HomeMy WebLinkAbout20131116.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR WOMEN'S WELLNESS CONNECTION
PROGRAM AND AUTHORIZE CHAIR TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, the Board has been presented with a Task Order Contract for the Women's
Wellness Connection Program between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Weld County Department of
Public Health and Environment, and the Colorado Department of Public Health and Environment,
commencing June 30, 2013, and ending August 31, 2017, with further terms and conditions being
as stated in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said contract, a copy of
which is attached hereto and incorporated herein by reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Task Order Contract for the Women's Wellness Connection Program
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of the Weld County Department of Public Health and
Environment, and the Colorado Department of Public Health and Environment be, and hereby is,
approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 6th day of May, A.D., 2013.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:
Weld County Clerk to the
BY:
Deputy Clerk to the Boar
APP
ttorney
Date of signature:
5/a,
Sean P. Conway
Mike Freeman
2013-1116
HL0040
Memorandum
TO:
FROM:
DATE:
SUBJECT:
William F. Garcia, Chair
Board of County Commissioners
Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment
April 25, 2013
Women's Wellness Connection
Task Order Contract FY 13-14
Enclosed for Board review and approval is a Task Order Contract between the Colorado
Department of Public Health and Environment and the Weld County Board of County
Commissioners for the benefit of the Weld County Department of Public Health and
Environment for continuation of the Women's Wellness Connection (WWC) program.
The WWC program provides low-income, uninsured and underserved women capable of
demonstrating lawful presence in Colorado access to timely, high quality screening and
diagnostic services to detect breast and/or cervical cancer at the earliest stages.
The amount available for this contract fiscal year 2013-2014 is $46,471 in federal pass -through
finding. This represents an increase of $7,709 from fiscal year 2012-2013. The term of this
contract is June 30, 2013 through June 29, 2014.
I recommend your approval of this Task Order Contract.
Enclosure
2013-1116
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
ROUTING NO.13 FLA 54772
APPROVED TASK ORDER CONTRACT - WAIVER #154
This Task Order Contract is issued pursuant to Master Contract made on 01/17/2012,. with routing number 13 FAA 00051
STATE:
State of Colorado for the use & benefit of the
Department of Public Health and
Environment
PSD-WWC
4300 Cherry Creek Drive South
Denver, Colorado 80246
TASK ORDER MADE DATE
03/29/2013
PO/SC ENCUMBRANCE N UMBER
PO FLA PSD1354772
TERM:
This Task Order shall be effective upon
approval by the State Controller, or designee,
or on 06/30/2013, whichever is later. The
Task Order shall end on 08/31/2017.
PRICE STRUCTURE:
Cost Reimbursement
PROCUREMENT METHOD:
Exempt
BID/RFP/LIST PRICE AGREEMENT NUMBER
Not Applicable
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE:
Emily Kinsella
Department of Public Health and Environment
PSD-WWC
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACTOR
Board of County Commissioners of Weld County
(a political subdivision of the state of Colorado)
915 10th Street
Greeley, Colorado 80632-0758
for the use and benefit of the
Weld County Depailuient of Public Health and
Environment, 1555 North 17th Avenue
Greeley, Colorado 80631
CONTRACTOR ENTITY TYPE:
Colorado Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY:
Not Applicable
CONTRACT PRICE NOT TO EXCEED:
$46,471.00
FEDERAL FUNDING DOLLARS:
STATE FUNDING DOLLARS:
$18,588.00
$27,883.00
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY 14: $46,471.00
CONTRACTOR REPRESENTATIVE:
Dave Rademacher, Weld County Commissioner
Weld County Department of Public Health and
Environment
1555 North 17th Avenue
Greeley, Colorado 80631
SCOPE OF WORK
Perform work for the Women's Wellness Connection (WWC) Program Service Delivery Initiative to
conduct breast and cervical cancer screenings for eligible women.
Page 1 of 6 Rev 6/25/09
EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A - Additional Provisions (and its attachments if any — e.g., A-1, A-2, etc.)
Exhibit B - Statement of Work (and its attachments if any — e.g., B-1, B-2, etc.)
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made
more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task
Order Contract provide morespecificity than these general clauses, the more specific provision shall control.
1. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including
any renewals or extensions, may not exceed five (5) years. The parties intend, and agree that all work shall
be performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1), C.R.S., as amended, this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof The Contractor is not
authorized to, and shall not; commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date, then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date, then the Contractor shall only commence perfointance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting_ terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits
and/or attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: 1) the
Page 2 of 6 Rev 6/25/09
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
Additional Provisions -_Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B".
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this
Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment
must be signed by the State and the Contractor, and be approved by the State Controller or an authorized
delegate thereof. This contract is subject to such modifications as may be required by changes in Federal
or State law, or their implementing regulations. Any such required modification shall automatically be
incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set
forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work -
Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the
Contractor shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective
Date is on or after July 1, 2009 and the maximum amount payable to Contractor hereunder is $100,000 or
higher]
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies and Guidance.
Evaluation of Contractor's performance shall be part of the normal contract administration process and
Contractor's performance will be systematically recorded in the statewide Contract Management System.
Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of
information relevant to the performance of Contractor's obligations under this Task Order Contract shall be
determined by the specific requirements of such obligations and shall include factors tailored to match the
requirements of the Statement of Project of this Task Order Contract. Such performance information shall
be entered into the statewide Contract Management System at intervals established in the Statement of
Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any identified
problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado
Department of Public Health and Environment and showing of good cause, may debar Contractor and
Page 3 of 6 Rev 6/25/09
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result
by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS
§24-105-102(6)), or (ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights
provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and
reinstatement of Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and
its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws,
state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be
amended. Without limitation, these federal laws and regulations include the Federal Funding
Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law
110-252, including without limitation all data reporting requirements required there under. This Act is also
referred to as FFATA.
Page 4 of 6 Rev 6/25/09
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 03/29/2013 - Contract Routing Number 13 FLA 54772
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order
Contract specified above.
1. The list of acronyms attached hereto as Attachment A-1 maybe referenced to in Exhibit A, Exhibit B,
and all and any attachments thereof in this Task Order Contract.
2. This Task Order Contract contains federal, and state, funds (see Catalog of Federal Domestic Assistance
(CFDA) number ** ***)
3. The United State Department of
federal funds under Award number
k******* (US****"}, through the
**, hereinafter "Award';,
has awarded
erfotmthe following
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a contractor as
of the effective date of that Award, then the State shall reimburse the Contractor for any allowable and
allocable expenses of the Contractor that have been incurred by the Contractor since the proposed effective
date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a contractor as of the effective date of that Award, then the State shall only
reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by
the Contractor on or after the effective date of this Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the
State Controller or delegee.
Notwithstanding the terms contained in General Provisions of the Master Contract, Section 27, Annual
Audit, for the purpose of this Task Order, the Contractor is a Vendor as defined by Office of Management
and Budget (OMB) Circular A-133 (Audits of States, Local Governments, and Non -Profit Organizations).
To receive compensation under this Task Order Contract, the Contractor shall provide breast and cervical
cancer screening services to women during the term of this Task Order Contract. The Contractor shall also
provide Women's Wellness Connection approved diagnostic services to women that meet the criteria in
accordance with the Statement of Work attached hereto as Exhibit B and incorporated herein. The
Contractor shall be paid in accordance with rates as outlined this Contract.
To be considered for payment, all Women's Wellness Connection services must be entered into eCaST
within thirty (30) days of service being performed. Breast and cervical cancer screening cases that exceed
sixty (60) calendar days in screening length and negatively affect the program's Core Performance
Indicators may or may not be reimbursed at the discretion of the State. Contractors shall only be paid for
cases that meet eligibility, performance and data requirements. Reimbursement is determined by the
outcome of the case; therefore, cases must be clinically complete before reimbursement occurs. The
Contractor shall be paid in accordance with rates as outlined in the Bundled Payment System, of this Task
Order Contract. This document is incorporated and made part of this Exhibit by reference and is available
on the following WWC website under "Screening and Diagnostic Services"
http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617581963. Rates may be revised or
updated during the period this statement of work is in effect. Cases may not be paid if the data in not
entered completely or accurately into the eCaST data system. Cases closed in eCaST as Lost to Follow -Up
or Refused will be paid at the highest level achieved as long as evidence of contact attempts is documented
in the case management module of eCaST. The WWC program will only pay one Contractor for services
provided to one woman. The WWC program only provides reimbursement for a client's clinically complete
case once per fiscal year. Short-term follow-up that occurs within the same fiscal year is not reimbursed
unless it results in a higher bundle. The WWC program will provide additional reimbursement according to
the bundled payment system for clients returning with new symptoms during the same fiscal year.
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 1 of 4 Revised: 12/19/06
EXHIBIT A
Within the Bundled Payment System, Contractors are reimbursed for case management services depending
on the outcome or complexity of the case. In order to receive reimbursement for case management
services, Contractors must do the following: Notify the patient of an abnormal result within two (2) weeks
of the procedure; Use WWC approved algorithms to determine next steps; Assess clients for barriers to
completing recommending diagnostic tests; Actively schedule diagnostic appointments on the patient's
behalf. This may be completed directly by the Contractor or by the subcontractor. Clients should not be
given a referral list and asked to schedule their own appointments. If applicable, the Contractor shall
comply with the "Lost to Follow Up/Refused Service Policy." This document is incorporated and made
part of this Exhibit by reference and is available on the following WWC website under "Screening and
Diagnostic Services": http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/125 1617581963
Referred in for diagnostics: Once all data is entered and the case in clinically complete, cases will be
reimbursed based on the difference between screening and diagnostic level achieved in the Bundled
Payment System.
It is expected that reimbursement will cover costs associated with: Enrollment of women into the WWC
Program; Cancer screening services, as outlined in the "Current Procedural Technology (CPT) Code List."
This document is incorporated and made part of this Exhibit by reference and is available at the following
WWC website under "Screening and Diagnostic Services": http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/1251617581963 • Patient navigation and case management services; Entry of all information
into eCaST; and Administrative procedures to place a client with a positive diagnosis of breast and/or
cervical cancer into Medicaid BCCP.
Data entered into eCaST are the basis for calculating reimbursement for each client screened. One
reimbursement check for all completed screenings that have met data and quality standards will be sent to
the Contractor each month. WWC will generate Contractor grant activity statements based on data entered
into eCaST each month on the 15`h or next business day thereafter. WWC will only provide reimbursement
for cases that are clinically complete and correctly entered into eCaST between June 30 and June 29 of the
following year. Contractors are given a data entry grace period from June 30 through the last business day
of July, annually. WWC will run a final billing for the current fiscal year on the last business day in July
and will implement grant funding change letters in August to assure all WWC funding is spent by August
31, annually.
6. Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have thirty (30) calendar days from the date a deliverable is
delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables
that have a different time negotiated by the State and the Contractor.
b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design
specifications for that particular deliverable, or is otherwise deficient, then the State shall notify
the Contractor of the failure or deficiencies, in writing, within thirty (30) calendar days of: 1) the
date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or
deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or
deficiency. The above time frame shall apply to all deliverables except for those deliverables that
have a different time negotiated by the State and the Contractor in writing pursuant to the State's
fiscal rules.
c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed
deliverable, the Contractor shall have a reasonable period of time, not to exceed ten (10) calendar
days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within
ten (10) calendar days, the Contractor shall be in default of its obligations under this Task Order
Contract and the State, at its option, may elect to terminate this Task Order Contract or the Master
Contract and all Task Order Contracts entered into pursuant to the Master Contract.
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 2 of 4 Revised: 12/19/06
EXHIBIT A
7. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Task Order Contract does not constitute a Business Associate
relationship under HIPAA.
8. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, unless otherwise provided for, all
data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this
Task Order Contract shall remain the sole property of the State, whether in individual, aggregate, identified
or de -identified form or any other form required by the State. To facilitate follow-up, research, surveillance
and evaluation, any such data collected, used or acquired shall be made available in any form required by
the State, to the State and any other entity designated by the State.
Any such data collected, used or acquired shall be used solely for the purposes of this Task Order Contract.
The Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell, or otherwise
make known any such data to unauthorized persons without the express prior written consent of the State or
as otherwise required by law. This includes a prior written request by the Contractor to the State for
submission of abstracts or reports to conferences, which utilize data collected under this Task Order
Contract.
Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or
work papers necessary to perform its duties under this Task Order Contract and in accordance with
professional standards.
9. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in
Data, Documents and Computer Software or Other Intellectual Property, or Section 23.i, General
Provisions, Media or Public Announcements, the State of Colorado, specifically the Department of Public
Health and Environment, shall be the owner of all printed materials, graphic representations, educational
materials, audio-visual products, or any other media, in whatever form, created under this Task Order
Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio
spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any
material, representation, product or other media form created under this Task Order Contract.
Any material, representation, product or other media form that will use the State's or logo or information
must be approved by the State prior to production and distribution. A minimum of ten (10) business days is
required for the review and approval process.
10. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 25,
Conformance with Law, the Contractor shall comply with the provisions of Section 601 of Title VI of the
Civil Rights Act of 1964, as amended, which states that "no person in the United States shall on the
grounds of race, color or national origin, be excluded from participation in, be denied the benefits of, or be
subjected to discrimination under any program actively receiving Federal financial assistance." The Office
for Civil Rights has established that it is the responsibility of any program that is a recipient of federal
funds to ensure that any Limited English Proficient (LEP) person or beneficiary have meaningful access to
programs, services and information. The Contractor and contract personnel shall adopt and implement
policies and procedures in which reasonable steps are taken to provide language assistance in order to
ensure equal access to LEP persons or beneficiaries. The Contractor and contract personnel shall advise
LEP individuals that language assistance will be provided at no cost to the LEP person or beneficiary.
11. Contractor agrees to provide services to all Program participants and employees in a smoke -free
environment in accordance with Public Law 103-227, also known as "the Pro -Children Act of 1994", (Act).
Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the provision of health, day care,
early childhood development services, education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments, by Federal
grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in
indoor facilities that are constructed, operated, or maintained with such Federal funds. The law does not
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 3 of 4 Revised: 12/19/06
EXHIBIT A
apply to children's services provided in private residences; portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or
Medicaid; or facilities where Women, Infants and Children (WIC) coupons are redeemed. Failure to
comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty
of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the
responsible entity. By signing this Task Order Contract, Contractor certifies that Contractor shall comply
with the requirements of the Act and shall not allow smoking within any portion of any indoor facility used
for the provision of services for children as defined by the Act. Contractor agrees that it shall require the
language of the Act be included in any subcontracts which contain provisions for children's services and
that all subcontractors shall sign and agree accordingly.
12. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 10,
Confidential or Proprietary Information, the Contractor shall protect the confidentiality of all applicant or
recipient records and other materials that are maintained in accordance with this Task Order Contract.
Except for purposes directly connected with the administration of this Task Order Contract, no information
about or obtained from any applicant or recipient shall be disclosed in a form identifiable with the applicant
or recipient without the prior written consent of the applicant or recipient, or the parent or legal guardian of
a minor applicant or recipient with the exception of information protected by Colorado Statute as it applies
to confidentiality for adolescent services in which case the adolescent minor and not the parent or legal
guardian must provide consent or as otherwise properly ordered by a court of competent jurisdiction.
Contractor shall have written policies governing access, duplication, and dissemination of all such
information. Contractor shall advise its employees, agents, servants, and any subcontractors that they are
subject to these confidentiality requirements.
13. The Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect, with
tobacco companies, owners, affiliate, subsidiaries, holding companies or companies involved in any way in
the production, processing, distribution, promotion, sales, or use of tobacco.
14. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be
the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB)
Generally Accepted Accounting Principles (GAAP) purchased under this Task Order Contract. At the end
of the term of this Task Order Contract, the State shall approve the disposition of all equipment.
15. The Contractor shall not use funds provided under this Task Order Contract for the purpose of lobbying as
defined in Colorado Revised Statutes (C.R. S.) 24-6-301(3.5)(a).
16. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Attachment A-2. The Grant Funding Change Letter is not valid until it
has been approved by the State Controller or designee.
17. The State may require the contractor to begin performance on the next contact phase as outlined in the
Statement of Work in Exhibit B and at the same terms and same conditions stated in the contract. If the
State exercises this option, it will provide written notice to the contractor at least one day prior to the end of
the current phase in a form substantially equivalent to Attachment A-3. If exercised, the provisions of the
Option Letter shall become part of and be incorporated into the original Task Order contract.
To be attached to CDPHE
Task Order v1.0 (3/12) contract template
Page 4 of 4 Revised: 12/19/06
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
Board of County Commissioners of Weld
County
(a political subdivision of the state of Colorado)
for the use and benefit of the
Weld County Department of Public Health and
Environment
Legal Name of Contracting Entity
/p7
Signature of Autho
William F. Garcia
cer MAY 0 6 2013
Print Name of Authorized Officer
STATE OF COLORADO:
John W. Hickenlooper, GOVERNOR
For Executive Director
Department of Public Health and Environment
Department Program Approval:
Chair, Board of Weld
County Commissioners By
Print Title of Authorized Officer
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §2430-202 requires the State Controller to approve all State Contracts. This Contract is not valid until
signed and dated below by the State Controller or delegate. Contractor is not authorized to begin performance until
such time. If Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor
for such performance or for any goods and/or services provided hereunder.
STATE CONTROLLER:
David J. McDermott, CPA
BY ..2✓ei'.%GZLze
Date S- 31-13
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Rev 6/25/09
go/ 3 -Ill 47
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Page 6 of 6 Rev 6/25/09
Attachment A-1
Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work:
ACS American Cancer Society
ACNS Alamosa County Nursing Service
ACF Administration for Children and Families
ADA Americans with Disabilities Act
ADAD Alcohol and Drug Abuse Division
AHA American Heart Association
AIDS Acquired Immune Deficiency Syndrome
ALA American Lung Association
ALA(C) American Lung Association (of Colorado)
AMCHP ssociation of Maternal Child Health Programs
ANR merican for Non -Smokers' Rights
ARC ddiction Recovery Centers
ARRA merican Recovery and Reinvestment Act
ASC dams State College
ASSIST merican Stop Smoking Intervention Study
ASTHO ssociation of State and Territorial Health Office
B&G oys & Girls
BACCHUS ACCHUS Peer Education Network
BAG uild a Generation
BBLHC oulder Broomfield Latino Health Coalition
BC oulder County
BCCP reast and Cervical Cancer Program
BCHD ent County Health Dept
BCPH oulder County Public Health
BCPHA aca County Public Health Agency
BCDSS aca County Dept Social Services
BCTEPP ent County Tobacco Education Prevention Partnership
BGC oys & Girls Club
BGCMD oys & Girls of Metro Denver
BHS roomfield High School
BMTF aby & Me Tobacco Free
BOCES oard of Cooperative Educational Services
BOH oard of Health
BRFSS ehavioral Risk Factor Surveillance System
BVBAG uena Vista Build a Generation
BVSD oulder Valley School District
Bx iopsy
C hoice
CAD oronary Artery Disease
CASB olorado Association of School Board
CB ommunity-based System
CBE linical Breast Exam
CBO ommunity-based Organization
CC Lear Creek
CC aster County
CC ommunity Coordination/Coordinator
CCAP arimer County Child Care Assistance Program
CCC olorado Cancer Coalition
CCCHE olorado Community Coalition for health Equity
CCGC olorado Clinical Guidelines Collaborative
CCIAA olorado Clean Indoor Air Act
CCMC olorado Clinical Managed Care Network
CCMC ommission for Case Manager Certification
CCPD ancer, Cardiovascular, and Pulmonary Disease
Page 1of6
Attachment A-1
CCTCI Colorado Chew Tobacco Collaborative Initiative
CCTEPP Custer County Tobacco Education Prevention Partnership
CDC Centers for Disease Control and Prevention
CDE Colorado Department of Education
CDPHE Colorado Department of Public Health and Environment
CDU Chronic Disease Unit
CEC Career Education Center
CEO Chief Executive Officer
CFDA Catalog of Federal Domestic Assistance
CFFC Colorado Foundation for Families and Children
CFPI Colorado Family Planning Initiative
CHIN Community Health Information Network
CICP Colorado Indigent Care Program
CJD Colorado Judicial Department
CM Case Management
CMC Colorado Mountain College
CMS Contract Management System
CMS Creative Media Solutions
CNCC Colorado Northwestern Community College
CNS County Nursing Service
CO Colorado
COD Colorado Donated Dental Services Program
COPAN Colorado Physical Activity and Nutrition Program
COV Colorado Van Program
CPCF Colorado Parent and Child Foundation
CPI -IA Colorado Public Health Association
CPT Current Procedural Technology
CRC Colorectal Cancer
CRCCP Colorectal Cancer Screening Program
CRUE Culturally Responsive Urban Education
CSAP Colorado Student Assessment Program
CSH Coordinated School Health
CSU Colorado State University
CSU-P Colorado State University -Pueblo's
CTC Connect to Care
CTEPA Colorado Tobacco Education and Prevention Alliance
CTFK Campaign for Tobacco -Free Kids
CTRP Colorado Tobacco Research Program
CTP Crossroads Turning Point
CU University of Colorado, Boulder
CWCCI Colorado Women's Cancer Control Initiative
CY Contract Year
DAISI Denver At-home Intervention Service Initiative
DASH Division of Adolescent & School Health (CDC)
DCMH Delta County Memorial Hospital
DH Denver Health
DHHA Denver Health and Hospital Authority
DHS Department of Human Services
DHHS Unites States Department of Health and Human Services
DOR Department of Revenue
DOS Delta Opportunity School
DSS Department of Social Services
E&I Education and Information
EAP Employee Assistance Program
EBHV Evidence -Based Home Visiting to Prevent Child Maltreatment Grant Program
ECC Early childhood council •
ECC Electrocardiogram
ECCLC Early Childhood Council of Larimer County
Page 2 of6
Attachment A-1
ECLC Early Childhood Leadership Council/Commission
E.D. Executive Director
EHR Electronic Health Record
EHS Early Head Start
EMR Electronic Medical Record
EMT Emergency Medical Technicians
EPA Environmental Protection Agency
EPE Epidemiology Planning and Evaluation
ESL English as a Second Language
ETS Environmental Tobacco Smoke (a.k.a. secondhand smoke)
FIRC Family and Intercultural Resource Center
FICA The Federal Insurance Contribution Act
FDA Food and Drug Administration
FIT/FOBT Fecal Immunochemical Test/Fecal Occult Blood Test
FNA Final Needle Aspiration
FPP Family Planning Program
FPL Federal Poverty Level
FRCC Front Range Community College
FTE Full Time Equivalent
FTP File Transfer Protocol
FY Fiscal Year
FYI Family Youth Initiatives
GASO Great American Smoke -out
GED General Education Development
GASP CO Group to Alleviate Smoking Pollution of Colorado
Get REAL (GR) Resist! Expose Advertising Lies (Youth Empowerment Program)
GLBT Gay, Lesbian, Bisexual, and Transgender
GYN Gynecological
HCP Health Care Program For Children with Special Needs
HCYS Huerfano County Youth Services
HHS Health and Human Services
HIPPA Health Insurance Portability and Accountability Act of 1996
HIPPY Home Instruction for Parents of Preschool Youngster
HIT Health Improvement Team
HIV Human Immunodeficiency Virus
HPV Human Papillomamavirus
HR Human Resources
hr hour
HRSA Health Resources and Services Administration
HSL High School Leadership
ID Identification
IIK Invest in Kids
ISHT Interagency School Health Team
IT Information Technology
JAC Juvenile Assessment Center
KIS Keeping in STEPP
KMH Keefe Memorial Hospital
KPC Kevin Patrick Caleum
LAHCDHD Las Animas Huerfano Counties District Health Department
LBW Low Birth Weight
LC Learning Community
LGBT Lesbian, Gay, Bisexual, Transgender
LEM Latins en Movimiento
LHA Local Health Agency
LHD Local Health Department
LLC Limited Liability Company
LRCC Latino Regional Community Coalition
LRPC Latino a Research and Policy Center
Page 3 of 6
Attachment A-1
LST Life Skills Training
LSTPEN Latino Statewide Tobacco Prevention and Education Netw
LWB Live Well Broomfield
MCHA Montezuma Housing Authority
MCHD Montezuma County Health Department
MCHS Montezuma -Cortez High School
MCPN Metro Community Provider Network
MCRC Media Campaign Resource Center— CDC
MD Medical Doctor
MHCBBC Mental Health Center Serving Boulder and Broomfield Counties
MIECHV Maternal, Infant and Early Childhood Home Visiting Program
MO - Month
MOB Medical Office Building
MOU Memorandum of Understanding
MPA Master of Public Administration in Health and Human Services
MPH Master of Public Health
MRI Magnetic Resonance Imaging Scan
MS Master of Science
MSA Master Settlement Agreement
MUH Multi-user Housing
MYAT Multi -Disciplinary Youth Assessment Team
N/A Not Applicable
NACCHO National Association of County and City Health Officials
NACR Native American Cancer Research
NAQC North American Quitline Consortium
NASBE National Association of State Board of Education
NCCRT National Colorectal Cancer Round Table
NCHD Northeast Colorado Health Department
NCI National Cancer Institute
NE North East
NFP Nurse -Family Partnership
NFPNSO Nurse -Family Partnership National Service Office
NHVP Nurse Home Visitor Program
NIDA National Institute on Drug Abuse
NIH National Institute of Health
NJH National Jewish Medical and Research Center
N -O -T Not -on -Tobacco, (ALA's Youth Smoking Cessation Program)
NP Nurse Practitioner
NPP Nurturing Parenting Program
NRT Nicotine Replacement Therapy
NSBA National School Boards Association
OSH Office on Smoking or Health (CDC)
OTC Over the Counter
PA Physician's Assistant
PAC Prevention Awareness Crew
PACT Partners Assessing Chew Tobacco
PAT Parents as Teachers
PCCHD Pueblo City -County Health Department
PPC Personal Care Providers
PE Presumptive Eligibility
PEN Parent Engagement Network
PVCHC Peak Vista Community Health Center
PHN Public Health Nurse
PIO Public Information Officer
PM Peer Mentor
PMC Parkview Medical Center
PMR Planning Management Region
PN Patient Navigator
Page 4 of 6
Attachment A-1
PO Purchase Order
PPC Policy Partner Committee
PPFC Pikes Peak Family Connections
PPN Prevention Policy Network
PRA Policy Resource Alliance
PRAMS Pregnancy Risk Assessment and Monitoring Survey
PRIDE Pure Respect Initiative Direct Education
PSA Public Service Announcement
PSD Prevention Service Division
PTEPP Pueblo Tobacco Education and Prevention Partnership
PVC Prairie View Clinic
QI Quarter One
Q2 Quarter Two
Q3 Quarter Three
Q4 Quarter Four
QI Quality Improvement
QOL Quality of Life
RDAC Regional Disparities Advisory Council
RFA Request for Applications
RFP Request For Proposals
RIP Reach, Implementation and Effectiveness
RIHEL Regional Institute for Health and Environment
RMC Rocky Mountain Center for Health Promotion & Education
RMRH Rocky Mountain Rural Health
RMYC Rocky Mountain Youth Corps
RN Registered Nurse
Rx Prescription
RY Reconnecting Youth
SafeCare
SAMHSA Substance Abuse Mental Health Services Administration
SB School -based System
SBAG Salida Build A Generation
SBHC School -Based Health Centers
SCYC School Community Youth Coalition
SCRHC Southern Colorado Regional Health Collaborative
SD Service. Delivery
SECH Southeast Colorado Hospital
SEMHS Southeast Mental Health Services
SES Socio-Economic Status
SEW School Employee Wellness
SGR Surgeon General's Report
SHAC Smoke -free Housing Action Committee
SHI School Health Index
SHS Secondhand Smoke
SIDS Sudden Infant Death Syndrome
SLV San Luis Valley
SMART Staying Motivated at Reducing Temptations
SMART OUTCOME OBJECTIVE Specific, Measurable, Achievable, Realistic, Time -Bound
SMSU Self Management Service Unit
SRO School Resource Officer
STD Sexually Transmitted Disease
STEPP State Tobacco Education and Prevention Partnership
STW Straight -to -Work
SVVSD St. Vrain Valley School District
SWOT Strengths, Weaknesses, Opportunities, Threats
SYNAR Synar Regulation
TA Technical Assistance
TABS Tobacco Attitudes and Behavior Survey
Page 5 of 6
Attachment A-1
TAG Technical Advisory Group (for evaluation & TPEG)
TANF Temporary Aid to Needy Families
TARP Tobacco Advocacy and Resource Partnership
TBD To Be Determine
TCP Tobacco Control Partners
TDAC Tobacco Disparities Advisory Council
TDG Tobacco Disparities Grant
TDS Tobacco Disparities Subcommittee
TEACH Teaching Equity to Advance Community Health
TEFAP The Emergency Food Assistance Program
TEPCGP Tobacco Education Prevention and Cessation Grant Program
TEPP Tobacco Education Prevention Partnership
TFCCI Tobacco -Free Colorado Communities Initiative
TFLC Tobacco Free Larimer County
TFS Tobacco -Free Schools
TFS Law Tobacco -Free Schools Law
TGYS Tony Grampsas Youth Services
Title V Title V of the Social Security Act
TND Project Toward No Drug Abuse
TPEG Tobacco Program Evaluation Group
TPI Tobacco Prevention Initiative
TRC Tobacco Education and Prevention and Cessation Program Review Committee
TRI Tobacco Rapid Improvement Activity
TRIA Tobacco Rapid Improvement Assessment
TTI Tony Grampsas Tobacco Initiative
UCD - University of Colorado — Denver
UCDHSC Health Sciences Center at UCD (sometimes abr. UCHSC)
UCDHSC University of Colorado at Denver and Health Sciences Center
URL Uniform Resource Locator
US United States of America
USSTC US Smokeless Tobacco Company
VP Vice President
Well COA Wellness Councils of America
WHU Women's Health Unit
WIC Women, Infants, Children
WWC Women's Wellness Connection
Y@C Youth at Crossroads
YE Youth Empowerment
YPH Youth Partnership for Health
Yr Year
YRBS Youth Risk Behavior Survey
YSAP Youth Substance Abuse Prevention Coalition
YTS Youth Tobacco Survey
YVMC Yampa Valley Medical Center
5 A's Ask, Advise, Assess, Assist, Arrange
2A's R Ask, Advise, Refer
Page 6 of 6
Attachment A-2
GRANT FUNDING CHANGE LETTER
Date:
State Fiscal Year: 1 Grant Funding Change Letter #
TO: Insert Grantee's name
CMS Routing #
In accordance with Section of the Original Contract routing number , [insert the following
language here if previous amendment(s), renewal(s) have been processed] as amended by [include all
previous amendment(s), renewal(s) and their routing numbers], [insert the following word here if
previous amendment(s), renewal(s) have been processed] between the State of Colorado, Department
of Public Health and Environment and Contractor's Name beginning Insert start date <insert start date of
original contract> and ending on Insert ending date <insert ending date of current contract amendment>,
the undersigned commits the following funds to the Grant:
The amount of grant funds available and specified in Section of <insert contract amendment
number and routing number> is ❑ increased or ❑ decreased by $amount of change to a new total
funds available of $ <insert new cumulative total> for the following reason: . Section
is hereby modified accordingly.
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or , whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
BY:
By: Lisa Ellis, Purchasing & Contracts Unit Director
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Grants. This Grant is not valid until signed and dated below by
the State Controller or delegate. Grantee is not authorized to begin performance until such time. If Grantee begins performing prior
thereto, the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided
hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Date:
Page 1 of 1
Effective Date: 1/6/09 -Rev 8/25/09
Attachment A-3
OPTION LETTER
[ Date:
State Fiscal Year:
Option Letter No.
CMS Routing #
1) OPTIONS: Choose all applicable options listed in §1 and in §2 and delete the rest.
a. Option to renew only (for an additional term)
b. Change in the amount of goods within current term
c. Change in amount of goods in conjunction with renewal for additional term
d. Level of service change within current term
e. Level of service change in conjunction with renewal for additional term
f. Option to initiate next phase of a contract
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options 1(a -e): In accordance with Section(s) of the Original Contract routing number
between the State of Colorado, Insert Name of Department or Higher Ed Institution , and Contractor's
Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on
Insert ending date at a cost/price specified in Section , AND/OR an increase/decrease in the amount of
goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment, Exhibit etc.
b. For use with Option 1(f), please use the following: In accordance with Section(s) of the Original
Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed
Institution , and Contractor's Name, the State hereby exercises its option to initiate Phase indicate which
Phase: 2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price
specified in Section
c. For use with all Options 1(a -f): The amount of the current Fiscal Year contract value is
increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration
for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first
sentence in Section is hereby modified accordingly. The total contract value including all previous
amendments, option letters, etc. is Insert New $ Amt.
3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
PROGRAM APPROVAL:
By:
By: Lisa Ellis, Purchasing & Contracts Unit Director
Date:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below
by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins
performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or
services provided hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Date:
Page 1 of 1
Effective Date: 1/6109 -Rev 8/25/09
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 3/29/2013 - Contract Routing Number 13 FLA 54772
These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above.
I. Project Description:
Program Overview: Women's Wellness Connection (WWC) provides breast and cervical cancer screening
(clinical breast exams, mammograms, pelvic examinations, and Pap tests) to eligible women through multiple
statewide providers.
Program Purpose and Mission: The purpose and mission of the Women's Wellness Connection (WWC) is to
provide, promote and ensure quality breast and cervical cancer screenings for underserved women in Colorado
and to connect them to resources.
Beneficiaries: Direct beneficiaries are women residing in Colorado who are uninsured or underinsured; and
who meet age, income and lawful presence requirements of the program. Target populations include women of
diverse ethnic backgrounds, women living in geographically isolated and medically underserved areas, those
who are rarely or never screened for breast and/or cervical cancer.
Project Period: Date of fully executed contract — June 30, 2013 through August 31, 2017.
Period for Clinical Service Delivery: Date of fully executed contract — June 30, 2013 through June 29,
annually through 2017. For each annual Period for Clinical Service Delivery, cases not clinically complete by
June 29 shall not be paid.
Budget: The budget amount for the Period for Clinical Service Delivery shall be determined on an annual basis
and this contract shall be increased or decreased in accordance with the Additional Provisions.
II. Performance Requirements/Deliverables:
The content of electronic documents located on CDPHE and non-CDPHE websites and information contained
on CDPHE and non-CDPHE websites may be updated periodically during the contract term. The Contractor
shall monitor documents and website content for updates and comply with all updates.
A. Administration:
a. Contractor contact information shall be provided to WWC within fifteen (15) calendar days of the
start of the fully executed contract. The Contractor shall use the "Agency and Site Contacts
Form." Which form is incorporated and made part of this SOW by reference and is available on
the following WWC website at http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/1251617581963 under the "Other" heading.
1. The Contractor must identify and support a WWC Coordinator, Clinical Liaison, eCaST
Coordinator, Agency Director, Contract Administrator, Signature Authority, Fiscal
Payment Coordinator, Fiscal Manager, and Case Manager(s). The Contractor shall
comply with the requirements stated in the "Contacts Descriptions" document. Which
form is incorporated and made part of this SOW by reference and is available at the
following WWC website at: http://www.colorado.gov/cs/Satellite/CDPI-IE-
PSD/CBON/1251617581963 under the "Other" heading.
2. The Contractor shall complete the "New Contractor Checklist" form which will be
provided by WWC within fifteen (15) calendar days of the start of the fully executed
contract.
b. All staff changes during the contract period shall be reported to WWC within fifteen (15) calendar
Page 1 of 5
Page 1 of 5
Exhibit B- Statement of Work
V l/MAR2012
EXHIBIT B
days. The Contractor shall use the "Agency and Site Contacts Form" or another form provided by
WWC.
c. Contractor shall enter data into the eCaST data system.
1. CDPHE will provide training on the eCaST system to the Contractor, unless otherwise
approved by the program.
i. New data entry staff must be trained by WWC on eCaST within thirty (30)
calendar days of hire, unless otherwise approved by the program.
2. Any changes to Contractor staff responsible for WWC data entry must be reported to the
WWC Program within fifteen (15) calendar days.
3. The Contractor shall renew eCaST users annually. The Contractor shall use the "Agency
and Site Contacts Form" or another form provided by WWC, and shall be submitted to
WWC staff.
4. It is expected that if a Contractor enrolls a client in WWC and provides initial cancer
screening services, the same Contractor shall be responsible for entering all data in
eCaST and assuring that clinically appropriate follow-up care is completed through case
management services.
5. Clients eligible for WWC may be enrolled in the program at any point in their screening
or diagnostic cancer screening care prior to biopsy. Clients should be enrolled and noted
as "referred in for diagnostics" in eCaST if they are enrolled in the WWC program for
diagnostic services only.
d. When corresponding with the WWC Staff, Contractors must use all privacy and security measures
to protect the client's personal health information.
1. Accepted forms of communication include:
i. WWC identification number used in unencrypted email conversations;
ii. Mail or fax clearly marked "Confidential" ;
iii. HIPAA compliant files transmitted via secure File Transfer Protocol (FTP) sites;
and
iv. Secure encrypted email.
2. If a Contractor intends to use data from eCaST for publications, conference presentations,
and/or research projects, the Contractor must notify and receiveprior approval from the
WWC Program.
e. At least one representative from the Contractor and/or its network provider sites shall attend
meetings or conference calls hosted by WWC staff Contractors can make up attendance by
reviewing meeting minutes or a recorded version at a later time.
1. The Contractor will attend WWC sponsored conference calls, meetings and trainings,
including:
i. 50% of WWC monthly Health Improvement Team (HIT) calls;
ii. 50% of bimonthly eCaST Users Group Conference Calls;
iii. 100% of WWC clinical webinars; and
iv. Other meetings and trainings as needed.
f. The Contractor should consult with their American Cancer Society Community Coordinator at
least bi-annually.
g. The Contractor receives a contracted funding amount that they can use to provide services under
the WWC program for the annual Period for Clinical Service Delivery. Once this funding cap
has been reached, the WWC program will not pay for any additional expenses incurred by the
Contractor.
I. Contractors are responsible for management of funds including:
i. Ensuring that all funds are fully spent by the end of the contract period;
ii. Reviewing eCaST reports monthly (after the 15th of the month) to determine
spending status.
iii. Ensuring enough funds remains at the end of the contract year to pay for a woman
in need of BCCP Medicaid.
iv. Making programmatic changes as needed to adjust spend rate.
Page 2 of 5
Page 2 of 5
Exhibit B- Statement of Work
V l /MAR2012
EXHIBIT B
2. Contractors who are under spent in their budgets may have funds taken back and
reallocated to other Contractors at any time during the contract period.
h. Changes to basic eligibility requirements of the program may not be made by the Contractor
without WWC approval including:
1. Age requirements;
2. Income requirements;
3. Insurance status; and
4. Legal presence requirements.
B. Provision of Clinical Services:
a. Contractors shall perform basic breast and cervical cancer screening services on -site at the
contractor's place of business. Basic screening services include clinical breast exams, pelvic
exams and Pap tests.
b. The Contractor shall provide screening services to women and have entered qualifying procedures
into eCaST no later than August 31, annually.
c. The Contractor shall provide all services referenced on the "Current Procedural Technology (CPT)
Code List" directly or through a subcontractor agreement. The Contractor shall not charge WWC
for services not listed on the CPT Code List. This form is incorporated and made part of this SOW
by reference and is available on the following WWC website at
http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617581963 under the "Screening
and Diagnostic Services" heading.
d. Contractors shall ensure all steps involved in the breast and cervical screening and diagnostic
process can be performed within 60 calendar days of the first abnormal finding.
1. For services that cannot be provided on -site, the Contractor must maintain a network of
subcontractors. Contractors shall complete and forward a "Subcontractor Form "within
15 calendar days of the fully executed contract to WWC Data Specialist. This form is
incorporated and made part of this SOW by reference and is available on the following
WWC website at http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/1251617581963 under the "Other" heading.
2. All subcontractor changes during the contract period shall be reported to WWC within
fifteen (15) calendar days of occurrence using the "Subcontractor Form" above or another
form provided by WWC.
3. Subcontracts must be secured with local providers to the extent possible. Women should
not be required to travel more than 60 miles for any service unless a highly specialized
service (breast surgery, stereotactic biopsy, etc.) is required and is not available at any
facility in that radius. Any subcontracts for services beyond 60 miles must receive WWC
staff approval.
4. Services performed by subcontractors shall:
i. Be performed in an outpatient setting to the extent possible.
ii. Not exceed the Medicare reimbursement rate as established in the annual CPT
Code List. Rates in the CPT Code List included as part of this scope of work shall
be the rates that Contractors use through the entire annual Period for Clinical
Service Delivery.
iii. Only perform and charge the Contractor for procedures in the CPT Code List.
iv. Not be charged to WWC eligible women unless services are performed that are not
on the CPT Code List. Women may be charged for services outside the CPT Code
List, but should be notified before services are performed and be told how much
the services will cost.
v. If services outside of the CPT Code List are required, arrangements for completing
and paying for services should be specified in the subcontractor agreement.
vi. Be agreed upon in writing through the use of a signed contract which includes the
period of service.
e. The Contractor shall comply with the requirements stated in the WWC Provider Toolkit. This
Page 3 of 5
Page 3 of 5
Exhibit B- Statement of Work
V 1/MAR2012
EXHIBIT B
document is incorporated and made part of this SOW by reference and is available on the
following WWC website http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/1251617581963 under the "Professional Development" heading.
f. The Contractor shall comply with requirements stated in a) the most current American Society for
Colposcopy and Cervical Pathology (ASCCP) consensus guidelines for cervical cancer screening
services and the California Department of Health Services Breast Cancer Diagnosis Algorithms
for breast cancer screening services and b) the WWC Tobacco Use Assessment Policy. Both
documents are incorporated and made part of this SOW by reference and are available on the
following WWC website at: http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/1251617581963 under the "Screening and Diagnostic Services" heading.
g. The Contractor shall comply with the requirements of case management stated in the WWC
Provider Toolkit. Clinical aspects of case management shall be provided by a Registered Nurse,
Physician Assistant or Physician in good standing to provide healthcare in the state of Colorado.
h. The Contractor shall comply with the requirements of enrollment of eligible women with a Breast
and Cervical Cancer Program (BCCP) eligible diagnosis into Breast and Cervical Cancer Program
(BCCP) Medicaid. The "BCCP Enrollment Step List" is incorporated and made part of this SOW
by reference and is available on the following WWC website at
http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617581963 under the "Medicaid
BCCP" heading.
C. Enrollment:
a. The Contractor shall comply with the WWC Program Eligibility Criteria in the WWC Provider
Toolkit.
1. The Contractor shall:
i. Comply with Lawful Presence Requirements according to Colorado Department of
Revenue guidelines. This information is incorporated and made part of this SOW
by reference as is available at the following website at the Department of Revenue
website at http://www.colorado.gov/cs/Satellite/Revenue-
Main/XRM/1216289012112
ii. Shall annually obtain a signed lawful presence affidavit. The Contractor shall keep
a copy in the patient's medical record before services are rendered. This form is
incorporated and made part of this SOW by reference and is available at the
following WWC website at: http://www.colorado.gov/cs/Satellite/CDPHE-
PSD/CBON/125 1617581963 under the "Patient Enrollment and Eligibility"
heading, and
iii. Shall check the "Verified Legal Presence" box in the electronic record in eCaST.
2. The Contractor shall complete the WWC Patient History Form. This form is incorporated
and made part of this SOW by reference and is available at the following website at:
http://www.colorado.cov/cs/Satellite/CDPHE-PSD/CBON/125 1617581963 under the
"Patient Enrollment and Eligibility" heading.
III. Monitoring Provision for LPHAs
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the WWC Unit Manager. Methods used will include review of
documentation reflective of performance including progress reports and other documentation as applicable. The
Contractor's performance will be evaluated at set intervals and communicated to the contractor. A Final
Contractor Performance Evaluation will be conducted at the end of the life of the contract.
IV. Resolution of Non -Compliance for all entities regardless of PSD risk rating
The Contractor will be notified in writing within 30 calendar days of discovery of a compliance issue.
Within 45 calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to
determine the action(s) necessary to rectify the compliance issue and determine when the action(s) must be
completed. The action(s) and time line for completion will be documented in writing and agreed to by both
Page 4 of 5
Page 4 of 5
Exhibit B- Statement of Work
V 1 /MAR2012
EXHIBIT B
parties. If extenuating circumstances arise that requires an extension to the time line, the Contractor must email
a request to the WWC Unit Manager and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure time lines are met and the issue(s) is resolved. If the
Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may
exercise its rights under the Remedies section of the General Provisions of this contract.
Page 5 of 5
Page 5 of 5
Exhibit B- Statement of Work
V I /MAR2012
Of2,IA
John W. Hickenlooper, Governor
Chrietopher E. Urbina, MD, MPH
Executive Director and Chief Medical Officer
Dedicated to protecting, and improving the health and environment of thepeople of Colorado
4300 Cherry Creek. Dr. a
Denver, Colorado 802464-1520
Phone (303 692-2000
Located in Glendale, Colorado
httpJlwww,cdphe.stete.Co.us
June 28, 2013
Laboratory Services Division
8100 Lowry Blvd.
Denver, Colorado 80230-692S
('303) 692-309O
Re: Award information for Women's; Wellness Connection. (WWC): Contract
• Colorado.Deparunent
of Public. Health.
and Environment.
Dear. Women's, Wellness Connection Contractors,
The federal award funding the Womeni's: Wellness Condaection (WWC) contract that your :agency sipped
has just been received. by the Colorado Department of .Public; Health and Environment. You were
previously notified :that the award language would be included prior to the State Controller's signature.
In order to expedite the processing of the WWC contracts, this letter will serve as notification of the
federal award number associated with.yout WWC. contract..
The Additional. Provisions,Sections 2 and 3 shall be readand understood to be:
"2. This Contract.cort.aiT1s.federai funds (see Catalog of Federal: Domestic- .Assistance
(CFDA) number 93.283)
The United States Department ofHealth and Human Services (US. HHS), through the
Centers for. Disease Control and Prevention (CDC),hasawarded federal funds under
Notice. of Cooperative Agreement Award, hereinafter "NCAA", number 1tU58DP003868-.
02, to perform the following' _ breast and cervical cancer screening."
Please retain a. copy of this letter with your executed contract.
Please: contact me with any questions at (303) 632-255.3 or at wavne.east@state.co.us.
Respectfully,
Wayne Fast'
Contracts Administrator.
6/28/13
State.co.us Executive Branch Mail - CDPHE-Weld County-WWC-13 FLA 54772 - Notification
STATE OF
COLORADO
CDPHE-Weld County-WWC-13 FLA 54772 - Notification
East - CDPHE, Wayne <wayne.east@state.co.us>
To: chom@co.weld.co.us, ddrew@co.weld.co.us, tgeiser@co.weld.co.us
Cc: Emily Kinsella - CDPHE <emily.kinsella@state.co.us>, Ivy Hontz - CDPHE <ivy.hontz@state.co.us>, Kris
McCracken - CDPHE <kris.mccracken@state.co.us>, Abigail Aukema - CDPHE <abigail.aukema@state.co.us>
Hi Debbie,
Fri, Jun 28, 2013 at 2:31 PM
This email serves as notification of your FULLY EXECUTED Colorado Department of Public Health &
Environment (CDPHE) Contract listed below:
Contractor Name: Weld County Department of Public Health and Environment
Contract Number: 13 FLA 54772
Division: Prevention Services Division - PSD
Program Name: Women's Wellness Connection - WWC
Project Name: Service Delivery
Reason for Contract: New Contract
Please "Reply to Sender" acknowledging the receipt of this email.
The Contract listed above has been fully executed and you may begin work on June 30, 2013. An
original hard copy of the Contract will be mailed to you soon.
The federal grant information was not known at the time this contract was drafted, so that
information was not included on page 1 of the Additional Provisions. The federal grant information
is attached to this grant execution e-mail, and a hard copy will be mailed with a signed copy of
the contract.
Please contact me with questions or concerns. My contact information is listed below.
Sincerely,
Wayne East
https://mail.g oog le.conn/mail/u/0/?ui=2&ilrac804dObcf&vievrpt&search=sent&th= 13f8c7bae99fd19b
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0/28/13 State.co.us Executive Branch Mail - CDPHE-Weld County-NM/C-13 FLA 54772 - Notification
Contracts Administrator
Colorado Department of Public Health and Environment (CDPHE)
(303)692-2553
WWC Award.pdf
401K
https://mail.g oog le.condmail/u/0/?ui=2&ik=ac804d0bcf&view=pt&search=sent&th= 13f8c7bae99fd19b 2/2
Hello