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Home My WebLink About20071696.tiff RESOLUTION RE: APPROVE TASK ORDER CONTRACT FOR NURSE HOME VISITOR PROGRAM AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS,the Board has been presented with a Task Order Contract for the Nurse Home Visitor Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County,on behalf of the Weld County Department of Public Health and Environment, and the Colorado Department of Public Health and Environment, commencing July 1, 2007, and ending June 30, 2008, with further terms and conditions being as stated in said task order contract, and WHEREAS,after review,the Board deems it advisable to approve said task order contract, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Task Order Contract for the 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 task order contract. The above and foregoing Resolution was,on motion duly made and seconded, adopted by the following vote on the 18th day of June, A.D., 2007. BOARD OF COUNTY COMMISSIONERS t - n UNTY, COLD DO ATTEST: E:'Long, Chair Weld County Clerk to the Boa 1161 GLA- �, m Jerks; ro-Tem BY: Deputy CI 4 k to the Board Willia . Garcia APP A 1 'kk Robert D. Mas en ty Attorney c Dougla Rademach r k Date of signature: 7 927 2007-1696 HL0034 Memorandum TO: David E. Long, Chair Board of County Commissioners IFROM: Mark E. Wallace, MD, MPH C Director, Department of Public Health and Environment COLORADO• DATE: June 8, 2007 Y"s 5 /ASA,,S SUBJECT: Task Order Contract for the Nurse Home Visitor Program Enclosed for Board review and approval is a task order contract 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. Under the provisions of this contract, WCDPHE will provide countywide nurse home visitor services to low-income, first-time mothers. The funding from this task order will be used to support health, education, and other resources for new young mothers during pregnancy and the first years of their infants' lives. For providing the services described above during the time period of Julyl, 2007 through June 30, 2008, the State will pay Weld County an amount not to exceed $500,105, and it is anticipated Medicaid will pay approximately $166,547. I recommend your approval of this task order. Enclosure N yy O /4� O � m c— -_arm f1' nO n --- pc f7 cn N 2007-1696 • DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT ROUTING NO.08 FLA 00184 APPROVED TASK ORDER CONTRACT-WAIVER#154 This Task Order Contract is issued pursuant to Master Contract made on 01/23/2007,with routing number 08 FAA 00052 STATE: CONTRACTOR State of Colorado for the use&benefit of the Board of County Commissioners Department of Public Health and of Weld County Environment 915 10th Street Prevention Services Division Greeley, Colorado 80632-0758 Nurse Home Visitor Program for the use and benefit of the 4300 Cherry Creek Drive South Weld County Department of Public Denver,Colorado 80127 Health and Environment 1555 North 17th Avenue Greeley,Colorado 80631 TASK ORDER MADE DATE: CONTRACTOR ENTITY TYPE 05/25/2007 Colorado Political Subdivision PO/SC ENCUMBRANCE NUMBER: CONTRACTOR FEIN OR SOCIAL SECURITY NUMBER: PO FLA FHS0800184 846000813 • TERM: BILLING STATEMENTS RECEIVED: This Task Order shall be effective upon Monthly approval by the State Controller,or designee, or on 07/01/2007,whichever is later. The STATUTORY AUTHORITY: Task Order shall end on 06/30/2008. Section 25-31-101,et seg.,C.R.S.,as amended PRICE STRUCTURE: CONTRACT PRICE NOT TO EXCEED: Cost Reimbursement $500,105.00 PROCUREMENT METHOD: FEDERAL FUNDING DOLLARS: $ Exempt STATE FUNDING DOLLARS: $500,105.00 BID/RFP/LIST PRICE AGREEMENT NUMBER MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR: Not Applicable FY 08: $500,105.00 • LAW SPECIFIED VENDOR STATUTE: Not Applicable STATE REPRESENTATIVE: CONTRACTOR REPRESENTATIVE: Esperanza Ybarra Ms.Judy Nero Department of Public Health and Environment Business Manager (Prevention Services Division Weld County Health Department Nurse Home Visitor Program 1555 North 17th Avenue 4300 Cherry Creek Drive South Greeley,Colorado 80631 Denver,CO 80127 SCOPE OF WORK: Contractor is to provide nurse home visitor services to low-income, first-time mothers in the state of Colorado. Page 1 of 4 0706 7—/676 EXHIBITS: The following exhibits are hereby incorporated: Exhibit A- Additional Provisions (and its attachments if any—e.g.,A-1,A-2,etc.) Exhibit B- Statement of Work and Budget(and its attachments if any—e.g.,B-1,B-2,etc.) Exhibit C- Limited Amendment Template for Task Orders Exhibit D - Medicaid Reimbursement Guidelines Exhibit E- Funding Letter GENERAL PROVISIONS The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task Order Contract provide more specificity than these general clauses,the more specific provision shall control. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract including,but not limited to,Exhibit One thereto. The total term of this Task Order Contract,including any renewals or extensions,may not exceed five(5)years.The parties intend and agree that all work shall be performed according to the standards,terms and conditions set forth in the Master Contract. 2. In accordance with section 24-30-202(1),C.R.S.,as amended,this Task Order Contract is not valid until it has been approved by the State Controller,or an authorized delegee thereof. The Contractor is not authorized to,and shall not;commence performance under this Task Order Contract until this Task Order Contract has been approved by the State Controller or delegee. The State shall have no financial obligation to the Contractor whatsoever for any work or services or,any costs or expenses,incurred by the Contractor prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order Contract on or before its proposed effective date,then the Contractor shall commence performance under this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order Contract after its proposed effective date,then the Contractor shall only commence performance under this Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through and including the date specified on page one of this Task Order Contract,unless sooner terminated by the parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract. Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of the terms and conditions of this Task Order Contract. 3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made a part hereof as if fully set forth herein. Unless otherwise stated,all exhibits and/or attachments to this Task Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated, the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event of conflicts or inconsistencies between the Master Contract and this Task Order Contract(including its exhibits and/or attachments),or between this Task Order Contract and its exhibits and/or attachments,such conflicts or inconsistencies shall be resolved by reference to the documents in the following order of priority: I)the Special Provisions of the Master Contract;2)the Master Contract(other than the Special Provisions)and its exhibits and attachments in the order specified in the Master Contract;3)this Task Order Contract;5)the Page 2 of 4 Additional Provisions-_Exhibit A,and its attachments if included,to this Task Order Contract;4) the Scope/Statement of Work-Exhibit B,and its attachments if included,to this Task Order Contract;6)other exhibits/attachments to this Task Order Contract in their order of appearance. 4. The Contractor,in accordance with the terms and conditions of the Master Contract and this Task Order Contract,shall perform and complete,in a timely and satisfactory manner,all work items described in the Statement of Work and Budget,which are incorporated herein by this reference,made a part hereof and attached hereto as"Exhibit B". 5. The State,with the concurrence of the Contractor,may, among other things,prospectively renew or extend the term of this Task Order Contract, subject to the limitations set forth in the Master Contract,increase or decrease the amount payable under this Task Order Contract,or add to,delete from,and/or modify this Task Order Contract's Statement of Work through a"Limited Amendment for Task Orders"that is substantially similar to the sample form Limited Amendment that is incorporated herein by this reference and identified as Exhibit C. To be effective,this Limited Amendment must be signed by the State and the Contractor,and be approved by the State Controller or an authorized delegate thereof. Upon proper execution and approval,this Limited Amendment shall become a formal amendment to this Task Order Contract. This contract is subject to such modifications as may be required by changes in Federal or State law,or their implementing regulations. Any such required modification shall automatically be incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set forth herein. 6. The conditions,provisions,and terms of any RFP attached hereto,if applicable,establish the minimum standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's Proposal,if attached hereto,or any attachments or exhibits thereto,or the Scope/Statement of Work- Exhibit B,establishes or creates standards of performance greater than those set forth in the RFP,then the Contractor shall also meet those standards of performance under this Task Order Contract. Page 3 of 4 IN WITNESS WHEREOF,the State has executed this Task Order Contract as of the day first above written. CONTRACTOR: STATE OF COLORADO: Board of County Commissioners BILL RITTER,JR. GOVERNOR of Weld County for the use and benefit of the Weld County Department of Public Health and Environment Legal Name of Contracting Entity By /lsz4&, For Executive Director 846000813 Department of Public Health and Environment Socia ecurity Number or FEIN///') 1 \V'.. _ Department Program Approval: Signature of Authorized Officer 8 2007 'JUN / /�/� O� . �� y/ David E. Long, Chairman By1 �` i-Cc-�I i-i �j/ Print Name&Title of Authorized Officer / GOVERN NTAL N TIES: Ee° ll A (An attes I a ;a r r IL i�r"�y tlaa ATTEST: ° G ac Y/S Weld Cou C Clerk t q Boa h IR61 'Q Attest(Seal)B / Olt s'rt al e) De ty C erk to the oard ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller,or such assistant as he may delegate,has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below,the State of Colorado may not be obligated to pay for the goods and/or services provided. STATE CONTROLLER: Leslie M.Shenefelt By Date WELD COUNTY DEPARTMENT OF PUBLIC4W,AALATH AND ENV�ROONMEE,N,T Page 4 of 4 BYa_ V v l 1 /�i�-�X0.L •\ Mark E. Wallace, MD, MPH-Director EXHIBIT A ADDITIONAL PROVISIONS To Task Order Contract Dated 05/25/2007- Contract Routing Number 08 FLA 00184 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 1. Health Insurance Portability and Accountability Act(HIPAA)Business Associate Determination. The State has determined that this Task Order Contract does not constitute a Business Associate relationship under HIPAA. 2. This Task Order Contract is governed by those rules that were adopted by the state of Colorado's Board of Health pursuant to section 25-31-104,C.R.S.,as amended,incorporated herein by reference. 3. To receive compensation under this Task Order Contract,the Contractor shall submit a signed Monthly Cost Reimbursement Statement in a format acceptable to the State. A sample Cost Reimbursement Statement is attached hereto as Attachment A-1 and incorporated herein by this reference. A Cost Reimbursement Statement must be submitted within sixty(60)calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit B. 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. Cost 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;5)describe the incurred expenditures if reimbursement is allowed and requested;and,6) 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. Cost Reimbursement Statements shall be sent to: Esperanza Ybarra Prevention Services Division Nurse Home Visiting Program Colorado Department of Public Health and Environment PSD-WH-A4 4300 Cherry Creek Drive South Denver,CO 80246 To be considered for payment,billings for payments pursuant to this Task Order Contract must be received within a reasonable time after the period for which payment is requested,but in no event no later than sixty (60)calendar days after the relevant performance period has passed. Final billings under this Task Order Contract must be received by the State within a reasonable time after the expiration or termination of this Task Order Contract;but in no event no later than sixty(60)calendar days from the effective expiration or termination date of this Task Order Contract. Unless otherwise provided for in this Task Order Contract,"Local Match", 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. To be attached to CDPHE Page I of 3 Revised: 12/19/06 Task Order v1.0(11/05)contract template • EXHIBIT A 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 without the prior,expressed,written consent of the State. A transfer from one line item to another line item may not exceed ten percent(10%)of the total amount of the line item from which the transfer is made. 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 prior to the transfer,enter into an amendment to the Original Task Order Contract with the State,which requires State Controller or delegate approval,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 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 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. To be attached to CDPHE Page 2 of 3 Revised: 12/19/06 Task Order v1.0(11/05)contract template EXHIBIT A 9. The Contractor shall protect the confidentiality of all applicant or recipient records and other materials that are maintained in accordance with this Task Order Contract. Except for purposes directly connected with the administration of this Task Order Contract,no information about or obtained from,any applicant or recipient shall be disclosed in a form identifiable with the applicant or recipient without the prior written consent of the applicant or recipient,or the parent or legal guardian of a minor applicant or recipient with the exception of information protected by Colorado statute as it applies to confidentiality for adolescent services in which case the adolescent minor and not the parent or legal guardian must provide consent or,as otherwise properly ordered by a court of competent jurisdiction. The Contractor shall have written policies governing the access to,and duplication and dissemination of,all such information. The Contractor shall advise its employees,agents,servants,and subcontractors,if any,that they are subject to these confidentiality requirements. 10. Under this Task Order Contract,the Contractor may refer families participating in any and all programs in its agency such as WIC,EPSDT, Immunization Clinics,Family Planning,HCP,etc.to appropriate enabling and direct care service programs in the community. All pregnant women in need of resources for prenatal medical care may be provided with information about programs such as Prenatal Plus,WIC,etc.,as needed. The Contractor may provide all individuals seeking reproductive health services:with information about pregnancy planning,the consequences of unintended pregnancies,and,referrals to comprehensive family planning services. 11. Contractor shall ensure that the provisions of Section 601 of Title VI of the Civil Rights Act of 1964 are carried out. That Act states that"no person in the United States shall on the ground of race,color,or national origin,be excluded from participation in,be denied the benefits of,or be subjected to discrimination under any program or actively receiving Federal financial assistance." The Office of Civil Rights has concluded that it is the responsibility of any program which is a recipient of funds from the Department of Health and Human Services to ensure that clients who do not speak or understand English well,be provided interpretation services to ensure that the service provider and the client can communicate effectively. The Contractor shall have policies and procedures to ensure that interpretation services are available for clients with Limited English Proficiency and shall advise such clients that an interpreter shall be provided for them. If a client has their own interpreter,they shall be advised that the Contractor shall provide an interpreter if the client so chooses. To be attached to CDPHE Page 3 of 3 Revised: 12/19/06 Task Order v1.0(11/05)contract template / Fl \ eti L.. DD 3 § \ � _ H ) / ( F. \ Q z O \ X ) ) \ - ; _ / § k \ tic & z = - 0 ) 7 ° H H § A4C F tt co / k k ] - 2 2 « § / 0 k .2ti te § } O 0 } O. ;o _ \ k - w i ° \ .cn CAC \ \ .. / \ ( \ / - o ' ' H \ § / 7 k a _ ° e — \� ) \ � ' \ } L. Gil a LIJ ; ! « ! t © = e ; — ` _ ! ` 6 vi e \ \ / ct ) ! ] ( \ § / Q \ ) / ! ! @ § ) § » C ® d ( ) / \ ) \ � ( \ ( a2 _ < EXHIBIT B STATEMENT OF WORK To Task Order Contract Dated 05/25/2007- Contract Routing Number 08 FLA 00184 These provisions arc to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. 1. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order Contract,shall perform and complete, in a timely and satisfactory manner, all activities and services related to the Colorado Nurse Home Visitor Program(NHVP). 2. The Contractor shall coordinate its efforts with the state's NHVP Director,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). 3. The Contractor shall perform and complete all activities related to the NI-IVP.The services provided by the contractor must be deemed acceptable, in good faith, by the state. 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: • Colorado Nurse Home Visitor Program Act,as described in §25-31-101,C.R.S. • Rules Concerning the Nurse Home Visitor Program: http://www.cdphe.state.co.us/Ds/nursehome/index.html • NHVP Fiscal and Programmatic Processes and Procedures: http://www.cdphe.state.co.us/ps/nursehome/index.html • NHVP Audit Recommendations,as applicable: httu://www.cdphe.state.co.us/ps/nursehome/index.html • NHVP Grantee Caseload Guidelines: http://www.cdphe.state.co.us/ns/nursehome/index.html • Nurse-Family Partnership Implementation Agreement: http://www.cdphe.state.co.us/ns/nursehome/index.html 4. The Contractor shall provide the nurse home visitor services in accordance with the FY2007-08 Final Approved Budget,attached as Attachment B-1. 5. The Contractor shall complete the NFPNSO training in the following sequence: (I)Training I ("Pregnancy"),(2)Training II("Infancy", and(3)Training III("Toddler'). The contractor must also attend all nurse supervisor training as required. The contractor must ensure that at least one staff member receives the Nursing Child Assessment Satellite Training(NCAST). The contractor is responsible for scheduling and payment of the training. 6. The Contractor will be required to participate in meetings or trainings as requested by the CDPHE and NFPNSO. The contractor, as applicable, must cover all trainings costs. 7. The Contractor shall submit, but not limited to,the following reports, incorporated by reference. These documents are located at htto://www.cdohe.state.co.us/os/nursehome/index.html: • Expenditure to Date Report, due no later than January 31,2008 • Mid-Year Budget Projections Report, due no later than February 28,2008 • Final Expenditure Report due September 30,2008 • Annual Progress Report due no later than March 31, 2008 8. 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 To be attached to CDPHE Page I of 2 Revised: 12/19/06 Task Order v1.0(11/05)contract template EXHIBIT B (HIPAA)regulations, including, but not limited to, authorizations, data use agreements,business associate agreements,as necessary. Contractor's failure to comply with any applicable provision of HIPAA will constitute a breach of this agreement. 9. The Contractor shall provide the equipment and supplies needed for Program implementation. 10. The Contractor shall ensure that program eligibility is based on the client's income and should not be restricted by age or length of gestation and that all program brochures and referral materials are stated as such. 11. The Contractor shall utilize a standard, linguistically appropriate program application in which clients document their income or attest that they receive no income as a means of verifying program eligibility. Client income documentation must be collected and maintained. 12. The Contractor shall submit Medicaid reimbursement requests for all eligible clients in accordance with the Colorado Department of Health Care Policy and Financing procedures and the Medicaid Reimbursement Guidelines,which is incorporated herein by this reference, made a part hereof,and attached hereto as Exhibit D. 13. 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 CDPHE as stated in the FY2007-08 Final Approved Budget,attached as Attachment B-I. 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. The state makes funding adjustments on this contract using a Funding Letter substantially equivalent to Exhibit E and bearing the approval of the State Controller or his designee. The funding letter shall not be deemed valid until it shall have been approved by the State Controller or his designee. 14. 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. 15. Notwithstanding anything in this contract to the contrary,the parties understand and agree that all terms and conditions of this contract which may require continued performance,compliance, or effect beyond the termination date of the contract and shall survive such termination date and shall be enforceable by the State as provided herein in the event of failure to perform or comply by the Contractor. To be attached to CDPHE Page 2 of 2 Revised: 12/19/06 Task Order v1.0(11/05)contract template . COLORADO NURSE HOME VISITOR PROGRAM ArrAcum6NT as 2007.08 Budget GRANTEE:WELD COUNTY Dept of Public Health&Environment-150 families I FOR THE PERIOD: July 1,2007-June 30.2011/ PROJECT: Nurse Home Vistor-continuation ; Annual No.of SOURCE OF FUNDS TOTAL - _ T y.`p IS'r-t Salary months AMOUNT Other Sources ' Rate Budget FTE REQUIRED i6dpL I1 HB PERSONAL SERVICES 1 ma Arianne Rowe-Denning RN BSN NHV PHN II 54,020 12 1 54,020 13998 40.524 __--- __._ _... Eva Rodriguez RN BSN NHV PHN II 54,020 12 1 _ 54,020 13498 40 524 Gem Holton RN ESN NHV PHN II 53414 12 1 53,4__14 _ _ 13&44 90,070 Vesta Unruh,RN BSN NHV PHN II 50,579 12 1 50,579 12636 37,943 Kathy Hag_nara,RN BSN NHV PHN II 48937 12 1 48,93] 12226 36,711 NHV 4r6 PHN II 47,818 12 1 47,818 11,946 35872 Lorena Pasillas,Data Enty Support OTIII 30576 12 1 30,576 7639 22,937 Debbie Brehauer.RN BEN Supervisor _ 40298 12 075 40,298 10067 30,231 Fnnge Benefits: Rate=33.32% 126 503 31,604 94,899 1.TOTAL PERSONAL SERVICES 508,165 126,454 379,711 OPERATING(Detail Expenses) Office Supplies($360Inurs�ear)__ ( _ ____j_ 2,520 _ 830 _. 1890 Client Support M t als($50/fanily/ye nderrer a3cy fund). . J 8.0001 1999 6,001 Copes of fomislfaultalors($25Ramly/y ar) I3,]50 937 2,813 Postage(Indudes($6Ra Ily/year andb Outreach/ativssry bd)i, 9001 225 675 Computer Network Fee: 450 112 338 Land Line Telephones _ I 1,500 375 1.125 Cellular Phone U ag.Fees($50Aurselmonthl 4200 1050 3.150 Medical Suppllrs (p0O/NHV/year) 1,200 300 -900 Professional.TTLOPERA11NG rut($5OOMurselyeac$25Ws1ppWYear,AtlNsory Board meetings) 4970 174012 3,338 2.TOTAL OPERATNG 26,970 6,]40 20,230 EQUIPMENT(Detail Expenses) ' 'i _ C terlmtare 2 for 0708 _ 2.000 500 1,500 p `Rrs Cell Phonere replacement 175 19 56 3.T (portable) la _ 300 75 225 3.TOTAL EQUIPMENT 2,3]5 594 1]81 TRAVEL(Detail Expenses) NFP NHV(hotel/meals/nileacfe'parldng)E1 (NHVU6) 539 135 404 NFP NHV jtobal/meals/mileage/parkirg) E2(NHVNB) _I� 539 _--_ 135 404 NFP NHV(ho61/ ealslm IeagelpaMir�LE3(NH L_ ___ - 360 95 205 NFP NHV(hobl/mealsrmbeaye/parkrg) E3(Kath)0 —_. -- _ ___ __380 _- 95 205 NFP Supervisor(hotel/ ealsfnileage/parNng)E3 380 95 285 NCAST Supervisor(hotel,nealsrmileage) I____- 1,779 444 __. 1,335 NCAST NHV(hotel/meals/mileage) (NHV#B) I 1779 444 1,335 Mileage-died mils/supervisor visM14outreadl(5465/m) 39060 9758 29,302 4.TOTAL TRAVEL 44,836 11201 33.635 NFP TRAINING&TECH ASSISTANCE(Detail Expenses)^I NFP PD Tuiton(El.E2,E3)prior to July 2007($2,709Vall 0 0 0 NFP PO Turbon,July 2007-July 2008j$3p00)_. _ 0 0 0 NFP Supervisor PD Tuition(53,245 per arpervlsor) 0 0 0 NFPPDMatedals($381/NHV) ' - _0 0 0 Ongoly Nurse Ed wbon($1 159 per Supervisor&NHV team)__ -_. _ 1,159 290 869 Technical Assistance and products($6,695/agenc)' _. _ _ _6,695 1673 5,022 Indired Costs'(17%of Nurse PD,Tech Asst Products) 1,335 334 1,001 5.TOTAL TRAINING&TECH ASSISTANCE 9.189 2,297 6,892 NCAST COSTS(Detail NCAST Training&Materiels) l I NCAST Registz5on($790/nurse)-. _-_ 1,580 395 1,185 NCAST Materials($248'nurs_� 496 124 --_. 372 6.TOTAL NCAST COSTS 2,076 519 1,557 OTHER COSTS(Detai Other Program Costs) )) _. PIPE materials($1]0/guitleMiV) 170 42 128 7. TOTAL DAHERCOSTS 170 42 128 MIA, 17422 CI'PROGRAM COSTS IAod 2-7,1 71 591,781 147,847 443,934 ADMINSTRATIVE COSTS(Detail Adminstntive Costs) I I Indirect 1416% ]9,8]1 18700 _-- 56,1]1 TOY4I.ADVINISTIA➢VC COSTS 74,871 18,700 55,171 666,652 166,547 500,105 LIST OTHER SOURCES of FUNDING I.e ,•km _. - —'....- -.-- MEDICAID 166,547 $ I TOT AL CRIERSOURCES 166,54] Signature of Authorized Representative Date EXHIBIT( DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT (ADD PROGRAM NAME HERE) DEPARTMENT OR AGENCY NUMBER *** CONTRACT ROUTING NUMBER **-***** ELIMINATE ALL INFORMATION APPEARING IN RED LIMITED AMENDMENT FOR TASK ORDERS#* This Limited Amendment is made this ****day of*********,200*, 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,LEGAL NAME OF ENTITY,(letal type of entity),whose address or principal place of business is Street Address,City,State&Zip Code,hereinafter referred to as the"Contractor". FACTUAL RECITALS The parties entered into a Master Contract,dated ******** **,****, with contract routing number** *** ***** "the Master Contract"). Pursuant to the terms and conditions of the Master Contract,the parties entered into a Task Order Contract, dated ******** **, ****,with contract encumbrance number PO *** **********, and contract routing number** *** *****, [insert the following if previous amendment(s), change order(s), renewal(s) have been processed: as amended by] [include all previous amendment(s),change order(s),renewal(s) and their routing numbers], [insert the following if previous amendment(s).change order(s),renewal(s) have been processed: collectively) referred to herein as the"Original Task Order Contract,whereby the Contractor was to provide to the State the following: [Briefly describe what the Contractor was to do under the Original Task Order Contract—indent this paragraph] [Please choose one of the following four options and delete the other three options not selected] The State promises to [choose one and delete the other] increase/decrease the amount of funds to be paid to the Contractor by ********** Dollars, ($*.**)during the current term of the Original Task Order Contract in exchange for the promise of the Contractor to perform the [choose one and delete the other] increased/decreased work under the Original Task Order Contract. Page 1 of 5 EXHIBIT C The State promises to pay the Contractor the sum of********** Dollars, (S*.**) in exchange for the promise of the Contractor to continue to perform the work identified in the Original Task Order Contract for the renewal term of****years/months,ending on ******** **, ****. The State promises to [choose one and delete the other] increase/decrease the amount of funds to be paid to the Contractor by********** Dollars, ($*.**)for the renewal term of**** [choose one and delete the other] years/months,ending on ******** **, ****, in exchange for the promise of the Contractor to perform the [choose one and delete the other[ increased/decreased work described herein. The State hereby exercises a"no cost"change to the [choose those that apply and delete those that don't apply[ budget,specifications within the Statement of Work,project management/manager identification,notice address or notification personnel,or performance period within the [choose one and delete the other] current term of the Original Task Order Contract or renewal 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 Limited Amendment to the Original Task Order Contract consists of the payments and services that shall be made pursuant to this Limited Amendment, and promises and agreements herein set forth. 2. It is expressly agreed to by the parties that this Limited Amendment is supplemental to the Original Task Order Contract,contract routing number** *** *****, [insert the following language here if previous amendment(s),change order(s), renewal(s) have been processed] as amended by [include all previous amendment(s),change order(s), renewal(s) and their routing numbers[, [insert the following word if previous amendment(s).change order(s), renewal(s) have been processed,otherwise delete"collectively""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 Limited 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: [Please choose one of the following three options and delete the two options not selected] A. [Use this paragraph when changes to the funding level of the Original Task Order Contract occur during the current term of the Original Task Order Contract] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number** *** *****. This Limited Amendment is for the current term of********* ** Page 2 of 5 • • EXHIBIT C ****,through and including********* **, ****. The maximum amount payable by the State for the work to be performed by the Contractor during this current term is [choose one and delete the other[ increased/decreased by ********** Dollars, ($*.**),for an amended total financial obligation of the State of********** DOLLARS,($*.**). [Delete the following sentence if not applicable in your situation] The revised Statement of Work is incorporated herein by this reference and identified as"Attachment *". [Delete the following sentence if not applicable in your situation] The revised Budget is incorporated herein by this reference and identified as"Attachment *". The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original Task Order Contract are reaffirmed. A. [Use this paragraph when the Original Task Order Contract will be renewed for another term] This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number** *** *****. This Limited Amendment is for the renewal term of********* ** ****,through and including ********* **, ****. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is ********** Dollars, (5*.**) for an amended total financial obligation of the State of********** DOLLARS,($*.**). [Delete the following sentence if not applicable in your situation]The revised Statement of Work is incorporated herein by this reference and identified as"Attachment*". [Delete the following sentence if not applicable in your situation] The revised Budget is incorporated herein by this reference and identified as"Attachment*". The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original Task Order Contract are reaffirmed. A. [Use this paragraph when there are "no cost changes" to the Budget, the specifications within the original Statement of Work,allowable contract provisions as noted,or performance period.[ This Limited Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number** *** *****. This Limited Amendment[choose those that apply and delete those that don't] modifies the Budget in [identify location in contract[,modifies the Statement of Work in [identify location in contract[,modifies the project management/manager identification in ]identify location in contract],modifies the notice address or notification personnel in [idenrify location in contract],modifies the period of performance in [identify location in contract] of the Original Task Order Contract. The revised [choose those that apply and delete those that don't] Budget,Statement of Work,project management/manager identification, notice address or notification personnel,or period of performance is incorporated by this reference and identified as. All other terms and conditions of the Original Task Order Contract are reaffirmed. 4. The effective date of this Limited Amendment is **/**/****, or upon approval of the State Controller, or an authorized delegate thereof,whichever is later. Page 3 of 5 • EXHIBIT C 5. Except for the Special Provisions and other terms and conditions of the Master Contract and the General Provisions of the Original Task Order Contract, in the event of any conflict, inconsistency, variance, or contradiction between the terms and provisions of this Limited Amendment and any of the terms and provisions of the Original Task Order Contract, the terms and provisions of this Limited 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 4 of 5 EXHIBIT C IN WITNESS WHEREOF, the parties hereto have executed this Limited Amendment on the day first above written. CONTRACTOR: STATE: [LEGAL NAME OF CONTRACTOR] STATE OF COLORADO (a political subdivision of the State of Colorado) Bill Ritter,Jr. Governor By: By: Name: For the Executive Director Title: DEPARTMENT OF PUBLIC HEALTH FEIN: AND ENVIRONMENT ATTEST: PROGRAM APPROVAL: Because the Contractor is a governmental entity, an attestation is required By: (Seal, required) By: City, City and County, County, Special District,or Town Clerk or Equivalent [Delete inapplicable language,' ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This limited amendment is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for goods and/or services provided. STATE CONTROLLER Leslie M. Shenefelt By: Date: Page 5 of 5 Exhibit D Colorado Department of Public Health and Environment State Fiscal Year 2007-2008 Colorado Nurse Home Visitor Program MEDICAID REIMBURSEMENT GUIDELINES Agencies receiving funding through the Colorado Nurse Home Visitor Program (NHVP) are required to bill the Colorado Department of Health Care Policy and Financing (HCPF) for Targeted Case Management (TCM) services provided to Medicaid eligible mothers and children receiving services through the NHVP. Below is the information pertaining to the NHVP Medicaid reimbursement process. Contractor Name: Weld County Department of Public Health and Environment Reimbursement Period: July I,2007 To June 30,2008 Definition of Reimbursable Services: Colorado Nurse Home Visitors will provide Targeted Case Management (TCM) services to first-time (defined as no previous live births), pregnant women or whose first child is less than one month old and who are at or below 200%of the Federal Poverty Level. Program enrollment occurs during pregnancy, or within one month postpartum, and services are designed to continue through the child's second.birthday. TCM services include: Assessment of the needs for health, mental health, social services, education, housing, child care, and related services for the women and children; Development of care plans to obtain the needed services; Referral to resources to obtain the needed services, including to medical providers who provide care to Medicaid-eligible pregnant women and children; Routine monitoring and follow-up visits with the women in which the progress in obtaining the needed services is monitored, problem-solving assistance is provided,and the care plans are revised to reflect the women and children's current needs. Medicaid Billing Information: NHVP providers will submit bills through the Medicaid Management Billing Cycle Information System(MMIS)at the end of the month for each mother/child receiving a visit. Medicaid Reimbursement Rate $190.04 Claim Form CO-1500 Claim Type E(practitioner/physician) 40(clinic) Category of Service Includes provider types 16(clinic),32(Family Qualified Health Center),and 45 (Rural Health Center). G9006,HD(For services rendered to the mother) Procedure Code Modifiers T1017,HD(For services rendered to the child) Page 1 of 2 For the Mother-Services to the mother shall be limited to 3 units per month with a lifetime maximum of 30 units,or 3 units per month for 10 months. One (1)unit equals 15 minutes of service. Each unit will equal$63.35 ($190.04 divided by 3). Full Medicaid reimbursement will be earned with a minimum of 45 minutes of service per month. Service Limits For the Child- Services to the child shall be limited to 3 units per month with a lifetime maximum of 75 units,or 3 units per month for 25 months. One(1) unit equals 15 minutes of service. Each unit will equal$63.35 ($190.04 divided by 3). Full Medicaid reimbursement will be earned with a minimum of 45 minutes of service per month. Affiliated Computer Services(ACS),the Medicaid fiscal agent,has a 120-day "timely filing"policy(invoices must be submitted to ACS within 120 days Billing Requirements from the date of service). Claims are usually paid/denied/adjusted within two weeks of receipt—the maximum ACS response time is set at 30 days. For information related to Medicaid billing and training,please contact Affiliated Computer Services(ACS)at http://coloradomedicaid.acs-inc.com or Provider Services Unit at 1-800-237-0757 or(303)534-0146 Monday through Friday,8:00 a.m.to 5:00 p.m. Medicaid Contractor You may also contact Ginger Burton,Colorado Department of Health Care Policy and Financing,at 303-866-2693 or Ginger.I3urton{d.state.co.us if you have questions on the Medicaid enrollment or billing process. FY 2007-2008 Funding Structure: Medicaid Reimbursement Rate $190.04 Estimated Annual Medicaid Revenue $166,547 CDPHE Tobacco Funding $500,105 TOTAL FY07-08 NHVP FUNDING $666,652 Page 2 of 2 •• Exhibit E SAMPLE FUNDING LETTER Date: State Fiscal Year: TO: (contractor's name here) SUBJECT: Funding Letter No. In accordance with Exhibit B, Paragraph 13 of contract routing number , between the State of Colorado Department of Public Health and Environment (division) and (contractor's name) covering the period of (contract start date) through (contract end date), the undersigned commits the following funds to the contract: The amount of funds available and specified in Paragraph is (increased/decreased) by ($ amount of change) to a new total funds available of ($ ) to satisfy orders under the contract. Paragraph is hereby modified accordingly. This funding letter does not constitute an order for services under this contract. This funding letter is effective upon approval by the State Controller or such assistant as he may designate. APPROVALS: State of Colorado: Bill Ritter, Jr., Governor By: Date: For the Executive Director Colorado Department of Public Health and Environment By: Date: For (Division) ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS 24-30-202 requires that the State Controller approve all state contracts. This contract is not valid until the State Controller, or such assistant as he may delegate, has signed it. The contractor is not authorized to begin performance until the contract is signed and dated below. If performance begins prior to the date below, the State of Colorado may not be obligated to pay for goods and/or services provided. State Controller Leslie M. Shenefelt By: Date: Date Issued: February 10,2003 Page 1 of 1 STATE OF COLORADO Bill Ritter,Jr.,Governor James B. Martin, Executive Director pF cot_ Dedicated to protecting and improving the health and environment of the people of Colorado 411 4300 Cherry Creek Dr.S. Laboratory Services Division + . Denver,Colorado 80246-1530 8100 Lowry Blvd. +� » Phone(303)692-2000 Denver,Colorado 80230-6928 'Ins* 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 July 10, 2007 Weld County Department of Public Health and Environment Judy Nero 1555 North 17th Avenue Greeley, CO 80631 RE: Nurse Home Visitor Program (NHVP)Task Order Contract Contract Routing Number 08 FLA 00184 Family Planning Program (FPP) Task Order Contract Contract Routing Number 08 FLA 00081 Dear Ms. Nero, Enclosed please find fully executed copies of each of the above referenced Contracts for your files. The FPP Task Order Contract covers the period from July 1, 2007 through and including June 30, 2008. The NHVP Task Order Contract covers the period from July 4, 2007 through and including June 30, 2008. If you have any questions regarding these Contracts please contact me, Deb Polk, Contract Specialist at 303- 692-2492 or by email at deb.polk(a)state.co.us or the individual program managers: Candace Grosz, FPP Manager—303-692-2482 or by email at candace.qroszastate.co.us Esperanza Ybarra, NHVP Manager-303-692-2482 or by email at esperanza.ybarra(�Dstate.co.us Sincerely, Deb Polk Contract Specialist, Fiscal Services Unit Center for Healthy Families and Communities, Prevention Services Division Colorado Department of Public Health and Environment 4300 Cherry Creek Drive South Denver, Colorado 80246 Phone: 303-692-2492 Fax: 303-753-9249 Deb.volkastate.co.us Enclosure 2"07 - ) L09 LI Hello