HomeMy WebLinkAbout20111507.tiff RESOLUTION
RE: APPROVE AMENDMENT #3 TO TASK ORDER CONTRACT FOR NURSE HOME
VISITOR 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 Amendment#3 to Task Order Contract for
the Nurse Home Visitor 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, 2011, and ending June 30, 2012, 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 Amendment #3 to the Task Order Contract for the Nurse Home Visitor
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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of June, A.D., 2011.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COL RADO
ATTEST •C/ �% -72 GULL /AJLz J1/t/-/
arbara Kirkmeyer Chair /
Weld County Clerk to the '• . �� 5t`J:'- =��XCUSED
►�,� .A, Sean P. Conway, Pro-Tem
De y Jerk to the Board '� > � EXCUSED
Wi ' m F. Garcia
APP AST • a�
David Lo
vi E. Long
unty A torney '9.00?‘---5 Co -t/l-\ ct.CGC�
'Douglas R demache
Date of signature: (OM/
Dirac) to Ti Cc, Q V'. 1-IL 2011-1507
'aU (% ,I g -I I HL0038
86 20 Memorandum
1TO: Barbara Kirkmeyer, Chair
Board of County Commissioners
W E L D_E O U N T Y FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment tic a
DATE: 5-27-11
SUBJECT: Nurse Home Visitor Program,
Amendment for Task Orders #3
Enclosed for Board review and approval is contract amendment between the Colorado
Department of Health and Environment and the Board of County Commissioners of Weld
County on behalf of the Department of Public Health and Environment (WCDPHE). This
amendment is for grant funding change in the Nurse Home Visitor Program.
If approved, the funding for this contract will continue to allow the Department to provide
registered nurses for bi-monthly home visits to low-income, first time mothers residing in Weld
County. These home visits begin in pregnancy and continue until the client's child reaches the
age of two years. Clients are educated and encouraged to develop positive maternal/child health
practices and understanding of infant/toddler developmental needs, effective parenting and
maternal economic self-sufficiency. Increased exposure in southwest Weld County has made a
positive impact on new client referrals. Nurse Home Visitor outreach efforts have proven
effective in stimulating referrals from community partners such as Human Services and Youth
and Family Connections.
The term of this contract is July 1, 2011 through June 30, 2012.Total funding for this amendment
period will not exceed $620,954. This is a decrease of$20,752 due to a decrease in funds
provided from the Tobacco Settlement Funds to the Colorado Nurse-Family Partnership
program. Most of the decrease, $19,880, resulted from denying the requested .25 increase for the
Program Supervisor. There was also $873 in other Administrative costs which was moved to an
adjusted Medicaid estimate in the budget. The total contract $620,954 amount is fully funded by
the Colorado State Tobacco Settlement Funds and Medicaid payments. I recommend your
approval of this contract amendment.
Enclosure
2011-1507
STATE OF COLORADO
John W.Hickenlooper,Governor
Christopher E.Urbina,MD,MPH 7.ov-coio�
Executive Director and Chief Medical Officer
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr.S. Laboratory Services Division .• r
Denver,Colorado 80246-1530 8100 Lowry Blvd. 87e
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
DATE
Weld County Department of Public Health and Environment
1555 North 17t" Avenue
Greeley, CO 80631
Hi Debbie Drew,
Enclosed is your copy of the fully executed Colorado Department of Public Health and Environment
Amendment listed below. You may begin work on 07/01/11.
Contractor Name: Weld County Department of Public Health and Environment
Task Order Number: 12 FLA 29940
Original Contract Number: 08 FLA 00184
Division: Prevention Services Division/PSD
Program Name: Nursing Home Visitor Program/NHVP
Reason for Contract: Nurse Home Visit Services
Please contact me with questions or concerns. My contact information is listed below.
Sincerely,
Jacqueline O'Bryan
Contract Manager
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
PSD-A4-FSU
Denver, CO 80246
303-692-2485
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-NIIVP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
12-29940
AMENDMENT FOR TASK ORDERS#3
This Amendment is made this 20th day of April,2(111,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.for the use and benefit of the WELD
COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT(a political subdivision of the
state of Colorado),whose address or principal place of business is 1555 North 17th Avenue.Greeley.CO 80631
hereinafter referred to as the"Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract,dated January 23.2007,with contract routing number 08 FAA 00052 .
Pursuant to the terms and conditions of the Master Contract,the parties entered into a Task Order Contract,date d
May 25,2007,with contract encumbrance number PO FLA FHS0800184, and contract routing number O8-FLA-
00184, as amended by Funding Letter 41, contract routing number 08-FLA-00741, Limited Amendment#1,
contract routing number 09-FLA-00019, Grant Funding Change Letter#2,contract routing number 09-FLA-
00951,Contract Amendment#1,contract routing number 10-FLA-00019,Grant Funding Change Letter#3.contract
routing number 10-FLA-13559,Amendment for Task Order 42.contract routing number 11-FLA-15839, and Grant
Funding Change Letter#4,contract routing number 11-FLA-29818,collectively referred to herein as the `Original
Task Order Contract,whereby the Contractor was to provide to the State the following:
Contractor is to provide nurse home visitor services to low-income,first-time mothers in the
state of Colorado
The State promises to pay the Contractor the sum of Six Hundred Twenty Thousand.Nine Hundred Fifty-Four
Dollars,(S620.954.001 in exchange for the promise of the Contractor to continue to perform the work identified in
the Original Task Order Contract for the renewal term of i2 months,ending on June 30.2012.
NOW THEREFORE, in consideration of their mutual promises to each other. stated helpsv.the parties hereto agree
as follows:
. 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.
if is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order
Contract, contract routing number 08-F1,A-00184. as amended by Funding Letter 41,contract routing
number(18-FLA-00741, Limited Amendment#1,contract routing number 09-FLA-00019, Grant
Funding Change Letter#2.contract routing number 09-FLA-00951, Contract Amendment#1. contract
routing number 10-FLA-00019.Grant Funding Change Letter 43. contract routing number 1f-FLA-13559,
Amendment for Task Order#2. contract routing number 1 i-FLA-15839,and Grant Funding Change Letter
#4.contract routing number I 1-FLA-29818,collectively referred to herein as the Original Contract.which
is by this reference incorporated herein. All terms. conditions. and provisions thereof unless specifically
modified herein.arc to apply to this Amendment as though they were expressly rewritten. incorporated.and
Page 1 of 5 Re% 3'16.2010
X(i/- .5('
included herein.
i. It is expressly agreed to by the parties that the Original Task Order Contract is and shall he 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 08-FLA-00184. This Amendment is for the renewal term of ,iuh'
2011,through and including June 30,2012. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Six Hundred Twenty-
Thousand, Nine Hundred Fifty-Four Dollars,(5620,954.001 for an amended total financial
obligation of the State of TWO MILLION. EIGHT HUNDRED SEVENTY-NINE
THOUSAND. FOUR HUNDRED NINETY-SEVEN DOLLARS,(S2.879,497.00). This is an
increase of Six Hundred Twenty Thousand, Nine Hundred Fifty-Four Dollars (5620,954.00)
of the amount payable from the previous term. The revised Additional Provisions is incorporated
herein by this reference and identified as"Exhibit I:". The revised Statement of Work is
incorporated herein by this reference and identified as"Exhibit L". The revised Budget is
incorporated herein by this reference and identified as "Exhibit M".
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 July 1,2011,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 CONTINGEN'T UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 2 of 5 Rey 3."i 6.201 0
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Page 3 of 5 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:
BOARD OF COUNTY COMMISSIONERS OF WELD STATE OF COLORADO
COUNTY for the use and benefit of the WELD COUNTY John W. Hickenlooper,Governor
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT(a political subdivision of the
state of Colorado)
4rfiAl4i A6 !/J By: 67 -
Signature of uthorized facer For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Barbara Kirkmeyer
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
JUN 2 0 2011
PROGRAM APPROVAL:
By: fill a 11y-/ �,7JJ/J�\ J
ALL CONTRACTS Mt/ST 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.
ATE CONTROLLER
avid J. McDer tt,CPA
By:
Date:
b V
Page 4 of 5 Rev 3/16:2010
>9C// - ��''(
EXHIBIT K
ADDITIONAL PROVISIONS
To Task Order Contract Made 04/20/2011 - Contract Routing Number 12 FLA 29940
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
1. 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.
2. This Task Order Contract is governed by those rules that were adopted by the state of Colorado's Board of
Health pursuant to section 25-31-104,C.R.S.,as amended,incorporated herein by reference.
3. To receive compensation under this Task Order Contract,the Contractor shall submit a signed Monthly
Contract Reimbursement Statement in a format acceptable to the State. A sample Contract
Reimbursement Statement can be found on the website
http://www.cdnhe.state.co.us/ps/nursehome/index.html,under the Fiscal tab,titled Contract
Reimbursement Statement, and incorporated herein by this reference. A Contract Reimbursement
Statement must be submitted within sixty(60)calendar days of the end of the billing period for which
services were rendered. Contract Reimbursement Statements must be accompanied by detailed cost ledger
to reflect all purchases being invoiced under that contract and should include date of payment,payee name
and amount,and check or voucher number, when available.Expenditures shall be in accordance with the
Statement of Work attached hereto as Exhibit L. These items may include, but are not limited to,the
Contractor's salaries, fringe benefits,supplies,travel,operating, indirect costs which are allowable,and
other allocable expenses related to its performance under this Task Order Contract.
Contract Reimbursement Statements shall: I)reference this Task Order Contract by its contract routing
number,which number is located on page one of this Task Order Contract; 2) state the applicable
performance dates; 3)state the names of payees; 4)include a brief description of the services performed
during the relevant performance dates: and, 5)show the total requested payment. Payment during the
initial,and any renewal or extension,term of this Task Order Contract shall be conditioned upon
affirmation by the State that all services were rendered by the Contractor in accordance with the terms of
this Task Order Contract. Contract Reimbursement Statements shall be sent to:
Fiscal Officer
Nurse Home Visiting.Program(NHVP)
Prevention Services Division
Colorado Department of Public Health and Environment
PSD-A4
4300 Cherry Creek Drive South
Denver,CO 80246
To be considered for payment, billings for payments pursuant to this Task Order Contract must be received
within a reasonable time after the period for which payment is requested, but in no event no later than
sixty(60)calendar days after the relevant performance period has passed. Final billings under this
Task Order Contract must be received by the State within a reasonable time after the expiration or
termination of this Task Order Contract; but in no event no later than sixty(60)calendar days from the
effective expiration or termination date of this Task Order Contract.
Unless otherwise provided for in this Task Order Contract,"Other Funding Sources", if any,shall be
included on all billing statements as required by the funding source.
To be attached to CDPHE Page I of 3 Revised: 12/19/06
Task Order v1.0(I I/05)contract template
EXHIBIT K
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
4. The Contractor is authorized to make limited transfers of funds from one line item in its Budget to another
line item in its Budget but must notify the Nurse Home Visitor Program Director by email prior to the
transfer. A transfer from one line item to another line item may not exceed ten percent(10%)or one
thousand dollars(S1000).whichever is less,of the total amount of the line item from which the transfer is
made unless prior written approval is received from the Nurse Home Visitor Program Director. If the
Contractor desires to transfer more than ten percent(10%)from one line item in its budget to another line
item in its budget then the Contractor shall request and receive prior written approval from the Nurse Home
Visitor Program Director by completing and submitting a NH VP Budget Revision Request Form before
the transfer can be made. This form is located on the website
http:/,'www.cdphe.state.co.us'psinursehome.:index.html,under the Fiscal tab,and is incorporated herein by
reference,.
5. The Contractor agrees to provide services to all Program participants and employees in a smoke-free
environment in accordance with Public Law 103-227,also known as"the Pro-Children Act of 1994",(Act).
Public Law 103-227 requires that smoking not be permitted in any portion of any indoor facility owned or
leased or contracted for by an entity and used routinely or regularly for the provision of health,day care,
early childhood development services,education or library services to children under the age of 18, if the
services are funded by Federal programs either directly or through State or local governments,by Federal
grant,contract, loan,or loan guarantee. The law also applies to children's services that are provided in
indoor facilities that are constructed,operated,or maintained with such Federal funds. The law does not
apply to children's services provided in private residences;portions of facilities used for inpatient drug or
alcohol treatment;service providers whose sole source of applicable Federal funds is Medicare or
Medicaid;or facilities where Women. Infants and Children (WIC)coupons are redeemed. Failure to
comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty
of up to$1,000 for each violation and/or the imposition of an administrative compliance order on the
responsible entity. By signing this Task Order Contract,the Contractor certifies that the Contractor shall
comply with the requirements of the Act and shall not allow smoking within any portion of any indoor
facility used for the provision of services for children as defined by the Act. The Contractor agrees that it
shall require that the language of the Act be included in any subcontracts which contain provisions for
children's services and that all contractors shall sign and agree accordingly.
6. The Contractor certifies,to the best of its knowledge and belief,that no federally appropriated funds have
been paid or shall be paid by or on behalf of the Contractor,to any person for influencing or attempting to
influence an officer or employee of any agency, a Member of Congress,an officer or employee of
Congress,or an employee of a Member of Congress in connection with the awarding of this Task Order
Contract,and the extension.continuation.renewal. amendment,or modification of this Task Order
Contract,or any grant, loan,or other cooperative agreement that utilizes Federal funds. If any funds other
than federally appropriated funds have been paid or shall he paid to any person for influencing or
attempting to influence an officer or employee of any agency.Member of Congress.an officer or employee
of Congress in connection with this Task Order Contract,or any other grant.loan,or other cooperative
agreement.then the Contractor shall complete and submit Standard Form -LLL. "Disclosure Form to
Report Lobbying" in accordance with its instructions. The Contractor shall require that the language of this
certification be included in the award documents for subawards at all tiers(including subcontracts,
subgrants.and contracts under grants, loans,and cooperative agreements)and that all subrecipients shall
certify and disclose accordingly. This certification is a material representation of fact upon which reliance
was placed when this transaction was made or entered into. This certification is a prerequisite for making
or entering into this transaction imposed by section 1352. title 31.C.S. Code. Any person who fails to file
the required certification shall be subject to a civil penalty of not less than $10,000 and not more than
$100,000 for each such failure.
7. Notwithstanding anything herein to the contrary,the parties understand and agree that all terms and
conditions of this Task Order Contract and the exhibits and attachments hereto which may require
To be attached to CDPHE Page 2 of 3 Revised: 12/19/06
Task Order v1.0(11/05)contract template
EXHIBIT K
continued performance,compliance or effect beyond the termination date of this Task Order Contract shall
survive such termination date and shall be enforceable by the State as provided herein in the event of such
failure to perform or comply by the Contractor.
9. The Contractor shall protect the confidentiality of all applicant or recipient records and other materials that
are maintained in accordance with this Task Order Contract. Except for purposes directly connected with
the administration of this Task Order Contract,no information about or obtained from,any applicant or
recipient shall be disclosed in a form identifiable with the applicant or recipient without the prior written
consent of the applicant or recipient,or the parent or legal guardian of a minor applicant or recipient with
the exception of information protected by Colorado statute as it applies to confidentiality for adolescent
services in which case the adolescent minor and not the parent or legal guardian must provide consent or,as
otherwise properly ordered by a court of competent jurisdiction. The Contractor shall have written policies
governing the access to,and duplication and dissemination of,all such information. The Contractor shall
advise its employees,agents,servants,and subcontractors, if any,that they are subject to these
confidentiality requirements.
10. Under this Task Order Contract,the Contractor shall refer families participating in any and all programs in
its agency such as WIC,Early and Periodic Screening,Diagnosis and Treatment(EPSDT), Immunization
Clinics, Family Planning, HCP,Prenatal Plus(PNP),etc.to appropriate enabling and direct care service
programs in the community. All pregnant women in need of resources for prenatal medical care are
provided with information about programs such as WIC,PNP,etc.as needed;provide all individuals
seeking reproductive health services with information about pregnancy planning,the consequences of
unintended pregnancies,and,referrals to comprehensive family planning services; and all children ages
birth through two years who may be eligible for early intervention services are referred to Early.
Intervention Colorado.
11. Contractor shall ensure that the provisions of Section 601 of Title VI of the Civil Rights Act of 1964 are
carried out. That Act states that"no person in the United States shall on the ground of race, color,or
national origin,be excluded from participation in,be denied the benefits of,or be subjected to
discrimination under any program or actively receiving Federal financial assistance." The Office of Civil
Rights has concluded that it is the responsibility of any program which is a recipient of funds from the
Department of Health and Human Services to ensure that clients who do not speak or understand English
well, be provided interpretation services to ensure that the service provider and the client can communicate
effectively. The Contractor shall have policies and procedures to ensure that interpretation services are
available for clients with Limited English Proficiency and shall advise such clients that an interpreter shall
be provided for them. If a client has their own interpreter,they shall be advised that the Contractor shall
provide an interpreter if the client so chooses.
12. The services or activities under this Contract may be carried out by the Contractor,or through subcontracts
with other providers or.through collaborative partnerships with other community partners. The State
authorizes the Contractor to subcontract some,or all,or the services that are to be performed under this
Contract. However,a subcontractor is subject to all of the terms and conditions of this Contract.
Additionally,the contractor remains ultimately responsible for the timely and satisfactory completion of all
work performed by any subcontractor(s) under this Contract. If the Contractor desires to subcontract some.
or all,of the services that are to be performed under this Contract,the Contractor shall obtain the prior,
express,written consent of the State before entering into any subcontract.The Contractor shall maintain,at
a minimum a Memorandum of Understanding or other binding contractual agreement,and provide a copy
to the Nurse Home Visitor Program Director fifteen(15) calendar days from the date the agreement is
executed. The Contractor shall maintain records of any subcontractors for a minimum of three years.
To be attached to CDPHE Page 3 of 3 Revised: 12/19/06
Task Order v1.0(11/05)contract template
EXHIBIT L
STATEMENT OF WORK
To Task Order Contract Made 04/20/11 -Contract Routing Number 12 FLA 29940
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above.
Introduction
In order to implement the Nurse Home Visitor Program (NHVP) efficiently and effectively and to promote the
successful partnerships between state public entities and the private sector, responsibility for the program is
divided between the Colorado Department of Public Health and Environment,which is responsible for financial
administration of the program,and the University of Colorado at Denver Anschutz Medical Campus (the Health
Sciences Facility) which is responsible for programmatic and clinical support, evaluation, and monitoring for
the program.
Contractor responsibilities to CDPHE:
1. 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 activities and
services related to the fiscal management of the Colorado Nurse Home Visitor Program. The fiscal
management provided by the contractor for the program must be deemed by the state to be acceptable
and in good faith. For fiscal management to be"acceptable" it must comply with all, but not limited
to, the items listed below, which are incorporated and made part hereof by reference. These
documents are located at: http://www.cdphe.state.co.us/ns/nursehome/index.html
• Colorado Nurse Home Visitor Program Act,as described in §25-31-101,C.R.S.
• Senate Bill 10-073
• NHVP Grantee Fiscal Requirements
• Rules Concerning the Nurse Home Visitor Program
• Medicaid Reimbursement Guidelines
2. The Contractor shall submit the following reports,when requested and by the indicated due dates,
incorporated by reference.These documents are located at:
http://www.cdphe.state.co.us/ps/nursehorne/index.hunl
• Expenditure Year-to-Date/Mid-Year Projections Report
• Final Expenditure Report
3. The Contractor shall complete in a satisfactory manner and by the indicated date, all activities stated
in the "Areas Requiring Performance Improvement Plan or Funding Conditions" in the NHVP
Application Review Summary letter which is incorporated and made part hereof by reference.
4. The Contractor shall participate in meetings or trainines as requested by the State, and the Contractor
must cover all costs as applicable.
5. The Contractor shall provide the nurse home visitor services in accordance with the Application
Review Summary and the FY2012 Proposed Budget,Exhibit M.
6. Funding adjustments may be made during the term of this contract. Grant awards are made using
NHVP funding and Medicaid reimbursement estimates. The total amount of funding for the term of
this contract may not exceed the Total Amount Requested from the CDPHE as provided in the FY2012
Proposed Budget, Exhibit M. If the contractor draws more Medicaid funding,the state wil I reduce the
NHVP funding. Unless otherwise approved, overages of Medicaid funding in one fiscal year are
reconciled in the subsequent fiscal year. If the contractor draws less Medicaid funding the state may
increase the NHVP funding, if funding is available.during the Mid-Year Budget Projections process.
Page 1 of 2
EXHIBIT L
7. The State may increase or decrease funds available under this Contract using a Grant Funding Change
Letter substantially equivalent to Exhibit E of the original Contract. The Grant Funding Letter is not
valid until it has been approved by the State Controller or designee.
8. The Contractor shall submit Medicaid reimbursement requests for all eligible clients. Department of
Health Care Policy and Financing (HCPF) oversees the submission of Medicaid reimbursement
requests for compliance with HCPF procedures and the Medicaid Billing Manual. The Medicaid
Billing Manual can be accessed at http://www.cdphe.stare.co.uslos/nursehomeiindex.html
9. CDPHE will monitor the contract through documentation reviews, fiscal site visits, reports from the
Health Sciences Facility, and meetings with the contractor as necessary to ensure compliance with
fiscal requirements. The contractor shall provide reasonable access to financial documents and staff as
requested.
10. If the State believes in good faith that a fiscal activity or service fails to meet the standard for that
particular activity or service, or is otherwise deficient,then the State shall notify the Contractor of the
failure or deficiencies in writing. Corrective action shall be addressed through a Fiscal Action Plan or
some other method defined by the State. Due dates for completion of activities listed in an Fiscal
Action Plan will be negotiated on a case by case basis.
Page 2 of 2
Exhibit M
NHVP
FY2011-12 Proposed Budget for the period ofJuly 1, 2011 through June 30, 2012
COUNTY
Project Name:
TOTAL CDPHE TOTAL AGENCY
FY 11/12 BUDGET July 1, FY11/12 FY11/12 NHVP
2011 to June 30, 2012 CONTRACT
Annual No. of BUDGET (B+C) BUDGET (A+B+C)
Salary months A. Other B. Medicaid C. CDPHE
Sources of Estimate 62 FUNDING (A+ B+ C)
Rate Budget FTE Funding•1 (NHVP)*3
PERSONAL SERVICES(Detail Expenses) BUDGET
Personal Services(Title and Name) - $0 $0
$0 $0
Garvey, Dana-PHN II, NHV 51,631 12 1 55.558 $46 073 $51,631 $51,631
Hagihara. Kathleen-PHN II , NHV - 54,549 12 1 $5,872 $48,677 $54.549 $54,549
Holton, Geraldine-PHN II, NHV - — 59.055 12 1 $6,357 552,698 $59.055 $59,055
Passillas, Lorena-OOiceTechnician 34,128 12 1 $3,674 $30,454 $34,128 $34,128
Rowe-Denning, Mane_PHN 11, NHV _ 59,561 12 1 $6 411 $53,150 $59.561 $59,561
Silverman, Barbara-PHN II, NHV 26,815 12 0.5 52,886 $23,929 $26.815 $26,815
Unruh,Veata-PHN II, NHV 56,389 12 1 $6,070 $50,319 $56.389 $56,389
;Woodward,Jodi-PHN II, NHV 25,064 12 0.5 $2 688. $22,366 $25.064 $25,064
$0 $0
$0 $0
Contractual/Fee for Service $0 $0
$0 $0
$0 $0
Supervising Personnel $0 $0
Francisco, Barbara-PHN III, Supervisor 68,645, 12 0.75 _ $5,882 $38,10__2 $43.984 543.984
$0 $0
Fringe Benefits Rate= 35 54% 151,350 MMI NNU $16,291 — $129,840 $148,131 $146,131
$0 $0
1.TOTAL PERSONAL SERVICES $0 $61,699 S495.608I $557,307' $557,307
OPERATING (Detail Expenses) I BUDGET
Office Operating Expenses(i e, supplies, pens. etc) 4000 - - _ __$431 - $3,569 $4,000 - $4,000
Client Support Materials 6000 $648 $5,354 $6,000 $6,000
Printing& Publications 4200 $452 $3,748 $4.200 $4,200
Postal&Shipping Services 1300 $140 $1,160 $1.300 $1.300
Communications(long distance, cellular and network service) 4060 $436 $3,614 $4.050 $4,050
Medical and Program Supplies 1200 $129 $1.071 $1.200 $1.200
'Outside Services 0 $0 $0
0 $0 $0
2. TOTAL OPERATING $0 $2,234 $18,516' $20,7501 $20,750
EQUIPMENT(Detail Expenses) I BUDGET
Computers w/Software 0 $0 $0
Cellular Phones 90 $10 $80 $90 $90
3.TOTAL EQUIPMENT $0 $10 $80' $901 $90
TRAVEL(Detail Expenses) I BUDGET
Visit Outreach Mileage 24,000 _ $2,583 $21,417 $24.000 $24,000
N_CCFC/UCHSC Training Travel 185 $20 $165 $185 $185
NCAST Travel 0 $0 $0
PIPE Travel 50 _ $5 $45 $50 $50
Program Meetings(nurses,supervisor,other) 480 $52 $429 $481 $481
Other Travel 0 $0 $0
4. TOTAL TRAVEL $0 $2,680 $22,058. $24,718 $24,716
NFP TRAINING& TECH ASSISTANCE(Detail Expenses) I BUDGET
Technical Assistance 8816 949 $7,867 $8,816 $8.816
On-going Nurse Education 1526 164 $1,362 $1,526 $1,526
Initial Nurse Education 0 $0 $0
Initial Supervisor Education - 0 $0 $0
Education Materials _ _ 0 _ $0 $o
Professional Development 4500 484 $4,016 54.500 $4,500
5.TOTAL TRAINING &TECH ASSISTANCE $0 $1,597 $13,245 $14,842 $14,842
NCAST COSTS(Detail NCAST Training& Materials) I BUDGET
NCAST Registration 0 SO $0
NCAST Materials 0 SO $0
PIPE Training Materials _ 0 _ $0 - $0
0 SO $0
6. TOTAL NCAST COSTS 0 $0 $0 $0 $0 $0.
OTHER COSTS(Detail Other Program Costs) I BUDGET
SO $0
$0 SO
$0 —$O
SO $0
7. TOTAL OTHER COSTS $0 $0 $0, $0 $O ,
TOTAL DIRECT PROGRAM COSTS(Add budget categories 1-7) SO $68,200 I $549,505 $617,704 $817,704 .
ADMINSTRATNE COSTS(Detail Administrative Costs) BUDGET
Accounting, budgeting, financial, audit and purchasing $4.340 $4,340 - $4,340
Personnel mannernent,payroll,legal -. _$5.713 $5,713 - - $5.713
Information technology systems/data processing services _ $14,600 $14,600 $14,600
Bu lding/Property management expenses $29,500 $29,500 $29,500
Administrative Staff support/Medicaid billing for NFP services 9597 $17,296 $26.893 $26,893
- $0 $81,046
TOTAL ADMINISTRATIVE COSTS $0 I $9,697 I $71,449 $81,048 $81,046
TOTAL PROJECT COSTS (Direct Program + Administrative Costs) $0 I $77,797 $620,954. $698,750 . $698.750
TOTAL PROGRAM COSTS
TOTAL APPROVED BUDGET
DIFFERENCE/ADJUSTMENT
Specify"OTHER SOURCES"(cash or in-kind)from the column A.above.
$
$
$
$
Total Other Sources $0.00
Signature of Authorized Agency Representative: Date Date
'Signature of CDPHE Program Director: Date Date
ISignature of CDPHE Fiscal Officer: Date Date
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