The URL can be used to link to this page

Browse Search

Home My WebLink About20072780.tiff RESOLUTION RE: APPROVE TASK ORDER CONTRACT FOR HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS 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 Health Care Program for Children with Special Needs 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 October 1, 2007, and ending September 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 Health Care Program for Children with Special Needs 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 29th day of August, A.D., 2007. Analsaw, BOARD OF COUNTY COMMISSIONERS , • JL�% WELD COUNTY, COLORADO ATTEST: Leib 1 s , "�►' �n , • _XCUSED r Nry. 1661 1'' yt;: -= 5 David E. Long, Chair Weld County Clerk to thet .. . ""O Nr. , ._, I iLz Je/ BY: J �� t r • 1 William J ke,, Pr Tem a�2 ,I �� I � �% D uty CI to the Boar. William F. Garcia ADO D AST EXCUSED \, Robert D. Masden nt torney r ,,,rl� ,� DouglaVRademach Date of signature: M 2007-2780 HL0034 n4 ; AZ/ %r?/, . ) 754 -/ --0 ? Memorandum TO: David E. Long, Chair Board of County Commissioners IFROM: Mark E. Wallace, MD, MPH ODirector, Department of Public Health /p and Environment C �V^X a� COLORADO DATE: August 23, 2007 SUBJECT: HCP Program Task Order Contract 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 (CDPHE) for the Health Care Program for Children with Special Needs (HCP). This contract will provide funding in the amount of$182,009 for the time period October 1, 2007 through September 30, 2008. Of this amount, $81,904 is pass through funding from the federal government, and the balance of$100,105 is State of Colorado funding. These funds will be used to provide core public health services for children with special health care needs. Some of the services provided will be case finding, community involvement, and interagency collaboration for children and their families who are determined eligible for such services. Eligible children are those who have or are at risk for a chronic physical, developmental, behavioral, or emotional condition. I recommend your approval of this contract. Enc. m o� 0 2zro r- rn N -- C cn n rri 11 d' N Pi ~ 2007-2780 DEPARTMENT 01'PUBLIC I!EACH I AM)ENVIRONMENT ROUTING NO.08 FLA 00446 APPROVED TASK ORDER CONTRACT-WAIVER#154 This Task Order Contract is issued pursuant to Master Contract made on 12/18/2006,with routing number 08 FAA 00052 S'i Ails. CONTRACTOR: State of Colorado for the use& benefit of the Board of County Commissioners of Weld County Department of Public Health and 915 10th Street, Greeley, Colorado 80632-0758 Environment for the use and benefit of the Prevention Services Division, HCP Weld County Department of Public Health and 4300 Cherry Creek Drive South Environment, 1555 North 17th Avenue Denver,Colorado 80246 Greeley, Colorado 80631 TASK ORDER MADE DATE: CONTRACTOR ENTI'IY'1'YPI:: 08/01/2007 Colorado Political Subdivision PO/SC ENCUMBRANCE NUMBER: CONTRACTOR FEIN OR SOCIAL SECURITY NUMBER: PO FLA HCP0800446 84-6000813 B TERM: BILLING STATEMENTS RECEIVED: This Task Order shall be effective upon Monthly approval by the State Controller, or designee, or on 10/01/2007 whichever is later. The STATUTORY AL'TI IORI CY: Task Order shall end on 09/30/2008. C.S.R. 25-1.5-101, 25-1-709 PRICE STRUCTURE: CONTRACT PRICE NOT TO EXQ:ED: Fixed Price $182,009.00 I'ROCUREMI(NT METHOD: FEDERAL FUNDING DOLLARS: $81,904.00 Exempt STATE FUNDING $100,105.00 BID/REP/FIST PRICE AGREEMENT NUMBER: MAXIMUM AMOUNT AVAILABLE PER FISCAI,YEAR Not Applicable FY 08: $136,507.00 FY 09: $45,502.00 LAW SPECIFIED VENDOR STATUTE: Not Applicable S'TA'TE RIEPRDSENTA'I'IVE: CONTRACTOR REPRILSEN'TATI VI': Kathy Watters Judy Nero Department of Public Health and Weld County Department of Public Health and Environment Environment Prevention Services Division,HCP 1555 North 17th Avenue 4300 Cherry Creek Drive South Greeley, Colorado 80631 Denver, CO 80246 SCOPE of WORK: In partnership with other community organizations, shall facilitate the development and enhancement of community-based systems of care for the maternal and child populations. And to ensure that all families have access to direct care services, as well as enabling and population-based services that address the issues and health problems delineated in the MCH performance measures. Page 1 of 4 • • CXI IIII' 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 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. 1. 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: 1)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 of Weld BILL RITTER,JR.GOVERNOR County for the use and benefit of the Weld County Department of Public I{ealdr and / Environment Legal Name of Contracting Entity By For Executive Director 84-6000813 B Department of Public Health and Environment Social Security Number or FEIN Department Program Approval: Signature of Authorized Officer Y William H. Jerke, Chair Pro—Tem By Print Name Sr Title of Authorized Officer 08/29/2007 GOVERNMENTAL ENTITIES: ?e_1 (An attestation and se re r u"�Ac]I /G /t$ II'e L/ \ l%�hA//Av/// I -t...`E/J L� a 11/4 1861 (-3` 'CS Attest(Seal)By_ C_r1-, .. ��'AAAMMMf44 �J. (Town/City/County Clerk 6•Equivalent) �� ._ov. � ' seal here) R Atsat 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.Shenefel By Date 07 WELD COUNTY DEPARTMENT F PUBLIC HEALTI} A PdVIRO T� BY: Page 4 of 4 tilj ` Gl� Mark E. Wallace, MD, MPH-Director 02607- aYicc EXHIBIT A ADDITIONAL PROVISIONS To Task Order Dated 08/01/2007 Routing Number 08 FLA 00446 These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above. The United State Department of Health and Human Services ("HHS"),through the Maternal and Child Health Services Block Grant(MCH)has awarded the State Title V federal funds under Notice of Grant Award("NGA)number B04MC04248 (See, Catalog of Federal Domestic Assistance("CFDA") number 93.994). The State's Prevention Services Division(PSD) is charged with the administration of funds from the Title V MCH Block Grant to improve the health and well being of the maternal, child/adolescent and children with special health care needs populations through assessing population needs, influencing health policy,engaging in strategic planning and coordinating/implementing best practices and evidenced-based programs. The authority for the administration of the Title V MCH Block Grant, including the maternal,child and children with special health care needs resides in Title V of the Social Security Act, §§ 501-509. Each state that receives MCH funds from the HHS must demonstrate to the HHS that it has served three(3) distinct population groups with the MCH funds. These three(3) distinct population groups are: "the prenatal population",which is defined to include women of childbearing age, pregnant women, and mothers;the"child and youth population", which is defined to include infants, children, and adolescents from birth through age twenty(20);and,the"children with special health care needs population" (CSHCN), which is defined as those children who have,or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally. The State has formulated a comprehensive statewide plan to carry out a Maternal and Child Health Program, funded by Title V MCH dollars. As part of the comprehensive plan, it is the express intent of the state to support local public health agencies in contributing to a coordinated,efficient statewide program which focuses on specific MCH performance measures set by the MCH state and Federal agencies. Local public health agencies,working in partnership with other community organizations, facilitate the development and enhancement of community-based systems of care for the maternal,and child population. The goal of these systems is to ensure that all families have access to direct care services,as well as, enabling and population-based services that address the issues and health problems delineated in the MCH performance measures. If the underlying Award authorizes the State to pay all allowable and allocable expenses of a contractor as of the effective date of that Award,then the State shall reimburse the Contractor for any allowable and allocable expenses of the Contractor that have been incurred by the Contractor since the proposed effective date of this Task Order Contract. If the underlying Award does not authorize the State to pay all allowable and allocable expenses of a contractor as of the effective date of that Award,then the State shall only reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by the Contractor on or after the effective date of this Task Order Contract, with such effective date being the later of the date specified in this Task Order Contract or the date the Task Order Contract is signed by the State Controller or delegee. 2. The Contractor shall be reimbursed for the Children with Special Health Care Needs(CSHCN)services in accordance with the Budget, which is incorporated herein by this reference, made a part of hereof attached hereto as"Attachment B-1 for the initial term of this Task Order. In consideration for those CSHCN services timely and satisfactory performed by the Contractor under this Task Order,the State shall cause to be paid to the Contractor an amount not to exceed $182,009.00. Of the HCP financial obligation, $81,904.00 are identified as attributable to a funding source of the federal government and,$100,105.00 are identified as attributable to a funding source of the state of Colorado. Page 1 of4 EXHIBIT A 3. To receive compensation for HCP Regional Coordinator Services under this Task Order Contract,the Contractor shall submit a signed monthly Invoice/Cost Reimbursement Statement in a format acceptable to the State. A sample Invoice/Cost Reimbursement Statement is attached hereto as Attachment A-1 and incorporated herein by this reference. An Invoice/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 and incorporated herein. 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. Invoice/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. Invoice/Cost Reimbursement Statements shall be sent to: Fiscal Services Unit Accounts Payable Prevention Services Division Colorado Department of Public Health and Environment PSD-CHFC-A4 FC-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. The final payment for the twelfth(12th) month or fourth(4`h)quarter, for the initial term of this Task Order, and any renewal or extension hereof, is contingent upon the State's timely receipt of a Final Expenditure Report from the Contractor by utilizing the"Application Budget and Final Expenditure Report"form incorporated herein by this reference located on the MCH website: www.cdphe.state.co.us/ps/mch/plan/forms.html and the Health Care Program for Children with Special Health Care Needs(HCP)website www.hcpcolorado.org Reimbursement for the HCP Regional Office Services under this Task Order, and any renewal or extension hereof,shall be made to the Contractor on a monthly. Accordingly,the Contractor shall be paid one twelfth(1/12)of the State's financial obligation for the HCP services under this Task Order each month for the first eleven(11) months. The final payment for the twelfth(12th)month or fourth(4`h)quarter, for the initial term of this Task Order, and any renewal or extension hereof, is contingent upon the State's timely receipt of a Final Expenditure Report from the Contractor by utilizing the"Application Budget and Final Expenditure Report"form incorporated herein by this reference located on the MCH website www.cdphe.state.co.us/ps/mch/plan/forms.html and the Health Care Program for Children with Special Health Care Needs(HCP) website www.hcpcolorado.orQ The State shall reimburse the Contractor for actual indirect costs up to the Prevention Services Division's maximum of twenty-five percent(25%) when the Contractor's indirect rate is based on Direct Costs, twenty-seven percent(27%) when the Contractor's indirect rate is based on Salary Only,or thirty percent (30%)when the Contractor's indirect rate is based on Salary and Fringe where no other direct costs are charged. Page 2 of 4 • EXHIBIT A 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. 4. The Contractor shall retain and use all revenues generated by the individual CSHCN Programs for services in those programs. 5. Title V, Section 504(b)(6).Title V funds may not be used to pay for any item or service(other than an emergency item or service)furnished by an individual or entity convicted of a criminal offense under the Medicare or any State health care program(i.e.,Medicaid,Maternal and Child Health,or Social Services Block Grant Programs). 6. 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,the Contractor certifies that the Contractor will comply with the requirements of the Act and will 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 will 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. The Contractor certifies,to the best of its knowledge and belief,that no federally appropriated funds have been paid or will 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, and the extension, continuation,renewal,amendment, or modification of this Task Order,or any grant, loan, or other cooperative agreement that utilizes Federal funds. If any funds other than federally appropriated funds have been paid or will 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,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. 8. The Contractor shall not charge for services those individuals of families at or below the official poverty guidelines, updated periodically in the Federal Register by the U.S. Department of Health and Human Services under the authority of42 U.S.C. 9902(2), in accordance with Title V, Section 501 (I)(B)and Section 505 (5)(D). The most current version of this document is available on the MCH website: www.cdohe.state.co.us/ps/mch/plan/forms.html and the Health Care Program for Children with Special Page 3 of 4 EXHIBIT A Health Care Needs(HCP) website www.hcpcolorado.org If the Sate receives new poverty guidelines from the DHHS during the term of this Contract,the State shall immediately update the guidelines on the MCH and HCP websites. The Contractor shall use these new poverty guidelines, if any, upon receipt thereof from the State. If any charges are imposed for services to clients who are above the one hundred percent(100%)of poverty level, such charges must be on a sliding scale which takes into account the client's family size, income and resources. These charges and the sliding fee scale must be made available to the general public and to all clients and must be based on the agency's usual and customary cost for the service. Clients must understand they shall not be denied services for inability to pay any of the sliding fee charges. The Contractor shall protect the confidentiality of all applicant or recipient records and other materials that are maintained in accordance with this Task Order. Except for purposes directly connected with the administration of this Task Order,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. 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 activity 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 will advise such clients that an interpreter will be provided for them. If a client has their own interpreter,they shall be advised that the Contractor will provide an interpreter if the client so chooses. 10. The services or activities under this Task Order may be carried out by the Contractor itself, or through subcontracts with other providers or,through collaborative partnerships with other community partners. The State authorizes the Contractor to subcontract some, or all,of the services that are to be performed under this Task Order. However,a subcontractor is subject to all of the terms and conditions of this Task Order. Additionally,the Contractor remains ultimately responsible for the timely and satisfactory completion of all work performed by any subcontractor(s)under this Task Order. If the Contractor desires to subcontract some,or all, of the services that are to be performed under this Task Order,the Contractor shall obtain the prior, express, written consent of the State before entering into any subcontract. 11. Survival of Certain Contract Terms. 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. 12. The State has determined that this contract does not constitute a Business Associate relationship under HIPAA. Page 4 of 4 \ . ] e 2 . ) . DD — k : § 3 ■ _ s t -2 OE }O / X g ) / \ / H \ k6. E4 W § a D4 4 4.1 ° % i \ $ \ j § ) k < } § F a) E j 7 4E-1 § § $ to \ k § a-. m \ : \ \ § & a o 2 d = A a / / S § / H rtcl� � \ O CU w ` \ in 2 ctt . 'C « ( & \ :, 7. 1O tel -• ca Ih- 41 / \ \ \ § \ {) } ) ) _C z 2 C t } un ca ; / { C § CO (3 } ° \ H j @ / - k \ j = e 0 ° } j ± 3i a I ) \ Q ± © 64m o 6 & \ \ 0 ) / \ \ j \ \ - \ EXHIBIT B STATEMENT OF WORK Weld County Department of Health and Environment To Task Order Contract Dated 08/01/2007-Contract Routing Number 08 FLA 00446 This Statement of Work is for one of the three Maternal and Child Health(MCH)populations,which covers Children with Special Health Care Needs(CSHCN). 1. Under this Task Order the Contractor shall provide the core public health services of assessment,policy development,and assurance on behalf of the Children with Special Health Care Needs(CSHCN)population as described and defined in"Core Public Health Services Delivered by MCH Agencies",a component of the MCH Guidelines available on the MCH website: www.cdphe.state.co.us;ps/mch/plan/forms.html and the Health Care Program(HCP)website: www.hcpcolorado.ore The MCH Guidelines are incorporated and made part hereof by reference. 2. The Contractor shall provide leadership,in coordination with public and private community partners,in the development and implementation of the Contractor's Children with Special Health Care Needs Operational Plan. 3. The State shall provide guidance and technical assistance to the Contractor to support the implementation of the Contractor's Children with Special Health Care Needs Operational Plan for federal fiscal year 2007-2008 and for the development of the Contractor's Children with Special Health Care Needs Operational Plan for the federal fiscal year 2008-2009. 4. The Children with Special Health Care Needs Operational Plans are to be based on a community planning process that includes a review of the health status needs of the CSHCN population and of the health system resources of the community. These plans are further designed to: a. Contribute to the accomplishment of the National and State priorities,performance measures,and outcome measures,as identified in the MCH Guidelines. b. Provide for the continuation of the core public health services of assessment,policy development,and assurance on behalf of the matemal and child health populations;and in implementing the 10 essential services for this population in partnership with the State, as identified in the MCH Guidelines. c. Work with public and private community partners to plan for the development and maintenance of resources that assure access to direct care and services for vulnerable children and adolescents with special health care needs,such as those who are low- income,uninsured,underinsured,living in rural or underserved areas,or from ethnic or cultural minority communities who may experience language or cultural barriers to services; d Facilitate outreach and enrollment efforts,including having information and applications on site,to increase enrollment of eligible children and adolescents,including those with special health care needs,in Medicaid(Colorado Baby Care/Kid's Care Program)or Child Health Plan Plus(CHP+)and Supplemental Security Income(SSI); e. Refer families participating in any and all programs in its agency such as Women,Infants and Children(WIC);Early and Periodic Screening,Diagnosis and Treatment(EPSDT): immunizations clinics; Family Planning;HCP etc.to appropriate enabling and direct care service programs in the community; Page 1 of 3 EXHIBIT B f. Work with public and private community partners to plan for the development and implementation of population-based approaches for addressing MCH performance measure and priority issues for children with special health care needs in the community. 5. The Contractor shall receive technical assistance and consultation from State HCP consultant(s)to further their understanding of the effects of their operational plan and program activities in the facilitation of a medical home approach fro CSHCN. 6. The Contractor shall perform in accordance with the HCP Contract,Performance Measures,and responsibilities listed in the MCH Guidelines. The Guidelines are periodically updated and the contractor will be notified by email when updates/revisions are made. The contractor is responsible for complying with any updates/revisions. 7. The Contractor shall follow the policies and procedures in the"HCP Policies and Procedures Manual"which is made available on the HCP website: www.hcpcolorado.org 8. The Contractor shall work collaboratively with the State for consultation,technical assistance,oversight and training on documentation in the Health Care Program for Children with Special Needs/Clinical Health Information Record of Patients(HCP/CHIRP)database and to ensure that all HCP/CHIRP database users follow the HCP/CHIRP database policies and procedures as outlined in the HCP Policy and Procedure Manual and CHIRP User Guide which are made available on the HCP web site:www.hcpcolorado.org. 9. The Contractor shall follow the HCP/CHIRP Security policy and procedures outlined in the CHIRP User Guide, HCP Policy and Procedure Manual,and Data Security Use and Confidentiality Agreement signed by each user. 10. The Contractor shall orient and provide ongoing training on the HCP program, including HCP/CHIRP operations, to their agency and county nursing services staff assigned to HCP responsibilities. The Team Leader will provide a summary of their training and orientation activities in their agency/region through the completion of the HCP/CHIRP Community Encounter screen in CHIRP. 11. The Contractor shall work cooperatively with the public health nurses from Weld County. 12. The Contractor's Team Leader or designee,will meet at least annually with public health nurses from each county assigned to their regional office to; a) Review County's goals and those related to CSHCN and consult on County needs assessment activities for CSHCN b) Provide consultation and technical assistance regarding HCP policies and procedures related to care coordination services,HCP clinics,CHP+/Medicaid/551,newborn hearing screening,family involvement and medical home c) Determine procedures for sharing documentation,medical records and County procedures for HCP/CHIRP documentation 13. The Contractor shall convene at least one meeting annually of all regional office staff to include county public health nurses and discipline coordinators. The assigned HCP agency consultant shall be invited to attend these meetings. The Team Leader shall provide meeting minutes to the HCP agency consultant through the completion of the HCP/CHIRP Community Encounter screen in CHIRP. 14. The Contractor shall submit,but not limited to,the following reports,incorporated by reference. These documents,including instructions for completion and submission are available in the MCH Guidelines located on the MCH website:www.cdphe.state.co.us/p,dmch/plan/forms.hnnl and the HCP website:www.hcpcolorado.org. a. Final Expenditure Report,Children With Special Health Care Needs,for federal FY 2006-2007 b. Core Public Health Services Actual Expenditure Report for federal FY 2006-2007 Page 2 of 3 EXHIBIT B c. Table I Number of Individuals Served for federal FY 2006-2007. Responsible for the Children with Special Health Care Needs line item ONLY d. Children with Special Health Care Needs Operational Plan Annual Report for federal FY 2007-2008 e. HCP Performance Measure Report for federal FY 2006-2007 f. Monthly Updated Clinic Schedules for this contract period g. Core Public Health Services Budget Estimate,Section II for federal FY 2008-2009 h. Application Budget,CSHCN for federal FY2008-2009 i. Children with Special Health Care Needs Operational Plan for federal FY 2008-2009 15. The Contractor shall assure attendance of at least one agency HCP staff representative to state or regional teleconferences,meetings,and/or videoconference meetings that the state may organize to address priority HCP needs,promote learning groups,increase skills as HCP practitioners and/or carry out state and local HCP planning activities. 16. The contractor shall participate in activities in conjunction with the State to ensure that the program planning, evaluation and monitoring requirements as described in this Task Order and Exhibits are met. Activities include,but are not limited to,participation in site visits and meetings as requested by the State at the Contractor's location. 17. The Contractor shall cooperate with the State and provide all requested records regarding recipients for whom services were provided under this Task Order. Page 3 of 3 Attacment B-1 APPLICANT: Weld County Department of Public Health and Environment PROJECT: Health Care Program for Children with Special Needs (HCP) FOR THE PERIOD: OCTOBER 1, 2007 through SEPTEMBER 30, 2008 Funded by CDPHE HCP Weld County Regional Office: (1/12 payable monthly October 2007 through August 2008, September 2008 payment contingent upon the State's timely receipt of the Contractor's FY 08 Final $152,959 Expenditure Report) Sub-total HCP Regional Office: 5152,959 HCP Regional Coordinator Services: Audiology $2,000 Travel for Colo. Academy of Audiology meeting $250 Regional Coordinator Training, Travel, Educaiton $2,500 Support for Interdisciplinary Team $24,300 Sub-total HCP Regional Coordinator Services: $29,050 Total HCP Weld County Regional Office $182,009 Page 1 of 1 EXHIBIT C DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT (ADD PROGRAM NAME HERE) DEPARTMENT OR AGENCY NUMBER *** CONTRACT ROUTING NUMBER ELIMINATE ALL INFORMATION APPEARING IN RED LIMITED AMENDMENT FOR TASK ORDERS #* This Limited Amendment is made this **** day of*********, 200*, by and between the State of Colorado,acting by and through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal place of business is 4300 Cherry Creek Drive South,Denver, Colorado 80246,hereinafter referred to as the"State"; and,LEGAL NAME OF ENTITY,(legal type of entity), whose address or principal place of business is Street Address, City, State& Zip Code,hereinafter referred to as the"Contractor". FACTUAL RECITALS The parties entered into a Master Contract, dated ******** **, ****, with contract routing number** *** *****"the Master Contract"). Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated******** ** ****, with contract encumbrance number PO *** ********** and contract routing number** *** *****, [insert the following if previous amendment(s), change order(s), renewal(s) have been processed: as amended by] (include all previous amendment(s), change order(s),renewal(s) and their routing numbers], (insert the following if previous antendment(s), change order(s), renewal(s) have been processed: collectively( referred to herein as the"Original Task Order Contract, whereby the Contractor was to provide to the State the following: [Briefly describe what the Contractor was to do under the Original Task Order Contract— indent this paragraphs (Please choose one of the following four options and delete the other three options not selected] The State promises to [choose one and delete the other] increase/decrease the amount of funds to be paid to the Contractor by ********** Dollars, ($*.**) 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 The State promises to pay the Contractor the sum of********** Dollars, ($*.**) in exchange for the promise of the Contractor to continue to perform the work identified in the Original Task Order Contract for the renewal term of**** years/months, ending on******** **, ****. The State promises to (choose one and delete the other) increase/decrease the amount of funds to be paid to the Contractor by**********Dollars, ($*.**) 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 otherl 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 Ichoose 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 amendnent(s), change order(s), renewal(s) have been processed,otherwise delete"collectively' Ieollectively 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: I 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 situations 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, ($*.**) for an amended total financial obligation of the State of********** DOLLARS, ($*.**). [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 Onginal 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 [identify 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 • 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] O (a political subdivision of the State of Colorado o ernor By: (D) Name: D For the Executive Director Title: S DEPA OF PUBLIC 0 H ENVIRONMENT D M APPROVAL: O , Because the Con ov entity, an attestat c) e By: (Seal, required) By: City, City and County, County, Special District,or Town Clerk or Equivalent (Delete inapplicable language.I 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 STATE OF COLORADO ers Bill Ritter,Jr.,Governor James B.Martin,Executive Director ��,°F c°lo Dedicated to protecting and improving the health and environment of the people of Colorado RQ 4300 Cherry Creek Dr.S. Laboratory Services Division * y Denver,Colorado 80246-1530 8100 Lowry Blvd. *1876• Phone(303)692-2000 Denver,Colorado 80230-6928 TDD Line(303)691.7700 (303)692-3090 Colorado Department Located in Glendale,Colorado of Public Health http://www.cdphe.state.co.us and Environment Prevention Services Division Center for Healthy Families and Communities Children with Special Health Care Needs Unit Telephone:(303)692-2370;FAX:(303)753-9249 November 2,2007 Ms.Judy Nero Weld County Department of Public Health and Environment 1555 North 17t Avenue Greeley,Colorado 80631 Re: Health Care Program for Children with Special Needs Task Order Contract Routing#00446 Dear Ms.Nero: Enclosed please find a fully executed copy of the above referenced Task Order for your files. This Task Order covers the period from October 22,2007 through and including September 30,2008. If you have any question regarding this Task Order,please contact Charla Low,HCP Fiscal Officer or Kathy Watters, CSHCN Unit Director.Charla can be reached at 303-692-2423 or charla.low@state.co.us and Kathy can be reached at 303- 692-2418 or Kathy.waters(r)state.co.us. Sincerely, aLota. F . Aida H. Diaz HCP Contract Coordinator 303-692-2384 placida.diazgstate.co.us Enclosure:Task Order cc: file Hello