HomeMy WebLinkAbout20091223.tiffRESOLUTION
RE: APPROVE CONTRACT AMENDMENT#1 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 Contract Amendment #1 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, 2009, and ending June 30, 2010, 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 Contract Amendment #1 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 27th day of May, A.D., 2009.
ATTEST:
Weld County Clerk to the
BY
Deputy -rk to the Board
APPROVED AS TO FORM:
4cMou
Date of signature:
6/ Y1/4'7
BOARD OF COUNTY COMMISSIONERS
WE P CQQNTYOLORADO
liam F. Garcia,
air
uglas/Rademach r, Pro-Tem
Sean P. Conway
iilLAA
arbpa Kirkmey
David E. Long
c
2009-1223
HL0036
fa'srm
COLORADO
Memorandum
TO: William F. Garcia, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Director, Department of Public Health
and Environ�
GU,
DATE: May 5, 2009 4x-ee9S
SUBJECT: Contract Amendment #1 for the Nurse
Home Visitor Program
Enclosed for Board review and approval is a contract amendment between the Weld County
Board of Commissioners on behalf of the Department of Public Health and Environment
(WCDPHE) and the State of Colorado through the Colorado Department of Public Health and
Environment for the Nurse Home Visitor Program.
This amendment will provide renewal funding for WCDPHE to provide countywide nurse home
visitor services to low-income, first-time mothers. The funding will be used to support health,
education, and other resources for new young mothers during pregnancy and the first years of
their infants' lives. The amendment also modifies the Statement of Work, Exhibit I by the
addition of items #19 and #20 as stated below:
1119. On or about July 16. 2008. Contractor was notified that the Medicaid reimbursement rates
being billed by Contractor for NHVP Targeted Case Management claims (NHVP Claims) are
suspected to be erroneous. Such rates were established by the Health Care Policy and Financing
(HCPF) of the State of Colorado (HCPF Established Rates). Contractor provided NHVP services
pursuant to the Original Task Order Contract and billed in good faith according to, and in reliance
upon, the accuracy of the HCPF Established Rates. The State, in association with HCPF and the
Center for Medicare and Medicaid Services, will be conducting a study (HCPF/CMS Study) to set
new Medicaid rates for NHVP Claims. Until such time as Contractor is instructed to modify its
billing, it will continue to bill according to the HCPF Established Rates. Should the HCPF/CMS
Study result in new Medicaid reimbursement rates (New Rates) that are less than the IICPF
Established Rates, the State shall: I) notify Contractor immediately of the New Rates and their
effective date, and 2) refrain from recouping the difference between the HCPF Established Rates
and the New Rates for NHVP Claims billed and paid from July 16. 2008, to the effective date of
the New Rates. (The term recouping shall include, but not be limited to, direct demand for
payment or the withholding of any Medicaid reimbursement or other State appropriated hinds due
Contractor.) Contractor shall have the right to consider its responsibilities under this Contract
Amendment ill terminated upon notification of the effective date of the New Rates if Contractor
no longer desires to provide NHVP services for payment of claims under the New Rates.
#20. NHVP providers shall retain the right to contest the application of any potential recoupment
under this agreement to HCPF and/or CMS.
The amendment also contains new provisions concerning the monitoring of vendor performance
on state contracts and inclusion of contract performance information in a statewide contract
management system. For providing the services for the time period of July 1, 2009 through June
30, 2010, the State will pay Weld County an amount not to exceed $545,633 and it is anticipated
Medicaid will pay approximately $170,056.
EXHIBIT
Enclosure
lion -e/142. -SC.
Page 1 of 1
Jennifer VanEgdom
From: Talya DeAngelis
Sent: Tuesday, May 26, 2009 9:16 AM
To: Jennifer VanEgdom
Subject: FW: Nurse Home Visitor Program contract update
From: Mark Wallace
Sent: Tuesday, May 26, 2009 8:39 AM
To: Barbara Kirkmeyer
Cc: Bruce Barker; Talya DeAngelis
Subject: Nurse Home Visitor Program contract update
Barb,
As you know Bruce worked on revised language for paragraph 19 of the scope of work as part of the proposed new NHVP
agreement between WCDPHE and CDPHE for the next state fiscal year. We forwarded that language back to the state and I
had a conversation last Friday around the revised language with the Chief Fiscal Officer for the program inside CDPHE. She
agreed with parts of the new language and suggested some changes to other parts but she first wanted their attorney to
review the language. It is our hope that this review will result in new language coming back to us sometime today.
In hopes that the language would be close to what Bruce has suggested I asked the clerk to the board to place the contract on
the agenda for the board to consider tomorrow. I anticipate that if we can't reconcile language that I will come to the meeting
tomorrow and ask for you all to postpone consideration; however, if we can get back language similar to Bruce's then I'd like
to see us proceed to meet the deadline for returning the agreement to the State. Tomorrow's board meeting is the last time for
us to consider the contract and still meet the State's deadline. I advised CDPHE that we might not be able to meet the State's
deadline if language around paragraph 19 is still in dispute. They understood.
Just an update about where we're at with this large contract.
Mark
5/26/2009
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD - NHVP
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
10-00019
CONTRACT AMENDMENT#1
THIS AMENDMENT, made this 17th day of April, 2009, by and between the State of Colorado for the use and
benefit of 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, Colorado
80631, hereinafter referred to as the "Contractor"
FACTUAL RECITALS
Authority exists in the Law and Funds have been budgeted. appropriated, and otherwise made available and a
sufficient unencumbered balance thereof remains available for payment; and
Required approval, clearance, and coordination has been accomplished from and with all appropriate agencies; and
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
May 25, 2007, with contract encumbrance number PO FLA FHS0800184, and contract routing number 08 FLA
00184 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 purpose for this amendment is described below.
To renew the contract for one year, to modify the Additional Provisions and the Statement of Work
and to incorporate a new provision to the General Provisions of the Task Order Contract,
concerning the monitoring of vendor performance on state contracts and inclusion of contract
performance information in a statewide contract management system.
NOW THEREFORE, it is hereby agreed that
1. Consideration for this amendment to the original task order contract, dated May 25. 2007 with contract
routing number 08 FLA 00184 and contract encumbrance PO FLA F1150800184, consists of the payments
which shall be made pursuant to this amendment and the 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 08 FLA 00184, as amended by Funding Letter # 1, Contract Routing
Number 08 FLA 00741, Limited Amendment #1, Contract Routing Number 09 FLA 00019, and Grant
Funding Change Letter # 2, Contract Routing Number 09 FLA 00951, collectively referred to herein as the
Page 1 of 4 rev 4/3/09
oTh 29 -/ 3
Original Task Order 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 agreed 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 08 FLA 00184. This Amendment is for the renewal term of July 1,
2009, through and including June 30, 2010. Exhibit A, Additional Provisions, of the Original
Task Order Contract is hereby revised for the renewal term and incorporated herein by this
reference and identified as Exhibit H.
B. The maximum amount payable by the State for the work to be performed by the Contractor during
this renewal term is Five Hundred Forty -Five Thousand, Six Hundred Thirty -Three Dollars.
($545,633.00) for an amended total financial obligation of the State of ONE MILLION, FIVE
HUNDRED FORTY THOUSAND, THIRTY-SEVEN DOLLARS, ($1,540,037.00). This is an
increase of Five Hundred Forty -Five Thousand, Six Hundred Thirty -Three Dollars.
($545,633.00) for of the amount payable from the previous term. The revised specification to the
original Statement of Work for this renewal term is incorporated herein by this reference and
identified as Exhibit I. The revised Budget for this renewal term is incorporated herein by this
reference and identified as Attachment I-1. The Original Task Order Contract is modified
accordingly.
C. The General Provisions of the Contract are hereby modified to incorporate the following language:
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102
concerning the monitoring of vendor performance on state contracts and inclusion of contract
performance information in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this
Task Order Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies
and Guidance. Evaluation of Contractor's performance shall be part of the normal contract
administration process and Contractor's performance will be systematically recorded in the
statewide Contract Management System. Areas of review shall include, but shall not be limited to
quality, cost and timeliness. Collection of information relevant to the performance of Contractor's
obligations under this Task Order Contract shall be determined by the specific requirements of
such obligations and shall include factors tailored to match the requirements of the Statement of
Project of this Task Order Contract. Such performance information shall be entered into the
statewide Contract Management System at intervals established in the Statement of Project and a
final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any
identified problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to
meet the performance measures established under the Statement of Project, the Executive Director
of the Colorado Department of Personnel and Administration (Executive Director), upon request
by the Colorado Department of Public Health and Environment, and showing of good cause, may
debar Contractor and prohibit Contractor from bidding on future contracts. Contractor may contest
the final evaluation and result by: (i) filing rebuttal statements, which may result in either removal
or correction of the evaluation (CRS §24-105-102(6)), or (ii) under CRS §24-105-102(6),
exercising the debarment protest and appeal rights provided in CRS §§24-109-106, 107, 201 or
202, which may result in the reversal of the debarment and reinstatement of Contractor. by the
Executive Director, upon showing of good cause.
Page 2 of 4 rev 4/3/09
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 upon approval of the State Controller or July 1, 2009 whichever is
later.
5. Except for the "Special Provisions", in the event of any conflict, inconsistency, variance, or contradiction
between the provisions of this amendment and any of the provisions of the original contract, the provisions
of this amendment shall in all respects supersede, govern, and control. The "Special Provisions" shall
always be controlling over other provisions in the contract or amendments. The representations in the
Special Provisions concerning the absence of bribery or corrupt influences and personal interest of State
employees 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 3 of 4 rev 4/3/09
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:
BOARD OF COUNTY COMISSIONERS OF WELD
COUNTY, for the use and benefit of the WELD
COUNTY DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
(a politicalu rvisio f the state of Colorado)
O.'
ignature of Ahthorized Officer
William F. Garcia
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
MAY 2 7 2009
STATE:
STATE OF COLORADO
Bill Ritter, Jr. Governor
By:
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Signatory avers to the State Controller or
that Contractor has not begun performance or
that a Statutory Violation waiver has been
requested under Fiscal Rules
PROGRAryf•A 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.
TE CONTROLLER
J. McDermo s CP
By:
❑Kevin Edwards ❑Yvonne And
Date:
fRobertJaros A lonald Rieck
WELD COUNTY DEPARTMENT OF
P IC HEALTH Argi ENIVH3ONAE
I
Page 4 of 4 BY:
Mark E. Wallace, MD, MPH -Direct
rev 4/3/09
. CCU_ /&a3
EXHIBIT H
ADDITIONAL PROVISIONS
To Task Order Contract Dated 04/17/09 - Contract Routing Number 10 FLA 00019
These provisions are to be read and interpreted in conjunction with the provisions of the
Task Order Contract specified above.
The revised Additional Provisions is effective July 1, 2009.
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 is attached hereto as Attachment H-1 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 H. 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: 1) 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.
To be attached to CDPHE
Task Order v1.0 (11/05) contract template
Page 1 of 3 Revised: 12/19/06
EXHIBIT H
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.
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 ($1000), 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 NHVP Budget Revision Request Form,
attached hereto as Attachment II -2, before the transfer can be made.
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 be 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, U.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
Task Order v1.0 (11/05) contract template
Page 2 of 3 Revised: 12/19/06
EXHIBIT H
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.
8. 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.
9. 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.
10. 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.
11. 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
Task Order v1.0 (11/05) contract template
Page 3 of 3 Revised: 12/19/06
Attachment H -
NURSE HOME VISITOR PROGRAM CONTRACT REIMBURSEMENT STATEMENT
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Attachment 1-4-2
NHVP BUDGET REVISION REQUEST
APPLICANT: FOR THE PERIOD
PROJECT:
CONTACT: PHONE NUMBER
Annual/Hourly
Salary/Rate
PERSONNEL:
Fringe Benefits: Rate =
2. OPERATING
B of
Months Time
Budget FTE
Original Budget
Revised Request Variance
3. EQUIPMENT
4. TRAVEL (In-state/Out-state)
t . ;Tot111:hievat
5. TRAINING
74w Traim
6 OTHER PROGRAM COSTS
Total Other Costs
Iota Programatic Costs (Personal. Operating, Travel, Training, otherl
7. ADMINISTRAN.TE.COSTS
Cow
$
Signature of Authorized Representative Date
R.. V2412000
BUDGETAPPLFORM XI S
Paget of 1 L L OO. ,m
EXHIBIT I
STATEMENT OF WORK
To Task Order Contract Dated 04/17/09 - Contract Routing Number 10 FLA 00019
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. The
revised Statement of work is effective July 1, 2009.
1. The Contractor shall coordinate its efforts with the state's NHVP Director, Colorado Department of
Health Care Policy and Financing (HCPF), and the University of Colorado at Denver and Health
Sciences Center (UCDHSC), National Center for Children, Families and Communities (National
Center), and/or subcontractors of the National Center including but not limited to the Nurse -Family
Partnership National Service Office (NFPNSO) and Invest in Kids (IIK).
2. 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 Colorado Nurse Home Visitor Program (NHVP). The services provided by the
contractor must be deemed by the state to be acceptable and in good faith. For a service 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/ps/nursehome/index.html
• Colorado Nurse Home Visitor Program Act, as described in § 25-31-101, C.R.S.
• NHVP Grantee Administrative/Fiscal Requirements
• Rules Concerning the Nurse Home Visitor Program
• NHVP Client Eligibility Verification and Documentation Guidance Document
• NHVP Continuation Grant Application (Progress Report)
• NHVP Client Application
• Medicaid Reimbursement Guidelines
• Federal Poverty Guidelines
• NHVP Audit Recommendations (as applicable)
• NHVP Grantee Caseload Guidelines
• Nurse -Family Partnership Implementation Agreement
3. The Contractor shall submit, but not limited to, the following reports, incorporated by reference.
These documents with corresponding due dates are located at:
http :www.cdphc.,tatcco us p 'nurschomc indcx.hunl
• Expenditure Year -to -Date & Mid -Year Budget Projections Report
• Final Expenditure Report
• Annual Progress Report (included in the NHVP Continuation Grant Application)
4. The Contractor shall perform and complete in a satisfactory manner all activities and services stated in
the annual progress report included in the NHVP continuation grant application which is incorporated
and made part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/ps/nursehome/index.html
5. The Contractor shall complete in a satisfactory manner and by the date listed, all activities stated in the
"Areas Requiring Performance Improvement Plan or Funding Conditions" in the NHVP Award
Summary letter which is incorporated and made part hereof by reference. This document is located at:
http://www.cdphe.state.co.us/ps/nursehome/index.html
6. The Contractor shall ensure that program eligibility is based on the client's income and is not restricted
by age or length of gestation and that all program brochures and referral materials are stated as such.
Page 1 of3
EXHIBIT I
7. The Contractor shall utilize a State provided, linguistically appropriate NHVP Client Application in
which clients document their income or attest that they receive no income as a means of verifying
program eligibility. Client income verification and documentation must be collected and maintained in
accordance with the NHVP Client Eligibility Verification and Documentation Guidance Document.
These documents are incorporated and made part hereof by reference and are located at :
http://www.cdphe.state.co.us/Ds/nursehome/index.html
8. The Contractor shall ensure that clients enrolled in Medicaid and the NHVP are not participating in the
Prenatal Plus Program (PNP) or any other Medicaid prenatal program.
9. The Contractor shall ensure that all nurse home visitors, supervisors and data entry staff complete all
required NFPNSO prerequisites and trainings within the required time frame. The contractor must
ensure that the supervisor and nurse home visitors receive the Nursing Child Assessment Satellite
Training (NCAST). The Contractor is responsible for scheduling and payment of these trainings.
10. The Contractor shall collect data for evaluation purposes, using forms developed by the National
Center and/or its subcontractors. Enter the data collected into the Clinical Information System (CIS)
program, on a monthly basis; taking all appropriate steps to maintain client confidentiality and obtain
any necessary written permissions or agreements for data analysis or disclosure of protected health
information, in accordance with the Health Insurance Portability and Accountability Act of 1996
(HIPAA) regulations, including, but not limited to, authorizations, data use agreements, business
associate agreements, as necessary. The Contractor's failure to comply with any applicable provision
of HIPAA will constitute a breach of this agreement.
11. The Contractor shall participate in meetings or trainings as requested by the State and the UCDHSC.
The Contractor must cover all training costs as applicable.
12. The Contractor shall provide the equipment and supplies needed for program implementation.
13. The Contractor shall provide the nurse home visitor services in accordance with the FY0910 Final
Approved Budget, attached as Attachment I-1.
14. 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 Project Cost Request from the State as provided in the FY0910
Final Approved Budget, attached as Attachment 1-1. If the contractor draws more Medicaid funding,
the state will 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 will increase the NHVP funding, if funding is available, during the Mid -Year Budget
Projections process.
15. The State may increase of decrease funds available under this Contract using a Grant Funding Letter
substantially equivalent to Exhibit E. The Grant Funding Letter is not valid until it has been approved
by the State Controller or designee.
16. The Contractor shall submit Medicaid reimbursement requests for all eligible clients in accordance
with HCPF procedures and the Medicaid Reimbursement Guidelines, which is incorporated and made
part hereof by reference. This document is located at:
htto://www.cdphe.state.co.us/ps/nursehome/index.html
17. The Contractor shall provide the state's NHVP administrators and program consultants with reasonable
access to its operations to perform: periodic site reviews, data reviews, fiscal reviews or other
evaluations of the contractor's NHVP program. The contractor shall cooperate during all periodic site
visits, data reviews, fiscal reviews and other evaluations or audits conducted by the State.
Page 2 of 3
EXHIBIT I
18. If the State believes in good faith that an 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. If the failure or deficiency is programmatic in nature, corrective action shall be
addressed through a Performance Improvement Plan (PIP) or some other method defined by the State.
If the failure is administrative or fiscal in nature, corrective action shall be addressed through an
Action Plan or some other method defined by the State. Due dates for completion of activities listed in
a PIP or Action Plan will be negotiated on a case by case basis.
19. On or about July 16, 2008, Contractor was notified that the Medicaid reimbursement rates being billed
by Contractor for NHVP Targeted Case Management claims (NHVP Claims) are not acceptable to the
Centers for Medicare and Medicaid Services (CSM). Such rates were established by the Department
of Health Care Policy and Financing (HCPF) of the State of Colorado (HCPF Established Rates).
Contractor provided NHVP services pursuant to the Original Task Order Contract and billed in good
faith according to, and in reliance upon, the accuracy of the HCPF Established Rates.
HCPF has conducted a rate study (HCPF/CMS Study) to set new Medicaid rates for NHVP
Claims. Said rate study has been included in a new State Plan Amendment (SPA) and forwarded to
CMS for their comments and approval, which is expected before June 30, 2009. The rates presented to
CMS by HCPF are considerably less than the current HCPF Established Rates, and therefore, the
Contractor is currently receiving claims payments in excess of what is expected to be the new HCPF
Established Rates. Once the new rates are approved in the SPA, HCPF will initiate a recoupment of
overpayment of funds. Such recoupment will be designed to repay CMS for the overpayment of claims
from July 16, 2008 through the approval of the new rates in the SPA.
It is the State's intent to mitigate the financial impact to the Contractor caused by this change to a
lower rate. Upon approval of the SPA, the State shall receive notice from HCPF of the amount due
from Contractor for the recoupment. The State is working with HCPF to design a process whereby, to
the extent such funds are available within the NHVP budget, the State will be able to transfer funds
directly to HCPF that will reimburse HCPF for the amount owed for recoupment by the Contractor,
making recoupment directly from the Contractor unnecessary.
Should such process not be approved, then HCPF will recoup the overpayment of claims directly from
the Contractor. In this instance, if funds are available within the NHVP budget, the parties will amend
this contract and increase the amount payable to the Contractor by the amount due to HCPF from the
Contractor.
Funds have been put aside for this purpose in the NHVP budget, and are currently deemed to be
available, based on current estimates of the new rates proposed to CMS in the SPA and number of
claims for the period of July 16, 2008 through June 30, 2009.
20. NHVP providers shall retain the right to contest the application of any potential recoupment under this
agreement to HCPF and/or CMS.
Page 3 of 3
Attachment I-1
FV2009-10 Proposed BudOat. July 1, 2609 - Jun* 30. 2010
Agency Weld County Health
Propct Herne Nurse Home Visitation
_
Annual
Salary
Rate
No. el
month.
Budget
FIE
TOTM.
AMOUNT
• REQilli O H ..
SOURCE OP FLINGS
A. Other
Sources
or Funding •2
I
I r } i
C. 864 JESTED
From
=PRE )IHVP)'t s2
PERSONAL SERVICES (Detail Expenses)
Personal Services (Title and Nance)
New. RN, BSN - PHN II
Nero Rowe -Denning. RA BSN - PHN u
Vesta Unruh. RN. BSN - PHN II
Kathy Hagihara RN. BSN -PHNII
S 50268
$ 57.626
$ 54.746
S 529B0
12.00
12.00
12.00
1200
1.00
1.00
1.00
1.00
I.
$ 11 9.8
$ 13.710
S 12,080
S 12.560
$ 38.342
$ 44.116
5 41,766
S 40,420
S 50,258
$ 57,826
5 54748
$ 52980
- _
$ 13710
S 44.116
- — i.
$ 67,626
_
Gera Holton RN. BSN - PHN II
S 57.026
/200
1.00
$ 38.733
$ _. _. 28,271
s 12.348_
$ 7.852
S 52.081
$ 33123
Berbera Sivermen, RN. BSN • PHN II _-_
Lonna Pashas. Data Entry Support - OT ill
5 52.081
S 33,123
1200
12.00
1.00
1 DO
Contractuel/Fee for Service
$ 32.589
$ 10.128
$ 42.717
.
Supervising Personnel
Barbera Francisco. RN. BSN: Superstars • PHN III
$ 42.717
12.00
075
_ _
_-
-
$ 33.836
$ 108,877
Fringe Benefits Rate • 35 54%
$ -__ 142.713
-•
S 142.713
5 - 415230:
Y: TOTAL PER9GNALSESSIOC6(Fc..:
$ 643,737t-
a -.
S' 925,046.
OPERATING (Detail Expanses)
'
Otnce Expertaes (rent. meta. & utilities)
-
$ 2.289
- _
$ 711
Office Operating Expenses 9 e. suppdas. pens. etc)
5 3.000
_..
S 358
S 296
S 525
$ __. .__._996
$ _ , 1.144
5 954
S 2975
0 3204
1.500
5 . 1.250
$ 3.900
s 4200
Medical 0 Program Supplies$
Postal 8 Shipping Services
Printing d Pudiceta0s- copes or larra/laciaatOrs
Telephone Services gong distance end cellular service)
3 _. .- 763
$ 1908
5 5.340
0 1 S26
5 1.000
,
s 237
Advisory Board Meetings
- _ ..
$ 592
5 1660
S -74
$ 2500
0 7,000
$ 2,000
Program Expenaeees meant materials not pin0rg)
Cent Support Material
Computer Network Fees
$ 20.103^
t, -TD$ 2.43PERATIN6."'""- -. ._ :-: " .:
..
i 6,247
EQUIPMENT (Detail Expenses) $- .. :,.'" •- .:.'t ,." :; .:.. •- ......t...�
..:.
Computersw•: Software
5 P 5 57
c t 5 344
Cellular Phone.
Blood pressure m0nibrs
S 76
S 450
V#OTALE4I RNT:,,,' :. J; .4r .:.::: ..::,.:t=t: ..:: ; .. .:''VS.'.,..
f 124 $ . !<' $)
TRAVEL (Detail Expanses)
Vis.tOutrmch Miba5e
S 33,000
S 38
$ 247
5
6 1.800
s
5 7.824
$ 9
$ 58
$ 427
S 25.178
$ 29
S 189
$ 1.373
NCCFC ICHSC Training Travel
NCAST Travel
PIPE Travel
Program Meetings (nurses. supervtsa. 0ti14r)
olne..ray.
...... .... ..... ...._. O.il!.'::C:.ts,
4l TOTAL 788087: ...:-;:':•::..". ...... :7:..:..::.•.a t.n•s=::::..:. °_.. ...
••::iSi�ii.
'
et1:::•
s 8,315
$ lik
NFP TRAINING 6 TECH ASSISTANCE (Debi) Expenses) [;•').:=="--:: !I:,i••• :
�:• . _
......"..;:.
.: .....
TecMrca A550ttrue
00-00 rg Nurse Education
little' Nurse Education
5 8310
$
$ 3.723
$ 1.970
S 863
S 6.340
$ 2840
-
—
--__
Initial Supervisor Education
f
$ Box _ r 612
tC `[ iEvi rC
r=,~ r i '•'•'
361
Education 'Notaries
Professional Development
S _ 473
� r. E
•,•_,_�.
`£ewu f-. - •
•• "
.. ..
f;1'OTAL TRAINING'S TECH ASSISTANCE .... .... .... "I ..
••.
NCAST COSTS (Debi) NCAST Training 6 Meterbls) � • •••.•,•
••• •••••,..•,,• ,,•
NCAST Reosoxt.on
, 790
5 138
$
$ 167
$ 603
S 105
$ 33
---_.
NCAST Materials
'�
PIPE.Training Trein5 Materals
..... - - ........... ..........
is>kR�Il�11CAf.T.G06's'e:i":: •.:: t;':.: :.. is:::••.r:•--iix�._............. .r ...;
� .....; .:�
...,,,
.•�
n
OTHER COSTS (Detail Oiler Program Costa 1.-. = .,..'';: � '. ••:........ .:• •:..r
, ...
..-
�:'�. -• • • "-
•, ...
`
S
5
4'f?:'q;::.�5i••`.',.`t0:,.);;' •• .......
TOTAL OTHER 6.G�i�:..:::::��::�=i�.�: .::::..: .:::: •.:S:,vt i?; i .1,:,•
:::..:,...:.._.:.mot
�<.._.'..?11:.,:.:.r...2".::.
:', •, -7:.,
f.:.
TOTAL DIRECT PROGRAM COSTS (Add budget 0 teQ0r15. 1.7)
S 623,184
$ -
E 148.118
$ 475.046
COSTS Attm9eMeBo. Coats)
An MINSTRATIVE (Detail
AdnwniS90tive Services (I 6 accong. edmin)
neeatree Suppre(riot pr0gramsuPpe j.--
5 92526
S -
3 21.838
$ 70,587
--- "—
-
.- -.. _
Accoumirg bank expenses)
$
(audit. .
Other Administrative Costs
$
TOTAL ADMINISTRATIVE COSTS S 92.525
$ -
S 21,938
S 70.587
TOTAL PROJECT COSTS ,11:0.1,-t•.j*,' _ uu50:r•70a17S 1 3nI>l
s 715.689
5
5 170.056
$ 845,633
STATE OF COLORADO
Bill Ritter, Jr., Governor
James B. Martin, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S.
Denver, Colorado 80246-1530
Phone (303) 692-2000
TDD Line (303) 691-7700
Located in Glendale, Colorado
http://www.cdphe.state.co.us
Prevention Services Division
Center for Healthy Families and Communities
Telephone: (303) 692-2370; FAX: (303) 782-5576
July 10, 2009
Laboratory Services Division
8100 Lowry Blvd.
Denver, Colorado 80230-6928
(303) 692-3090
Ms. Judy Nero
Weld County Department of Public Health
And Environment
1555 N. 17ih Avenue
Greeley, CO 80631
Re: NHVP Contract Amendment #1
Contract Routing Number 10 FLA 00019
Dear Ms. Nero:
Colorado Department
of Public Health
and Environment
Enclosed please find a fully executed copy of the above referenced Contract Amendment #1 for your files.
The additional funding awarded through this contract should be spent between the dates of July 8, 2009 and
June 30, 2010.
Please review your contract carefully, as non -substantive changes may have been made. This may include
minor edits in page numbers, document labels, or formatting. In the event larger revisions were required,
your organization would be notified in detail of these changes.
If there are any questions regarding this Contract Amendment, please contact Esperanza Ybarra, NHVP
Director at esperanza.ybarra0),,state.co.us or 303-692-2943 or Laura Lippman, Fiscal Officer at 303-692-2357
or laura.lippman(a,state.co.us.
Natalie Or.o -z-Campbell
Contracts Ma ager
Center for Health Families & Communities
Enclosure (1)
,, Apoei - / 223
Hello