HomeMy WebLinkAbout20121322.tiff RESOLUTION
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 July 1, 2012, and ending July 30, 2013, 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 30th day of May, A.D., 2012.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST:��a,,,,7'14
Sean P. C y, Chair
Weld County Clerk to the Board
IA n 1� illiam . Garcia, Pro-Tem
BY: r O
Deputy CIe7 to the Bo-��� ' .� 1, XCUSED
O 111 1981 ra Kirkmeyer
LOL
ST• .'y'�� • cA
David E. Long
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Douglas illademache
Date of signature: Cc •ai
4 trig -ck\te` Ct : 14-1, 2012-1322
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1861
Memorandum l'UlkrgTO: Sean Conway, Chair
r i Board of County Commissioners
i J FROM: Mark E. Wallace, MD, MPH, Director
Y Dept of Public Health & Environment
COU
NTT
DATE: May 7, 2012
SUBJECT: Women's Wellness Connection
Task Order Contract FY12-13
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 assess to timely, high quality screening and
diagnostic services to detect breast and/or cervical cancer at the earliest stages.
Currently, the maximum amount available for this contract for fiscal year 2012-2013 is
$13,500.00 in federal pass-through funding. This represents a decrease of$4,000.00 from fiscal
year 2011-2012. The term of this Contract is July 1, 2012 through June 30, 2013.
I recommend your approval of this Task Order Contract.
Enclosure
2012-1322
STATE OF COLORADO
John W.Hickenlooper,Governor
Christopher E. Urbina,MD,MPH 0p!;co2cip
Executive Director and Chief Medical Officer
Dedicated to protecting and improving the health and environment of the people of Colorado ,t i
4300 Cherry Creek Dr. S. Laboratory Services Division a *
Denver,Colorado 80246-1530 8100 Lowry Blvd.
Phone(303)692-2000 Denver,Colorado 80230-6928 Colorado Department
Located in Glendale,Colorado (303)692-3090 of Public Health
http://www.cdphe.state.co.us and Environment
6/25/12
Mark Wallace
Weld County Department of Public Health
& Environment
1555 North 17th Avenue
Greeley, CO 80631
Dear Mr. Wallace,
Enclosed is your copy of the fully executed Colorado Department of Public Health and Environment
Task Order listed below. You may begin work on 7/1/12.
Contractor Name: Weld County Department of Public Health
&Environment
Contract Number: 13 FLA 43185
Original Contract Number: 13 FLA 43185
Division: Prevention Services Division
Program Name: Women Wellness Connection
Project Name: Service Delivery
Reason for Contract: New Contract
Please contact me with questions or concerns. My contact information is listed below.
Genevieve Ro den
Contract Coordinator
Prevention Services Division
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO 80246-1530
303-692-2553 genevieve.rowden@state.co.us
r 1
DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
ROUTING NO.13 FLA 43185
APPROVED TASK ORDER CONTRACT
This Task Order Contract is issued pursuant to Master Contract made on 01/17/2012,with routing number 13 FAA 00051
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County
Department of Public Health and (a political subdivision of the state of Colorado)
Environment for the use and benefit of the
PSD-\X'WC Weld County Department of Public Health and
4300 Cherry Creek Drive South Environment
Denver, Colorado 80246 1555 North 17 Avenue
Greeley,Colorado 80631
TASK ORDER MADE.DATE: CONTRACTOR ENTrtY TYPE:
4/18/2012 Colorado Political Subdivision
PO/SC ENCUMBRANCE NUNIBER:
PO FLA PPG1343185
TERM: BEIJING STATEMENTS RECEIVED:
This Task Order shall be effective upon Monthly
approval by the State Controller,or designee,
or on 07/01/2012,whichever is later. The STATUTORY AUTHORITY:
Task Order shall end on 06/30/2013 Not Applicable
PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED:
Reimbursement $13,500.00
PROCUREMENT METHOD: FEDHRAI.FUNDING DOLLARS: $13,500.00
Exempt STATE FUNDING DOLLARS: $0.00
BID/REP/LIST PRIG.AGREEMENT NUMBER: MAXIMUM AMOUNT AVAI IABLE PER FISCAL YEAR:
Not Applicable FY 13: $13,500.00
LAW SPECIFIED VENDOR STATUTE.:
Not Applicable
STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE:
Chandra Hardwick Mark Wallace
Department of Public Health and Environment Weld County Department of Public Health
PSD-WWC and Environment
4300 Cherry Creek Drive South 1555 North 17th Avenue
Denver,CO 80246 Greeley,CO 80631
SCOPE OF WORK:
Perform work for the Women's Wellness Connection (WWC) Program to conduct breast and cervical
cancer screenings of program eligible women.
Page 1 of 6 Rev 6/25/09
o1O/oz—/3c2c
Y I
EXf!BITS:
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 more specificity than these general clauses,the more specific provision shall control.
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 performance 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.
3. 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
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.
Page 2 of 6 Rev 6/25/09
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 arc 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 maybe 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 tenns 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 HATA.
Page 4 of 6 Rev 6/25/09
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: STATE OF COLORADO:
Board of County Commissioners of Weld John W.Hickenlooper, GOVERNOR
County
(a political subdivision of the State of Colorado)
for the use and benefit of the
Weld County Department of Public Health and
Environment
ent C/h`Legal Name of Contracting Entity ?Att-e4Y1-
/^./ For Executive Director
1/ , Department of Public Health and Environment
Signature of Authorized Officer
L
Sean P. Conway
Print Name of Authorized Officer
Depa t o am Ap oval:
Chair MAY 3 0 2012
Print Title of Authorized Officer
ALL CONTRACTS MUST BE APPROVED 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
Date 6 -
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C/O-/32a
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EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 4/18/2012-Contract Routing Number 13 FLA 43185
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 may be 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 funds(see Catalog of Federal Domestic Assistance(CFDA)
number 93.283)
3. The United State Department of Health and Human Services("USHHS"),through the Centers for Disease
Control and Prevention("CDC")has awarded federal funds under Award number U58DP003868-01,
hereinafter"Award",to perform the following—breast and cervical cancer screenings,and diagnoses
services,if needed,to the point of definitive diagnoses.
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.
4. 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).
5. Notwithstanding the terms contained in General Provisions of the Master Contract,Section 25,
Conformance with Law,Contractor shall comply with all applicable requirements of the following for
Contractor's respective entity type:
a. 2 Code of Federal Regulations(CFR)Part 215, Uniform Administration Requirements for Grants
and Agreements with Institutions of Higher Education, Hospitals, and Other Non-Profit
Organizations,formerly known as OMB Circular A-110;
b. OMB Circular A-I 02, Grants and Cooperative Agreements with State and Local Governments;
c. 2 C.F.R.230, Cost Principles for Nonprofit Organizations,formerly known as OMB Circular A-
122;
d. 2 C.F.R.225, Cost Principles for State, Local, and Indian Tribal Governments, formerly known as
OMB Circular A-87;
e. 2 C.F.R.220, Cost Principles for Educational Institutions,formerly known as OMB Circular A-
21;
f. OMB Circular A-133,Audits of States, Local Governments, and Non-profit Organizations
6. To receive compensation under this Task Order Contract,the Contractor shall provide 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 in this Task Order Contract.
To be attached to CDPHE Page 1 of 3 Revised: 12/19/06
Task Order v1.0(3/12)contract template
EXHIBIT A
To be considered for payment, all Women's Wellness Connection services must be entered into eCaST
within thirty(30)days of service being performed. 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.
7. 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.
8. 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.
9. Contractor must notify the State within thirty(30)days of a change of the Project Director or Principal
Investigator responsible for the performance of services provided under this Task Order Contract.
10. 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.
To be attached to CDPHE Page 2 of 3 Revised: 12/19/06
Task Order v1.0(3/12)contract template
EXHIBIT A
Publications,journal articles,etc.produced under a Centers for Disease Control and Prevention(CDC)
grant supported project must bear an acknowledgment and disclaimer,as appropriate,for example: "This
publication(journal article,etc. was supported by the Cooperative Agreement Number above from the
Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do
not necessarily represent the official views of the Centers for Disease Control and Prevention."
11. 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.
Neither the U.S. Department of Health and Human Services(HSS)nor the Centers for Disease Control
(CDC) logo may be displayed on any conference materials if such display would cause confusion as to the
conference source or give false appearance of Government endorsement. Use of the HHS name or logo is
governed by U.S.C. 13206-10,which prohibits misuse of the HHS name and emblem in written
communication. A non-federal entity is unauthorized to use the HHS name or logo governed by U.S.C.
1320b-10.The appropriate use of the HHS logo is subject to review and approval of the Office of the
Assistant Secretary for Public Affairs(OASPA).
12. 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.
13. 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.
14. Notwithstanding anything in this Task Order to the contrary,the parties understand and agree that all terms
and conditions of this Task Order which may require continued performance,compliance,or effect beyond
the termination date of this Task Order and shall survive such termination date and shall be enforceable by
the State as provided herein in the event of failure to perform or comply by the Contractor.
To be attached to CDPHE Page 3 of 3 Revised: 12/19/06
Task Order v1.0(3/12)contract template
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
Al IA American Heart Association
AIDS Acquired Immune Deficiency Syndrome
ALA American Lung Association
ALA(C) American Lung Association(of Colorado)
AMCHP Association of Maternal Child Health Programs
ANA Americans for Non-Smokers'Rights
ARC Addiction Recovery Centers
ARRA American Recovery and Reinvestment Act
ASC Adams State College
ASSIST American Stop Smoking Intervention Study
ASTHO Association of State and Territorial Health Office
B&G Boys&Girls
BACCIIUS BACCHUS Peer Education Network
BAG Build a Generation
BBLHC Boulder Broomfield Latino Health Coalition
BC Boulder County
BCCP Breast and Cervical Cancer Program
BCHD Bent County Health Dept
BCPH Boulder County Public Health
BCPHA Baca County Public Health Agency
BCDSS Baca County Dept Social Services
BCTEPP Bent County Tobacco Education Prevention Partnership
BGC Boys&Girls Club
BGCMD Boys&Girls of Metro Denver
MIS Broomfield High School
BMTF Baby&Me Tobacco Free
BOCES Board of Cooperative Educational Services
BOH Board of Health
BRFSS Behavioral Risk Factor Surveillance System
BVBAG Buena Vista Build a Generation
BVSD Boulder Valley School District
Bx Biopsy
C Choice
CAD Coronary Artery Disease
CASB Colorado Association of School Board
CB Community-based System
CBE Clinical Breast Exam
CBO Community-based Organization
CC Clear Creek
CC Custer County
CC Community Coordination/Coordinator
CCAP Larimer County Child Care Assistance Program
CCC Colorado Cancer Coalition
CCCHE Colorado Community Coalition for health Equity
CCGC Colorado Clinical Guidelines Collaborative
CCMC Colorado Clinical Managed Care Network
CCMC Commission for Case Manager Certification
CCPD Cancer,Cardiovascular,and Pulmonary Disease
CCIAA Colorado Clean Indoor Air Act
CCTCI Colorado Chew Tobacco Collaborative Initiative
Page 1 of 6
Attachment A-1
CCTEPP Custer County Tobacco Education Prevention Partnership
CDC Centers for Disease Control and Prevention
CDE Colorado Department of Education
CDPIIE 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
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
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
DI HA Denver health and hospital Authority
DIIS 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&l 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
ECLC Early Childhood Leadership Council/Commission
E.D. Executive Director
El IS Early IJead Start
EMR Electronic Medical Record
Page 2 of 6
Attachment A-1
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)
F1RC Family and Intercultural Resource Center
FICA The Federal Insurance Contribution Act
FDA Food and Drug Administration
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 R!EAL(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
filT Health Improvement Team
lily Human Immunodeficiency Virus
HPV Human Papillomamavirus
HR Human Resources
h 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 Latinas en Movimiento
LHA Local Ilealth Agency
LIID Local Health Department
LLC Limited Liability Company
LRCC Latino Regional Community Coalition
LRPC Latino a Research and Policy Center
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
Page 3 of 6
Attachment A-1
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
NC HD Northeast Colorado I lealth Department
NCI National Cancer Institute
NE North East
NIP Nurse-Family Partnership
NFPNSO Nurse-Family Partnership National Service Office
NIIVP Nurse Home Visitor Program
NIDA National Institute on Drug Abuse
NIH National Institute of I lealth
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
MIN Public Health Nurse
PIO Public Information Officer
PM Peer Mentor
PMC Parkview Medical Center
PMR Planning Management Region
PN Patient Navigator
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
Page 4 of 6
Attachment A-1
PSA Public Service Announcement
PSD Prevention Service Division
PTEPP Pueblo Tobacco Education and Prevention Partnership
PVC Prairie View Clinic
Ql 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
RIE Reach,Implementation and Effectiveness
RII IEL Regional Institute for Health and Environment
RMC Rocky Mountain Center fur Health Promotion&Education
RMRH Rocky Mountain Rural Health
RMYC Rocky Mountain Youth Corps
RN Registered Nurse
Rx Prescription
RY Reconnecting Youth
SafeCare
SAME ISA 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
Sill 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
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
Page 5of6
Attachment A-1
1
TDS Tobacco Disparities Subcommittee !
TEACH Teaching Equity to Advance Community Health
TEFAP The Emergency Food-Assistance 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
TPl Tobacco Prevention Initiative
TRC Tobacco Education and Prevention and Cessation Program Review Committee
TM Tobacco Rapid Improvement Activity '`
TRIA Tobacco Rapid Improvement Assessment v
TTl Tony Grampsas Tobacco Initiative
UCD University of Colorado—Denver V:
UCDHSC Health Sciences Center at UCD(sometimes abr.UCHSC)
UCDHSC University of Colorado at Denver and Health Sciences Center
US United States of America A'..
USSTC US Smokeless Tobacco Company ;;t
VP Vice President
Well COA Wellness Councils of America
WHU Women's Health Unit WIC Women,Infants,Children .j
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: I State Fiscal Year: I Grant Funding Change Letter# i CMS Routing#
TO: Insert Grantee's name
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: Lisa Ellis, Purchasing & Contracts Unit Director By:
Date:
ALL GRANTS REQUIRE APPROVAL BY 1'HE 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
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 04/18/2012-Contract Routing Number 13 FLA 43185
These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above.
I. Project Description:
Project Period: Date of fully executed contract-June 30,2013.
Background: The WOMEN'S WELLNESS CONNECTION (WWC) program provides low-income, uninsured
and underserved women 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. It is a state-run program funded by
the National Breast and Cervical Cancer Early Detection Program(NBCCEDP),which is administered through the
Centers for Disease Control and Prevention (CDC), and Amendment 35 Tobacco Tax state funds. Services are
available across Colorado.
Direct 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, and women between the ages of 50-64 for
screening mammograms.
Project Goals:
1. To deliver quality breast and cervical cancer screening and diagnostic services.
2. To provide women with an abnormal screening with quality case management services.
3. To provide these services at Medicare rates.
II. Definitions:
Breast Cancer Screen — Standard testing performed to determine the presence or non-presence of breast cancer.
Standard screening tests include a clinical breast exam(CBE)and a mammogram.
Bundled Payment System—Reimbursement system developed and administered by the WWC Program.
Reimbursement within this system is provided at the end of the case and at increasing levels depending on case
complexity.
Cervical Cancer Screen — Standard testing performed to determine the presence or non-presence of cervical
cancer. The standard screening tests are a Pap test and pelvic exam.
Contractor—Agency responsible for signing and administering this contract.
Definitive Diagnosis—The final point in cancer screening care where it is determined whether a woman has or
does not have breast or cervical cancer, This information is usually obtained after diagnostic services have been
rendered.
Diagnostic Testing—Further testing used when a definitive diagnosis is unable to be determined by the results of
prior screening tests.
Page I of8
Exhibit B-Statement of Work
V l/MAR2012
EXHIBIT B
eCaST—An electronic database system the WWC Program uses to track women screened,administer payment to
contractors for services performed and for report data to the CDC.
Lost to Follow Up—Clients screened within the program are considered to be lost to follow up when the
Contractor has contacted the client three times,once by certified letter,before ending case management efforts.
Evidence of these contacts should be part of the client's medical record.
Network — Any provider site that works under the contractor name and receives fiscal and administrative
assistance to do business.
Progress Report—A report that provides meeting standard(green),close to standard(yellow)and far from
standard(red)performance ratings on various deliverables in this scope of work. This report is generated by
WWC on a quarterly basis and shared with Contractors individually. This report may be used as the basis for
determining Contract Monitoring System ratings, funding decisions,and implementation of performance
improvement plans. Three or more far from standard(red)ratings on this report will cause a Contractor to receive
a below standard rating in the deliverables section of the Contract Monitoring System worksheet.
Refused—Clients screened within the program are considered to be refusing care if they choose not to complete
follow up care that is recommended for them. This refusal may occur verbally or in writing. Documentation of
this refusal should be kept in the client's medical record.
Subcontractor—An entity in the community that provides services for the Contractor that the Contractor cannot
perform onsite. Agreements are made between the Contractor and the subcontractor directly; WWC is not
involved in these negotiations or agreements. WWC is not responsible for reporting to or providing reimbursement
for any services to subcontracted entities.
An additional Acronym list will be included with the Additional Provisions(Exhibit A).
III. Performance Requirements/Deliverables:
Under this arrangement,the contractor shall provide and perform the following:
1. Administration:
a. Contact information must be updated annually to start work under this contract. An Agency& Site Contact
Form shall be sent to the Contractor by the State;the Contractor must complete and submit the form by July
1,2012 in order to start work under this contract.
All staff changes during the contract year must be reported to the WWC within fifteen(15)calendar
days.
b. Security access to eCaST must be renewed annually to start work under this contract. An eCaST Renewal
Form shall be sent to the Contractor by the State;the Contractor must complete and submit the form by July
1,2012 in order to start work under this contract.
c. If applicable,the Contractor must maintain a network of subcontractors and submit an updated list of these
subcontractors annually to start work under this contract. A Subcontractor Form shall be sent to the
Contractor by the State;the Contractor must complete and submit the form by July 1,2012 in order to start
work under this contract.
i. All subcontractor changes during the contract year must be reported to the WWC within fifteen(15)
calendar days.
d. The Contractor must identify and support a WWC Coordinator,Contacts Description document is located at:
http://womenswellnessconnection.org/sowfv13appendices.html.
i. The role of the WWC coordinator will be the point of contact between the Contractor and WWC and
will be considered the lead for the program at the agency level.
ii. It is expected that the WWC coordinator will promote and distribute the communication of updates,
policy changes,trainings,conference calls,progress reports,etc. throughout the Contractor and to
necessary staff.
iii. It is expected that the WWC coordinator will be responsible for ensuring that deliverables in this scope
of work are achieved.
Page 2 of 8
Exhibit B-Statement of Work
V1/MAR2012
EXHIBIT B
e. The Contractor must identify and support an eCaST Coordinator,Contacts Description document is located
at: http://womenswellnessconnection.ore/sowfvl3appendices.html. The role of the eCaST coordinator is
to ensure that all information about clients screened under the WWC Program is entered into eCaST.
a. It is expected that the eCaST coordinator will maintain data in eCaST that is up-to-date and meets
eCaST-specific Performance Indicators. Specific eCaST reports should be run and cleaned on a
regular basis,guidance on running these reports is provided in the eCaST Reports Quick Reference
located at: http://womenswellnessconnection.ore/sowfyl3appendices.html.
b. Respond to biannual Minimum Data Element(MDE)clean-up activities within the deadline
specified by WWC.
c. The WWC Coordinator role and eCaST Coordinator roles may be filled by the same person at each
Contractor.
f. The Contractor must identify and support a Clinical Liaison,Contacts Description document is located at:
http://womenswellnesseonneetion.org/sowfy13appendices.html.
i . The clinical liaison must be a nurse(RN)or preferably a nurse practitioner,physician's assistant or
physician.
ii. Receive and disseminate information on clinical policy changes and implementation of clinical
guidelines to all clinical staff involved with the program.
iii. Ensure that program clinical guidelines and policies are understood and implemented by all clinical
staff involved with the program.
iv. Attend 100%of WWC clinical webcasts or review a recorded version at a later time. Disseminate
information shared from webcasts with the Contractor's clinical staff.
2. Network:
a. Contractors are strongly encouraged to perform basic breast and cervical cancer screening services on-site.
These basic screening services include clinical breast exams,pelvic exams and Pap tests.
b. For services that cannot be provided on-site,the Contractor must maintain a network of subcontractors to
ensure that all steps involved in the breast and cervical screening and diagnostic process can be performed
within 60 days of the first abnormal finding. All services referenced on the Current Procedural Technology
(CPT)code list,information is located at:
http://womenswellnessconnection.ore/sowfvl3appendices.html,should be provided via the Contractor,
or through a subcontractor agreement.
c. 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,stereotactie
biopsy,etc.) is required and is not available at any facility in that radius.
d. Subcontractors:
Service performed by subcontractors shall:
1. Be performed in an outpatient setting to the extent possible.
2. Not exceed the Medicare reimbursement rate as established in the annual CPT code list.This
list is typically updated during the first few months of the calendar year,however,rates in the
CPT code list that is included as part of this scope of work shall be the rates that Contractors
use through the entire fiscal year.
3. Only perform and charge the Contractor for procedures in the CPT code list.
4. Not be charged to WWC eligible women unless services are performed that are not on the
CPT code list. If services outside of the CPT code list are required,arrangements for
completing and paying for services should be specified in the subcontractor agreement.
Women may be charged for services outside the CPT code list,but should be notified before
services are performed and be told how much they will cost.
5. Be agreed upon in writing through the use of a signed contract or memorandum of
understanding which includes the Period of service.
3. Enrollment:
a. The contractor must ensure that women screened under the WWC program:
i. Meet WWC Program Eligibility Criteria,document located at:
http://womenswellnessconnection.ore/sowfy 13appendices.html.
ii. Eligibility guidelines may be updated during the period this scope of work is in effect. When new
eligibility guidelines are adopted for implementation by the WWC,the Contractor will be notified
Page 3 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B
and responsible for implementing necessary changes to the Contractor workflow by a date
determined by WWC.
iii. Provide eligibility screenings and referrals in Spanish or other languages as requested.
b. Meet Lawful Presence Requirements. This requirement is met for each client by:
i. Annually obtaining a signed lawful presence affidavit,a sample and information is located at:
http://womenswellnessconnection.ore/sowfvl3appendices.html,and incorporated herein by this
reference and keeping a copy in the patient's medical record before services are rendered.
ii. Annually verifying required documentation for proof of lawful presence according to Department of
Revenue guidelines: http://www.colorado.gov/cs/Satcllite/Revenue-Main/XRM/1216289012112.
iii. Document verification of lawful presence on the WWC Patient History Form located at:
http://womenswellnessconnection.org/sowfvl3appendices.html and in eCaST for each woman the
Contractor will be requesting reimbursement.
1. The"Verified Legal Presence"box must be checked in the electronic record in eCaST.
2. Failure to document in eCaST will result in non-payment of all services rendered.
3. If documents used to verify lawful presence expire within the year following the original
screening and the client is seeking additional services through the program,the Contractor is
responsible for updating such documents before additional services are rendered.
4. Billing and Reimbursement:
a. The Contractor shall only request reimbursement from the WWC for a case that meets eligibility,
timeliness,performance and data requirements.
b. Reimbursement is determined by the outcome of the case,therefore, cases must be clinically complete
before reimbursement occurs. Reimbursement will occur according to the WWC Bundled Payment System
located at: http://womenswellnessconnection.org/sowfvl3appendices.html,and incorporated herein by
this reference. Rates may be revised or updated during the period this scope of work is in effect. If changes
are required to the Bundled Payment System,the Contractor will be notified at least thirty(30)days prior.
c. Cases may not be paid if:
i. They are abnormal and they exceed sixty(60)days in screening length.
ii. Procedures are entered into eCaST thirty(30)days or more after being performed.
iii. The data is not entered completely or accurately into the eCaST data system.
d. 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.
e. It is expected that if a Contractor enrolls a client in WWC and provides initial cancer screening services,the
same Contractor will be responsible for entering all data in eCaST and assuring that clinically appropriate
follow-up care is completed through case management services. The WWC program will only pay one
Contractor for services provided.
f. The WWC program only provides reimbursement for each client's clinically complete case once per fiscal
year. Short-term follow-up that occurs within the same fiscal year is not reimbursed.
g. Women eligible for WWC may be enrolled in the program at any point in their screening or diagnostic
cancer screening care prior to biopsy. Women should be enrolled and noted as"referred in for diagnostics"
in eCaST. 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.
h. It is expected that reimbursement will cover costs associated with:
i. Enrollment of women into the WWC Program;
ii. Cancer screening services,as outlined in the Current Procedural Technology(CPT)code list located at:
http://womenswellnesseonnection.org/sowiv13appendices.html);
iii. Patient navigation and case management services;
iv. Entry of all information into eCaST;and
v. Administrative procedures to place women with a positive diagnosis of breast and/or cervical cancer into
the Medicaid Program.
Data entered into eCaST are the basis for calculating reimbursement for each client screened.
J. One reimbursement check for all completed screenings that have met data and quality standards will be sent
to the Contractor each month.
i. WWC will generate Contractor grant activity statements based on data entered into eCaST each month on
the 15'5 or next business day thereafter.
ii. WWC will generate the final grant activity statement on the last business day in July. Cases that were
Page 4 of8
Exhibit B-Statement of Work
V I/MAR2012
• EXHIBIT B
clinically complete by June 30th,that are not entered,or not entered correctly, into eCaST by the last
business day in July will not be paid by WWC.
5. Service Delivery:
a. The Contractor shall follow and utilize all policies and guidelines according to the WWC Provider Toolkit
located on the internet at:
https://docs.eooele.com/file/d/OB9UrHzcBKK4hOTZINmI3YmYtZGY3MS00NzU3LWIvZTOtY2Y4Yzh
mZTlxMzU0/edit?hl=en US
i. The Provider Toolkit maybe updated during the period this scope of work is in effect.When new
documents/policy/guidelines or toolkit directives are adopted for implementation,the Contractor will be
notified and responsible for implementing necessary changes by a date determined by the WWC.
ii. The Contractor shall implement 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
unless otherwise notified by the WWC program.
b. All clients screened through WWC must be assessed for smoking status an provided with referrals to the
Quitline per the WWC Tobacco Use Assessment Policy located at:
http://womenswellnessconnection.org/sowfyl3appendices.html
6. Case Management
a. Case management services are required for every client with an abnormal screening in the program. Within
the Bundled Payment System,Contractors are reimbursed for case management services depending on the
outcome or complexity of the case.
b. Case management services are provided through a wide range of intervention types including but not
limited to phone calls,letters,certified letters,clinic visits,social media and home visits.
c. In order to receive reimbursement for case management services,Contractors must do the following:
i. Notify the patient of an abnormal result within two(2)weeks of the procedure
ii. Use WWC approved algorithms to determine next steps
iii. Assess clients for barriers to completing recommending diagnostic tests
iv. 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.
v. Implement the WWC Lost to Follow Up Policy located at:
http://wo menswellnessco n nection.org/sowfy 13appendices.html)
d. The following case management services should be offered on an as needed basis:
i. Accompany clients to appointments
ii. Arrange for qualified interpreter
iii. Coordinate clinical care
iv. Make referrals to other health care services
v. Provide patient education,advocacy and/or coaching
vi. Work with patient's support system/family
vii. Provide emotional support
e. Clinical aspects of case management should be provided by licensed health care providers in good standing
to provide healthcare in the state of Colorado.
7. Performance Standards:
a. The WWC program will conduct Contract Management System performance ratings three(3)times per
year.
b. The WWC program will conduct an annual contract monitoring assessment for each Contractor before July
1,2012. Contractors with high risk assessments may be required to have additional contract monitoring
practices put into place.
c. The contractor will meet or exceed WWC performance benchmarks. These performance benchmarks are
reported to Contractors on a quarterly basis with WWC Progress Reports,a Progress Report Sample is
located at: http://womenswellnessconnection.org/sowfyl3appendices.html.
Page 5 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B
i. Contractors receiving three or more"far from standard(red)"ratings for a period of six(6)months or
more will be given a below standard rating on the Contract Management System report.
H. Contractors who receive a below standard will be contacted by the WWC within two(2) weeks and may
be placed under a performance improvement plan.
Hi. The performance improvement plan will have expectations set by the WWC with time frames for
completion.
1. Contractors are responsible for developing and implementing a quality improvement plan to
meet expectations.
2. Unmet expectations may result is cancellation or limitation of the contract.
8. Site Visits:
a. The WWC will perform site visits to Contractors as needed. The purpose of a WWC site visit is to provide,
promote and ensure quality breast and cervical cancer screenings in Colorado at local agencies by focusing
on administrative and management functions and clinical oversight.
b. Selection of contractors to visit is based on,but not limited to,the following:
i. WWC Progress Reports;
ii. eCaST data reports,
iii. Technical assistance needs;
iv. Adherence to this scope of work;
v. Participation in program trainings,conference calls and webinars;and
vi. Ability to refer positively diagnosed women to Medicaid treatment.
c. Site visits will include, but not be limited to:
i. Completion of the WWC site visit prep tool;
H. Chart audit;
Hi. Review of subcontractor agreement(s);
iv. Review of program administration and program management;
v. Review of clinical services and case management activities; and
vi. Implementation of a corrective action plan for agencies not meeting two or more performance
indicators for a period of six(6)months or more prior to the site visit
d. WWC will provide a final report to the contractor within thirty(30)days of the visit.
9. eCaST System:
a. WWC staff,(WWC Current Staff Listing located at:
http://womenswellnessconnection.ore/sowfyl3appendices.html)will provide training on the eCaST
system to the Contractor, its administration staff, fiscal staff and provider site staff unless otherwise
approved by the program.
i. Any changes to Contractor staff responsible for WWC data entry must be reported to the Department
within fifteen(15)days.
H. New data entry staff must be trained by WWC on eCaST within thirty(30)days of hire,unless
otherwise approved by the program.
10. Communication:
a. When corresponding with the WWC Staff,Contractors must use all privacy and security measures to
protect the client's personal health information.
i. Accepted forms of communication include:
1. WWC identification number used in unencrypted email conversations;
2. Mail or fax clearly marked"Confidential";
3. HIPAA compliant files transmitted via secure File Transfer Protocol(FTP)sites; and
4. Secure encrypted email.
H. If a Contractor intends to use data from eCaST for publications,conference presentations,and/or
research projects,the Contractor must notify and receive prior approval from the WWC Program.
Hi. WWC will include the Contractor in all relevant program communications that may impact the success
of this contract, including:
1. eConnect;
2. eCaST Broadcast messages;
3. Special announcements to WWC providers;and
Page 6 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B
4. Other communications.
b. Contractor staff will respond to WWC emails,voicemails and faxes within 72 hours unless otherwise
specified.
c. Contractors are encouraged to contact WWC staff at any time with program questions or needs.
11. Training
a. At least one representative from the Contractor and/or its network provider sites must attend meetings or
conference calls hosted by WWC staff or review meeting minutes or a recorded version at a later time to
ensure compliance with this contract.
i. The Contractor will attend WWC sponsored conference calls, meetings and trainings, including but not
limited to:
1. 50%of WWC monthly Health Improvement Team(HIT)calls;
2. 50%of bimonthly eCaST Users Group Conference Calls;
3. 100%of WWC clinical webinars; and
4. Other meetings and trainings upon request.
ii. WWC will attend conference calls and meetings as needed and upon special request of the Contractor.
12. Medicaid Treatment for WWC Women Diagnosed with Cancer
a. The Contractor will ensure enrollment of eligible women with a positive diagnosis of breast or cervical
cancer into the Breast and Cervical Cancer Medicaid Program through the following specific procedures:
i. Using of the Step Enrollment Process, information located at:
thttp://womenswellnessconnection.org/sowly13appendices.html.
ii. Submitting initial completed paperwork to WWC within five(5)business days of cancer diagnosis.
The initial paperwork includes:
• WWC Personal History form;
• WWC Rules Form;
• Lawful Presence affidavit; and
• Pathology report confirming the diagnosis.
iii. Completing eCaST data entry within twenty-four(24)hours of diagnosis.
iv. Submitting final completed paperwork to WWC within five (5)business days of receiving approval
for presumptive eligibility. This final paperwork includes:
• Medicaid application signature page; and
• Presumptive eligible form.
v. Submitting complete Medicaid application to local Social Service agencies within fifteen(15)days
after diagnosis.
b. Documents used in the process of enrolling women into Medicaid for treatment may be updated during the
period this scope of work is in effect. When new documents are adopted for implementation by WWC,the
Contractor will be notified and responsible for implementing necessary changes by a date determined by the
WWC.
13. Budget Management
a Each Contractor receives a capped funding amount that they can use to provide services under the WWC
program each fiscal year. Once this funding cap has been reached, the WWC program will not pay for any
additional expenses incurred by the Contractor.
b. The capped funding amount is determined based on a competitive application process that will take place
each spring prior to the start of the fiscal year. Funding amounts will be adjusted based on the results of this
competitive application process. If a Contractor does not submit and competitive application for funding by
the specified deadline,no additional will be allocated to that Contractor during the fiscal year.
c. Contractors are responsible for management of funds including:
i. Ensuring that all funds are fully spent by the end of the contract period;
ii. Running eCaST report#81 —Screening Budget Tracking—monthly(after the 15`h of the month)to
determine spending status; and
iii. Making programmatic changes as needed to adjust spend rate.
d. Changes to basic eligibility requirements of the program may not be made by the Contractor without WWC
approval including:
Page 7 of 8
Exhibit B-Statement of Work
V I/MAR2012
EXHIBIT B
i. Age requirements;
ii. Income requirements;
iii. Insurance status;and
iv. Legal presence requirements.
e 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.
IV. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted throughout the
contract period by the Program's Women's Wellness Connection Unit Manager. Methods used will include review of
documentation reflective of performance to include quarterly progress reports and site visits,CMS Reports,eCaST data and
surveys. 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.
V. Resolution of Non-Compliance:
The Contractor will be notified in writing within thirty(30)calendar days of discovery of a compliance issue. Within
sixty(60)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 parties. If extenuating circumstances arise
that requires an extension to the time line,the Contractor must email a request to the Women's Wellness Connection 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 8 of 8
Exhibit 8-Statement of Work
V I/MAR2012
1 6 6 1 2 0 1 Memorandum
TO: Office of Clerk to the Board to the
Weld We County Commissioners
WELD.-CC OUNTY FROM: Administration Division-Department of
Public Health and Environment
DATE: Su I a- a 3, 4940, 2-
SUBJECT: yjvJC CO Oa c r
Attached to this memo is the finalized contract that the Health Department has received.
Please sign and date below indicating you have received the finalized contract and return
this signed memo to the Administration Division of the Health Department.
Please send the confirmation receipt to my attention. Thank you for your assistance with
the processing of this document.
ATTN: (.4 a
t.)
Contract Name: Wt roc nIS VvLti nit ss Connect) CM (enheaCr
Resolution Number: a Di a / 3 90-
Finalized Contract Received By: TOY11\ -Son- 1SDIri .,.
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Date Received: "1 - 13y-1a C r so
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