HomeMy WebLinkAbout20102601.tiff RESOLUTION
RE: APPROVE AMENDMENT#2 TO 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 Amendment#2 to 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, commencing November 1, 2010, and ending June 29, 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 #2 to 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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 1st day of November, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
,•�` ELD COUNTY, COLORADO
ATTEST: , Q.
J I$V s Radema her, air
Weld County Clerk to the Bo.: 61 (�,, 1„ /,
J.ara Kirkmeyer ro-Tem T
BY: 4tiT 3 ( 2i a.c i c' .
Depµt Clerk o/the =card ,S;:14(
APB ED O F RM:
/ \m F. Garcia
County Attorney ` cal
David E. Long
Date of signature: IV IC
3 O1/69\ b T — ( C, - H L - P
i to 2010-2601
/- P/-/1 HL0037
Memorandum
*et;
TO: Douglas Rademacher, Chair
Board of County Commissioners
viipe FROM: Mark E. Wallace, MD, MPH, Director
Department of Public Health and
Environment
COLORADO DATE: October 27, 2010
SUBJECT: Women's Wellness Connection Contract
Amendment#2
Enclosed for Board review and approval is Contract Amendment#2 between the Colorado
Department of Public Health and Environment and Weld County Board of County
Commissioners for the Department of Public Health and Environment's Women's Wellness
Connection (WWC) program. Funding for the WWC provider services is provided by both
federal and State of Colorado funding sources. The effective date of this amendment is
November 1, 2010.
The 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. Weld County will be reimbursed by the
State according to current Medicare rates (see attached reimbursement fee schedule) for the
provision of these services. I recommend your approval of this amendment.
Enclosure
2010-2601
STATE OF COLORADO
Bill Ritter,Jr.,Governor
Martha E. Rudolph, Executive Director A. c��oR
Dedicated to protecting and improving the health and environment of the people of Colorado �`/' o
4300 Cherry Creek Dr.S. Laboratory Services Division *
Denver,Colorado 80246-1530 8100 Lowry Blvd. .1876
Phone(303)692-2000 Denver,Colorado 80230-6928
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphe.state.co.us and Environment
December 6, 2010
Cynthia Horn
Weld County Department of Public Health and Environment
1555 North 17th Avenue
Greeley, Colorado 80631
Dear Ms. Horn,
Enclosed is your copy of the fully executed Colorado Department of Public Health and
Environment Amendment listed below. The effective date is November 29, 2010.
Contractor Name: Weld County Department of Public Health and Environment
Amendment Contract Agreement Number: 11 FLA 22806
Division: Prevention Services Division/PSD
Program Name: Women's Wellness Connection/WWC
Project Name: Breast and Cervical Cancer Screening
Reason for Contract: Implement spending cap and incorporation of the Grant Funding
Change Letter
Please contact me with questions or concerns. My contact information is listed below.
Sincerely,
„Xyltol,./ky L fit e
Ly�ddsay JY Clelland, M.S.
Prevention Services Division
PSD-A5
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-W WC
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
11-22806
AMENDMENT FOR TASK ORDERS#2
This Amendment is made this 22 day of September,2010,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),whose address or principal place of business is 915 10`"Street,Greeley,Colorado 80632-0758,for the
use and benefit of the Weld County Department of Public I Iealth and Environment,whose address or principal place
of business is 1555 North 17th Avenue,Greeley,Colorado 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,dated
April 24,2009,with contract encumbrance number PO FLA W HS10W WC,and contract routing number 09 FLA
01030,as amended by contract routing number 10 FLA 13404,collectively referred to herein as the"Original Task
Order Contract,whereby the Contractor was to provide to the State the following:
Breast and cervical cancer screening services and approved diagnostic services to Women's Wellness
Connection eligible women. The Contractor shall also enter a complete history in the electronic Cancer
Screening and Treatment(eCaST)database;and perform Medicaid presumptive eligibility for enrollment
in treatment under the Breast and Cervical Cancer Program as administered by Medicaid.
The State hereby exercises a"no cost"change to the specifications within the Scope of Work within the current
term of the Original Task Order Contract.
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 09 FLA 01030, as amended by 10 FLA 13404,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,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 09 FLA 01030. This Amendment modifies the Statement of Work
in Attachment B-1,of the Original Task Order Contract. The revised Statement of Work is
incorporated by this reference and identified as"Attachment B-1".
Page I of 3 Rev 3/16/2010
dolt-0766/
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 November 1,2010,or upon approval of the State Controller,or an
authorized delegate thereof,whichever is later.
5. Except for the Special Provisions and other terns 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.
Page 2 of 3 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 STATE OF COLORADO
OF WELD COUNTY Bill Ritter,Jr.Governor
(a political subdivision of the state of Colorado)
for the use and benefit of the
Weld County Department of Public Health
and Environment
MA-Cat fil/L
cx, 0O a Bv:
Signature f Authorized Officer For the Executive Director
NOV O 1 2010 DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Douglas Rademacher
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
PROGRAM PROVAL:
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.
ATE CONTROLLER
Da id J. McDermott,CP'
WELD COUNTY DEPARTMENT OF
By: /PU L� IC HEALTH r �,ENVIROP{jt7ENT
Mark E. Wallace, MD, MPH•Director
Date:
Page 3 of 3 Rev 3/16/2010
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
SCOPE OF WORK
Project Period: June 30, 2010 through June 29, 2012.
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 of the National Breast and Cervical Cancer Early
Detection Program (NBCCEDP), which is administered through the Centers for Disease Control
and Prevention (CDC). Services are available across Colorado.
Direct Beneficiaries: Direct beneficiaries are women residing in Colorado who are uninsured,
underinsured, or have a high insurance deductibles; are unable to pay for breast and/or cervical
screening services; 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 those that may have disabilities.
Project Goals:
1. To deliver WWC services within the contractor's existing network of subcontractors.
2. To provide quality services to women receiving WWC provided screenings.
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.
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.
Core Performance Indicators—Measures of clinical quality of care and penetration of
screenings in certain target populations. Indicators are set by the Centers for Disease
Control and Prevention (CDC) and are linked to WWC federal funding received.
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.
eCaST—An electronic database system the WWC Program uses to track women and
Page 1 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
administer payment to contractors for services performed.
Network — Any provider site that works under the contractor name and receives fiscal
and administrative assistance to do business.
Subcontractor — An entity in the community that provides services for the contractor
that the contractor can not perform onsite. Agreements are made between the contractor
and the subcontractor directly; WWC is not involved in these negotiations or agreements.
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 June 29, 2010 in order to start
work under this contract. A sample Agency & Site Contract Form is attached hereto
as Attachment B-1-A. incorporated herein by this reference.
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 June 29, 2010 in order to start
work under this contract. A sample eCaST Renewal Form is attached hereto as
Attachment B-1-B, incorporated herein by this reference.
c. 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 June 29, 2010 in order to start work under this
contract. A sample Subcontractor Form is attached hereto as Attachment B-1-C,
incorporated herein by this reference.
i. All subcontractor changes during the contract year must be reported to the
WWC within fifteen (15) calendar days.
2. Network:
Ensure breast and cervical cancer screening services for WWC eligible women are
performed by the contractor or through a subcontracted network of providers until a
definitive diagnosis has been achieved.
a. Subcontractors:
i 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
Current Procedural Technology (CPT) code list, attached hereto as
Attachment B-1-D, incorporated herein by this reference. This list is
updated annually and will be distributed by the WWC Program. The
Contractor is responsible for communicating rate changes to
Page 2of8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
subcontractors when they occur.
3. Specify that only services on the CPT code list will be performed and
charged to the Contractor.
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.
b. The Contractor must identify and support a WWC Coordinator at each screening
site (Attachment B-1-A).
i The role of the 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 coordinator will promote and distribute the
communication of updates, policy changes, trainings, Core Performance
Indicator reports, etc. throughout the agency and to necessary staff.
iii It is expected that the coordinator will be responsible for clinical quality
performance at the agency level (as demonstrated in the Core Performance
Indicator report) and update eCaST data as needed to keep the agency in
compliance.
c. The contractor must identify and support an eCaST Coordinator (Attachment B-1-
B).
i The role of the data coordinator is to ensure that all information about women
screened under the WWC Program is entered into eCaST.
ii It is expected that the data coordinator will maintain data in eCaST that is up
to date and meets Core Performance Indicators.
iii The WWC Coordinator role and WWC Data Coordinator role may be filled
by the same person agency.
3 Enrollment:
The contractor must ensure that women screened under the WWC program:
a. Meet WWC Program Eligibility Requirements, which are attached hereto as
Attachment B-1-E, and incorporated herein by this reference.
i 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.
ii Provide eligibility screenings and referrals in Spanish or other languages as
requested.
b. Meet Lawful Presence Requirements. This requirement is met for each woman by:
i Annually obtaining a signed lawful presence affidavit, a sample is attached
hereto as Attachment B-1-F, and incorporated herein by this reference and
Page 3 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
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/Satellite/Revenue-Main/XRM/1216289012112.
A copy of the required documentation should be kept in the patient's medical
record and may be requested or audited by WWC at any time.
iii Document verification of lawful presence on the WWC Patient History Form
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 at any point during
which WWC services were provided, the contractor is responsible for
updating such documents.
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.
i Cases out of compliance with any of these requirements may be deemed
ineligible for payment by the WWC Program.
b. Reimbursement will be provided at the end of the case when a definitive diagnosis
has been achieved, and all data has been entered in eCaST.
c. Reimbursement is determined by the outcome of the case. Payment will be
determined based on the highest level of care provided to the woman. The WWC
Level Reimbursement Fee Structure is attached hereto as Attachment B-1-G, and
incorporated herein by this reference.
i Cases that exceed sixty (60) days in screening length and negatively affect the
program's Core Performance Indicators may or may not be reimbursed at the
discretion of the WWC Program.
ii Cases that are closed out in eCaST as "lost to follow-up" or "refused" will be
paid at the highest level achieved.
iii It is expected that if a Contractor starts cancer screening services for a woman,
the same contractor will be responsible for closing the case and reaching the
point of definitive cancer diagnosis. In cases where more than one WWC
contracting agency is involved with the same woman, the contractor who
closes the case will receive all of the WWC funds at the highest level
achieved.
iv Rates for the reimbursement process may be revised or updated during the
period this scope of work is in effect. When changes are adopted for
implementation by WWC, the contractor will be notified at least sixty (60)
days prior.
d. It is expected that reimbursement will cover costs associated with:
Page 4of8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
i Enrollment of women into the WWC Program;
ii Cancer screening services, including Pap test, pelvic exam, clinical breast
exam and mammogram;
iii Case management of abnormal findings;
iv Diagnostic services to the point of a definitive diagnosis, as necessary;
v Entry of all information into eCaST; and
vi Administrative procedures to place women with a positive diagnosis of breast
and/or cervical cancer into the Medicaid Program.
e. Data entered into eCaST is the basis for calculating reimbursement for each woman
screened.
i Data for any WWC procedure must be entered into eCaST within thirty (30)
days of service being performed. Cases entered after this thirty (30) day
period may or may not be paid at the discretion of the WWC.
ii The contractor shall review eCaST reports #17 - Missing Data, #10—
Procedures not Covered, and #22 - Incomplete Cases Not Yet Paid to identify
women who may have missing essential information prior to the fourteenth
(14`h) of each month.
1. It is the responsibility of the Contractor to ensure its network of provider
sites has entered all required data elements prior to the WWC billing
cycle on the fourteenth (14`h) of each month.
2. Essential data elements missing from a woman's electronic record may
make the case ineligible for payment.
f One reimbursement check for all completed screenings that have met data quality
standards and occurred in the prior thirty (30) days will be sent to the Contractor
each month.
i The contractor will deal with WWC Program staff directly on non-payment of
women screened. If WWC staff is unable to rectify reimbursement, the
contractor will work with the WWC fiscal officer to the point of satisfaction
by both parties.
ii As the WWC Program budget allows, Contractors may be limited on the
number of women they can enroll and screen for the program in the fiscal
year.
g. The monetary budget cap for your agency is $35,000, for fiscal year 2010-2011.
Once you have reached this funding cap, the program will not be able to reimburse
for any further expenses.
i The State may increase or decrease funds available under this Contract using a
Grant Funding Letter substantially equivalent to Exhibit E. The Grant Funding
Change Letter is not valid until it has been approved by the State Controller or
designee.
5. Service Delivery:
a. The Contractor shall follow and utilize all policies and guidelines according to the
2010-2011 WWC Provider Toolkit as the standard of care when performing
services related to breast and cervical cancer screening.
Page 5 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
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 by WWC agencies, the Contractor will be notified
and responsible for implementing necessary changes by a date determined by
the WWC.
b. The Contractor may utilize the WWC Nurse Consultant for clinical consultation
services on any client.
6. Performance Standards:
a. The contractor will meet or exceed established WWC Core Performance Indicators
(Attachment B-1-H)
i. Contractors exceeding, meeting or not meeting indicators/reports will be
contacted by the WWC.
1. Contractors not meeting two or more Core Performance Indicators for a
period of six (6) months or more may be placed under a corrective action
plan.
a. This corrective action plan will have expectations set by the WWC
with time frames for completion.
b. Contractors are responsible for developing and implementing a
quality improvement plan to meet expectations.
c. Unmet expectations may result is cancellation or limitation of the
contract.
2. Contractors exceeding indicators will be recognized for good
performance.
a. The WWC reserves the right to perform regularly schedule
performance reviews.
7. Site Visits:
a. The WWC may perform site visits to select 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 Core Performance Indicators;
i. eCaST data reports, specifically Missing Data and Diagnostic Follow up
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 limited to:
i. Completion of the WWC prep tool;
ii. Chart audit;
iii. Review of subcontractor agreement(s);
Page 6 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
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 core 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.
e. Site Visits evaluations may be used as part of, but will not be a substitute for, the
quarterly Contract Management System (CMS) evaluations.
8. eCaST System:
a. WWC will provide training on the data system to the Contractor, its administration
staff, fiscal staff and provider site staff as needed or requested by the Contractor.
i. Any changes to staff that are responsible for data entry of WWC information
must be reported to the Department within fifteen (15) days.
ii. New provider site staff must be trained by WWC on eCaST within thirty (30)
days of hire.
b. Forms used to collect eligibility and enrollment information will be electronically
furnished by WWC.
9. Communication:
a. When corresponding with the WWC, Contractors must use all privacy and security
measures to protect the woman's personal health information.
i. Accepted forms of communication include:
1. WWC identification number used in all email conversations
2. Mail or fax clearly marked "Confidential"
3. HIPAA compliant files transmitted via secure File Transfer Protocol
(FTP) sites.
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 the WWC Program.
b. At least one representative from the Contractor and/or its network provider sites
must attend meetings hosted by WWC staff 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. 75% of WWC quarterly 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.
ii. WWC will include the Contractor in all relevant program communications
that may impact the success of this contract, including:
1. Bimonthly electronic WWC Newsletter;
Page 7of8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
2. eCaST Broadcast messages;
3. Special announcements to WWC providers; and
4. Other communications.
10. Medicaid Treatment for WWC Women Diagnosed with Cancer
a. The contractor will refer women with a positive diagnosis of breast or cervical
cancer to Medicaid.
i. Contractor personnel must follow the STEP Enrollment Process, which is
attached hereto as Attachment B-1-I, and incorporated herein by this
reference.
ii. Contractor will fax initial completed paperwork (WWC Personal History
form, WWC Rules Form, Lawful Presence affidavit and pathology report
confirming the diagnosis) to the WWC within five (5) business days of cancer
diagnosis.
iii. Women referred to Medicaid must be completely entered into eCaST within
twenty-four (24) hours of diagnosis.
iv. Contractor will fax final completed paperwork (Medicaid application
signature page and presumptive eligible form) to WWC within five (5)
business days of receiving approval for presumptive eligibility.
v. Contractors will ensure applications are submitted to local Social Service
agencies within thirty (30) business days after diagnosis.
vi. With the approval of the woman, a patient with a positive diagnosis can be
referred to the WWC Treatment Navigator.
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 arc adopted for implementation by WWC, the Contractor will be
notified and responsible for implementing necessary changes by a date determined
by the WWC.
Page 8of8
EXHIBIT E
GRANT FUNDING CHANGE LETTER
Date: State Fiscal Year: Grant Funding Change Letter# 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
Bill Ritter, Jr. GOVERNOR
Department of Public Health and Environment PROGRAM APPROVAL:
By: Lisa Ellis, Purchasing&Contracts Unit Director By:
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§24-30-202 requires the State Controller to approve all State Grants.This Grant is not valid until signed and dated below by
the State Controller or delegate.Grantee is not authorized to begin performance until such time.If Grantee begins performing prior
thereto,the State of Colorado is not obligated to pay Grantee for such performance or for any goods and/or services provided
hereunder.
STATE CONTROLLER
David J. McDermott, CPA
By:
Donald Rieck
Date:
Page 1 of 1
Effective Date: 1/6/09-Rev 8/25/09
y
Changes made to highlighted
areas after vendor signed.
Vendor notified with executed Attachment B-1
contract. as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
SCOPE OF WORK
Project Period: June 30, 2010 through June 29, 2012.
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 of the National Breast and Cervical Cancer Early
Detection Program (NBCCEDP), which is administered through the Centers for Disease Control
and Prevention (CDC). Services are available across Colorado.
Direct Beneficiaries: Direct beneficiaries are women residing in Colorado who are uninsured,
underinsured, or have a high insurance deductibles; are unable to pay for breast and/or cervical
screening services; 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 those that may have disabilities.
Project Goals:
1 . To deliver WWC services within the contractor's existing network of subcontractors.
2. To provide quality services to women receiving WWC provided screenings.
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.
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.
Core Performance Indicators - Measures of clinical quality of care and penetration of
screenings in certain target populations. Indicators are set by the Centers for Disease
Control and Prevention (CDC) and are linked to WWC federal funding received.
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.
eCaST - An electronic database system the WWC Program uses to track women and
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Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
administer payment to contractors for services performed.
Network - Any provider site that works under the contractor name and receives fiscal
and administrative assistance to do business.
Subcontractor - An entity in the community that provides services for the contractor
that the contractor can not perform onsite. Agreements are made between the contractor
and the subcontractor directly; WWC is not involved in these negotiations or agreements.
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 June 29, 2010 in order to start
work under this contract. A sample Agency & Site Contract Form is attached hereto
as Attachment F-1 , incorporated herein by this reference.
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 June 29, 2010 in order to start
work under this contract. A sample eCaST Renewal Form is attached hereto as
Attachment F-2, incorporated herein by this reference.
c. 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 June 29, 2010 in order to start work under this
contract. A sample Subcontractor Form is attached hereto as Attachment F-3,
incorporated herein by this reference.
i. All subcontractor changes during the contract year must be reported to the
WWC within fifteen ( 15) calendar days.
2. Network:
Ensure breast and cervical cancer screening services for WWC eligible women are
performed by the contractor or through a subcontracted network of providers until a
definitive diagnosis has been achieved.
a. Subcontractors:
i 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
Current Procedural Technology (CPT) code list, attached hereto as
Attachment F-4, incorporated herein by this reference. This list is
updated annually and will be distributed by the WWC Program. The
Contractor is responsible for communicating rate changes to
Page 2 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
subcontractors when they occur.
3. Specify that only services on the CPT code list will be performed and
charged to the Contractor.
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.
b. The Contractor must identify and support a WWC Coordinator at each screening
site (Attachment F-1).
i The role of the 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 coordinator will promote and distribute the
communication of updates, policy changes, trainings, Core Performance
Indicator reports, etc. throughout the agency and to necessary staff.
iii It is expected that the coordinator will be responsible for clinical quality
performance at the agency level (as demonstrated in the Core Performance
Indicator report) and update eCaST data as needed to keep the agency in
compliance.
c. The contractor must identify and support an eCaST Coordinator (Attachment F-2).
i The role of the data coordinator is to ensure that all information about women
screened under the WWC Program is entered into eCaST.
ii It is expected that the data coordinator will maintain data in eCaST that is up
to date and meets Core Performance Indicators.
iii The WWC Coordinator role and WWC Data Coordinator role may be filled
by the same person agency.
3 Enrollment:
The contractor must ensure that women screened under the WWC program:
a. Meet WWC Program Eligibility Requirements, which are attached hereto as
Attachment F-5, and incorporated herein by this reference.
i 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.
ii Provide eligibility screenings and referrals in Spanish or other languages as
requested.
b. Meet Lawful Presence Requirements. This requirement is met for each woman by:
i Annually obtaining a signed lawful presence affidavit, a sample is attached
hereto as Attachment F-6, and incorporated herein by this reference and
keeping a copy in the patient's medical record before services are rendered.
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Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
ii Annually verifying required documentation for proof of lawful presence
according to Department of Revenue guidelines:
http://www.colorado.gov/cs/Satellite/Revenue-Main/XRM/1216289012112.
A copy of the required documentation should be kept in the patient's medical
record and may be requested or audited by WWC at any time.
iii Document verification of lawful presence on the WWC Patient History Form
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 at any point during
which WWC services were provided, the contractor is responsible for
updating such documents.
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.
i Cases out of compliance with any of these requirements may be deemed
ineligible for payment by the WWC Program.
b. Reimbursement will be provided at the end of the case when a definitive diagnosis
has been achieved, and all data has been entered in eCaST.
c. Reimbursement is determined by the outcome of the case. Payment will be
determined based on the highest level of care provided to the woman. The WWC
Level Reimbursement Fee Structure is attached hereto as Attachment F-7, and
incorporated herein by this reference.
i Cases that exceed sixty (60) days in screening length and negatively affect the
program's Core Performance Indicators may or may not be reimbursed at the
discretion of the WWC Program.
ii Cases that are closed out in eCaST as "lost to follow-up" or "refused" will be
paid at the highest level achieved.
iii It is expected that if a Contractor starts cancer screening services for a woman,
the same contractor will be responsible for closing the case and reaching the
point of definitive cancer diagnosis. In cases where more than one WWC
contracting agency is involved with the same woman, the contractor who
closes the case will receive all of the WWC funds at the highest level
achieved.
iv Rates for the reimbursement process may be revised or updated during the
period this scope of work is in effect. When changes are adopted for
implementation by WWC, the contractor will be notified at least sixty (60)
days prior.
d. It is expected that reimbursement will cover costs associated with:
i Enrollment of women into the WWC Program;
Page 4 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
ii Cancer screening services, including Pap test, pelvic exam, clinical breast
exam and mammogram;
iii Case management of abnormal findings;
iv Diagnostic services to the point of a definitive diagnosis, as necessary;
v Entry of all information into eCaST; and
vi Administrative procedures to place women with a positive diagnosis of breast
and/or cervical cancer into the Medicaid Program.
e. Data entered into eCaST is the basis for calculating reimbursement for each woman
screened.
i Data for any WWC procedure must be entered into eCaST within thirty (30)
days of service being performed. Cases entered after this thirty (30) day
period may or may not be paid at the discretion of the WWC.
ii The contractor shall review eCaST reports # 17 - Missing Data, # 10 —
Procedures not Covered, and #22 - Incomplete Cases Not Yet Paid to identify
women who may have missing essential information prior to the fourteenth
( 14th) of each month.
1 . It is the responsibility of the Contractor to ensure its network of provider
sites has entered all required data elements prior to the WWC billing
cycle on the fourteenth ( 14`h) of each month.
2. Essential data elements missing from a woman's electronic record may
make the case ineligible for payment.
f. One reimbursement check for all completed screenings that have met data quality
standards and occurred in the prior thirty (30) days will be sent to the Contractor
each month.
i The contractor will deal with WWC Program staff directly on non-payment of
women screened. If WWC staff is unable to rectify reimbursement, the
contractor will work with the WWC fiscal officer to the point of satisfaction
by both parties.
ii As the WWC Program budget allows, Contractors may be limited on the
number of women they can enroll and screen for the program in the fiscal
year.
g. The monetary budget cap for your agency is $35,000, for fiscal year 2010-2011 .
Once you have reached this funding cap, the program will not be able to reimburse
for any further expenses.
i The State may increase or decrease funds available under this Contract using a
Grant Funding Letter substantially equivalent to Exhibit E. The Grant Funding
Change Letter is not valid until it has been approved by the State Controller or
designee.
5. Service Delivery:
a. The Contractor shall follow and utilize all policies and guidelines according to the
2010-2011 WWC Provider Toolkit as the standard of care when performing
services related to breast and cervical cancer screening.
i The Provider Toolkit may be updated during the period this scope of work is
Page 5 of 8
f
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
in effect. When new documents/policy/guidelines or toolkit directives are
adopted for implementation by WWC agencies, the Contractor will be notified
and responsible for implementing necessary changes by a date determined by
the WWC.
b. The Contractor may utilize the WWC Nurse Consultant for clinical consultation
services on any client.
6. Performance Standards:
a. The contractor will meet or exceed established WWC Core Performance Indicators
(Attachment F-8)
i. Contractors exceeding, meeting or not meeting indicators/reports will be
contacted by the WWC.
1 . Contractors not meeting two or more Core Performance Indicators for a
period of six (6) months or more may be placed under a corrective action
plan.
a. This corrective action plan will have expectations set by the WWC
with time frames for completion.
b. Contractors are responsible for developing and implementing a
quality improvement plan to meet expectations.
c. Unmet expectations may result is cancellation or limitation of the
contract.
2. Contractors exceeding indicators will be recognized for good
performance.
a. The WWC reserves the right to perform regularly schedule
performance reviews.
7. Site Visits:
a. The WWC may perform site visits to select 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 Core Performance Indicators;
ii. eCaST data reports, specifically Missing Data and Diagnostic Follow up
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 limited to:
i. Completion of the WWC prep tool;
ii. Chart audit;
iii. Review of subcontractor agreement(s);
iv. Review of program administration and program management;
Page 6 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
v. Review of clinical services and case management activities; and
vi. Implementation of a corrective action plan for agencies not meeting two or
more core 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.
e. Site Visits evaluations may be used as part of, but will not be a substitute for, the
quarterly Contract Management System (CMS) evaluations.
8. eCaST System:
a. WWC will provide training on the data system to the Contractor, its administration
staff, fiscal staff and provider site staff as needed or requested by the Contractor.
i. Any changes to staff that are responsible for data entry of WWC information
must be reported to the Department within fifteen ( 15) days.
ii. New provider site staff must be trained by WWC on eCaST within thirty (30)
days of hire.
b. Forms used to collect eligibility and enrollment information will be electronically
furnished by WWC.
9. Communication:
a. When corresponding with the WWC, Contractors must use all privacy and security
measures to protect the woman's personal health information.
i. Accepted forms of communication include:
1 . WWC identification number used in all email conversations
2. Mail or fax clearly marked "Confidential"
3 . HIPAA compliant files transmitted via secure File Transfer Protocol
(FTP) sites.
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 the WWC Program.
b. At least one representative from the Contractor and/or its network provider sites
must attend meetings hosted by WWC staff 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. 75% of WWC quarterly 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.
iii. WWC will include the Contractor in all relevant program communications
that may impact the success of this contract, including:
1 . Bimonthly electronic WWC Newsletter;
2. eCaST Broadcast messages;
Page 7 of 8
Attachment B-1
as modified by Task Order Amendment#2,
Task Order routing number 11 FLA 22806
3. Special announcements to WWC providers; and
4. Other communications.
10. Medicaid Treatment for WWC Women Diagnosed with Cancer
a. The contractor will refer women with a positive diagnosis of breast or cervical
cancer to Medicaid.
i. Contractor personnel must follow the STEP Enrollment Process, which is
attached hereto as Attachment F-9, and incorporated herein by this reference.
ii. Contractor will fax initial completed paperwork (WWC Personal History
form, WWC Rules Form, Lawful Presence affidavit and pathology report
confirming the diagnosis) to the WWC within five (5) business days of cancer
diagnosis.
iii. Women referred to Medicaid must be completely entered into eCaST within
twenty-four (24) hours of diagnosis.
iv. Contractor will fax final completed paperwork (Medicaid application
signature page and presumptive eligible form) to WWC within five (5)
business days of receiving approval for presumptive eligibility.
v. Contractors will ensure applications are submitted to local Social Service
agencies within thirty (30) business days after diagnosis.
vi. With the approval of the woman, a patient with a positive diagnosis can be
referred to the WWC Treatment Navigator.
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.
Page 8 of 8
L/71-The, MEMORANDUM
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To: Office of Clerk to the Board of Weld County Commissioners
Date: �--ranvaoii
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COLORADO From: 1bIL-/0L O eAn l 1 S , Health Department
Subject: W orne N' S We I Ine S s r.biet h?o Cr
Attached to this memo is the finalized contract, amendment to a contract, letter of renewal,
change order letter or other document as listed below.
Please sign and date below in the designated areas indicating you have received the finalized
document and return this signed memo to me in the Administration Division of the Health
Department.
Thank you for your assistance with the processing of this document.
Aft. Lla 1
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Document Name: WQme N S Weltne ss COWash Con1R -t
Resolution Number: 0 10 "' 4, 01
Finalized Document Received By: ,(s,t,__.
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Date Received: I - 16 - / /
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