HomeMy WebLinkAbout20122866.tiff RESOLUTION
RE: APPROVE AMENDMENT TO CONTRACT TASK ORDER #1 FOR WOMENS
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 an Amendment to Contract Task Order
#1 for the Womens 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 August 31, 2013, with
further terms and conditions being as stated in said amendment, and
WHEREAS, after review, the Board deems it advisable to approve said amendment, 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 Amendment to Contract Task Order#1 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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 10th day of October, A.D., 2012, nunc pro tunc July 1, 2012.
BOARD OF COUNTY COMMISSIONERS
� � � WELD COUNTY, COLORADO
ATTEST:\IlfICY �`'' �
AAd 4 '�V
Sean P.
c
Weld County Clerk to the Board '
S L.O William F. Garcia, Pro-Tent'/
BY: /�i/I �. ►•! �% ►'
Deputy Cler-9to the Boa �M �0-
ara Kirkmeyer T
APP Tr!"AS ORM:tr® �` '� e.
David E. Long
C. n y'= torney EXCUSED
Douglas Rademacher
Date of signature: /do?'..- DYa
3044Z 7-114.q.,
/0.-../D_/a � 2012-2866
HL0039
186, Memorandum
TO: Sean Conway, Chair
Board of County Commissioners
GFfl FROM: Mark E. Wallace, MD, MPH, Director
Dept of Public Health and Environment
DATE: September 26`h, 2012
SUBJECT: Women's Wellness Connection
Amendment of Task Orders#1
Enclosed for Board review and approval is an Amendment for Task Orders #1 between the
Colorado Department of Public Health and the Weld County Board of County Commissioners
for the benefit of the Weld County Department of Public Health and Environment for a fund
increase 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.
This amendment will provide an increase of funds paid by the contractor by $25,262.00 and to
extend the contract term by two months to end on August 31“, 2013. Of this amended amount
$23,547 are attributable to funding from the State and $1,715 are attributable to federal funding.
The amended total provided by CDPHE for the entire contract will now be $38,762.00. I
recommend your approval of this Task Order Amendment.
Enclosure
2012-2866
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-WWC
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
13-48444
AMENDMENT FOR TASK ORDERS#1
This Amendment is made this 28 day of August,2012,by and between the State of Colorado,acting by and through
the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal place of
business is 4300 Cherry Creek Drive South,Denver,Colorado 80246,hereinafter referred to as the"State";and,
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,whose address or principal
place of business is 1555 North 17'"Ave,Greeley,Colorado 80631,hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract,dated January 17,2012,with contract routing number 13 FAA 00051.
Pursuant to the terms and conditions of the Master Contract,the parties entered into a Task Order Contract,dated
April 18,2012,with contract encumbrance number PO FLA PPG 1343185 and contract routing number 13 FLA
43185, referred to herein as the"Original Task Order Contract, whereby the Contractor was to provide to the State
the following:
Perform work for the Women's Wellness Connection(W WC)Program to conduct breast and cervical
Cancer screenings for program eligible women.
The State promises to increase the amount of funds to be paid to the Contractor by Twenty Five Thousand,Two
Hundred Sixty Two Dollars,($25,262.00) in exchange for the promise of the Contractor to perform the work
identified in the Original Task Order Contract for the extended term of two months,ending on August 31,2013.
NOW THEREFORE, in consideration of their mutual promises to each other,stated below,the parties hereto agree
as follows:
1. Consideration for this Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Amendment,and promises and agreements herein set forth.
2. It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract,contract routing number 13 FLA 43185,referred to herein as the Original Contract,which is by
this reference incorporated herein. All terms,conditions,and provisions thereof,unless specifically
modified herein,are to apply to this Amendment as though they were expressly rewritten, incorporated,and
included herein.
3. It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified,
altered,and changed in the following respects only:
A. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified
by contract routing number 13 FLA 43185. This Amendment is for the extended term of July 1,
2012,through and including August 31,2013. The maximum amount payable by the State for the
Page I of 4 Rev 3/16/2010
work to be performed by the Contractor during this extended term is Twenty Five Thousand,
Two Hundred Sixty Two Dollars,($25,262.00) for an amended total financial obligation of the
State of THIRTY-EIGHT THOUSAND, SEVEN HUNDRED SIXTY-TWO DOLLARS,
1538,762.001. This is an increase of Twenty-Five Thousand,Two Hundred Sixty-Two Dollars,
($25,262.001 of the amount payable from the previous term. Of the maximum amount for this
extended term Twenty-Three Thousand, Five Hundred Forty-Seven Dollars,($23,547.00)are
attributable to a funding source of the State of Colorado and One Thousand, Seven Hundred
Fifteen Dollars,($1,715.00)are attributable to a funding source of the United States Government
(see Catalog of Federal Domestic Assistance (CFDA) number 93.283). Of the amended total
financial obligation of the State referenced above Twenty-Three Thousand, Five Hundred
Forty-Seven Dollars, ($23,547.00) are attributable to a funding source of the State of Colorado
and Fifteen Thousand, Two Hundred Fifteen Dollars, ($15,215.00) are attributable to a
funding source of the United States Government. The revised Statement of Work, if any, is
incorporated herein by this reference and identified as"Exhibit B".
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The effective date of this Amendment is October 12,2012,or upon approval of the State Controller,or an
authorized delegate thereof,whichever is later.
5. Except for the Special Provisions and other terms and conditions of the Master Contract and the General
Provisions of the Original Task Order Contract, in the event of any conflict, inconsistency,variance,or
contradiction between the terms and provisions of this Amendment and any of the terms and provisions of
the Original Task Order Contract,the terms and provisions of this Amendment shall in all respects
supersede,govern,and control. The Special Provisions and other terms and conditions of the Master
Contract shall always control over other provisions of the Original Task Order Contract or any subsequent
amendments thereto. The representations in the Special Provisions to the Master Contract concerning the
absence of personal interest of state of Colorado employees and the certifications in the Special Provisions
relating to illegal aliens are presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED,
AND OTHERWISE MADE AVAILABLE.
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Page 2 of 4 Rev 3/16/2010
IN WITNESS WHEREOF,the parties hereto have executed this Amendment on the day first above written.
* 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:
STATE OF COLORADO
Board of County Commissioners of Weld County John W.Hickenlooper,Governor
(a political subdivision of the state of Colorado)
for the use and benefit of the Weld County Department
of Public Health and EnvironmentC---ta?)p By: (?).P.41-1
Signature of Authorized Officer 'CT 1 # 2012 For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Sean P. Conway
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
PROGRAM APPROVAL:
By: •
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
By:
Date: /O-.V-/)-
Page 3 of 4 Rev 3/16/2010
02 P/07 -o7e6z
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Page 4 of 4 Rev 3/16/20 10
EXHIBIT B as modified by
Contract Amendment# I,
Contract Routing# 13 FLA 48444
STATEMENT OF WORK
To Contract Amendment Dated 8/28/2012-Contract Routing Number 13 FLA48444
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—August 31,2013.
Period for Service Delivery: Date of fully executed contract-June 29,2013. Cases that are not clinically
complete by June 29, 2013 will not be paid with fiscal year 2013 funds
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.
Page I of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
Diagnostic Testing—Further testing used when a definitive diagnosis is unable to be determined by the results of
prior screening tests.
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(See Exhibit A of the Original
Contract).
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 the
date of fully executed contract n order to start work under this contract.
i. 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 the
date of fully executed contract 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 the date of fully executed
contract 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.oresowfv13appendices.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.
Page 2 of 8
Exhibit B-Statement of Work
V I/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing#13 FLA 48444
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.
e. The Contractor must identify and support an eCaST Coordinator,Contacts Description document is located
at: http://womenswellnessconnection.org/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.org/sowfvl3appendices.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://womenswellnessconnection.oresowfyl3appendices.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.org/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, stereotactic
biopsy, etc.) is required and is not available at any facility in that radius.
d. Subcontractors:
Service performed by subcontractors shall:
I. 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.
Page 3 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
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.oresowfyl3anpendices.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
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.org/sowfvl3appendices.html,and incorporated herein by this
reference and keeping a copy in the patient's medical record before services are rendered.
i. Annually verifying required documentation for proof of lawful presence according to Department of
Revenue guidelines: http://www.colorado.gov/cs/Satellite/Revenue-Main/XRM/12162890 12 1 12.
iii. Document verification of lawful presence on the WWC Patient History Form located at:
http://womenswellnessconnection.org/sowfyl3appendices.html and in eCaST for each woman the
Contractor will be requesting reimbursement.
I. 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
Attachment B-1,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://womenswellnessconnection.org/sowfv l3appendices.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
Page 4 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
the Medicaid Program.
Data entered into eCaST are the basis for calculating reimbursement for each client screened.
i. One reimbursement check for all completed screenings that have met data and quality standards will be
sent to the Contractor each month.
ii. WWC will generate Contractor grant activity statements based on data entered into eCaST each month on
the 15th or next business day thereafter.
iii. WWC will only provide reimbursement for cases that are clinically complete and correctly entered
into eCaST from the date of contract execution through June 29,2013. Contractors are given a
data entry grace period from June 30,2013 through the last business day of July. WWC will run a
final billing for FY 2013 the last business day in July and will implement grant funds change letters
in August to assure all WWC funding is spent by August 31,2013.
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:
httos://docs.google.corn/file/d/OB9UrHzcBKK4hOTZINm13YmYtZGY3 MS00NzU 3 L W lyZTOtY2Y4Yzh
mZT1xM zU 0/edit?h I=en_US
i. The Provider Toolkit may be 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:
htto://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://womenswellnessconnection.org/sowfv l3appendices.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:
Page 5of8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
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 the
date of fully executed contract. 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.
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.
ii. 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.
iii. The performance improvement plan will have expectations set by the WWC with time frames for
completion.
I. 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;
ii. Chart audit;
iii. 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.org/sowfvl3appendices.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:
I. WWC identification number used in unencrypted email conversations;
2. Mail or fax clearly marked"Confidential" ;
Page 6 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
3. HIPAA compliant files transmitted via secure File Transfer Protocol(FTP)sites;and
4. Secure encrypted email.
ii. 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.
iii. 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
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.
i. 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:
(http://womenswellnessconnection.org/sowfv l3appendices.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.
Hi. 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
Page 7 of 8
Exhibit B-Statement of Work
V 1/MAR2012
EXHIBIT B as modified by
Contract Amendment# 1,
Contract Routing# 13 FLA 48444
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 15th 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:
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 may 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.
Page8 of 8
Exhibit B-Statement of Work
V I/MAR2012
Attachment B-1
Bundled Payment System
Bundled Payment System
Breast Levels
Effective 6/30/2012 Updated 3/9/2012
Level Definition of Level Reimbursement
B1 Result is normal and requires no further $50
action. Office visit for Clinical Breast Exam (CBE)
B2 Results of all tests are normal and require $220
no further action. $ 50 services from level B1
+ $140 mammogram
+ $ 30 patient navigation& admin fee
B3 Results are abnormal and require further $560
non-invasive diagnostic testing. The $220 services from level B2
definitive diagnosis is not cancer. May also + $280 Dx imaging and/or surgical consult
include surgical consult. + $ 60 case management& admin fee
B4 Results are abnormal, requiring additional $1445
invasive diagnostic testing. The definitive $560 services from level B3
diagnosis may be cancer or non-cancer. NO + $885 invasive diagnostic testing
treatment.
Cervical Levels
Effective 6/30/2012 Updated 3/9/2012
Level Definition of Level Reimbursement
Cl Result is normal and requires no further $50
action Office visit for pelvic exam
C2 Results of all tests are normal and require no $110
further action. $ 50 services from level Cl
+ $ 30 pap test
+ $ 30 patient navigation & admin fee
C3 Screening HPV test or Results are abnormal $220**
and require further non-invasive diagnostic $ 110 services from level C2
testing. The definitive diagnosis is not + $ 50 HPV test
cancer. May also include polyp removal. + $ 60 case management& admin fee
C4 Results are abnormal, requiring additional $480**
invasive diagnostic testing. The definitive $220 services from level C3
diagnosis may be cancer or non-cancer. NO + $260 colposcopy
treatment.
** If a second diagnostic procedure(i.e. LEEP/LOOP,colposcopy, CKC) is required, providers may request additional
reimbursement at the CPT rate. Must receive clinical pre-approval by WWC program staff.
Page 1 of I
STATE OF COLORADO
John W. Hickenlooper,Governor
Christopher E. Urbina, MD,MPH of co10
Executive Director and Chief Medical Officer NQ� X90
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr.S. Laboratory Services Division ,, x`
Denver,Colorado 80246-1530 8100 Lowry Blvd. \‘‘C'!.876_,"/
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
October 25, 2012
Mark Wallace
Weld County Department of Public Health
& Environment
1555 North 17th Ave.
Greeley, CO 80631
Dear Mr. Wallace, •
Enclosed is your copy of the fully executed Colorado Department of Public and Environment Contract
Amendment listed below. As you were previously notified, you may begin work on 10/24/12.
Contractor Name: Weld County Department of Public Health
& Environment
Contract Amendment Number: 13 FLA 48444
Original Contract Number: 13 FLA 43185
Division: Prevention Services Division (PSD)
Program Name: Women Wellness Connection
Reason for Contract Amendment: Increased Funding and Extension
Please feel free to contact me with any questions or concerns.
Genevieve Baldv*rK-
Contracts Cootdirjator
Prevention Services Division
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO 80246-1530
303-692-2553
genevieve.baldwin@state.co.us
Hello