000. If
the initial Award is $25,000 or more, but funding is subsequently de-obligated such
that the total award amount falls below $25,000, the Award shall continue to be subject
to the reporting requirements.
2.6.2.
The procurement standards in §2.8 below are applicable to new Awards made by Prime
Recipient as of December 26, 2015. The standards set forth in §2.10 below are
applicable to audits of fiscal years beginning on or after December 26, 2014.
2.7.
Subrecipient Reporting Requirements.
2.7.1.
If Contractor is a Subrecipient, Contractor shall report as set forth below.
2.7.1.1.
To SAM.
A Subrecipient shall register in SAM and report the following data
elements in SAM
for each
Federal Award Identification Number no later than the
end of the month following the month in which the Subaward was made:
2.7.1.1.1.
Subrecipient DUNS Number;
2.7.1.1.2.
Subrecipient DUNS Number + 4 if more than one electronic funds transfer
(EFT) account;
2.7.1.1.3.
Subrecipient Parent DUNS Number;
2.7.1.1.4.
Subrecipient’s address, including: Street Address, City, State, Country, Zip +
4, and Congressional District;
2.7.1.1.5.
Subrecipient’s top 5 most highly compensated Executives if the criteria in §4
above are met; and
2.7.1.1.6.
Subrecipient’s Total Compensation of top 5 most highly compensated
Executives if criteria in §4 above met.
2.7.1.2.
To Prime Recipient.
A Subrecipient shall report to its Prime Recipient, upon the
effective date of the Contract, the following data elements:
2.7.1.2.1.
Subrecipient’s DUNS Number as registered in SAM.
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2.7.1.2.2.
Primary Place of Performance Information, including: Street Address, City,
State, Country, Zip code + 4, and Congressional District.
2.8.
Procurement Standards.
2.8.1.
Procurement Procedures. A Subrecipient shall use its own documented procurement
procedures which reflect applicable State, local, and Tribal laws and regulations,
provided that the procurements conform to applicable Federal law and the standards
identified in the Uniform Guidance, including without limitation, §§200.318 through
200.326 thereof.
2.8.2.
Procurement of Recovered Materials. If a Subrecipient is a State Agency or an agency
of a political subdivision of the State, its contractors must comply with section 6002 of
the Solid Waste Disposal Act, as amended by the Resource Conservation and Recovery
Act. The requirements of Section 6002 include procuring only items designated in
guidelines of the Environmental Protection Agency (EPA) at 40 CFR part 247 that
contain the highest percentage of recovered materials practicable, consistent with
maintaining a satisfactory level of competition, where the purchase price of the item
exceeds $10,000 or the value of the quantity acquired during the preceding fiscal year
exceeded $10,000; procuring solid waste management services in a manner that
maximizes energy and resource recovery; and establishing an affirmative procurement
program for procurement of recovered materials identified in the EPA guidelines.
2.9.
Access to Records
2.9.1.
A Subrecipient shall permit Recipient and auditors to have access to Subrecipient’s
records and financial statements as necessary for Recipient to meet the requirements of
§200.331 (Requirements for pass-through entities), §§200.300 (Statutory and national
policy requirements) through 200.309 (Period of performance), and Subpart F-Audit
Requirements of the Uniform Guidance. 2 CFR §200.331(a)(5).
2.10.
Single Audit Requirements
2.10.1.
If a Subrecipient expends $750,000 or more in Federal Awards during the
Subrecipient’s fiscal year, the Subrecipient shall procure or arrange for a single or
program-specific audit conducted for that year in accordance with the provisions of
Subpart F-Audit Requirements of the Uniform Guidance, issued pursuant to the Single
Audit Act Amendments of 1996, (31 U.S.C. 7501-7507). 2 CFR §200.501.
2.10.1.1.
Election.
A Subrecipient shall have a single audit conducted in accordance with
Uniform Guidance §200.514 (Scope of audit), except when it elects to have a
program-specific audit conducted in accordance with §200.507 (Program-specific
audits). The Subrecipient may elect to have a program-specific audit if
Subrecipient expends Federal Awards under only one Federal program (excluding
research and development) and the Federal program's statutes, regulations, or the
terms and conditions of the Federal award do not require a financial statement audit
of Prime Recipient. A program-specific audit may not be elected for research and
development unless all of the Federal Awards expended were received from
Recipient and Recipient approves in advance a program-specific audit.
2.10.1.2.
Exemption.
If a Subrecipient expends less than $750,000 in Federal Awards
during its fiscal year, the Subrecipient shall be exempt from Federal audit
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requirements for that year, except as noted in 2 CFR §200.503 (Relation to other
audit requirements), but records shall be available for review or audit by appropriate
officials of the Federal agency, the State, and the Government Accountability
Office.
2.10.1.3.
Subrecipient Compliance Responsibility.
A Subrecipient shall procure or
otherwise arrange for the audit required by Part F of the Uniform Guidance and
ensure it is properly performed and submitted when due in accordance with the
Uniform Guidance. Subrecipient shall prepare appropriate financial statements,
including the schedule of expenditures of Federal awards in accordance with
Uniform Guidance §200.510 (Financial statements) and provide the auditor with
access to personnel, accounts, books, records, supporting documentation, and other
information as needed for the auditor to perform the audit required by Uniform
Guidance Part F-Audit Requirements.
2.11.
Contract Provisions for Subrecipient Contracts
2.11.1.
If Contractor is a Subrecipient, then it shall comply with and shall include all of the
following applicable provisions in all subcontracts entered into by it pursuant to this
Contract.
2.11.1.1.
Equal Employment Opportunity.
Except as otherwise provided under 41 CFR
Part 60, all contracts that meet the definition of “federally assisted construction
contract” in 41 CFR Part 60-1.3 shall include the equal opportunity clause provided
under 41 CFR 60-1.4(b), in accordance with Executive Order 11246, “Equal
Employment Opportunity” (30 FR 12319, 12935, 3 CFR Part, 1964-1965 Comp.,
p. 339), as amended by Executive Order 11375, “Amending Executive Order 11246
Relating to Equal Employment Opportunity,” and implementing regulations at 41
CFR part 60, “Office of Federal Contract Compliance Programs, Equal
Employment Opportunity, Department of Labor.
2.11.1.1.1.
During the performance of this contract, the contractor agrees as follows:
2.11.1.1.1.1.
Contractor will not discriminate against any employee or applicant for
employment because of race, color, religion, sex, or national origin. The
contractor will take affirmative action to ensure that applicants are
employed, and that employees are treated during employment, without
regard to their race, color, religion, sex, or national origin. Such action shall
include, but not be limited to the following: Employment, upgrading,
demotion, or transfer, recruitment or recruitment advertising; layoff or
termination; rates of pay or other forms of compensation; and selection for
training, including apprenticeship. The contractor agrees to post in
conspicuous places, available to employees and applicants for employment,
notices to be provided by the contracting officer setting forth the provisions
of this nondiscrimination clause.
2.11.1.1.1.2.
Contractor will, in all solicitations or advertisements for employees placed
by or on behalf of the contractor, state that all qualified applicants will
receive consideration for employment without regard to race, color,
religion, sex, or national origin.
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2.11.1.1.1.3.
Contractor will send to each labor union or representative of workers with
which he has a collective bargaining Contract or other contract or
understanding, a notice to be provided by the agency contracting officer,
advising the labor union or workers' representative of the contractor's
commitments under section 202 of Executive Order 11246 of September
24, 1965, and shall post copies of the notice in conspicuous places available
to employees and applicants for employment.
2.11.1.1.1.4.
Contractor will comply with all provisions of Executive Order 11246 of
September 24, 1965, and of the rules, regulations, and relevant orders of the
Secretary of Labor.
2.11.1.1.1.5.
Contractor will furnish all information and reports required by Executive
Order 11246 of September 24, 1965, and by the rules, regulations, and
orders of the Secretary of Labor, or pursuant thereto, and will permit access
to his books, records, and accounts by the contracting agency and the
Secretary of Labor for purposes of investigation to ascertain compliance
with such rules, regulations, and orders.
2.11.1.1.1.6.
In the event of Contractor's non-compliance with the nondiscrimination
clauses of this contract or with any of such rules, regulations, or orders, this
contract may be canceled, terminated or suspended in whole or in part and
the contractor may be declared ineligible for further Government contracts
in accordance with procedures authorized in Executive Order 11246 of
September 24, 1965, and such other sanctions may be imposed and remedies
invoked as provided in Executive Order 11246 of September 24, 1965, or
by rule, regulation, or order of the Secretary of Labor, or as otherwise
provided by law.
2.11.1.1.1.7.
Contractor will include the provisions of paragraphs (1) through (7) in every
subcontract or purchase order unless exempted by rules, regulations, or
orders of the Secretary of Labor issued pursuant to section 204 of Executive
Order 11246 of September 24, 1965, so that such provisions will be binding
upon each subcontractor or vendor. The contractor will take such action
with respect to any subcontract or purchase order as may be directed by the
Secretary of Labor as a means of enforcing such provisions including
sanctions for noncompliance: Provided, however, that in the event
Contractor becomes involved in, or is threatened with, litigation with a
subcontractor or vendor as a result of such direction, the contractor may
request the United States to enter into such litigation to protect the interests
of the United States.”
2.11.1.2.
Davis-Bacon Act.
Davis-Bacon Act, as amended (40 U.S.C. 3141-3148). When
required by Federal program legislation, all prime construction contracts in excess
of $2,000 awarded by non-Federal entities must include a provision for compliance
with the Davis-Bacon Act (40 U.S.C. 3141-3144, and 3146-3148) as supplemented
by Department of Labor regulations (29 CFR Part 5, “Labor Standards Provisions
Applicable to Contracts Covering Federally Financed and Assisted Construction”).
In accordance with the statute, contractors must be required to pay wages to
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laborers and mechanics at a rate not less than the prevailing wages specified in a
wage determination made by the Secretary of Labor. In addition, contractors must
be required to pay wages not less than once a week. The non-Federal entity must
place a copy of the current prevailing wage determination issued by the Department
of Labor in each solicitation. The decision to award a contract or subcontract must
be conditioned upon the acceptance of the wage determination. The non-Federal
entity must report all suspected or reported violations to the Federal awarding
agency. The contracts must also include a provision for compliance with the
Copeland “Anti-Kickback” Act (40 U.S.C. 3145), as supplemented by Department
of Labor regulations (29 CFR Part 3, “Contractors and Subcontractors on Public
Building or Public Work Financed in Whole or in Part by Loans or Grants from the
United States”). The Act provides that each contractor or Subrecipient must be
prohibited from inducing, by any means, any person employed in the construction,
completion, or repair of public work, to give up any part of the compensation to
which he or she is otherwise entitled. The non-Federal entity must report all
suspected or reported violations to the Federal awarding agency.
2.11.1.3.
Rights to Inventions Made Under a Contract or Contract.
If the Federal Award
meets the definition of “funding Contract” under 37 CFR §401.2 (a) and
Subrecipient wishes to enter into a contract with a small business firm or nonprofit
organization regarding the substitution of parties, assignment or performance of
experimental, developmental, or research work under that “funding Contract,”
Subrecipient must comply with the requirements of 37 CFR Part 401, “Rights to
Inventions Made by Nonprofit Organizations and Small Business Firms Under
Government Grants, Contracts and Cooperative Contracts,” and any implementing
regulations issued by the awarding agency.
2.11.1.4.
Clean Air Act (42 U.S.C. 7401-7671q.) and the Federal Water Pollution
Control Act (33 U.S.C. 1251-1387), as amended.
Contracts and subgrants of
amounts in excess of $150,000 must contain a provision that requires the non-
Federal award to agree to comply with all applicable standards, orders or
regulations issued pursuant to the Clean Air Act (42 U.S.C. 7401-7671q) and the
Federal Water Pollution Control Act as amended (33 U.S.C. 1251-1387).
Violations must be reported to the Federal awarding agency and the Regional
Office of the Environmental Protection Agency (EPA).
2.11.1.5.
Debarment and Suspension (Executive Orders 12549 and 12689).
A contract
award (see 2 CFR 180.220) must not be made to parties listed on the government
wide exclusions in the System for Award Management (SAM), in accordance with
the OMB guidelines at 2 CFR 180 that implement Executive Orders 12549 (3 CFR
part 1986 Comp., p. 189) and 12689 (3 CFR part 1989 Comp., p. 235), “Debarment
and Suspension.” SAM Exclusions contains the names of parties debarred,
suspended, or otherwise excluded by agencies, as well as parties declared ineligible
under statutory or regulatory authority other than Executive Order 12549.
2.11.1.6.
Byrd Anti-Lobbying Amendment (31 U.S.C. 1352).
Contractors that apply or
bid for an award exceeding $100,000 must file the required certification. Each tier
certifies to the tier above that it will not and has not used Federal appropriated funds
to pay any person or organization for influencing or attempting to influence an
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officer or employee of any agency, a member of Congress, officer or employee of
Congress, or an employee of a member of Congress in connection with obtaining
any Federal contract, grant or any other award covered by 31 U.S.C. 1352. Each
tier must also disclose any lobbying with non-Federal funds that takes place in
connection with obtaining any Federal award. Such disclosures are forwarded from
tier to tier up to the non-Federal award.
2.12.
Certifications.
2.12.1.
Unless prohibited by Federal statutes or regulations, Recipient may require
Subrecipient to submit certifications and representations required by Federal statutes
or regulations on an annual basis. 2 CFR §200.208. Submission may be required more
frequently if Subrecipient fails to meet a requirement of the Federal award.
Subrecipient shall certify in writing to the State at the end of the Award that the project
or activity was completed or the level of effort was expended. 2 CFR §200.201(3). If
the required level of activity or effort was not carried out, the amount of the Award
must be adjusted.
2.13.
Exemptions.
2.13.1.
These Federal Provisions do not apply to an individual who receives an Award as a
natural person, unrelated to any business or non-profit organization the individual may
own or operate in their name.
2.13.2.
A Contractor with gross income from all sources of less than $300,000 in the previous
tax year is exempt from the requirements to report Subawards and the Total
Compensation of its most highly compensated Executives.
2.13.3.
There are no Transparency Act reporting requirements for Vendors.
2.14.
Event of Default.
2.14.1.
Failure to comply with these Federal Provisions shall constitute an event of default
under the Contract and the State of Colorado may terminate the Contract upon 30 days
prior written notice if the default remains uncured five calendar days following the
termination of the 30 day notice period. This remedy will be in addition to any other
remedy available to the State of Colorado under the Contract, at law or in equity.
3.
NONDISCRIMINATION UNDER FEDERAL AND STATE AUTHORITY
3.1.
In addition to the statutes described in section 2.11 above, the Contractor shall also at all
times during the term of this Contract strictly adhere to, and comply with, all applicable
Federal and State laws, and their implementing regulations, as they currently exist and may
hereafter be amended, which are incorporated herein by this reference as terms and
conditions of this Contract. The Contractor shall also require compliance with these statutes
and regulations in subcontracts and subgrants permitted under this Contract. Applicable
Federal and State law and regulations include:
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Age Discrimination Act of 1975, as amended
42 U.S.C. 6101, et seq.,
45 CFR 90, 45 CFR 91
Age Discrimination in Employment Act of 1967
29 U.S.C. 621-634
Americans with Disabilities Act of 1990 (ADA)
42 U.S.C. 12101, et seq.,
28 CFR Part 35
Equal Pay Act of 1963
29 U.S.C. 206(d)
Federal Water Pollution Control Act, as
amended
33 U.S.C. 1251, et seq.
Immigration Reform and Control Act of 1986
8 U.S.C. 1324b
Section 504 of the Rehabilitation Act of 1973, as
amended
29 U.S.C. 794, 45 CFR
84, 45 CFR 85
Section 508 of the Rehabilitation Act of 1973
29 USC 794, 36 CFR
1194
Title VI of the Civil Rights Act of 1964, as
amended
42 U.S.C. 2000d, 45 CFR
80
Title VII of the Civil Rights Act of 1964
42 U.S.C. 2000e, 29 CFR
1606.2
Title IX of the Education Amendments of 1972,
as amended
20 U.S.C. 1681
Civil Rights Division
Section 24-34-301, CRS,
et seq
.
3.2.
The Contractor also shall comply with any and all laws and regulations prohibiting
discrimination in the specific program(s) which is/are the subject of this Contract. In
consideration of and for the purpose of obtaining any and all federal and/or state financial
assistance, the Contractor makes the following assurances, upon which the State relies.
3.2.1.
The Contractor shall not discriminate against any person on the basis of race, color,
ethnic or national origin, ancestry, age, sex, gender, sexual orientation, gender identity
and expression, religion, creed, political beliefs, or disability, including Acquired
Immune Deficiency Syndrome (AIDS) or AIDS-related conditions, in performance of
Work under this Contract
3.2.2.
At all times during the performance of this Contract, no qualified individual with a
disability shall, by reason of such disability, be excluded from participation in, or
denied benefits of the service, programs, or activities performed by the Contractor, or
be subjected to any discrimination by the Contractor.
3.2.3.
All websites and web content must meet Web Content Accessibility Guidelines
(WCAG) 2.1 Level AA standards, as issued by the World Wide Web Consortium.
3.3.
Procurement Provisions
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3.3.1.
The Contractor shall take all necessary affirmative steps, as required by 45 C.F.R.
92.36(e), Colorado Executive Order and Procurement Rules, to assure that small and
minority businesses and women’s business enterprises are used, when possible, as
sources of supplies, equipment, construction, and services purchased under this
Contract.
4.
FEDERAL
FINANCIAL
PARTICIPATION
RELATED
INTELLECTUAL
PROPERTY OWNERSHIP
4.1.
In addition to the intellectual property ownership rights specified in the Contract, the
following subsections enumerate the intellectual property ownership requirements the
Contractor shall meet during the term of the Contract in relation to federal financial
participation under 42 CFR §433.112 and 45 CFR §95.617.
4.1.1.
The Contractor shall notify the State before designing, developing, creating or
installing any new data, new software or modification of a software using Contract
Funds. The Contractor shall not proceed with such designing, development, creation or
installation of data or software without express written approval from the State.
4.1.2.
If the Contractor uses Contract Funds to develop necessary materials, including, but
not limited to, programs, products, procedures, data and software to fulfill its
obligations under the Contract, the Contractor shall document all Contract Funds used
in the development of the Work Product, including, but not limited to the materials,
programs, procedures, and any data, software or software modifications.
4.1.2.1.
The terms of this Contract will encompass sole payment for any and all Work
Product and intellectual property produced by the Contractor for the State. The
Contractor shall not receive any additional payments for licenses, subscriptions, or
to remove a restriction on any intellectual property Work Product related to or
developed under the terms of this Contract.
4.1.3.
The Contractor shall provide the State comprehensive and exclusive access to and
disclose all details of the Work Product produced using Contract Funds.
4.1.4.
The Contractor shall hereby assign to the State, without further consideration, all right,
interest, title, ownership and ownership rights in all work product and deliverables
prepared and developed by the Contractor for the State, either alone or jointly, under
this Contract, including, but not limited to, data, software and software modifications
designed, developed, created or installed using Contract Funds, as allowable in the
United States under 17 U.S.C.S. §201 and §204 and in any foreign jurisdictions.
4.1.4.1.
Such assigned rights include, but are not limited to, all rights granted under 17
U.S.C.S §106, the right to use, sell, license or otherwise transfer or exploit the Work
Product and the right to make such changes to the Work Product as determined by
the State.
4.1.4.2.
This assignment shall also encompass any and all rights under 17 U.S.C.S §106A,
also referred to as the Visual Artists Rights Act of 1990 (VARA), and any and all
moral rights to the Work Product.
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4.1.4.3.
The Contractor shall require its employees and agents to, promptly sign and deliver
any documents and take any action the State reasonably requests to establish and
perfect the rights assigned to the State or its designees under these provisions.
4.1.4.4.
The Contractor shall execute the assignment referenced herein immediately upon
the creation of the Work Product pursuant to the terms of this Contract.
4.1.5.
The State claims sole ownership and all ownership rights in all copyrightable software
designed, developed, created or installed under this contract, including, but not limited
to:
4.1.5.1.
Data and software, or modifications thereof created, designed or developed using
Contract Funds.
4.1.5.2.
Associated documentation and procedures designed and developed to produce any
systems, programs, reports and documentation.
4.1.5.3.
All other Work Products or documents created, designed, purchased, or developed
by the Contractor and funded using Contract Funds.
4.1.6.
All ownership and ownership rights pertaining to Work Product created in the
performance of this Contract will vest with the State, regardless of whether the Work
Product was developed by the Contractor or any Subcontractor.
4.1.7.
The Contractor shall fully assist in and allow without dispute, both during the term of
this Contract and after its expiration, registration by the State of any and all copyrights
and other intellectual property protections and registrations in data, software, software
modifications or any other Work Product created, designed or developed using
Contract Funds.
4.1.8.
The State reserves a royalty-free, non-exclusive and irrevocable license to produce,
publish or otherwise use such software, modifications, documentation and procedures
created using Contract Funds on behalf of the State, the Federal Department of Health
and Human Services (HHS) and its contractors. Such data and software includes, but
is not limited to, the following:
4.1.8.1.
All computer software and programs, which have been designed or developed for
the State, or acquired by the Contractor on behalf of the State, which are used in
performance of the Contract.
4.1.8.2.
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.
4.1.8.3.
All necessary data files.
4.1.8.4.
User and operation manuals and other documentation.
4.1.8.5.
System and program documentation in the form specified by the State.
4.1.8.6.
Training materials developed for State staff, agents or designated representatives in
the operation and maintenance of this software.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit H, PII Certification
Page 1 of 1
EXHIBIT H, PII CERTIFICATION
STATE OF COLORADO
THIRD PARTY ENTITY / ORGANIZATION CERTIFICATION FOR ACCESS TO PII
THROUGH A DATABASE OR AUTOMATED NETWORK
Pursuant
to
§
24-74-105,
C.R.S.,
I,
_________________,
on
behalf
of
__________________________ (legal name of entity / organization) (the “Organization”), hereby
certify under the penalty of perjury that the Organization has not and will not use or disclose any
Personal Identifying Information, as defined by § 24-74-102(1), C.R.S., for the purpose of
investigating for, participating in, cooperating with, or assisting Federal Immigration Enforcement,
including the enforcement of civil immigration laws, and the Illegal Immigration and Immigrant
Responsibility Act, which is codified at 8 U.S.C. §§ 1325 and 1326, unless required to do so to
comply with Federal or State law, or to comply with a court-issued subpoena, warrant or order.
I hereby represent and certify that I have full legal authority to execute this certification on behalf
of the Organization.
Signature:
__________________________
Printed Name:
__________________________
Title:
__________________________
Date:
___________
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Principal, Advisory
Eveline Van Beek
8/15/2023 | 12:25 EDT
Eveline Van Beek
KPMG LLP
Exhibit I – Substance Use Data
Page 1 of 2
EXHIBIT I, SUBSTANCE USE DATA
1.
COMPLIANCE WITH 42 CFR PART 2
1.1.
As part of this Contract the Department will provide Contractor with or Contractor will
receive or otherwise have access to, Part 2 Data for enrolled Members as defined under 42
CFR Part 2. Contractor shall handle all Part 2 Data in conformity with the requirements of
42 CFR Part 2 and 42 CFR § 2.33.
1.2.
Contractor shall use Part 2 Data only for the following purposes:
1.2.1.
Underwriting, enrollment, premium rating, and other activities related to the creation,
renewal, or replacement of a contract of health insurance or health benefits, and/or
ceding, securing, or placing a contract for reinsurance of risk relating to claims for
health care.
1.2.2.
Business planning and development, such as conducting cost management and
planning-related analyses related to managing and operating, including formulary
development and administration, development or improvement of methods of payment
or coverage policies.
1.2.3.
Risk adjusting amounts due based on enrollee health status and demographic
characteristics.
1.2.4.
Other payment/health care operations activities not expressly prohibited under Part 2.
1.3.
Contractor shall not use the Part 2 Data for any other purpose, to include care coordination
or case management, without appropriate Member consent as defined under 42 CFR Part
2.
1.4.
Contractor, upon receipt of Part 2 Data, shall:
1.4.1.
Not disclose Part 2 data without appropriate consent except as permitted under 42 CFR
Part 2 and in compliance with this Contract, which includes Exhibit B, Sections 6.1.1.1
through 6.1.1.1.5.
1.4.2.
Create safeguards, including documented policies and procedures, to prevent
unauthorized uses and disclosures of Part 2 Data. These policies and procedures shall
be reported in Contractors’ Data Governance Policy.
1.4.3.
Immediately report any unauthorized use, disclosures, or breaches of Part 2 Data to the
Department.
1.5.
This information has been disclosed to Contractor from records protected by 42 CFR Part
2. Federal law prohibits Contractor from making any further disclosure of the Part 2 Data
that identifies a Member as having or having had a substance use disorder either directly,
by reference to publicly available information, or through verification of such identification
by another person unless further disclosure is expressly permitted by the written consent
of the Member or as otherwise permitted by 42 CFR part 2. A general authorization for the
release of medical or other information is NOT sufficient for this purpose (
see
§ 2.31). The
federal rules restrict any use of the information to investigate or prosecute with regard to a
crime any patient with a substance use disorder, except as provided at §§ 2.12(c)(5) and
2.65.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit I – Substance Use Data
Page 2 of 2
1.6.
Contractor only shall redisclose Part 2 Data to a third party if the third party is a contracted
agent of Contractor helping to perform its duties under the Contract and the contracted
agent only discloses Part 2 Data back to Contractor or the Department.
1.7.
If Contractor obtains Member consent to disclose Part 2 Data, Contractor may disclose the
Part 2 Data in accordance with the consent to any person or category of persons identified
or designated in the consent, except that disclosure to central registries and in connection
with criminal justice referrals shall meet the requirements of 42 CFR § 2.34 and 42 CFR §
2.35.
1.8.
If Contractor obtains Member consent to disclose Part 2 Data for payment or health care
operations activities, a lawful holder who receives such data may further disclose that data
as may be necessary for the lawful holder’s contractors, subcontractor or legal
representatives to carry out payment or health care operations on behalf of such lawful
holder in accordance with 42 CFR § 2.33. Part 2 Data disclosures shall be limited to the
information necessary to carry out the stated purpose of the disclosure.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 1 of 17
EXHIBIT J, DELIVERABLES PAYMENTS
Exhibit B
Section
Number
Deliverable Name
Fixed
Deliverable
Payment in
SFY24
Fixed
Deliverable
Payment in
SFY25
Fixed
Deliverable
Payment in
SFY26
Fixed
Deliverable
Payment in
SFY27
Fixed
Deliverable
Payment in
SFY28
Additional
Payment Terms
(all Deliverables
to be paid
quarterly (see
Exhibit C))
2.9.1.2
Data Exchange
Document
$162,518.11
$0.00
$0.00
$0.00
$0.00
2.9.2.1.2
Data Quality Report
$48,755.43 per
quarter;
$195,021.72
total in SFY24
$28,440.67 per
quarter;
$113,762.68
total in SFY25
$21,669.08 per
quarter;
$86,676.32 total
in SFY26
$21,669.08 per
quarter;
$86,676.32 total
in SFY27
$21,669.08 per
quarter;
$86,676.32 total
in SFY28
Payments due
quarterly in each
SFY after the final
Data Quality
Report in each
calendar quarter is
accepted by the
Department in
each SFY.
2.10.1.1.1
Initial Draft Scope of
the SOC 1, Type II
Audit
$140,849.03
$0.00
$0.00
$0.00
$0.00
2.10.1.6.5
Contractor's Responses
to Findings, SOC 1,
Type II Report Action
Plan, and SOC 1, Type
II report and provide
monthly updates
$65,007.24
$65,007.24
$65,007.24
$65,007.24
$65,007.24
Payments due once
per SFY at the
time at which the
Department
accepted final
Response that fully
and finally
resolved any and
all findings.
2.10.1.6.3
SOC 1, Type II Report
$86,676.32
$86,676.32
$86,676.32
$86,676.32
$86,676.32
2.11.4.1.1
Audit/Assessment
Report
$108,345.41
$0.00
$0.00
$0.00
$0.00
3.2.1.4.1
Master Project
Management Plan
$812,590.55
$0.00
$0.00
$0.00
$0.00
3.2.5.1.2
Communications
Management Plan
$43,338.16
$0.00
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 2 of 17
3.3.1.1.2
Contractor's
Technology Solution
Configuration
Management Plan
$0.00
$119,179.95
$0.00
$0.00
$0.00
3.3.1.1.4.2
Revised Contractor's
Technology Solution
Configuration
Management Plan
$0.00
$32,503.62
$65,007.24
$65,007.24
$65,007.24
Maximum of one
payment per SFY,
as identified.
3.3.2.1.2
ICD for Department-
Defined Integration
$0.00
$140,849.03
$0.00
$0.00
$0.00
3.3.2.1.4.1
Updated ICD
$0.00
$0.00
$54,172.70
$54,172.70
$54,172.70
Maximum of one
payment per SFY,
as identified.
3.3.4.3
Contract Kickoff
Meeting
$54,172.70
$0.00
$0.00
$0.00
$0.00
3.3.5.1.2
Weekly Project Status
Report
$108,345.41 per
calendar
quarter;
$433,381.64
total in SFY24
$40,629.53 per
calendar
quarter;
$162,518.12
total in SFY25
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY26
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY27
$32,503.62 per
calendar
quarter;
$130,014.18
total in SFY28
Payments due
quarterly in each
SFY after the final
Weekly Project
Status Report in
each calendar
quarter is accepted
by the Department
in each SFY.
3.3.5.3.4
Monthly Contract
Management Report
$86,676.33 per
calendar
quarter;
$346,705.32
total in SFY24
$20,314.76 per
calendar
quarter;
$81,259.04 total
in SFY25
$16,251.81 per
calendar
quarter;
$65,007.24 total
in SFY26
$16,251.81 per
calendar
quarter;
$65,007.24 total
in SFY27
$16,251.81 per
calendar
quarter;
$65,007.24 total
in SFY28
Payments due
quarterly in each
SFY after the final
Monthly Contract
Management
Report in each
calendar quarter is
accepted by the
Department in
each SFY.
3.3.7.1.8
Initial RTM
$54,172.70
$0.00
$0.00
$0.00
$0.00
3.3.7.2
Updated RTM
$195,021.73
$162,518.11
$32,503.62
$0.00
$0.00
Maximum of one
payment per SFY,
as identified.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 3 of 17
3.3.8.1.2
Training Management
Plan
$162,518.11
$0.00
$0.00
$0.00
$0.00
3.3.9.1.2
Operational Readiness
Plan
$249,194.43
$0.00
$0.00
$0.00
$0.00
3.3.11.3
Operational Readiness
Review Meeting
$140,849.03
$0.00
$0.00
$0.00
$0.00
3.3.12.1.2
CMS Certification
Implementation Plan
$270,863.52
$0.00
$0.00
$0.00
$0.00
3.3.13.3.2
Operations and
Maintenance Plan
$270,863.52
$0.00
$0.00
$0.00
$0.00
3.3.16.1.4
APM 2 Program CMS
Certification
Management Plan
$86,676.32
$0.00
$0.00
$0.00
$0.00
3.3.17.3.2
CMS Certification of
the Technology
Solution as identified
by the Department
$0.00
$0.00
$140,849.03
$0.00
$0.00
3.3.18.1.2
Requirements
Specification Document
(RSD)
$75,841.78
$0.00
$0.00
$0.00
$0.00
3.3.19.1.2
Design Specification
Document (DSD)
$97,510.87
$0.00
$0.00
$0.00
$0.00
3.3.20.1.2
Business Continuity
and Disaster Recovery
Plan
$86,676.32
$0.00
$0.00
$0.00
$0.00
3.3.20.2.1
Annual Business
Continuity and Disaster
Recovery Plan
Affirmation
$10,834.54
$10,834.54
$10,834.54
$10,834.54
$10,834.54
3.3.21.1.3
Contract Turnover Plan
$140,849.03
$0.00
$0.00
$0.00
$0.00
3.4.3.1.1
Revised
Communications
Management Plan
$0.00
$43,338.16
$0.00
$0.00
$0.00
Maximum of one
payment in SFY25,
as identified.
5.2.1.2
Data Dictionary
$54,172.70
$0.00
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 4 of 17
5.2.1.4.2
Revised Data
Dictionary
$10,834.54
$10,834.54
$10,834.54
$10,834.54
$10,834.54
Maximum of one
payment per SFY,
as identified.
5.3.2.1.1
Mapping Documents
$400,878.00
$0.00
$0.00
$0.00
$0.00
6.2.2
System Security Plan
$119,179.95
$0.00
$0.00
$0.00
$0.00
6.2.4.2
Revised System
Security Plan
$0.00
$43,338.16
$43,338.16
$43,338.16
$86,676.32
8.3.3
Test Results
$0.00
$195,021.73
$0.00
$0.00
$0.00
Maximum of one
payment in SFY25,
as identified.
12.2.1
Survey Reports
$0.00
$65,007.24
$65,007.24
$65,007.24
$65,007.24
Maximum of one
payment per SFY,
as identified.
12.4.3
Training Materials
$0.00
$54,172.70
$54,172.70
$54,172.70
$54,172.70
Maximum of one
payment per SFY,
as identified.
12.5.1.1.3
Train-the-Trainer
Materials
$0.00
$27,086.35
$27,086.35
$27,086.35
$27,086.35
Maximum of one
payment per SFY,
as identified.
13.1.2.1.1.2
APM 2 Program
Operation Transition
Plan
$205,856.27
$0.00
$0.00
$0.00
$0.00
13.1.2.1.4.2
APM Program
Evaluation and
Feedback Report
$985,943.19
$0.00
$0.00
$0.00
$0.00
13.1.2.1.6.6
Ad Hoc Analyses
$0.00
$162,518.11
$97,510.87
$97,510.87
$195,021.73
Maximum of one
payment per SFY,
as identified.
13.1.2.1.7.2
APM 2 Program
Modeling Changes Plan
and Implementation
Strategy
$108,345.41
$0.00
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 5 of 17
13.1.2.1.8.3
APM 2 Partial
Capitation and Chronic
Condition Episodes
Threshold Model
$379,208.92
$0.00
$0.00
$0.00
$0.00
13.1.2.1.9.2
APM 2 Program
Provider Guidebook
$130,014.49
$0.00
$0.00
$0.00
$0.00
13.1.2.1.10.2
Primary Care Data
Sharing Analytics
Solution for the APM 2
Program
$0.00
$0.00
$866,763.25
$0.00
$0.00
13.1.2.2.1.2
APM 2 Program
Implementation Plan
$227,525.35
$0.00
$0.00
$0.00
$0.00
13.1.2.2.2.2
APM 2 Opt-Out Plan
$108,345.41
$0.00
$0.00
$0.00
$0.00
13.1.2.2.3.2
Chronic Condition
Episode Logic and
Business Rules
$75,841.78
$0.00
$0.00
$0.00
$0.00
13.1.2.2.4.2
APM 2 Program
Reconciliation Plan
$216,690.81
$0.00
$0.00
$0.00
$0.00
13.1.2.2.6.2
Updated APM 2
Actuarial Narrative
$97,510.87
$0.00
$0.00
$0.00
$0.00
13.1.2.2.7.2
APM 2 Stakeholder
Engagement Plan
$249,194.43
$0.00
$0.00
$0.00
$0.00
13.1.2.2.7.2
APM 2 Stakeholder
Engagement Plan
$0.00
$54,172.70
$54,172.70
$54,172.70
$54,172.70
Maximum of one
payment per SFY,
as identified.
13.1.2.2.8.2
RAE APM 2 Training
Overview
$200,439.00
$0.00
$0.00
$0.00
$0.00
13.1.2.2.9.1.2
Rate Workbooks
$108,345.41
$0.00
$0.00
$0.00
$0.00
13.1.2.3.1.1
Revised Rate
Workbooks
$0.00
$0.00
$43,338.16
$0.00
$0.00
13.1.2.3.2.3
Rate Workbooks
Reviews
$0.00
$65,007.24
$65,007.24
$65,007.24
$130,014.49
Maximum of one
payment per SFY,
as identified.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 6 of 17
13.1.2.3.3.2
Enrollment Summary
Report
$0.00
$54,172.70
$86,676.32
$86,676.32
$86,676.32
Maximum of one
payment per SFY,
as identified.
13.1.2.3.5.2
Final Aggregated APM
2 Performance Report
$0.00
$216,690.81
$216,690.81
$216,690.81
$216,690.81
13.1.2.3.6.2
External Facing APM 2
Model Performance
Report
$0.00
$140,849.03
$140,849.03
$140,849.03
$140,849.03
13.1.2.3.7.2
Final Provider
Performance Reports
$0.00
$140,849.03
$140,849.03
$140,849.03
$140,849.03
13.1.2.3.8.2
APM 2 Program
Management and
Tracking Report
$0.00
$43,338.00 per
calendar quarter,
starting in the
third quarter of
SFY25 (i.e.,
starting in the
January through
March quarter);
$86,676.00 total
in SFY25
$32,503.50 per
calendar
quarter;
$130,014.00
total in SFY26
$32,503.50 per
calendar
quarter;
$130,014.00
total in SFY26
$32,503.50 per
calendar
quarter;
$130,014.00
total in SFY26
Payments due
quarterly in each
SFY after the final
APM 2 Program
Management and
Tracking Report in
each calendar
quarter is accepted
by the Department
in each SFY.
13.1.2.3.9.2.2
Slide Presentation and
Agenda
$0.00
$97,510.87
$130,014.49
$130,014.49
$130,014.49
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Slide
Presentation and
Agenda was
accepted by the
Department.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 7 of 17
13.1.2.3.9.4.1
Webinar Recording
$10,834.54
$10,834.54
$10,834.54
$10,834.54
$10,834.54
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Webinar
Recording was
accepted by the
Department.
13.1.2.3.10.2
RAE Practice
Facilitator Trainings
$0.00
$108,345.41
$184,187.19
$216,690.81
$270,863.52
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final RAE
Practice Facilitator
Trainings were
accepted by the
Department.
13.1.2.3.11.1.2
Data Update Provider
Status Report
$0.00
$0.00
$24,377.50 per
calendar quarter,
starting in the
third quarter of
SFY26 (i.e.,
starting in the
January through
March quarter);
$48,755.00 total
in SFY26
$16,251.75 per
calendar
quarter;
$65,007.00 total
in SFY27
$16,251.75 per
calendar
quarter;
$65,007.00 total
in SFY28
Payments due
quarterly in each
SFY after the final
Data Update
Provider Status
Report in each
calendar quarter is
accepted by the
Department in
each SFY.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 8 of 17
13.1.2.3.11.2.2
Primary Care Data
Sharing Analytics
Solution for the APM 2
Program Change
Report
$0.00
$0.00
$43,338.00 per
calendar quarter,
starting in the
third quarter of
SFY26 (i.e.,
starting in the
January through
March quarter);
$86,676.00 total
in SFY26
$32,503.50 per
calendar
quarter;
$130,014.00
total in SFY27
$32,503.50 per
calendar
quarter;
$130,014.00
total in SFY28
Payments due
quarterly in each
SFY after the final
Primary Care Data
Sharing Analytics
Solution for the
APM 2 Program
Change Report in
each calendar
quarter is accepted
by the Department
in each SFY.
13.1.2.4.1.2
Primary Care Close-
Out Report for the
APM 2 Program
$0.00
$0.00
$0.00
$0.00
$140,849.03
13.1.2.4.2.2
Primary Care Transition
Plan for the APM 2
Program
$0.00
$0.00
$0.00
$0.00
$130,014.49
13.1.2.5.1.1
Revised APM 2
Program Modeling
Changes Plan and
Implementation
Strategy
$0.00
$0.00
$32,503.62
$32,503.62
$65,007.24
13.1.2.5.2.1.1
Revised APM 2 Partial
Capitation and Chronic
Condition Episodes
Threshold Model
$0.00
$65,007.24
$65,007.24
$65,007.24
$65,007.24
Maximum of one
payment per SFY,
as identified.
13.1.2.5.3.1
Revised APM 2
Program Provider
Guidebook
$140,849.03
$21,669.08
$21,669.08
$21,669.08
$21,669.08
Maximum of one
payment per SFY,
as identified.
13.1.2.5.4.1
Revised Chronic
Condition Episode
Logic and Business
Rules
$0.00
$32,503.62
$32,503.62
$32,503.62
$32,503.62
Maximum of one
payment per SFY,
as identified.
13.1.2.5.5.1
Revised Updated APM
2 Actuarial Narrative
$0.00
$97,510.87
$97,510.87
$97,510.87
$97,510.87
Maximum of one
payment per SFY,
as identified.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 9 of 17
13.1.3.1.1.1
Pediatric
Recommendation of
Analysis and Report
$140,849.03
$0.00
$0.00
$0.00
$0.00
13.1.3.1.2.2
Pediatric
Comprehensive
Literature Review
Report
$140,849.03
$0.00
$0.00
$0.00
$0.00
13.1.3.1.3.2
Pediatric Pre-Design
Research Report
$140,849.03
$0.00
$0.00
$0.00
$0.00
13.1.3.1.4.2.2
Pediatric Stakeholder
Engagement Meeting
Summary
$260,028.97
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified.
13.1.3.1.7.2
Pediatric APM Program
Model Design
Document
$335,870.76
$0.00
$0.00
$0.00
$0.00
13.1.3.1.9.2
RAE Communications
Materials
$0.00
$65,007.24
$0.00
$0.00
$0.00
13.1.3.1.10.1
RAE Trainings
$0.00
$43,338.16
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final RAE
Trainings were
accepted by the
Department.
13.1.3.1.11.2
Initial Payment Rates
$0.00
$140,849.03
$0.00
$0.00
$0.00
13.1.3.1.12.1
Initial Quality
Thresholds
$0.00
$140,849.03
$0.00
$0.00
$0.00
13.1.3.1.14.2
Pediatric APM Program
Provider Guidebook
$0.00
$0.00
$173,352.65
$0.00
$0.00
13.1.3.1.15.2
Pediatric APM Program
Reconciliation Plan
$0.00
$97,510.87
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 10 of 17
13.1.3.2.1.2
Primary Care Data
Sharing Analytics
Solution for the
Pediatric APM Program
$0.00
$0.00
$910,101.41
$0.00
$0.00
13.1.3.3.2.2
Pediatric APM Program
Implementation Plan
$0.00
$130,014.49
$0.00
$0.00
$0.00
13.1.3.3.3.1
CMS Meeting
Attendance
$97,510.87
$81,259.05
$65,007.24
$65,007.24
$65,007.24
Maximum of one
payment per SFY,
as identified.
13.1.3.3.4.2
Pediatric APM Program
Management Tracker
$0.00
$27,086.36 per
calendar quarter,
starting in the
third quarter of
SFY25 (i.e.,
starting in the
January through
March quarter);
$54,172.72 total
in SFY25
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY26
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY27
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY28
Payments due
quarterly in each
SFY after the final
Pediatric APM
Program
Management
Tracker in each
calendar quarter is
accepted by the
Department in
each SFY.
13.1.3.4.1.1
Revised Provider
Payment Rate
Communications
Materials
$0.00
$97,510.87
$54,172.70
$54,172.70
$54,172.70
13.1.3.4.2.2
Final Aggregated
Performance Report
$0.00
$162,518.11
$130,014.49
$130,014.49
$130,014.49
13.1.3.4.3.2
Final Provider
Performance Reports
$0.00
$119,179.95
$119,179.95
$119,179.95
$119,179.95
13.1.3.4.4.1.1
External Facing Model
Performance Report
$0.00
$75,841.78
$54,172.70
$54,172.70
$54,172.70
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 11 of 17
13.1.3.5.1.1.2
Slide Presentation and
Agenda
$0.00
$54,172.70
$86,676.32
$86,676.32
$86,676.32
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Slide
Presentation and
Agenda was
accepted by the
Department.
13.1.3.5.1.3.4
Pediatric APM Program
Annual Stakeholder
Engagement Report
$0.00
$32,503.62
$32,503.62
$32,503.62
$32,503.62
Maximum of one
payment per SFY,
as identified.
13.1.3.6.1.2
Primary Care Close-
Out Report
$0.00
$0.00
$0.00
$0.00
$32,503.62
13.1.3.6.2.2
Primary Care Transition
Plan for the Pediatric
APM Program
$0.00
$0.00
$0.00
$0.00
$43,338.16
13.1.3.7.1.2
Revised Payment Rates
$0.00
$0.00
$130,014.49
$130,014.49
$130,014.49
13.1.3.7.2.2
Revised Quality
Thresholds
$0.00
$0.00
$130,014.49
$130,014.49
$130,014.49
13.1.3.8.1.2
Updated Provider Data
Status Report
$0.00
$65,007.24
$130,014.49
$130,014.49
$130,014.49
13.1.3.8.2.2
Primary Care Data
Sharing Analytics
Solution Change Report
for the Pediatric APM
Program
$0.00
$65,007.24
$130,014.49
$130,014.49
$130,014.49
Maximum of one
payment per SFY,
as identified.
13.2.1.1.1.2
Maternity Bundled
Payment Program
Operation Transition
Plan
$260,028.97
$0.00
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 12 of 17
13.2.1.2.1.2
Maternity Bundled
Payment Program
Evaluation Plan
$151,683.57
$0.00
$0.00
$0.00
$0.00
13.2.1.2.3.2
Maternity Bundled
Payment Program
Evaluation Report
$227,525.35
$0.00
$0.00
$0.00
$0.00
13.2.1.3.1.2
Maternity Bundled
Payment Program Data
Sharing Solution
(“Portal/Dashboard”)
$834,259.63
$0.00
$0.00
$0.00
$0.00
13.2.2.1.2
Updated Public-Facing
Maternity Bundled
Payment Program
Documentation and
Information
$184,187.19
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Updates
were accepted by
the Department.
13.2.2.2.1.2
Provider Recruitment
Outreach Strategy
$216,690.81
$0.00
$0.00
$0.00
$0.00
13.2.2.2.2.3
Provider Recruitment
Outreach Materials
$130,014.49
$0.00
$0.00
$0.00
$0.00
13.2.2.2.3.1.6
Maternity Bundled
Payment Program
Webinars
$205,856.27
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Maternity
Bundled Payment
Program Webinar
was accepted by
the Department.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 13 of 17
13.2.2.2.4.1
Maternity Bundled
Payment Program
Feedback Collection
Activities for both
Internal Stakeholders
and External
Stakeholders
$205,856.27
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final document
is accepted by the
Department.
13.2.2.2.4.3
Summary of
Stakeholder Feedback
for both Internal
Stakeholders and
External Stakeholders
$346,705.30
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the final Summary
document is
accepted by the
Department.
13.2.3.1.2
Quarterly Provider
Performance Report
$101,122.38per
calendar quarter,
starting in the
second quarter
of SFY24 (i.e.,
starting in the
October through
December
quarter);
$303,367.14
total in SFY24
$40,629.53 per
calendar
quarter;
$162,518.12
total in SFY25
$65,007.24 per
calendar
quarter;
$260,028.96
total in SFY26
$75,841.79 per
calendar
quarter;
$303,367.16
total in SFY27
$75,841.79 per
calendar
quarter;
$303,367.16
total in SFY28
13.2.3.2.1
Initial Cost Thresholds
and Quality Goals
$70,424.51
$70,424.51
$70,424.51
$70,424.51
$70,424.51
13.2.3.3.1
Annual Provider
Episode Cost
Thresholds Update
$65,007.24
$65,007.24
$65,007.24
$65,007.24
$65,007.24
13.2.3.4.1
Annual Provider
Quality Goals Update
$65,007.24
$65,007.24
$65,007.24
$65,007.24
$65,007.24
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 14 of 17
13.2.3.5.2
Annual Maternity
Bundled Payment
Program Reconciliation
Report for each
Provider
$368,374.38
$108,345.41
$108,345.41
$108,345.41
$108,345.41
13.2.3.6.1.2
Maternity Bundled
Payment Program
Operation Transition
Plan
$0.00
$0.00
$173,352.65
$0.00
$0.00
13.2.3.6.2.2
Maternity Bundled
Payment Program to
New Maternity APM
Program Transition
Plan
$0.00
$0.00
$151,683.57
$0.00
$0.00
13.3.1.1.2
Existing Maternity
APM Scoping Review
Report
$0.00
$108,345.41
$0.00
$0.00
$0.00
13.3.1.2.2
Health Disparities
Research Report
$0.00
$119,179.95
$0.00
$0.00
$0.00
13.3.1.3.4.4.1
Final Stakeholder
Meeting Presentation
$335,870.76
$0.00
$0.00
$0.00
$0.00
Maximum of one
payment per SFY,
as identified, due
in the calendar
quarter following
the calendar
quarter in which
the last submitted
Final Stakeholder
Meeting
Presentation was
accepted by the
Department.
13.3.1.4.2
Workgroup Summary
Report
$0.00
$97,510.87
$0.00
$0.00
$0.00
13.3.2.1.2.2
New Maternity APM
Program Pilot Testing
Plan
$297,949.87
$0.00
$0.00
$0.00
$0.00
13.3.2.1.4.2
Model Design Report
$0.00
$0.00
$140,849.03
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 15 of 17
13.3.3.1.2
Pilot Provider-Facing
Reports
$0.00
$0.00
$173,352.65
$0.00
$0.00
13.3.3.1.4.1
Revised Pilot Provider-
Facing Reports
$0.00
$0.00
$130,014.49
$0.00
$0.00
13.4.1.1.1.2
Differences in Episode
Groupers Document
$162,518.11
$0.00
$0.00
$0.00
$0.00
13.4.1.1.2.2
Episode Grouper
Output Comparison
Report
$411,712.54
$0.00
$0.00
$0.00
$0.00
13.4.1.1.6.2
Rural Facility
Evaluation Plan
$249,194.43
$0.00
$0.00
$0.00
$0.00
13.4.1.2.1.2
Procedure Episodes
Plan
$65,007.24
$0.00
$0.00
$0.00
$0.00
13.4.1.2.10.2
Document of
Recommended
Performance Measures
$0.00
$21,669.08
$0.00
$0.00
$0.00
13.4.1.2.11.2
Performance Measure
Specifications
Document
$379,208.92
$0.00
$0.00
$0.00
$0.00
13.4.1.2.2.2
Report of Feasibility
$32,503.62
$0.00
$0.00
$0.00
$0.00
13.4.1.2.3.1
Procedure Episodes
$108,345.41
$0.00
$0.00
$0.00
$0.00
13.4.1.2.4.2
Procedure Episode
Selection Criteria
$108,345.41
$0.00
$0.00
$0.00
$0.00
13.4.1.2.5.2
Procedure Episode
Selection Report
$0.00
$270,863.52
$0.00
$0.00
$0.00
13.4.1.2.9.2
Feasibility of
Measuring Surgeon
Performance Report
$0.00
$227,525.35
$0.00
$0.00
$0.00
13.4.1.3.4.2
Stakeholder Working
Group Feedback and
Recommendations
Document #1
$0.00
$140,849.03
$0.00
$0.00
$0.00
13.4.1.3.5.2
Impact of
Recommended
Revisions Document #1
$0.00
$65,007.24
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 16 of 17
13.4.1.4.1.2
Measurement and
Validation Report
$0.00
$335,870.76
$0.00
$0.00
$0.00
13.4.1.4.2.2
Risk Adjustment
Methods Document
$0.00
$227,525.35
$0.00
$0.00
$0.00
13.4.1.4.3.2
Risk Adjustment Model
Document
$0.00
$173,352.65
$0.00
$0.00
$0.00
13.4.1.4.4.2
Risk-Adjusted
Measurement and
Validation Report
$0.00
$54,172.70
$0.00
$0.00
$0.00
13.4.1.5.4.2
Stakeholder Working
Group Feedback and
Recommendations
Document #2
$0.00
$162,518.11
$0.00
$0.00
$0.00
13.4.1.5.5.2
Impact of
Recommended
Revisions Document #2
$0.00
$21,669.08
$0.00
$0.00
$0.00
13.4.1.6.1.2
Regional Stakeholder
Plan for Contractor's
Technology Solution
$0.00
$0.00
$65,007.24
$0.00
$0.00
13.4.1.6.4.1
Regional Stakeholder
Meeting Summary
Meeting
$0.00
$0.00
$21,669.08
$0.00
$0.00
13.4.1.7.1.2
Rural Facilities
Technology Evaluation
Plan
$0.00
$0.00
$173,352.65
$0.00
$0.00
13.4.1.7.2.2
CO Providers of
Distinction for
Facilities Program
Methods Document
$0.00
$119,179.95
$0.00
$0.00
$0.00
13.4.1.7.3.2
Incentives for CO
Providers of Distinction
for Facilities Program
Proposal
$0.00
$97,510.87
$0.00
$0.00
$0.00
13.4.1.7.4.2
Facility Performance
Report Publication Plan
$0.00
$97,510.87
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit J, Deliverables Payments
Page 17 of 17
13.4.2.1.2
Updated Performance
Reports
$0.00
$32,503.62 per
calendar quarter,
starting in the
third quarter of
SFY25 (i.e.,
starting in the
January through
March quarter);
$65,007.24 total
in SFY25
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY26
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY27
$32,503.62 per
calendar
quarter;
$130,014.48
total in SFY28
Payments due
quarterly in each
SFY after the final
Pediatric APM
Program
Management
Tracker in each
calendar quarter is
accepted by the
Department in
each SFY.
13.4.2.2.2
Technology Solution
Expansion Plan for the
CO Providers of
Distinction for
Facilities Program
$0.00
$119,179.95
$0.00
$0.00
$0.00
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit K
Page 1 of 6
EXHIBIT K, INFORMATION TECHNOLOGY PROVISIONS
This Exhibit regarding Information Technology Provisions (the “Exhibit”) is an essential part of
the agreement between the State and Contractor as described in the Contract to which this
Exhibit is attached. Unless the context clearly requires a distinction between the Contract and
this Exhibit, all references to “Contract” shall include this Exhibit. If there is language in the
main body of this Contract or any other exhibit referencing “Force Majeure”, this Exhibit shall
not be subject to the “Force Majeure” language. The provisions of this Exhibit are of vital
importance to the State and the security of the State.
1.
PROTECTION OF SYSTEM DATA
A.
In addition to the requirements of the main body of this Contract, if Contractor or any
Subcontractor is given access to State Information Technology resources or State
Records by the State or its agents in connection with the Contractor’s performance
under the Contract, Contractor shall protect such Information Technology resources
and State Records in accordance with this Exhibit. All provisions of this Exhibit that
refer to Contractor shall apply equally to any Subcontractor performing work in
connection with the Contract.
B.
The terms of this Exhibit shall apply to the extent that Contractor’s obligations under
this Contract include the provision of Information Technology goods or services to
the State. Information Technology is computer-based equipment and related services
designed for the storage, manipulation, and retrieval of data, and includes, without
limitation:
i.
Any technology, equipment, or related services described in 24-37.5-102(2),
C.R.S.;
ii.
The creation, use, processing, disclosure, transmission, or disposal of State
Records, including any data or code, in electronic form; and
iii.
Other existing or emerging technology, equipment, or related services that
may require knowledge and expertise in Information Technology.
C.
Contractor shall, and shall cause its Subcontractors to meet all of the following:
i.
Provide physical and logical protection for all hardware, software,
applications, and data that meets or exceeds industry standards and the
requirements of this Contract.
ii.
Maintain network, system, and application security, which includes, but is not
limited to, network firewalls, intrusion detection (host and network), annual
security testing, and improvements or enhancements consistent with evolving
industry standards.
iii.
Comply with State and federal rules and regulations related to overall security,
privacy, confidentiality, integrity, availability, and auditing.
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit K
Page 2 of 6
iv.
Provide that security is not compromised by unauthorized access to
workspaces, computers, networks, software, databases, or other physical or
electronic environments.
v.
Promptly report all Incidents, including Incidents that do not result in
unauthorized disclosure or loss of data integrity, to a designated representative
of the State’s Office of Information Security (“OIS”).
vi.
Comply with all rules, policies, procedures, and standards issued by the
Governor’s Office of Information Technology (“OIT”), including change
management, project lifecycle methodology and governance, technical
standards, documentation, and other requirements posted at
https://oit.colorado.gov/standards-policies-guides/technical-standards-policies
.
D.
Subject to Contractor’s reasonable access security requirements and upon reasonable
prior notice, Contractor shall provide the State with scheduled access for the purpose
of inspecting and monitoring access and use of State Records, maintaining State
systems, and evaluating physical and logical security control effectiveness.
E.
Contractor shall perform current background checks in a form reasonable acceptable
to the State on all of its respective employees and agents performing services or
having access to State Records provided under this Contract, including any
Subcontractors or the employees of Subcontractors. A background check performed
within 30 days prior to the date such employee or agent begins performance or
obtains access to State Records shall be deemed to be current.
i.
Upon request, Contractor shall provide notice to a designated representative
for the State indicating that background checks have been performed. Such
notice will inform the State of any action taken in response to such
background checks, including any decisions not to take action in response to
negative information revealed by a background check.
ii.
If Contractor will have access to Federal Tax Information under the Contract,
Contractor shall agree to the State’s requirements regarding Safeguarding
Requirements for Federal Tax Information and shall comply with the
background check requirements defined in IRS Publication 1075 and §24-50-
1002, C.R.S.
2.
DATA HANDLING
A.
Contractor may not maintain or forward these State Records to or from any other
facility or location, except for the authorized and approved purposes of backup and
disaster recovery purposes, without the prior written consent of the State. Contractor
may not maintain State Records in any data center or other storage location outside
the Continental United States for any purpose without the prior express written
consent of OIS.
B.
Contractor shall not allow remote access to State Records from outside the
Continental United States, including access by Contractor’s employees or agents,
without the prior express written consent of OIS. Contractor shall communicate any
request regarding non-U.S. access to State Records to the Security and Compliance
DocuSign Envelope ID: 8D1339B8-98AE-4AEE-B9FF-4C0F5E502F72
Exhibit K
Page 3 of 6
Representative for the State. The State shall have the sole discretion to grant of deny
any such request.
C.
Upon request by the State made any time prior to 60 days following the termination
of this Contract for any reason, whether or not the Contract is expiring or terminating,
Contractor shall make available to the State a complete download file of all State
data.
i.
This download file shall be made available to the State within 10 Business
Days of the State’s request, shall be encrypted and appropriately
authenticated, and shall contain without limitation, all State Records, Work
Product, and system schema and transformation definitions, or delimited text
files with documents, detained schema definitions along with attachments in
its native format.
ii.
Upon the termination of Contractor’s provision of data processing services,
Contractor shall, as directed by the State, return all State Records provided by
the State to Contractor, and the copies thereof, to the State or destroy all such
State Records and certify to the State that it has done so. If any legal
obligation imposed upon Contractor prevents it from returning or destroying
all or part of the State Records provided by the State to Contractor, Contractor
shall guarantee the confidentiality of all State Records provided by the State to
Contractor and will not actively process such data anymore. Contractor shall
not interrupt or obstruct the State’s ability to access and retrieve State Records
stored by Contractor.
D.
The State retains the right to use the established operational services to access and
retrieve State Records stored on Contractor’s infrastructure at its sole discretion and
at any time. Upon request of the State or of the supervisory authority, Contractor
shall submit its data processing facilities for an audit of the measures referred to in
this Exhibit in accordance with the terms of this Contract.
3.
DELIVERY AND ACCEPTANCE
Reserved
4.
WARRANTY
A.
Notwithstanding the acceptance of any Work or Deliverable, or the payment of any
invoice for such Work or Deliverable, Contractor warrants that any Work or
Deliverable provided by Contractor under this Contract shall be free from material
defects and shall function in material accordance with the applicable specifications.
Contractor warrants that any Work or Deliverable shall be, at the time of delivery,
free from any harmful or malicious code, including without limitation viruses,
malware, spyware, ransomware, or other similarly function designed to interfere with
or damage the normal operation of Information Technology resources. Contractor’s
warranties under this section shall apply to any defects or material nonconformities
discovered within 180 days following delivery of any Work or Deliverable.
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B.
Upon notice during the warranty term or any defect or material nonconformity,
Contractor shall submit to the State in writing within 10 business days of the notice
one or more recommendations for corrective action with sufficient documentation for
the State to ascertain the feasibility, risks, and impacts of each recommendation. The
State’s remedy for such defect or material non-conformity shall be:
i.
Contractor shall re-perform, repair, or replace such Work or Deliverable in
accordance with any recommendation chosen by the State. Contractor shall
deliver, at no additional cost to the State, all documentation required under the
Contract as applicable to the corrected Work or Deliverable; or
ii. Contractor shall refund to the State all amounts paid for such Work or
Deliverable, as well as pay to the State any additional amounts reasonably necessary
for the State to procure alternative goods or services or substantially equivalent
capability, function, and performance.
C.
Any Work of Deliverable delivered to the State as a remedy under this section shall
be subject to the same quality assurance, acceptance, and warranty requirements as
the original Work or Deliverable. The duration of the warranty for any replacement
or corrected Work of Deliverable shall run from the date of the corrected or
replacement Work or Deliverable.
5.
COMPLIANCE
A.
In addition to the compliance obligations imposed by the main body of the Contract,
Contractor shall comply with:
i.
All Colorado Office of Information Security (OIS) policies and procedures
which OIS has issued pursuant to §§24-37.5-401 through 406, C.R.S. and 8
CCR § 1501-5 and posted at
https://oit.colorado.gov/standards-policies-
guides/technical-standards-policies
ii.
All information security and privacy obligations imposed by any federal, state,
or local statute or regulation, or by any specifically incorporated industry
standards or guidelines, as applicable based on the classification of the data
relevant to Contractor’s performance under the Contract. Such obligations
may arise from:
a.
Health Information Portability and Accountability Act (HIPAA)
b.
IRS Publication 1075
c.
Payment Card Industry Data Security Standard (PCI-DSS)
d.
FBI Criminal Justice Information Service Security Addendum
e.
CMS Minimum Acceptable Risk Standards for Exchanges
f.
Electronic Information Exchange Security Requirements and Procedures For
State and Local Agencies Exchanging Electronic Information With The Social
Security Administration
iii.
Contractor shall implement and maintain all appropriate administrative,
physical, technical, and procedural safeguards necessary and appropriate to
ensure compliance with the standards and guidelines applicable to
Contractor’s performance under the Contract.
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iv.
Contractor shall allow the State reasonable access and shall provide the State
with information reasonably required to assess Contractor’s compliance. Such
access and information shall include:
a.
An annual SOC2 Type II audit including, at a minimum, the Trust Principles
of Security, Confidentiality, and Availability, or an alternative audit
recommended by OIS; or
b.
The performance of security audit and penetration tests, as requested by OIS.
v.
To the extent Contractor controls or maintains information systems used in
connection with State Records, Contractor will provide OIS with the results of
all security assessment activities when conducted on such information
systems, including any code-level vulnerability scans, application level risk
assessments, and other security assessment activities as required by the
Contract or reasonable requested by OIS. Contractor will make reasonable
efforts to remediate any vulnerabilities or will request a security exception
from the State. The State will work with Contractor and OIS to prepare any
requests for exceptions from the security requirements described in this
Contract and its Exhibits, including mitigating controls and other factors, and
OIS will consider such requests in accordance with their policies and
procedures referenced herein.
6.
TRANSITION OF SERVICES
Upon request by the State prior to expiration or earlier termination of this Contract of any
Services provided in this Contract, Contractor shall provide reasonable and necessary
assistance to accomplish a complete transition of the Services designated by the State. All
services related to such transition shall be performed at no additional cost beyond what
would be paid for the Services in this Contract.
7.
LICENSE OR USE AUDIT RIGHTS
A.
To the extent that Contractor, through this Contract or otherwise as related to the
subject matter of this Contract, has granted to the State any license or otherwise
limited permission to use any Contractor Materials, the terms of this section shall
apply.
B.
Contractor shall have the right at any time during and throughout the Contract Term,
but not more than once per Fiscal Year, to request via written notice in accordance
with the notice provisions of the Contract that the State audit its use of and certify to
its compliance with any applicable license or use restrictions and limitations
contained in this Contract (an “Audit Request”). The Audit Request shall specify the
time period to be covered by the audit, which shall not include any time periods
covered by a previous audit. The State shall complete the audit and provide
certification of its compliance to Contractor (“Audit Certification”) within 120 days
following the State’s receipt of the Audit Request.
C.
If upon receipt of the State’s Audit Certification, the Parties reasonably determine
that; (i) the State’s use of licenses, use of software, use of programs, or any other use
during the audit period exceeded the use restrictions and limitations contained in this
Contract (“Overuse”) and (ii) the State would have been or is then required to
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purchase additional maintenance and/or services (“Maintenance”). Contractor shall
provide written notice to the State in accordance with the notice provisions of the
Contract identifying any Overuse or required Maintenance and request that the State
bring its use into compliance with such use restrictions and limitations.
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