Eas-Sea Expires December of Even Years

Rates of payment remain the same and will be re-calculated every summer as Medicaid adjusts the rates. 

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NOW THEREFORE, in consideration of the promises and covenants contained herein, the parties agree as follows: 
 
B. Services to be Performed by Contractor. Contractor will provide the following professional services, (hereinafter “Services”): 

The Services are provided consistent with the terms and conditions of AGENCY Contract with various state entities including but not limited to HCPF, CDHPE, various community entities including but not limited to RMHS, DP and governed by multiple statues and regulations including be not limited to chapter 26 and 8.600, the terms of which are incorporated herein by this reference (the “Master Contract”). And any and all updated regulations.

 

In regard to how services are delivered to children, individuals, community and families, Contractor will adhere to current state guidance for service delivery method(s) and service definitions.

 

Contractor will be involved in the process of developing individual(s)’ plan(s). The Annual plan and quarterly or as needed updates. This will include the Evaluation/Assessment, the Global Outcomes, and plan Outcomes/Plan of Action pages, that document methods and procedures used and measurable results of ongoing assessment of all developmental domains to support the ongoing need for Services

 

4. Contractor will provide the necessary support for the parent or other caregivers to achieve the outcomes identified in the plan. 

5. Contractor will plan to participate in annual plan development for the entirety of the meeting (roughly 90 minutes) to record strengths and needs within the global outcomes as well as any appropriate assessments. 

6. Contractor will assist in developing strategies, supports and services to fully support individuals. 

7. Contractor agrees at its expense to become trained in and use any state or license required Training. 

8. Contractor will maintain current and accurate documentation and update their ` information in the AGENCY Database. 

It is the express intent of the parties that the Contractor is an independent contractor and not an employee, agent, partner, or joint venturer of AGENCY and all of their respective business activities are separate and not combined. The parties agree that: 

 

Terms and Conditions 
A. Term of Agreement. The term of this Agreement will commence on this date and will continue for 1 year (the “Termination Date”) unless earlier terminated as provided herein. If, by [day before end of term], the parties do not agree in writing to extend this Agreement past the Termination Date, then this Agreement and Contractor’s Services to AGENCY will automatically terminate as of the Termination Date without notice. 

 

Contractor will keep any written materials which pertain to the delivery of Services for a period of six (7) years after the date of closure of the record or for such further periods as may be necessary to resolve any matters that may be pending.

 

Written Documentation 
Will be submitted to AGENCY per current software expectations at the time of service with GPS at the start and end of service and electronic verification of start and end time with client signature and photo verification. Documentation may require updating if information is missing or out of alignment with plan or definition. Documentation may require updating if session details are needed for clarity. Payments will be held until documentation is submitted to AGENCY per electronic format or hand delivered by contractor to office. There is a fee for processing paperwork outside of the electronic format. 

 

C. Contractor Status and Requirements

 

Contractor is obligated to report to AGENCY any other agents they would like to work with in regards to providing services. Due to changes in Colorado regulations stating all persons must have a written contract directly with the PASA on the service plan. 

 Colorado regulations state that any persons working with a contractor to provide care must have a written contract directly with the PASA on the service plan. This includes Host Home providers and family care givers. Any provider chosen to provide back-up services to a provide must also have a direct contract with the PASA. 

Client Status.

All clients are accepted for care only by the care coordinating PASA, needs to reach out to in order to establish a working contract with, include their contact information. (type none if none) *

Legal name is:

Easter Seals Colorado

5755 West Alameda Avenue

Lakewood, CO  80226

 

 

In the instance of multi-agency collobration all agencies must approve providers where care coordinating PASA and renderinger PASA may be different.

 

6. Contractor at its expense will defend (with counsel of AGENCY choice), indemnify and hold AGENCY and its directors, officers, managers, board members, employees and agents harmless from any liability, actions, investigations, claims, costs, damages, penalties, expenses (including reasonable attorney’s fees) arising out of Contractor’s or its subcontractor’s failure to fulfill these obligations, breach of the terms of this Agreement, or the negligence or intentional conduct of Contractor or its directors, officers, members, managers, employees, agents, subcontractors or anyone else acting under Contractor’s direction or control. 
Contractor does not have the right to assign or transfer any of its rights or obligations under this Agreement without the express advance written permission of AGENCY to be determined at AGENCY’ sole discretion. 

 

7. Contractor will obtain and pay for any training that may be necessary in order for Contractor to perform the Services. AGENCY will not provide any training to Contractor. Though AGENCY may host community training contractors have access to.

 

8. Contractor will provide its own tools, labor, and supplies in such quantities and of the proper quality to professionally and timely perform the Services as defined in the individual(s)’ plan. AGENCY will not provide tools or equipment to Contractor.

 

9. Contractor on behalf of itself acknowledges receipt of and compliance with AGENCY Fraud, Waste and Abuse Reporting Policy and AGENCY Policy of Medicaid List of Excluded Individuals and Entities (with appropriate attachments). Contractor agrees to provide certification of these policies annually to AGENCY in the designated format.

 

10. 
 THE IC SHALL PERFORM THE DUTIES HEREUNDER AS AN INDEPENDENT CONTRACTOR AND NOT AS AN EMPLOYEE . IC SHALL BE ACCOUNTABLE TO AGENCY FOR THE ULTIMATE RESULTS OF ITS ACTIONS BUT SHALL NOT BE SUBJECT TO DIRECTION AND CONTROL OF AGENCY. NEITHER THE IC NOR ANY AGENT OR EMPLOYEE OF THE IC SHALL BE DEEMED TO BE AN EMPLOYEE OF AGENCY. IC SHALL PAY WHEN DUE ALL REQUIRED EMPLOYMENT TAXES AND INCOME TAX WITHHOLDINGS, INCLUDING ALL FEDERAL AND STATE INCOME TAX AND LOCAL HEAD TAX ON ANY MONIES PAID PURSUANT TO THIS CONTRACT, IC WILL RECEIVE A 1099 AT THE END OF THE YEAR. THE CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND ITS EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS IC OR A THIRD PARTY PROVIDES SUCH COVERAGE AND THAT AGENCY DOES NOT PAY FOR OR OTHERWISE PROVIDE SUCH COVERAGE. IC SHALL HAVE NO AUTHORIZATION, EXPRESS OR IMPLIED, TO BIND AGENCY TO ANY AGREEMENTS, LIABILITY, OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH HEREIN. IC SHALL PROVIDE AND KEEP IN FORCE WORKER’S COMPENSATION (AND SHOW PROOF OF SUCH INSURANCE) AND UNEMPLOYMENT COMPENSATION INSURANCE IN THE AMOUNTS REQUIRED BY LAW, AND SHALL BE SOLELY AND ENTIRELY RESPONSIBLE FOR THE ACTS OF THE CONTRACTOR, ITS EMPLOYEES AND AGENTS. IF CONTRACTOR WISHES TO GAIN EMPLOYEES OR AGENTS THEN CARE COORDINATION AGENCY MUST BE INVOVLED AND APPROVED ALL AGENTS. AGENCY DOES NOT PROVIDE WORKERS COMPENSATION INSURANCE. IC SHALL FURNISH AGENCY WITH WRITTEN CERTIFICATION OF THE EXISTENCE OF SUCH COVERAGE, PRIOR TO THE FINALIZATION OF CONTRACT PROVISIONS. 

 

TERMINATED CONTRACTS ARE NOT ELIGIBLE FOR FINAL PAY RULES AND REGULATIONS AND FINAL PAY RULES AND REGULATIONS ARE ONLY FOR EMPLOYEES AND DO NOT APPLY TO INDEPENDENT CONTRACTS. REIMBURSEMENT UPON CONTRACT TERMINATION WILL REMAIN IN ACCORDANCE TO CONTRACT.

Payment for Services 
For the satisfactory performance of the Services herein, AGENCY will pay Contractor IF AND ONLY IF services are provided in a contractual compliant manner that funding sources will accept with adequate documentation and in accordance with written service plan from community center board. CONTRACTORS are responsible for managing units is a way that maintains consistent service throughout plan year. 

 

Payment 
1. For Services rendered in accordance with the provisions of APPROVED PLAN with supporting documentation including contact notes in alignment with plan, service notes in alignment with definition, scoring of goals, and narratives reflecting both supported provided and needed,  

 

fixed rate per 15-minute units (exceptions apply to select services that are paid at a per service rate or a variable rate), based on the number of units specified in the plan. For visits  
lasting longer than plan specifies, Contractor must request approval prior to providing service. AGENCY
will not pay Contractor an additional fee for mileage or other expenses or fees unless a travel stipend is assigned.

 

AGENCY will make payments to Contractor for its Services by the end of the month following the month of service. AGENCY will pay contractor for actual time in fixed  rate per 15-minute units Actual time is defined as face-to-face time spent  Within the plan parameters. With all billing claims paratmeters following Medicaid guidelines.

 

Invoices 
2. Contractor will provide session invoices complete with documentation and verified through both photos submission AND LIVE TIME activation and deactivation to AGENCY system, in order for AGENCY to meet its requirement to input billing into the funders system in a timely manner 

 

Monthly: prior to fund release contractor must confirm accuracy of claims submitted

Termination of Agreement. 
This contract is subject to immediate cancellation by AGENCY without any liability to the Contractor in the event that:  

 

a. AGENCY determines, in its sole and absolute discretion, that the health, safety, or welfare of persons receiving Services from Contractor may be in jeopardy. Alcohol, drugs, and other controlled substances impair an individual’s judgment, resulting in increased safety risks, injuries, and faulty decision making. Accordingly, this Agreement is subject to immediate termination if any employee or agent of Contractor is under the influence of or intoxicated by alcohol, drugs, or controlled substances while providing Services. b. Contractor violates any term or condition of this Agreement; c. Contractor’s performance of Services does not satisfy state-mandated specifications or the plans or feedback related to lack of or diminished professional conduct; or

 

d. AGENCY Contract with the funding sources (as amended) is terminated, or performance thereunder suspended for any reason. 

 

Government funded 
Payment pursuant to this contract, is wholly or partially in federal or state funds. Accordingly, this Agreement is subject to and contingent upon the continuing availability of federal or state funds for the purposes hereof. In the event that said funds, or any part thereof, become unavailable, as determined by AGENCY, AGENCY may immediately terminate this contract or amend it accordingly.  
Enforcement and Waiver. 
The failure of either party in any one or more instances to insist upon strict performance of any of the terms and provisions of this Agreement, will not be construed as a waiver of the right to assert any such terms and provisions on any future occasion or of damages caused thereby.  

 

Severability. 
If any of the provisions of this Agreement will be invalid or unenforceable, such invalidity or unenforceability will not invalidate or render unenforceable the entire Agreement, but rather the entire Agreement will be construed as if not containing the particular invalid or unenforceable provision or provisions, and the rights and obligations of the party will be construed and enforced accordingly, to effectuate the essential intent and purposes of this Agreement. 

 

Nonexclusive Nature. 
This Agreement does not grant Contractor any exclusive privilege or right to supply Services to AGENCY. AGENCY makes no representations or warranties as to a minimum or maximum procurement of Services hereunder.  

 

Governing Law and Venue. 
This Agreement will be construed and interpreted in accordance with, and its performance governed by, the laws of the State of Colorado. Venue for any litigation which may arise out of this Agreement will be exclusively in the state or federal courts located in Arapahoe County or the City and County of Denver, Colorado.  

 

Entire Agreement, Amendments and Modification. 
This Agreement constitutes the entire Agreement between AGENCY and Contractor with respect to the subject matter of this Agreement, and these provisions will supersede or replace any conflicting or additional provisions which may be contained in any other writing, document or the like. In the event of a conflict between any provisions appearing in any other writing and in this Agreement, the provisions of this Agreement will be controlling.  

 

Binding. 
This Agreement is binding upon the parties, their successors and assigns. The parties expressly understand and agree that nothing in this Agreement is intended, or will be construed, to confer upon or give any person other than AGENCY and Contractor and their respective successors and assigns any rights or remedies under or by reason of this Agreement. Contractor may not transfer or assign any of its right or obligations under this Agreement without the express written permission of AGENCY at its sole discretion.  

 

Subject to Change. 
The Contactor understands that AGENCY does not control the terms, rules, regulations, or funding these Services being provided. Consequently, this contract is subject to change, at any time without notice, because of changes implemented by the GOVERNING BODIES. This includes, but is not limited to, the rates paid under this Agreement or the qualifications, licensure, or insurance required of contractors.  It may also include the sell or merge of AGENCY.

 

Knowing and Voluntary. 
The parties have carefully read this Agreement and state that they enter into the Agreement knowingly and voluntarily after having had sufficient opportunity to obtain the advice of separate legal counsel, if desired.  

 

Contracts with Public Entity. 
AGENCY is contracting with Contractor for Services to be provided to a public entity. Incorporated into this Agreement is an Agreement to Comply/Certification of Compliance with C.R.S. § 8-17.5- 101, et. seq., regarding the prohibition against the Contractor knowingly employing or contracting with an unlawful alien to perform work under the Agreement, which must be signed as a condition of this Agreement, and regarding the parties’ participation in the E-Verify program or department program. 

 

Client Pairing and Accessibility 
Clients vendors choose to serve through AGENCY but take part in the onboarding and monitoring requirements. Clients service plans must be signed and accepted by AGENCY prior to the start of service. 

 

Response 
Responses are expected within 24 hours for general requests. 

Insurance. 
All required insurance must be provided by Contractor or subcontractors at their own expense during the term of this Agreement. All insurance amounts are required by the relevant rules, policies, and regulations coverage will not be reduced below the limits described below or canceled without notice of such reduction or cancellation. Contractor will require that any of its agents who perform services will maintain like insurance. No later than seven days after execution of this Agreement, Contractor on behalf of itself and its subcontractors will provide AGENCY with certificates of insurance evidencing the types and amounts specified below 

 

Standard Workers’ Compensation - 
as required by state statute, and Employer’s Liability Insurance covering all of Contractor’s employees acting within the course and scope of their employment.  

 

Commercial General Liability Insurance - 
for operations and contractual liability adequate to cover the liability assumed hereunder and with limits of not less than $1,000,000 on account of any one person, and $1,000,000 for each occurrence of property damage and personal injury. This insurance must be listed under General Liability, not Workplace Liability. 

 

Auto Insurance (rates may be different depending on services selected to render) - 
Automobile Liability insurance at a level ordinarily expected by a reasonable person in the community. However, coverage up to $1,000,000 individual and $1,000,000 per occurrence of bodily injury and property damage is strongly recommended. 

 

Professional Liability Insurance - 
with minimum limits of liability of not less than $1,000,000.  

 

Protected Health Information - 
 The Contractor and its applicable subcontractors will obtain and maintain, during the term of this Contract, liability insurance covering all loss of Protected Health Information data and claims based upon alleged violations of privacy rights through improper use or disclosure of Protected Health Information with minimum annual limits as follows:  

 

Cyber/Network Security and Privacy Liability insurance 
 The Contractor and its applicable employees will obtain and maintain, during the term of this Contract, Cyber/Network Security and Privacy Liability insurance. covering civil, regulatory, and statutory damages, contractual damages, data breach management exposure, and any loss of income or extra expense as a result of actual or alleged breach, violation, or infringement of right to privacy, consumer data protection law, confidentiality, or other legal protection for personal information, as well as State Confidential Information with minimum limits as follows: 

 

Notice. 
Any notice to be given hereunder by either party to the other will be in writing and will be deemed given when sent by certified mail with a courtesy copy by email as set forth below. If either party changes its address during the term herein, it will so advise the other party in writing as herein provided and any notice thereafter required to be given will be sent by certified mail to such new address.  

 

Legal name is:

Easter Seals Colorado

5755 West Alameda Avenue

Lakewood, CO  80226

       · Fraud 

 

The Office of the Inspector General (OIG) has identified the following areas in which fraud frequently occurs amount home health agencies. Employees, clients and affiliates must be aware of what they consist of and take care to avoid them:

 

1. Services Not Rendered: AGENCY cannot bill for services not actually rendered. Billing for services not actually rendered involves submitting a claim that represents the provider performed a service that all or part of which was simply not performed at the time stated.

 

2 Medically Unnecessary Services: AGENCY cannot bill for medically unnecessary services. Billing for medically unnecessary services involves knowingly seeking reimbursement for a service that is not warranted by the client's current and documented medical condition.

 

3 Duplicate Billing: Duplicate billing occurs when the home health agency submits more than one claim for the same service; bills for multiple services at the same time; or a bill is submitted to more than one primary payer at the same time. ***Sone services are specifically designed to allow assistance during medical appointments such as mentorship and personal care.

 

4 Unqualified Personnel: AGENCY cannot bill for services for which the provider is unqualified or unlicensed to perform If a license or qualification lapses; then alternate, licensed personnel must perform the visit

 

5 Misapplying Funds Providers and clients shall not steal, embezzle or otherwise convert to the benefit of another person, or intentionally misapply any funds, money, premiums, credits or other assets of a provider of any healthcare benefit program; including Medicare, Medicaid or a private payer.

 

If a anyone client or provider, is found to be engaging in fraudulent documentation; AGENCY will report such actions to the proper authorities, seek financial restitution and reserves the right to discipline the employee up to termination, contract remediation or termination, and/or discharge a client

 

                · Pay all associate fees, including but not limited to fines, court costs, etc. 
                · Pay a 20% fee of all billed services in order for services to be audited for further fraud.  

 

        · Over Payment 
Refunding of Payments AGENCY shall promptly refund any payments made by state or federal agencies or private payers which were made erroneously and of which AGENCY was aware. If a collaborator realizes or discovers that documentation was submitted with incorrect information that may result in an overpayment, they must immediately notify AGENCY . 

 

                · In the event that overpayments are made by the AGENCY due AGENCY error, omission, error, fraud, or in the event that the State or Federal government seeks to recover from AGENCY any sums of money based upon a claim on behalf of a collaborator, the collaborator shall immediately reimburse such funds to AGENCY in accordance with the Medical Assistance Act, C.R.S., Section 26-4-112, or as otherwise allowed by law. 

 

                · The parties understand and agree that AGENCY shall have the right to offset against payments due to the Collaborator hereunder, or by other legal means recover any debts owed by the Collaborator to the CCB or to the State. 
                · Any amounts which have been paid by AGENCY and which are found to be improper in accordance with the terms of this contract shall be immediately returned to AGENCY , or may be withheld from future payments. 

 

        · Collaborators must provide tools to be able to access documentation in addition to providing services, such as but not limited to, the ability to access the internet securely, etc. 

 

        · AGENCY shall receive, on behalf of Collaborators, all payments and payment transmittal documents from Medicaid and the State of Colorado or relevant agent.AGENCY SHALL release the funds for all reimbursable services the last business day of the month following the month service was provided. No payments shall be due from AGENCY to the Contractor unless the funds for such payments are received by AGENCY

 

        · Outside forms are permissible. Forms must have all information that is mandated in order to bill and meet rules and regulations including verification policy. There is an additional 10 % fee per month for providers who submit documentation in alternative methods. 

 

Rate sheets are provided per contractor.

CONFIDENTIALITY: Provider acknowledges that in the performance of Provider’s duties under this Agreement, Provider will or may come to know information that is treated by Easter Seals Colorado as confidential information. Provider agrees not to reveal any such information to any person or entity, at any time, without the express written consent of Easter Seals Colorado. Provider shall observe and comply with all applicable Colorado rules and regulations and Easter Seals Colorado policies and procedures regarding confidentiality.

 

4. Before starting the Services covered by this Agreement, Contractor on behalf of itself and its subcontractors will provide to Easter Seals Colorado a current clear background check or complete a background check form for Easter Seals Colorado to use to obtain a current background check; proof of applicable training for any required certificate(s) and/or licensure(s), and proof of required certificate(s) and/or licensing. If requested, Contractor will provide such background checks within 48 hours of the request.

 

3. Contractor and its subcontractors, if any, will maintain the proper certification(s) and/or licensure(s) to perform the Services defined by this Agreement, as required by the State of Colorado. Procedures AND all applicable regulations and policies. Contractor will pay for all costs and time associated with obtaining, updating, and/or otherwise maintaining required certification(s) and/or licensure(s) as well as all expenses associated with complying with the provisions of all state, local and federal laws, regulations, ordinances, requirements, and codes which are applicable to its performance of the Services hereunder. If Contractor performs any of the Services through a subcontractor, the subcontractor shall perform the Services consistent with all of the terms and conditions of this Agreement, and Contractor shall be primarily liable for all of Services performed by their subcontractor.

 

TRAINING: The Provider represents and warrants that they have obtained and will maintain, throughout the term of this contract, the following qualifications which are material to Provider’s continuing eligibility 
Training required prior to unsupervised contact with a Person:  

 

First Aid certificate.  
CPR certificate.  
Qualified Medication Administration Person (QMAP) through a state approved training course for medication administration. If assisting with medication or a host home   
Overview of incident reporting requirements, MANE, confidentiality, and legal rights; and,  
Review of Person’s support needs (may include, if applicable, seizure protocol, dietary issues, lifting, transferring, and positioning, adaptive equipment orientation, or hygiene protocols).    
Rights  
Confidentiality  
Incident Reporting  
MANE   
Electronic Data Management  
Dispute Resolution  
Grievance Resolution  
CPR  
First-Aid  
Medication Administration (QMAP)  
Infection Control and Prevention  
Behavior Management  
Personal Needs Management  
Other training deemed necessary by Easter Seals Colorado to provide appropriate supports to Persons receiving services   
 Other training deemed necessary by regulation. 

At least 12 topics of in service training per year that reflects current regulations, AGENCY policies, state expectations, and current community need.  The Provider will bear the cost of the training.  

 

This HIPAA Business Associate Agreement ("Agreement") is entered into on this date by and between AGENCY (hereinafter "Covered Entity") and IC VENDOR (hereinafter "Business Associate"). 
It is the intent of the Covered Entity and the Business Associate to protect the privacy and provide for the security of Protected Health Information ("PHI") disclosed to the Business Associate pursuant to the Agreement in compliance with the Health Insurance Portability and Accountability Act of 1996 ("HIPAA"), the Health Information Technology for Economic and Clinical Health Act ("HITECH"), and privacy and security regulations published by the U.S. Department of Health and Human Services ("DHHS") contained at 45 CFR Parts 160 and 164 which may be periodically revised or amended ("HIPAA Rules") and other applicable laws. The purpose of this Agreement is to satisfy certain standards and requirements of HIPAA and the HIPAA Rules, including, but not limited to, Title 45, Sections 164.504(e), 164.308, 164.310, 164.312, 164.314 and 164.316 of the Code of Federal Regulations ("CFR"), as the same may be amended from time to time. 
In consideration of the mutual promises below and the exchange of information pursuant to the Agreement, the parties agree as follows: 

 

I. Definitions 
Catch-all definition: The following terms used in this Agreement shall have the same meaning as those terms in the HIPAA Rules: Data Aggregation, Disclosure, Health Care Operations, Individual, Minimum Necessary, Notice of Privacy Practices, Protected Health Information, Required By Law, Security Incident, Subcontractor, Unsecured Protected Health Information, and Use. 

 

Specific definitions:

 

“Breach” means the unauthorized access, acquisition or use of protected health information in a manner that violates the Privacy Rule by compromising the security or privacy of the protected health information.

 

Business Associate. “Business Associate” shall generally have the same meaning as the term “Business Associate” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean [Insert Name of Business Associate].

 

“C.F.R.” means the Code of Federal Regulations.

 

Covered Entity. “Covered Entity” shall generally have the same meaning as the term “Covered Entity” at 45 CFR 160.103, and in reference to the party to this agreement, shall mean AGENCY.

 

“Designated Record Set” has the meaning set forth in 45 C.F.R. §164.501.

 

“DHHS” means the Department of Health and Human Services.

 

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996, 42 U.S.C. §§1320d1320d8, as amended, and the regulations promulgated thereunder, 45 C.F.R. Parts 160 and 164.

 

HIPAA Rules. “HIPAA Rules” shall mean the Privacy, Security, Breach Notification, and Enforcement Rules at 45 CFR Part 160 and Part 164.

 

“Privacy Rule” means the Standards for Privacy of Individually Identifiable Health Information as set forth in 45 C.F.R. Part 160 and Subparts A and E of Part 164.

 

“Protected health information” (sometimes referred to in this Agreement as “PHI”) has the meaning set forth in 45 C.F.R. §164.501 and is limited for purposes of this Agreement to information created or received by Business Associate from or on behalf of a Business Associate Covered Entity Client.

 

“Required by Law” has the meaning set forth in 45 C.F.R. §164.501.

 

“Secretary” means the Secretary of the Department of Health and Human Services or his or her designee.

 

“Security Rule” means the Standards for Security of Individually Identifiable Health Information set forth in 45 C.F.R. Part 160 and Subparts A and C of Part 164.

 

II. Obligations and Activities of Business Associate.

 

Business Associate agrees to:

 

A. Not use or disclose Protected Health Information other than as permitted or required by the Agreement or as required by law;

 

B. Use appropriate safeguards and comply with Subpart C of 45 CFR Part 164 with respect to electronic Protected Health Information, to prevent use or disclosure of Protected Health Information other than as provided for by the Agreement. Electronic transmissions of PHI must be executed in a secure format. Scanned documents sent to an email address must be sent using encryption software. Confidentiality statements attached to electronic transmissions alone do not constitute a secure format;

 

C. Report to Covered Entity any use or disclosure of Protected Health Information not provided for by the Agreement of which it becomes aware, including breaches of unsecured Protected Health Information as required at 45 CFR 164.410, and any security incident of which it becomes aware;

 

1. Business Associate shall, upon becoming aware of a Disclosure of PHI in violation of this Agreement by Business Associate, its officers, directors, employees, contractors or agents or by a third party to which Business Associate Disclosed PHI, immediately report in writing any such Disclosure to the Covered Entity in a manner and time not to exceed three (3) business days to permit Covered Entity to timely determine if Covered Entity must report the Disclosure to the individual or any governmental entity as may be required by law, and to permit Covered Entity to do so within the time required by law. Business Associate agrees to have procedures in place for mitigating, to the maximum extent practicable, any harmful effect from the Use or Disclosure of PHI in a manner contrary to this Agreement or the HIPAA Regulations.

 

E. Make available Protected Health Information in a designated record set to the Covered Entity as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.524;

 

D. In accordance with 45 CFR 164.502(e)(1)(ii) and 164.308(b)(2), if applicable, ensure that any subcontractors that create, receive, maintain, or transmit Protected Health Information on behalf of the Business Associate agree to the same restrictions, conditions, and requirements that apply to the Business Associate with respect to such information;

 

1. Within ten (10) business days of a request by the Covered Entity, Business Associate agrees to comply with Covered Entity's request to accommodate an individual's access to his/her PHI. In the event an individual contacts Business Associate directly about access to PHI, Business Associate shall within three (3) business days forward such request to the Covered Entity. Any denials of access to the PHI requested shall be the responsibility of the Covered Entity

 

F. Make any amendment(s) to Protected Health Information in a designated record set as directed or agreed to by the Covered Entity pursuant to 45 CFR 164.526, or take other measures as necessary to satisfy Covered Entity’s obligations under 45 CFR 164.526;

 

1. Within ten (10) business days of receipt of a request from the Covered Entity for the amendment of an individual's PHI, Business Associate shall promptly incorporate any such amendments into the PHI. In the event an individual contacts Business Associate directly about making amendments to PHI, Business Associate will not make any amendments to the individual's PHI but shall forward such request to the Covered Entity within three (3) business days of such contact. Any denials of requested amendment to PHI shall be the responsibility of the Covered Entity.

 

G. Maintain and make available the information required to provide an accounting of disclosures to the Covered Entity as necessary to satisfy Covered Entity’s obligations under 45 CFR 
1. Business Associate hereby agrees to maintain a record of Disclosures of PHI for a retention period of six (6) years. Business Associate agrees to make information regarding Disclosures of PHI regarding an individual available to the Covered Entity within ten (10) business days of a request by the Covered Entity. 

 

2. At a minimum, Business Associate shall provide the Covered Entity with the following information: 
a. the date of the Disclosure; b. the name of the entity or person who received the PHI, and if known, the address of such entity or person; c. a brief description of the PHI Disclosed; d. a brief statement of the purpose of such Disclosure which includes an explanation of the basis for such Disclosure; and, e. the names of all individuals whose PHI was Disclosed. In the event the request for an accounting is delivered directly to Business Associate, Business Associate shall within three (3) business days forward such request to the Covered Entity. 

 

3. It shall be the Covered Entity's responsibility to prepare and deliver any such accounting requested. Business Associate hereby agrees to implement an appropriate recordkeeping process to enable it to comply with the requirements of this Section.

 

H. To the extent the Business Associate is to carry out one or more of Covered Entity’s obligation(s) under Subpart E of 45 CFR Part 164, comply with the requirements of Subpart E that apply to the Covered Entity in the performance of such obligation(s); and

 

I. Make its internal practices, books, and records available to the Covered Entity and to the Secretary of DHHS for purposes of determining compliance with the HIPAA Rules.

 

III. Permitted Uses and Disclosures by Business Associate

 

A. Business Associate may only use or disclose Protected Health Information in such a manner as necessary to perform the services set forth in the Services Agreement separately entered into by Covered Entity and Business Associate.

 

B. Business Associate may use or disclose Protected Health Information as required by law.

 

C. Business Associate agrees to make uses and disclosures and requests for Protected Health Information consistent with Covered Entity’s minimum necessary policies and procedures as described in Addendum 1A.

 

D. Business Associate may not use or disclose Protected Health Information in a manner that would violate Subpart E of 45 CFR Part 164 if done by Covered Entity, except for the specific uses and disclosures set forth below.

 

E. Business Associate may use Protected Health Information for the proper management and administration of the Business Associate or to carry out the legal responsibilities of the Business Associate.

 

F. Business Associate may disclose Protected Health Information for the proper management and administration of Business Associate or to carry out the legal responsibilities of the Business Associate, provided the disclosures are required by law, or Business Associate obtains reasonable assurances from the person to whom the information is disclosed that the information will remain confidential and used or further disclosed only as required by law or for the purposes for which it was disclosed to the person, and the person notifies Business Associate of any instances of which it is aware in which the confidentiality of the information has been breached.

 

G. Business Associate may provide data aggregation services relating to the health care operations of the Covered Entity.

 

IV. Provisions for Covered Entity to Inform Business Associate of Privacy Practices and Restrictions.

 

A. Covered Entity shall notify Business Associate of any limitation(s) in the notice of privacy practices of Covered Entity under 45 CFR 164.520, to the extent that such limitation may affect Business Associate’s use or disclosure of Protected Health Information.

 

B. Covered Entity shall notify Business Associate of any changes in, or revocation of, the permission by an individual to use or disclose his or her Protected Health Information, to the extent that such changes may affect Business Associate’s use or disclosure of Protected Health Information.

 

C. Covered Entity shall notify Business Associate of any restriction on the use or disclosure of Protected Health Information that Covered Entity has agreed to or is required to abide by under 45 CFR 164.522, to the extent that such restriction may affect Business Associate’s use or disclosure of Protected Health Information.

 

V. Permissible Requests by Covered Entity 
Covered Entity shall not request Business Associate to use or disclose Protected Health Information in any manner that would not be permissible under Subpart E of 45 CFR Part 164 if done by Covered Entity.  

 

VI. Term and Termination

 

A. Term. The Term of this Agreement shall be effective as of the date noted in the first paragraph of this Agreement, and shall continue in effect until cancelled, unless the Covered Entity terminates for cause as authorized in paragraph (b) of this Section, whichever is sooner.

 

B. Termination for Cause. Business Associate authorizes termination of this Agreement by Covered Entity, if Covered Entity determines Business Associate has violated a material term of the Agreement.

 

C. Obligations of Business Associate Upon Termination. Upon termination of this Agreement for any reason, Business Associate shall return to Covered Entity or, if agreed to by Covered Entity, destroy all Protected Health Information received from Covered Entity, or created, maintained, or received by Business Associate on behalf of Covered Entity, that the Business Associate still maintains in any form. Business Associate shall retain no copies of the Protected Health Information.

 

D. Survival. The obligations of Business Associate under this Section shall survive the termination of this Agreement.

 

VII. Miscellaneous

 

A. Regulatory References. A reference in this Agreement to a section in the HIPAA Rules means the section as in effect or as amended.

 

B. Disclaimer. Covered Entity makes no warranty or representation that compliance by Associate with this Contract, HIPAA, or the HIPAA Regulations will be adequate or satisfactory for Associate’s own purposes. Associate is solely responsible for all decisions made by Associate regarding the safeguarding of Protected Information.

 

C. No Third-Party Beneficiaries. Nothing express or implied in this Contract is intended to confer, nor shall anything herein confer, upon any person other than Covered Entity, Business Associate and their respective successors or assigns, any rights, remedies, obligations or liabilities whatsoever.

 

D. Injunctive Relief. Covered Entity shall have the right to injunctive and other equitable and legal relief against Business Associate or any of its agents in the event of any use or disclosure of Protected Information in violation of this Contract or applicable law.

 

E. Amendment. The Parties agree to take such action as is necessary to amend this Agreement from time to time as is necessary for compliance with the requirements of the HIPAA Rules and any other applicable law.

 

F. Insurance. Each party to this Agreement will be responsible for its own insurance coverage. Insurance shall include coverage for costs related to breaches of unsecured PHI, including the costs to notify affected individuals, DHHS and, if applicable, the media.

 

G. Indemnification. Each party will indemnify and hold harmless the other party to this Agreement from and against any and all claims, losses, liabilities, costs and other expenses incurred as a result of, or arising directly or indirectly out of or in connection with: 
1. any misrepresentation, breach of warranty or non-fulfillment of any undertaking on the part of the party under this Agreement; and 

 

2. any claims, demands, awards, judgments, actions and proceedings made by any person or organization arising out of or in any way connected with the party's performance under this Agreement.

 

H. Severability. In the event any provision of this Agreement is held to be unenforceable for any reason, the unenforceability thereof shall not affect the remainder of this Agreement, which shall remain in full force and effect and enforceable in accordance with its terms.

 

I. Governing Law. This Agreement shall be construed broadly to implement and comply with the requirements relating to the Privacy Rule, the Security Rule, and other HIPAA laws, rules and regulations. All other aspects of this Agreement shall be governed under the laws of the State of Colorado and venue for any actions relating to this Agreement shall be in Arapahoe County, Douglas County and City of Aurora, Colorado.

 

J. Interpretation. Any ambiguity in this Agreement shall be interpreted to permit compliance with the HIPAA Rules.

 

AGENCY is committed to following local, state and federal laws, rules and regulations.

REPORTING 
 To assist us with our commitment to appropriate and legal conduct, all AGENCY contractors, and their employees are required to report any violations that come to their attention.  

 

If a contractor or agent (including employees of contractors or agents) believes that a representative of AGENCY is billing for services that

 

(i) were not actually provided (services that did not occur or are improperly coded);

(ii) were medically unnecessary; or

(iii) were provided in a significantly sub-standard manner...

 

The contractor, agent or employee should immediately contact Easter Seals Colorado at 303-233-1666.

 

AGENCY policies are designed to prevent fraud, waste and abuse - 
in connection with payments by the federal government for health care services and promote ethical conduct by our contractors and agents. Federal and state laws concerning penalties for submitting false and fraudulent claims to the government are discussed below. We want you to know about federal laws concerning penalties for submitting false or fraudulent claims. We also want you to be aware that contractors or agents or their employees who act as "whistleblowers" when they believe false or fraudulent claims are being submitted receive certain protections under law.  

 

Federal laws concerning the submission of false or fraudulent claims for payment to Medicare, Medicaid or other Federal health programs are: 
l. Federal False Claims Act 31 USC Sections 3729 through 3733. Known as the FCA, this statute make a person civilly liable if they: knowingly presents, or causes to be presented, a false or fraudulent claim, record or statement for payment and approval; 

 

• conspires to defraud the government by getting a false or fraudulent claim allowed or paid; uses a false record or statement to avoid or decrease an obligation to pay the government; or

 

• commits other fraudulent acts listed in the statute. A person acts "knowingly" if he or she has actual knowledge of the falsity of the submitted information, or acts in "deliberate ignorance" or "recklessly disregards" the truth or falsity of the information. Penalties for providers such as the company that files false claims are

 

Mistakes 
When a mistake is made notify Easter Seals Colorado as soon as the mistake is recognized for the proper corrections can take place. 

 

A: Data Collection, Credentials, and Billing Honesty 
If at any time contractor is out of compliance, there are penalties up to forfeiture of pay. PROVIDERS WITHOUT NEEDED CREDENTIALS MAY NOT PROVIDE SERVICES. 

Data is due at the time of service with verification from family / client. Delay in data may result in fees, delayed reimbursement, or no reimbursement depending on funding sources and applicable regulations. 

I attest that the documentation made provided in each record accurately reflect he services provided, diagnosis, treatments, and information as recorded during this session. The electronic health record does accurately reflect my role, relationship, position and intent as indicated by my name, title and capacity for the record. I attest that this information is true, accurate, and complete to the best of my knowledge. I understand that any falsification, omission, or concealment of material fact may subject me to administrative, civil, or criminal liability. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature. I agree and understand that these statements are being made under penalty of perjury.

 

  By working with any client I attest that I have read all available information in their file as there file functions as each client's person specific training. Furthermore, by accepting a client I attest that my expertise matches the clients needs and that I am a competent provider for that person's specific needs. If I’m not then I will decline working with client or create a client/family action plan on what needs to take place in order for there to be a client need / provider skill match.

 

               I commit that all information providing is true and accurate to my knowledge. If at ANY TIME, any information on my part changes that would possibility violate this agreement I must stop seeing clients right away, contact Easter Seals Colorado and determine an appropriate action plan. Examples would be, if I had a law suit filed against me, have been accused of a crime, my insurance or license lapsed, etc. (this in not an all-inclusive list). If any of my contact information or credentials needs to be updated I will contact AGENCY immediately. 

 

       · Notices will be in writing and will be deemed given when sent via email or task in EHR.  

 

G: Payments, HIPAA, Fraud, Waste, and Business Associate Agreement 
· Collaborators will provide services in accordance with the individualized service plan governed by the rules and regulations provided by the state of Colorado which are reflected in ANGENCY policies and procedures. -Colorado rules and regulations including the Business Associate Agreement. 

 

· Collaborators shall permit access to sessions, or cooperate with request for information such as a phone call, meeting, or report, to AGENCY , the CCB, the State of Colorado Department of Human Services, the Colorado Department of Health Care Policy and Financing, the U.S. Department of Health and Human Services, and any other duly authorized agent or governmental agency including the Medicaid Fraud Control Unit.

 

· Have access to any place where service is being provided at any reasonable time during the term of this contract to observe the operation of the programs carried on by the Contractor with or without notice.

 

· Collaborators shall submit any final Plans of Correction required to AGENCY within 24 hours of a request and respond to request for client / provider information within 24 hours.

 

· Collaborators may provide any of the services for which the credentials and contract demands are met that AGENCY is qualified to provide.

 

Collaborators will, 
· Provide information for the development of the service plan. 
· Document methods and procedures used and outcome on session data and reviews. 

 

· Provide necessary support to client / caregiver to achieve the outcomes identified in the service plan. 
· Determine how plans are implemented to gain the desired results. 

 

------ Employee's and volunteers will follow any and all handbooks and verbal instructions provided detailing how services are performed. Independent Contractors are excluded from this statement. ------

 

       · AGENCY will pay for satisfactory provided services rendered in accordance with the provisions below. Payments are based on the number of units specified in the service plan. 

 

               · All providers may only use the units designated for their specific use, in the amount, scope, frequency, and duration outlined in the service plan. Each service may only be provided for the time span listed for that service. Providers who bill beyond the approved amount, scope, frequency, or duration WILL NOT BE PAID FOR SERVICES rendered and that family is NOT RESPONSIBLE for payment if payment cannot be collected due to inappropriate billing. You must have written authorization in order to document that you have authorization of services.

 

               · It is the responsibility of the provider to make sure that enough units are available to last each client the ENTIRE SERVICE PLAN YEAR! Even with a fluctuation statement, a provider may not use an excessive amount of units that leaves a client not able to get their needs met throughout the year or to significantly reduce utilization to make the units "stretch." If the provider neglects this duty the provider is responsible for providing the services for the remainder of the service plan, without reimbursement or to reimburse the service plan the dollar amount needed to fund the remaining of the service plan for the units that were over utilized otherwise this would be considered fraud.

 

               · If there is a special circumstance that requires a mass amount of units be used and the family wishes to change the expectation of services being available throughout the entire year, the provider, case manager, family, and the contract holding agency must all be made aware, agree, and have written documentation to the fact. 

 

               · Providers shall comply with all AGENCY billing procedures and requirements, which may be amended by AGENCY . 

 

                       · All submissions of required documentation in order to maintain funding sources, remain in compliance with the State of Colorado rules and regulations, and AGENCY policies and procedures including needed documentation for client and provider file alike.

BAA and HIPAA 
BAA Agreement; It means you are personally responsible for safeguarding all client information and are responsible for the consequences if you compromise information. 

 

I understand that I am responsible for complying with the HIPAA policies and regulations.

 

I Will treat all Information received, which relates to the patients of the provider, as confidential and privileged Information.

 

I will not access patient information unless I have the need to know this information in order to perform my job.

 

I will not disclose Information regarding the Provider's patients to any person or entity other than as necessary to perform my job, and as permitted under the HIPAA Policies.

 

I Will not log on to any of the Provider's computer systems that currently exist or may exist in the future unless I am instructed to do so by the Privacy Officers.

 

I Will not use e-mail to transmit consumer information unless I am instructed to do so by the AGENCY or client's have given permission in writing.

 

I will not take patient Information from the premises of the Provider in paper or electronic form without first receiving permission from the AGENCY

 

Upon separation from AGENCY , I agree to continue to maintain the confidentiality of any information I learned while associated with AGENCY , I agree to turn over any keys; access cards, or any other device that would provide access to the provider or Its information.

 

· Please note, accessing confidentially information on a public Wi-Fi source is a violation of HIPPA

 

I understand that violation of this agreement could result in my termination, effective immediately and a report to authorities.

H: Remedies and Termination 
We want all of our community to have the chance for personal and business development. If possilbe when their is a concern or contract violation we will attempt actions plans in order to be able to move forward.  

 

AGENCY may utilize the following remedial actions, in addition to all other remedial actions authorized by law, should it find that IC substantially failed to satisfy the scope of work found in this contract. Substantial failure to satisfy the scope of work shall be defined to mean incorrect or improper activities or inaction by Collaborator as determined by AGENCY . These remedial actions are as follows:

 

        · Collaborator is deemed to be out of compliance at any time, then corrections or a plan of correction will be required. Written notification will specify if corrections are to be made immediately, or, if a plan of correction shall be developed and the deadline for correction specified. IC is responsible for responding within 24 hours of a request for phone conference or other communication.

 

        · If corrections are not made by the time frame specified by AGENCY , or an acceptable plan of correction is not submitted by the deadline specified in the notification of non-compliance, and if the health, safety and welfare of persons is not found to be in jeopardy, IC and AGENCY may renegotiate time frames and plan(s) of action.

 

        · Payment to Collaborators may be withheld until the necessary services or corrections in performance are satisfactorily completed.

 

        · Payments may be denied or recovered from Collaborator for those services or deliverables which have not been performed and which, due to circumstances caused by Collaborator, cannot be performed or, if performed would be of no value to AGENCY . Determination of the amount of payment denied shall be reasonably related to the amount of work or deliverables lost to AGENCY . In addition to other fees, contracts under remediation may have associated fees.

 This contract is subject to immediate cancellation by AGENCY in the event that

AGENCY:

· AGENCY determines that the health, safety, or welfare of persons receiving services from IC may be in jeopardy.

 

        · Core agreement has been violated.

 

        ·Collaborator's performance of services not satisfying state-mandated specifications or the individual(s)' service plan or contract has been violated.

 

        · Fraud.

 

        · Funding sources change or become unavailable as determined by AGENCY . AGENCY may immediately terminate this contract or amend it

 

        · Final payment may be withheld pending an audit of outstanding payables due when a contract is terminated. If outstanding payables related to an individual’s care are due, they may be paid by AGENCY and the balance withheld from final payment to Contractor. 

 

To align with client respect and to protect client well being in the event of:

 

Termination of client specific service at client request agent IS NOT permitted to contact client further. Any needs will be directed towards agency.  
Provider initiated termination with notice, statement may be shared with clients 
Termination of contract due to violation, agent IS NOT permitted to contact client further. Client's may initiate contact with provider.