HomeMy WebLinkAbout20002485.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR MATERNAL AND CHILD HEALTH SERVICES
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 for the Maternal and Child
Health Services 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 October 2, 2000, and ending September 30, 2001, with further
terms and conditions being as stated in said task order, and
WHEREAS, after review, the Board deems it advisable to approve said task order, 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 for the Maternal and Child Health Services
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.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 16th day of October, A.D., 2000, nunc pro tunc, October 2, 2000.
BOARD OF COUNTY COMMISSIONERS
ATTEST: /�/0,41y'' WEL► COUNTY, •Le - DO
��'/%f► ���1 `CJJ,` i � �i�
arbara J. it meyer, Chair
Weld County Clerk to the
Fit , J. ile, Pro-Tem
t
BY: �u�� 6 �.'1 t1lJ��+ Kr _4 "`
Deputy Clerk to the Boar. � �� �.i.�-
. Baxter
Q ED AS TQ-fORM:
Dale K. Hall
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bounty tt rney 'At/
Glenn Vaad+
2000-2485
HL0027
ft.
40c: Memorandum
11111 TO: Barbara J. Kirkmeyer, Chair,
CBoard of County Commissioners
O FROM: Mark E. Wallace, MD, MPH, Director,
COLORADO Department of Public Health and
Environment
DATE: October 9, 2000
SUBJECT: Maternal and Child Health Services Task
Order
Enclosed for Board review and approval is the Maternal and Child Health Services Task Order
between the Colorado Department of Public Health and Environment (CDPHE) and Weld
County Department of Public Health and Environment (WCDPHE).
This task order will provide continuation funding for the Prenatal and Child Health programs at
WCDPHE. In the Prenatal Program, it will be used to provide prenatal and postpartum care,
including education and counseling and Prenatal Plus enhanced services for low income
women. The funding for the Child Health Program will provide well child clinic services to clients
aged 0 to 16 years. These services include health and psychosocial history, age appropriate
screenings, physical exams, immunizations, teaching of risk-reducing behaviors to parents, and
referrals to appropriate resources for children exhibiting actual or potential physical or emotional
problems.
For these services, WCDPHE will receive a total reimbursement of $140,671 for the period
October 1,2000 through September 30, 2001.
I recommend your approval of this task order.
Enclosure
7213 --,PV e>S
Department or Agency Name
COLORADO DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
Department or Agency Number
FAA
Contract Routing Number
01-00848
TASK ORDER
This TASK ORDER is made this 29TH day of SEPTEMBER 20O0 by and between:the State of Colorado,for
the use and benefit of the COLORADO 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,the BOARD OF COUNTY COMMISSIONERS OF WELD
COUNTY(a political subdivision of the state of Colorado).whose address or principal place of business is 915
10th Street,3rd Floor,Greeley,Colorado 80631 for the use and benefit of the Weld County Department of
Public Health and Environment,whose address or principal place of business is 1555 North 17'"Avenue,
Greeley,Colorado 80631 hereinafter referred to as"the Contractor".
FACTUAL RECITALS
The State has received Title V funds from the United States Department of Health and Human Services(HHS)
under the Maternal and Child Health Services Block Grant(MCH). The State's Division of Family and Community
Health Services(DFCHS) is charged with the administration of funds from Title V of the MCH Block Grant. These
Title V MCH funds are to be used"for the purpose of enabling each State: (a)to provide and to assure mothers and
children(in particular those with low income or with limited availability of health services)access to quality
maternal and child health services;(b)to reduce infant mortality and the incidence of preventable diseases and
handicapping conditions among children,to reduce the need for inpatient and long-term care services,to increase
the number of children(especially preschool children)appropriately immunized against disease and the number of
low income children receiving health assessments and follow-up diagnostic and treatment services, and otherwise to
promote the health of mothers and infants by providing prenatal,delivery,and postpartum care for low income,at-
risk pregnant women,and to promote the health of children by providing preventive and primary care services for
low income children;(c)to provide rehabilitation services for blind and disabled individuals under the age of 16
receiving benefits under Title XVI,to the extent medical assistance for such services is not provided under Title
XIX;and,(d)to provide and to promote family-centered, community-based,coordinated care for children with
special health care needs and to facilitate the development of community-based systems of services for such
children and their families"(Title V of the Social Security Act, Sec.501.[42 U.S.C.701](1)A).
The State has formulated a comprehensive statewide plan to carry out a Maternal and Child Health Services
program(Program), funded by these Title V MCH funds. This comprehensive statewide plan allocates Title V
MCH funds to the implementation of the Program through various participating agencies in order to provide these
health care services to the people of the state of Colorado.
It is the express intent of the parties that in order to support community-based determinations as to the use of the
MCH funds while contributing to a coordinated,efficient,statewide program for the use of those funds. Local
public health agencies,such as the Contractor,shall provide leadership, in coordination with public and private
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community partners, in the development and implementation of county or district maternal and child health plans.
The State shall provide:guidance and technical assistance to the Contractor to support the implementation of its
MCH plan for federal fiscal year 2000-2001 and for the development of its MCH Plan for the following federal
fiscal year.
Each state that receives MCH funds from the HHS must demonstrate to the HHS that it has served three(3)distinct
population groups with those MCH funds. These three(3)distinct population groups are:"the perinatal
population",which is defined to include women of childbearing age,pregnant women,and mothers;the"child and
adolescent population",which is de£med to include infants,children,and adolescents from birth through age twenty
(20); and,"children with special health care needs population",which is defined to include those children who have,
or might have,special health care needs. Under this Task Order,the Contractor shall provide the core public health
services of assessment,policy development, and assurance on behalf of the perinatal population and for the child
and adolescent population as described and defined in"Attachment A","Core Public Health Services Delivered by
MCH Agencies",which is incorporated herein by this reference,made a part hereof,and attached hereto. The
parties acknowledge that the Contractor shall provide services to the children with special health care needs(cshcn)
population through a separate contract with the State. However, under this Task Order,the Contractor shall assess
the needs of the cshcn population and develop a plan for the future delivery of services to that population while it
also assesses the needs of,and develops plans for the continued delivery of services to,the perinatal and the child
and adolescent populations.
The Contractor's decision to provide,or not provide, direct patient care services should be based on an assessment
of the capacity of the community's public and private providers to meet the direct health care needs of its perinatal
and child and adolescent population. 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.
Finally,as to the State,authority exists in the Law and Funds have been budgeted,appropriated, and otherwise
made available,and a sufficient uncommitted balance thereof remains available for subsequent encumbering and
payment in Fund Number 100,Organizational Unit Code 6530,and 6710,Appropriation Code 585 and Object
Code 5420 under Master Contract Routing Number 00-FAA 00008. All required approvals,clearances,and
coordination have been accomplished from and with all appropriate agencies.
NOW THEREFORE, in consideration of their mutual promises to each other,stated below,the parties hereto
agree as follows:
A. PERIOD OF PERFORMANCE AND TASK ORDER TERMINATION. The effective date of this
Task Order is October 2,2000 or on the date this Task Order is approved by the State Controller,
whichever is later. The term of this Task Order shall commence on October 2,2000 and continue
through and including September 30,2001 unless sooner terminated by the parties pursuant to the terms
and conditions of the Master Contract and this Task Order. The total term of this Task Order, including
any renewals or extensions hereof,may not exceed five(5)years.
B. DUTIES AND OBLIGATIONS OF THE CONTRACTOR. The Contractor, in accordance with the
terms and conditions of the Master Contract and this Task Order,shall perform and complete in a timely
and satisfactory manner all work in accordance with the following:
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1. Plan Implementation. The Contractor shall implement its Local Agency Annual Maternal and
Child Health Plan(Plan)for those services and activities which will be completed in federal
fiscal year 2000-2001 (October 1,2000,through September 30,2001). This Plan was previously
developed by the Contractor, in consultation with the State,in federal fiscal year 1999-2000
based on an assessment of the health status needs of its maternal-child populations and of the
health system resources of its community.This Plan is incorporated herein by this reference,made
a part hereof,and attached hereto as"Attachment B".
The Plan is designed to:a. contribute to the accomplishment of the State's priorities,performance
measures,and outcome measures,as identified in"Attachment C",which is incorporated herein
by this reference,made a part hereof,and attached hereto;b.move a local public health agency
out of the direct personal care provider role when it is possible for other community providers to
provide quality primary and preventive care;c.provide for the continuation of the core public
health services of assessment,policy development, and assurance on behalf of the maternal-child
populations; d. assure access to direct care and services for vulnerable women,children,and
adolescents, such as those who are low-income,uninsured,under insured,or who live in rural or
under served areas,or who are from ethnic or cultural minority communities and may experience
language or cultural barriers to services;and,e. contribute to a comprehensive health
improvement plan as described in"Healthy People 2010","Public Health Infrastructure
Development Objective II",if such a health improvement plan is developed by a local public
health agency.
A. Direct Care Services to Women of Childbearing Age: Under this Task Order,the
Contractor shall provide public health services to enhance the health status of women of
childbearing age. All pregnant women seeking prenatal care shall be provided with
information about,and be referred to,comprehensive prenatal care services. The
Contractor shall also assure that all individuals seeking reproductive health services: are
provided with information about pregnancy planning;are advised of the consequences of
unintended pregnancies;and,are referred to comprehensive family planning services that
ensure confidentiality. If the Contractor does provide medical prenatal and postpartum
care,then the Contractor shall:
1. provide prenatal and postpartum care,including education and counseling, in
accordance with the"Prenatal Care Guidelines",a copy of which has been made
available to the Contractor by the State as of the effective date of this Task
Order.
2. offer the following program components to pregnant women:
a. coordinated care between medical providers and the Contractor
including assistance in securing delivery services;
b. referrals and assistance in seeking continuous infant and child health
care;
c. free pregnancy testing in order to provide appropriate medical referrals
for women with positive tests;and,
d. free pregnancy testing in order to provide contraceptive education,
medical referrals,and non-prescriptive contraceptives,if appropriate,to
women with negative pregnancy tests,and referral for a local family
planning provider.
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3. Individual records on each prenatal patient shall be maintained by the
Contractor and are subject to audits,either self or independent,to be determined
by the State.
4. The Contractor shall use all program income generated from the collection of
patient fees and patient or third party donations only for perinatal services which
further the objectives of the legislation under which this Task Order is entered
into. In accordance with Title V, Section 501 (b)(2)and Section 505 (2)(d),the
Contractor shall not impose any charge for services provided to patients at or
below 100%of the poverty level. As of the effective date of this Task Order,
federal poverty guidelines have been provided to the Contractor by the State.
The Contractor may charge patients who are between 100%and 185%of the
poverty level on a sliding fee scale. The Contractor shall advise patients at or
below 133%of poverty level to apply for Medicaid.
B. Provision of CBC/KCP and CCHP+ Program Information: The Contractor shall:
1. Inform potentially eligible applicants or recipients that the"Colorado Baby
Care/Kid's Care Program"(CBC/KCP),a program within Medicaid,exists and
that these potentially eligible applicants or recipients should apply for coverage
under that program through the local county department of social services;
2. Inform potentially eligible applicants or recipients that the Colorado Child
Health Plan Plus+(CCHP+)exists;
3. Inform potentially eligible applicants or recipients that CBC/KCP and CCHP+
may be a potential source of payment for a child's care;
4. Inform potentially eligible applicants or recipients that in order to receive
continuing coverage under CBC/KCP and/or CCHP+they must complete an
application as soon as possible(CBC/KCP allows for up to sixty(60)calendar
days of presumptive eligibility for pregnant women who are registered with
Medicaid.);
5. Obtain from Medicaid and the CCHP+,and have present at its facility,current
information regarding eligibility for,and services provided under CBC/KCP and
CCHP+;and,
6. Have registration forms for CCHP+available at all times.
C. Direct Care Services For Children And Adolescents. If the Contractor chooses to
provide direct health care services to infants,children,or adolescents,then its public
health nursing assessments and interventions shall be consistent with the
recommendations for child health care as delineated in the State's"Child Health Manual"
and other policies and guidelines which have been,or will be,made available to the
Contractor. If the Contractor chooses to provide direct health care services,then the
Contractor shall provide all of the following direct care services:
1. child and adolescent health clinic services,as indicated and appropriate,
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including:
a. a complete health and psychosocial history and unclothed physical
exam;
b. age-appropriate screening,including but not limited to,developmental
screening by the providers or other appropriate community resources;
c. age-appropriate immunizations;
d. age-appropriate anticipatory guidance and teaching of risk-reducing
behaviors to parents,children,and adolescents,including but not
limited to,teaching injury prevention techniques,prevention of motor
vehicle injury and death through the use of infant and child car seats
and seat belts;
e. nursing management and/or referral(s)to appropriate resources for
children exhibiting actual or potential problems in their physical
and/or,developmental and/or psychosocial/emotional status,and,
f. an assessment of adolescent protective and risk-taking behaviors
including the use of alcohol,tobacco,and other drugs;depression and
school adjustment; sexual activity; involvement as either a victim or
perpetrator of violence;motor vehicle safety;and the provision of
intervention services or referrals when appropriate.
2. Home Visitation Services Home visitation services as indicated to infants,
children and their families. The primary purpose of these visits is public health
nursing intervention designed to reduce the risk of injury and disease to the
child and to strengthen child and family development.
3. HCP Referrals: Case finding(s)and medical referral(s)through the above child
health activities for children eligible for the State's Health Care Program for
Children with Special Needs.
4. Other Referrals: Appropriate referrals for all children who fail screening tests
or who are in need of medical or other diagnosis or treatment. The Contractor
shall document its attempts to follow up on these referrals.
5. Submission of Direct Care Documentation: If the Contractor choose to provide
direct child and adolescent health clinic services,then on or before January 15,
2002, the Contractor shall submit to the State,the following documentation:
a. A copy of the aggregate results of a qualitative audit completed on at
least ten percent(10%)of the Contractor's active child health clinic
records,using the State's"Child Health Impact Tool",or a similar
audit approved by the State, indicating that seventy-five(75%)of all
problems,identified through public health nursing assessments have
been appropriately referred, improved,or resolved.
b. Evidence that ninety percent(90%)of all two(2)year old children
enrolled at the Contractor's child health clinics for at least one(1)year
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are current on all recommended immunizations, including but not
limited to Hemophilus B.
2. Submission of Year End Progress Report for Federal Fiscal Year 1999-2000. On or before
January 15,2001,the Contractor shall submit to the State for review and approval a"Year End
Progress Report"for federal fiscal year 1999-2000. This report shall contain: a narrative progress
report following the format presented in"Attachment G",which is incorporated herein by this
reference,made a part hereof, and attached hereto;a completed"Number of Individuals Served
(Unduplicated)Under Title V Report,utilizing Table 1 (7 AR),as in the format presented in
"Attachment E"which is incorporated herein by this reference,made a part hereof,and attached
hereto;for those services provided by the Contractor in federal fiscal year 1999-2000;and,a final
fiscal expenditures report,reporting actual expenditures and match separately for the perinatal and
child health programs showing both the maternal and child health spending and associated match
and signed by a certified official, following the format previously identified as Attachment F.
3 Submission of Annual MCH Plan for Federal Fiscal Year 2001-2002. On or before May 15,
2001,the Contractor shall submit an Annual MCH Plan for federal fiscal year 2001-2002. A
sample format,which the Contractor may use, is incorporated herein by this reference,made a part
hereof,and attached as"Attachment H". The Annual MCH Plan for federal fiscal year 2001-
2002 shall include an assessment of the community health needs and the Contractor's future plans
to address the priority needs for all three(3)maternal-child populations, i.e.the perinatal
population,the child and adolescent population, and the children with special health care needs
population. The federal fiscal year 2001-2002 Annual Maternal and Child Health Plan shall be
based on an reassessment of qualitative and quantitative data. The federal fiscal year 2001-2002
Annual MCH Plan shall:
A. assess and prioritize the health status needs of women of childbearing age,pregnant
women,mothers, infants,children,and adolescents, and children with special health care
needs, of the county, district,or area served by the Contractor;
B. in collaboration with local stakeholders and consumers,reassess the health system and
related service resources of the community served by the Contractor;
C. prioritize the health care needs of the community to be addressed by the Contractor;and,
D. describe the activities or services to be carried out under the federal fiscal 2001-2002
Annual MCH Plan,utilizing the descriptors of direct care services, enabling services,
population based services,or infrastructure building activities, as defined in Attachment
A.
The services or activities may be: current services or activities which effectively address
identified health care needs of the community; or,new services or activities designed to
address unmet or emerging health care needs of the community. These current or new
services or activities may include the provision of direct health care services,information
and referral services,follow up services,case management services; injury or disease
prevention services,activities,or initiatives,or health promotion services or activities.
These current or new services or activities may also include projects designed to build
the Contractor's,or the local community's, infrastructure,whichever is appropriate,for
effective health status improvement. These services or activities may include the creation
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of a community planning structure to develop needed health care resources,or carrying
out a needs assessment. The services or activities chosen by the Contractor should be
best practices or evidence based approaches as identified by a review of the applicable
literature,through the Contractor's past successful experience,or innovative approaches
based on a review of the applicable literature and consultation with experts.
4. Submission of Federal Fiscal Year 2001-2002 Budget Estimate Form. On or before May 15,
2001,the Contractor shall also submit to the State for review and approval two"Budget Estimate
Forms",one for services for the Children With Special Health Care Needs population and the
other for both the Perinatal population and the Child and Adolescent population,for the federal
fiscal year 2001-2002 Annual MCH Plan. The Contractor may use the sample format contained in
"Attachment I",which is incorporated herein by this reference,made a part hereof, and attached
hereto.
5. Review of Federal Fiscal Year 2001-2002 Annual MCH Plan and Budget Estimate Form. Within
forty-five(45)calendar days after the date of submission,the federal fiscal year 2001-2002
Annual MCH Plan and the accompanying Budget Estimate Forms shall be reviewed by the State.
Any recommendations or requirements for changes or additions to that Annual MCH Plan and
Budget Estimate Form shall be provided to the Contractor by the State on or before July 1,2001.
The Contractor and State program staff shall negotiate an agreement, if necessary,regarding any
State proposed recommendation(s)or requirement(s)by August 1,2001. An approved federal
fiscal year 2001-2002 Annual MCH Plan and Budget Estimate Form shall be incorporated as an
attachment into a new maternal and child health services contract or renewal letter beginning
October 1,2001.
6. Submission of Year End Progress Report for Federal Fiscal Year 2000-2001: On or before
January 15,2002, the Contractor shall submit a"Year End Progress Report"to the State for
federal fiscal year 2000-2001,using a format identical or similar to that contained in
"Attachment D",which is incorporated herein by this reference and made a part hereof. This
report shall contain: a narrative progress report,a completed"Number of Individuals Served
(Unduplicated)Under Title V Report",utilizing Table 1 (7 AR). This sample report is previously
referenced and identified as"Attachment E", for those services provided by the Contractor in
federal fiscal year 2000-2001;and,a final fiscal expenditures report,reporting actual expenditures
and match separately for the perinatal and child health programs showing both the maternal and
child health spending and associated match and signed by a certified official,following the format
attached hereto as"Attachment F",which is incorporated herein by this reference and made a
part hereof.
7. Authorization to Subcontract: The State authorizes the Contractor to subcontract some, or all,of
the services which 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 which are to be performed under this Task Order,then the Contractor shall obtain the
prior,express,written consent of the State before entering into any subcontract.
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C. DUTIES AND OBLIGATIONS OF THE STATE. The State, in accordance with the terms and
conditions of the Master Contract and this Task Order, shall perform and complete in a timely and
satisfactory manner all work in accordance with the following:
1. Assistance and Support to the Contractor. It is the duty of the State:to provide technical
assistance to the Contractor;to support the Contractor's implementation of its MCH Plan for
federal fiscal year 2000-2001;and,to assist the Contractor in the development of an information
based Annual Maternal and Child Health)Plan for federal fiscal year 2001-2002. Accordingly,
the State shall:
A. On or before February 1,2001,provide an update of the service area specific maternal
and child health services data set to be utilized by the Contractor in developing its
Annual MCH Plan.
B. Provide on-going consultation services to the Contractor on the use of the maternal and
child health data set in the Contractor's assessment and planning process.
C. Research data sources to obtain additional service area specific data,particularly any race
or ethnic health disparity data,to add to the maternal and child health data set and
provide updated information to the Contractor.
D. Provide consultation services to the Contractor regarding community-based assessment
and planning resources, including model tools and processes.
E. Provide consultation services to the Contractor regarding"Best Practice"and"Evidence-
Based"activities or interventions to address the Contractor's identified health status
needs.
2. Review of Federal Fiscal Year 2001-2002 Annual MCH Plan and Budget Estimate Form. Within
forty-five(45)calendar days after the date of submission,the federal fiscal year 2001-2002
Annual MCH Plan and its accompanying Budget Estimate Form shall be reviewed by the State.
Any recommendations or requirements for changes or additions to that Annual MCH Plan and
Budget Estimate Form shall be provided to the Contractor by the State on or before July 1,2001.
The Contractor and State program staff shall negotiate an agreement, if necessary,regarding any
State proposed recommendation(s)or_requirement(s)by August 1,2001. An approved federal
fiscal year 2001-2002 Annual MCH Plan and Budget Estimate Form shall be incorporated as an
attachment into a new maternal and child health services Task Order beginning October 1,2001.
3. Compensation. In consideration of those services timely and satisfactorily performed by the
Contractor under this Task Order,the State shall cause to be paid to the Contractor an amount not
to exceed$ONE HUNDRED FORTY THOUSAND SIX HUNDRED AND SEVENTY ONE
DOLLARS,($140,671.00)for the term between October 2,2000,and September 30,2001. Of
this total financial obligation of the State to the Contractor under this Task Order,$140.671.00 are
identified as attributable to a funding source of the United States and$0.00 are identified as
attributable to a funding source of the state of Colorado. Payments under this Task Order are
subject to verification by the State that the Contractor has fully and satisfactorily complied with
the terms and conditions of this Task Order. The Contractor shall maintain original
documentation for all costs related to the Contractor's performance under this Task Order for a
period of six(6)years following the date of termination of this Task Order.
4. Payment Mechanism. Monthly reimbursements under this Task Order shall be paid to the
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Contractor by the State based upon one-twelfth(1/I2)of the projected cost of this Task Order.
D. ADDITIONAL PROVISIONS.
I. Restriction on Use of Title V Funds: 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).
2. Smoke-free Environment: The Contractor shall provide all 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,smoke-free shall mean that smoking is not permitted in
any portion of any indoor facility owned, leased, or otherwise contracted for by the Contractor if
that facility is routinely or regularly used for the provision of child care or health services to any
child under the age of 18 when those services are funded all or in part with Federal funds.
3. Limitation on Charges for Services: The Contractor shall not charge for services those individuals
of families who are at or below the official poverty line as defined by the Office of Management
and Budget(OMB)in accordance with Title V,Section 501 (B)(2)and Section 505 (2)(d). As
of the effective date of this Contract,the 100%of poverty income guideline for farm or non-farm
families is currently at$8,350 for an individual;$11,250 for a family of 2; $14,150 for a family
of 3;$17,050 for a family of 4; $19,950 for a family of 5; $22,850 for a family of 6;$25,750 for
a family of 7;$28,650 for a family of 8. For families of more than eight,the Contractor shall add
$2,900 for each additional member to determine the appropriate poverty income guideline These
poverty income guidelines may change during the term of this Task Order. If new poverty income
guidelines are received by the State from the OMB,then the State shall forward these new poverty
income guidelines to the Contractor. The Contractor shall use these new poverty income
guideline upon receipt.
4. Use of Sliding Fee Scale: If the Contractor imposes any charges for services to clients who are
above 100%of poverty level,then these charges must be based on a sliding fee scale which takes
into account the clients family size, income,and available resources. These charges and the
sliding fee scale must be made available to all clients and the general public, and must be based on
the Contractor's usual and customary cost for the service. Clients must understand that they will
not be denied services because of an inability to pay any of the sliding fee charges.
5. Confidentiality: 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 a minor
applicants or recipient's parent or guardian 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
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requirements.
6. Title VI Compliance: The 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. Even if a client has their own interpreter,they shall be advised that the
Contractor will provide an interpreter if the client so chooses.
7. Change Order Letter Process. The State may prospectively increase or decrease the amount
payable under this Task Order through a"Task Order Change Order Letter". A sample Task
Order Change Order Letter is incorporated herein by this reference,made a part hereof, and
attached hereto as"Attachment J". To be effective,the Task Order Change Order Letter must
be: signed by the State and the Contractor;and,approved by the State Controller or an authorized
designee thereof. Additionally,the Task Order Change Order Letter shall include the following
information:
A. Identification of the related Master Contract by its contract routing number and this Task
Order by its contract number,and the affected Task Order paragraph number(s);
B. The type(s)of service(s)or program(s)increased or decreased and the new level of each
service or program;
C. The amount of the increase or decrease in the level of funding for each service or
program and the new total financial obligation;
D. The intended effective date of the funding change;and,
E. A provision stating that the Task Order Change Order Letter shall not be valid until
approved by the State Controller or such assistant as he may designate.
Increases or decreases in the level of contractual funding made through this task order change
order letter process during the initial or renewal terms of this Task Order may be made under the
following circumstances:
F. If necessary to fully utilize appropriations of the state of Colorado and/or non-
appropriated federal grant awards;
G. Adjustments to reflect current year expenditures;
H. Supplemental appropriations,or non-appropriated federal funding changes resulting in an
increase or decrease in the amounts originally budgeted and available for the purposes of
this Task Order;
Page 10 of 12
I. Closure of programs and/or termination of related contracts or task orders;
J. Delay or difficulty in implementing new programs or services;and,
K. Other special circumstances as deemed appropriate by the State.
Upon proper execution and approval,the Task Order Change Order Letter shall become an
amendment to this Task Order. Except for the General and Special Provisions of the Master
Contract,the Task Order Change Order Letter shall supersede this Task Order in the event of a
conflict between the two. It is expressly understood and agreed to by the parties that the task
order change order letter process may be used only for increased or decreased levels of funding,
corresponding adjustments to service or program levels,and any related budget line items. Any
other changes to this Task Order,other than those authorized by the task order renewal letter
process described below,shall be made by a formal amendment to this Task Order executed in
accordance with the Fiscal Rules of the State of Colorado.
If the Contractor agrees to and accepts the proposed change,then the Contractor shall execute and
return the Task Order Change Order Letter to the State by the date indicated in the Task Order
Change Order Letter. If the Contractor does not agree to and accept the proposed change, or fails
to timely return the partially executed Task Order Change Order Letter by the date indicated in the
Task Order Change Order Letter,then the State may,upon written notice to the Contractor,
terminate this Task Order twenty(20)calendar days after the return date indicated in the Task
Order Change Order Letter has passed. The written notice shall specify the effective date of
termination of this Task Order. In the event of termination under this clause,the parties shall not
be relieved of their respective duties and obligations under this Task Order until the effective date
of termination has occurred.
E. ATTACHMENTS. All attachments to this Task Order are incorporated herein by this reference and made
a part hereof as if fully set forth herein. In the event of any conflict or inconsistency between the terms and
conditions of this Task Order and those of any attachment hereto,the terms and conditions of this Task
Order shall control.
Page 11 of 12
IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO
OF WELD COUNTY Bill Owens,Governor
For the use and benefit of the
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT
(a political subdivision of the state of Colorado)
By: By: rt—
Barbara J. Kirk eyer o For the xecutive Directo
Chair (10/16/2000) Colo do Department of
FEIN: 84-6000813 Public Health and Environment
If Corporation,Town/City/County,or Equivalent: PROGRAM APPROVAL:
.49,e
.
ATTE Utfd.:& % BY:
is ��.-ry f`
���. . .
ti�J�
By:
CMCINNUICS0MC`• �'. ' +'+i\is�i �'F:1 , ���,xxl te [
Deputy Clerk to th•` dil1
APPROVALS:
COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL
OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER
Ken Salazar,Attorney eneral Arthur L.Barnhart,State Controller
CLl/ r By: -J
By:
WELD COUNTY UEPAR₹MEN₹ OF
PUBLIC HEALTH
� '2
AV/ ENVIRONMENT
�
BY: "'` %% Page 12 of 12
Mark E. Wallace, MD, MPH•Director
ATTACHMENT A
CORE PUBLIC HEALTH SERVICES
DELIVERED BY MCH AGENCIES
DIRECT
HEALTH CARE
SERVICES:
(GAP FILLING)
Examples:
Basic Health Services,
and Health Services for CSHCN
ENABLING SERVICES:
Examples:
Transportation,Translation,Outreach,
Respite Cue,Health Education,Family
Support Services,Purchase of Health Insurance,
Case Management,Coordination with Medicaid,
WIC,and Education
POPULATION-BASED SERVICES:
Examples:
Newborn Screening,Lead Screening,Immunization,
Sudden Infant Death Syndrome Counseling,Oral Health,
Injury Prevention,Nutrition
and Outreach/Public Education
INFRASTRUCTURE BUILDING SERVICES:
Examples:
Needs Assessment,Evaluation,Planning,Policy Development,
Coordination,Quality Assurance,Standards Development,Monitoring,
Training,Applied Research,Systems of Cue,and Information Systems
MCHB/OscH {0!10/97
Definitions of the Four Types of Services
by Which
the Core Public Health Services are Provided by Maternal and Child Health Programs
as Defined by the Maternal and Child Health Bureau
Direct health care services are defined as basic health services. Such services are generally
delivered"one on one"between a health professional and a patient in an office, clinic or
emergency room. Basic services include what most consider to be ordinary medical care,
inpatient and outpatient medical services, allied health services, drugs, laboratory testing, x-ray
services, dental care, and pharmaceutical products and services. State Title V programs support
services such as prenatal care, child health, school health and family planning by directly
operating programs or by funding local providers. Direct health care services also include health
care services for children with special needs.
Enabling services are defined as services that allow or provide for access to and the derivation of
benefits from the array of basic health care services. Enabling services include transportation,
translation, outreach, respite care, health education, family support services, purchase of health
insurance, case management, and coordination of care. These kinds of services are especially
necessary for the low-income population which is disadvantaged, geographically or culturally
isolated, and for those with special and complicated health needs.
Population-based services are defined as services which are intended and available for the entire
population, rather than for a selected group of individuals. Disease, prevention, health promotion
and statewide outreach come under this heading. Oral health, injury prevention, nutrition and
outreach and public education are topics which also belong in this category. Population-based
services are generally available for women and children regardless of whether they receive care
in the public or private sector or whether or not they have health insurance.
Infrastructure Building services are defined as those services that are directed at improving and
maintaining the health status of a population. Included among those services are development
and maintenance of health systems, standards, and guidelines, training, data, and planning.
Needs assessment, evaluation, policy development, quality assurance, information systems, and
applied research are all contained within the infrastructure umbrella.
ATTACHMENT C
Colorado MCH Priorities
1.) Reduce teen pregnancy and unintended pregnancy in women of all ages.
2.) Improve perinatal outcomes.
3.) Reduce child and adolescent morbidity.
4.) Increase health and safety in child care settings.
5.) Improve efforts to reduce unintentional and intentional injury, addressing motor vehicle
crashes, suicide, child abuse and other violence.
6.) Improve immunization rates for all children.
7.) Increase access to health care (including behavioral health care).
8.) Improve state and local infrastructure by increasing capacity to analyze data, carry out
evaluations, develop quality standards, and assure availability of services to all children,
including children with special health care needs.
9.) Reduce substance abuse (alcohol, tobacco, and drugs).
10.) Improve oral health and access to oral health care.
National MCH Performance Measures
1 The percent of State SSI beneficiaries less that 16 years old receiving rehabilitative
services from the State Children with Special Health Care Needs Program
2 The degree to which the State Children with Special Health Care Needs Program
provides or pays for specialty and subspecialty services,including care coordination,
not otherwise accessible or affordable to its clients (nine-point scale)
3 The percent of Children with Special Health Care Needs in the State who have a
"medical home"
4 Percent of newborns in the State with at least one screening for each of PKU,
hypothyroidism, galactosemia, hemoglobinopathies (e.g. the sickle cell diseases)
5 Percent of children through age 2 who have completed immunizations for Measles,
Mumps, Rubella, Polio, Diptheria, Tetanus, Pertussis, Haemophilus Influenza,
Hepatitis B
6 The rate of birth (per 1,000) for teenagers aged 15 through 17 years
7 Percent of third grade children who have received protective sealants on at least one
permanent molar tooth
8 The rate of deaths to children aged 1-14 caused by motorvehicle crashes per 100,000
children
9 Percentage of mothers who breastfeed their infants at hospital discharge
10 Percent of Children with Special Health Care Needs (CSHCN) in the State CSHCN
program with a source of insurance for primary and specialty care
11 Percent of all children in the state without health insurance
12 The rate (per 100,000) of suicide deaths among youths aged 15 - 19
13 Percent of very low birth weight live births
14 Percent of potentially Medicaid eligible children who have received a service paid
by the Medicaid Program
15 Percentage of newborns who have been screened for hearing impairment before
hospital discharge
16 The degree to which the State assures family participation in program and policy
activities in the State CSHCN program
17 Percent of very low birth weight infants delivered at facilities for high-risk deliveries
and neonates
18 Percent of infants born to pregnant women receiving prenatal care beginning in the
first trimester
Outcome Measures
1 The infant mortality rate per 1,000 five births
2 The ratio of the black infant mortality rate to the white infant mortality rate
3 The neonatal mortality rate per 1,000 live births
4 The postneonatal mortality rate per 1,000 live births
5 The perinatal mortality rate per 1,000 live births
State-Chosen MCH Performance Measures
1.) The proportion of high school students reporting having drunk alcohol in the past month.
2.) The proportion of all pregnancies that are unintended.
3.) The incidence of maltreatment of children younger than 18 (including physical abuse,
sexual abuse, emotional abuse, and/or neglect).
4.) The proportion of child care settings with access to comprehensive health and safety
consultation and training.
5.) The rate of deaths to adolescents age 15 - 19 caused by motor vehicle crashes per 100,000
children.
6.) The proportion of high school students reporting regular use of tobacco products.
7.) The proportion of children and adolescents attending public schools who have access to
research-based health education and to basic preventive and primary physical and
behavioral health services through school-based health centers.
8.) The percent of Medicaid-eligible children who receive dental services as part of their
comprehensive services.
9.) The percentage complete of an integrated data system for MCH programs, beginning with
HCP. (Ends as a state performance measure with FFY 00.)
10.) The rate of homicides among teens 15 - 19 and among black male teens.
11.) The degree to which the State supports data analysis and dissemination of results for local
and state MCH planning. (Begins with FFY 01, replacing State Performance Measure 9.)
•
ATTACHMENT D
Outline for Year End Progress Report
for Federal Fiscal Year 2000-2001
(October 1, 2000 through September 30, 2001)
DUE JANUARY 15, 2002
Please put the agency name, contact person and telephone number at the beginning of the report
or on a cover page.
MCH Plan Progress Report
A. Perinatal Population:
1. Restate the priority needs of the perinatal population for which the MCH
funds were used.
2. For each priority need for which MCH funds were used:
Restate the objective(s) which addressed that priority need;
State if the objective was fully met, partially met, or not met;
Describe what was accomplished, including summarizing
important activities.
B. Child and Adolescent Population:
1. Restate the priority needs of the child and adolescent population for which
the MCH funds were used.
2. For each priority need for which MCH funds were used:
Restate the objective(s)which addressed that priority need;
State if the objective was fully met,partially met, or not met;
Describe what was accomplished, including summarizing
important activities.
C. Children with Special Health Care Needs (CSHCN) Population:
1. Restate the priority needs of the children with special health care needs
population for which the CSHCN funds were used, through the contract
with the Health Care Program for Children with Special Health Care
Needs(HCP):
2. For each priority need for which the CSHCN funds were used:
Restate the objective(s) which addressed that priority need;
State if the objective was fully met, partially met, or not met;
Describe what was accomplished, including summarizing
important activities.
3. Please describe any mechanisms that are in place in your community for
coordination of health services which are new since the report in January
of last year. This would include coordination among providers of primary
care, habilitative and rehabilitative service, or other specialty medical
treatment services, mental health services and home health care.
4. Please describe any mechanisms that are in place in your community for
coordination and service integration among programs serving children
with special health care needs, including early intervention and special
education, social services and family support services, which are new
since the report in January of last year.
II Describe any important changes in administrative or organizational aspects of the
program which affected service delivery during the twelve-month period.
III Describe any emerging issues regarding the perinatal population, child and adolescent
population and/or the children with special health care needs population in your
community.
IV Fill out Tables I and II as applicable and submit along with your report.
V Complete the Final Expenditure Report for Maternal and Child Health Programs for the
MCH funded services for the Perinatal Population and for the Child and Adolescent
Population. (Attachment F).
Please submit five (5) copies of your report to:
Carolyn Dodge, CPS, FCHSD-ADM A4
Family and Community Health Services Division
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO 80246-1530
no later than 5:00 P.M. on Tuesday, January 15, 2002
for the period October 1, 2000 through September 30, 2001
Program
Prepared by
Telephone
TABLE I (7 AR)
NUMBER OF INDIVIDUALS SERVED (UNDUPLICATED) UNDER TITLE V
By Class of Individuals and Health Coverage, FY 2000-2001* *October 1, 2000 through September 30, 2001.
(1) (2) (3) (4) (5) (6)
Number
Number with Number Number
Unduplicated Count by with Title XXI with Other With No Number
Class of Individual Served Total Number' Medicaid2 (CHIP)3 Insurance' Coverages Unknow
n
Pregnant women, postpartum and deliveries'
t-
Infants under age one (not elsewhere)e
Children age 1-22 (not elsewhere)1°
Children with special health care needs'
Other individuals (not elsewhere)9
Total MCH Population"
Please take the Total Number shown in Column 1 for Children age 1-22 and estimate the number in each of the following age groups:
Age 1-4: Age 5-9: Age 10-14: Age 15-19: Age 20-22: -
Estimates (round numbers) are acceptable and are preferable to no data. Please estimate to the best of your ability. Be sure that Col.
(2) + Col. (3) + Col. (4) + Col. (5) + Col. (6) = Col. (1). If a person can be counted in more than one class in a year, select one class
only in which to report them. If you cannot provide information on health coverage, show Col. (1) figures in Col. 6 (number unknown)
as well. These data will be used at the state level to compile Colorado's Annual Form 7 AR in the MCH federally required Annual
Report. If you need help call Sue Ricketts, Family and Community Health Services, Colorado Department of Public Health and
Environment, (303)692-2316.
Include this table with the Final Progress Report due January 21, 2002, to Carolyn Dodge, CPS, FCHSD-ADM-A4, Colorado
Department of Public Health and Environment, 4300 Cherry Cr. Dr. South, Denver, CO 80246-1530.
Footnotes for Table 1 (7 AR):
'Total number of individuals who received a direct service (in person or by phone) from the Title V program regardless of the primary
source of coverage.
2Number of individuals in Column 1 whose primary source of coverage was Title XIX.
3Number of individuals in Column 1 whose primary source of coverage was Title XXI (Child Health Insurance Program).
'Number of individuals in Column 1 whose primary source of coverage was private insurance, including HMOs, PPOs, etc.
'Number of individuals in Column 1 for whom there was no payment. It will be assumed that the costs of care for these patients was
wholly supported by Title V.
'Total number of pregnant (or postpartum) women who received any services provided or paid for in whole or in part by Title V.
'Total number of individuals under the age of 22 who received any services under the State plan for children with special health care
needs provided or paid for in whole or in part by Title V.
'Total number of infants less than one who received any services provided or paid for in whole or in part by Title V.
9Total number of individuals (other than pregnant or postpartum women, infants, children age 1 through 21 or children with special
health care needs) who received services provided or paid for in whole or in part by Title V.
10Total number of individuals ages 1 through 21 who received any services provided or paid for in whole or in part by Title V (excluding
children with special health care needs or pregnant women through 21).
"Total is the sum of the numbers shown for each of the classes of individuals (each class is mutually exclusive of every other class).
Table I, 7/26/00
c:\123 r3\mch a p p02\6mo&fp r.d oc
is\sue\mchapp02\6mo&fpr.doc
Table II applies only to programs providing service to pregnant women and/or infants under the age of 1.
Program
Prepared by
Telephone
TABLE II (8 AR)
NUMBER OF DELIVERIES AND INFANTS SERVED BY TITLE V
UNDUPLICATED COUNT BY RACE AND ETHNICITY, FY 00-01*
(1) (2) (3) (4) (5) (6)
(7) (8)
Asian or
Total All American Pacific Other& Total Total Non-
Races White Black Indian Islander Unknown Hispanic Hispanic
Total Pregnant Women served by
program '
Total Infants served by program2
* October 1, 2000 through September 30, 2001.
=Total number of pregnant/postpartum/delivery care women paid for in whole or in part by Title V. While the table title says deliveries, the
number should include women who received prenatal care regardless of how their delivery was covered.
Total infants under the age of 1 who received any services provided or paid for in whole or in part by Title V.
The numbers in Column 1 should be the same as the numbers in Column 1 in Table I (7AR)! Estimates are acceptable and are
preferable to no data. Please estimate to the best of your ability.
Be sure that Col. (2) + Col. (3) + Col. (4) + Col. (5) + Col. (6) = Col. (1). Columns (7) and (8) must also equal Col. (1). These data will be
used at the state level to compile Colorado's Annual Form 8 AR in the MCH federally required Annual Report. If you need help call Sue
Ricketts, Family and Community Health Services, Colorado Department of Public Health and Environment, (303)692-2316.
Include this table with the Final Progress Report due January 21, 2002, to Carolyn Dodge, CPS, FCHSD-ADM-A4, Colorado
Department of Public Health and Environment, 4300 Cherry Cr. Dr. South, Denver, CO 80222-1530.Table II
ATTACHMENT F
FINAL EXPENDITURE REPORT for MATERNAL AND CHILD HEALTH PROGRAMS
CONTRACTOR:
PROGRAM:
PERIOD:
TOTAL EXPENDITURES APPLICANT AND MATERNAL AND
OTHER CHILD HEALTH
FROM CDPHE
$ $ $
SOURCE OF "APPLICANT AND OTHER"
STATE PER CAPITA (1) $
LOCAL/COUNTY (2) $
MEDICAID $
PATIENT FEES $
OTHER $
TOTAL $
(1) MAY THESE STATE PER CAPITA FUNDS BE USED TO MATCH THE
MATERNAL AND CHILD HEALTH BLOCK GRANT YES NO
(2) MAY THESE LOCAL/COUNTY FUNDS BE USED TO MATCH THE
MATERNAL AND CHILD HEALTH BLOCK GRANT YES NO
SIGNATURE OF DIRECTOR OR AUTHORIZED REPRESENTATIVE
NOTE: Even though CDPHE, Maternal and Child Health Services program is no longer requesting that
contractors report actual expenditures by individual line items, contractor is responsible for maintaining
expenditure information in sufficient detail so that they can meet the requirements of an audit.
H:MCHEXPRPT
ATTACHMENT G
Outline for Year End Progress Report
for Federal Fiscal Year 1999-2000
(October 1, 1999 through September 30, 2000)
Due January 15, 2001
Please put the agency name, contact person and telephone number at the beginning of the report
or on a cover page.
Please report the progress which was made in addressing the needs of the perinatal population
and of the child and adolescent population, under the Preliminary Plan for Utilization of
Maternal and Child Health Block Grant Funds, submitted to the State in December, 1999.
A. Progress in addressing needs of the Perinatal Population:
1. What direct services, if any, did your agency provide or use MCH funds to
provide?
2. What enabling services, if any, did your agency provide?
3. What population-based services, if any, did your agency provide?
4. What infrastructure building services or activities, if any, did your agency
provide?
5. Were there substantial changes in the types or amounts of any of the services
provided from the planned services as described in your agency's Preliminary
Plan for Utilization of MCH Block Grant Funds for federal fiscal year 1999-2000?
Explain the reason(s) for any substantial changes?
B. Progress in addressing needs of the Child and Adolescent Population:
1. What direct services, if any, did your agency provide?
2. What enabling services, if any, did your agency provide?
3. What population-based services, if any, did your agency provide?
4. What infrastructure building services or activities, if any, did your agency
provide?
5. Were there substantial changes in the types or amounts of any of the services
provided from the planned services as described in your agency's Preliminary
Plan for Utilization of MCH Block Grant Funds for federal fiscal year 1999-2000?
Explain the reason for any substantial change(s).
C. Please describe any important changes in administrative or organizational aspects of the
program which affected service delivery during the twelve-month period.
D. Describe any emerging issues regarding the perinatal population, child and adolescent
population and/or the children with special health care needs population in your
community.
E. Fill out Tables I and II as applicable and submit along with your report.
F. Complete the Final Expenditure Report for Maternal and Child Health Programs for the
MCH funded services for the Perinatal Population and for the Child and Adolescent
Population(Attachment F).
Please submit five (5) copies of your report to:
Carolyn Dodge, CPS, FCHSD-ADM A4
Family and Community Health Services Division
Colorado Department of Public Health and Environment
4300 Cherry Creek Drive South
Denver, CO 80246-1530
no later than 5:00 P.M. on Monday,January 15, 2001
ATTACHMENT H
COUNTY MCH PLAN
The County MCH Plan asks the local public health agency to assess and prioritize the health
status needs of the Perinatal Population, the Child and Adolescent Population and the Children
with Special Health Care Needs Population (CSHCN) and to identify how the MCH funds will
be used to address the priority needs. The Plan is to categorize the activities or services which
will be used to address the needs by four types of services, i.e. direct care services, enabling
services, population-based services or infrastructure-building activities as defined by the
Maternal and Child Health Bureau in "Core Public Health Services Delivered by MCH
Agencies".
Quantitative and qualitative data gathered at the state and local levels should be used in assessing
health status needs. The resources available in the community to meet the needs should also be
assessed and considered in establishing the priorities to be addressed. Local public health
agencies are encouraged to collaborate with public and private partners in the development of the
Maternal and Child Health Plans.
Colorado has identified ten MCH priorities to be addressed with MCH Block Grant funding.
The services or activities provided under the MCH funding should be responsive to one or more
of the priorities. There is no ranking of the ten priorities. They are as follows:
1. Reduce teen pregnancy and unintended pregnancy in women of all ages.
2. Improve perinatal outcomes.
3. Reduce child and adolescent morbidity.
4. Increase health and safety in child care settings.
5. Improve efforts to reduce unintentional and intentional injury, addressing motor
vehicle crashes, suicide, child abuse and other violence.
6. Improve immunization rates for all children.
7. Increase access to health care (including behavioral health care).
8. Improve state and local infrastructure by increasing capacity to analyze data, carry
out evaluations, develop quality standards, and assure availability of services to
all children, including children with special health care needs.
9. Reduce substance abuse (alcohol, tobacco, and drugs).
10. Improve oral health and access to oral health care.
Please present the Statement of Need and the Plan for each of the three population groups, 1)
perinatal, 2) children and adolescents and 3) children with special health care needs using the
following format:
1
1. PERINATAL POPULATION - Preventive and primary care for childbearing age women,
pregnant women, and mothers
A. Statement of Need -- What are the priority needs of the Perinatal population in the
County or District, based on an assessment of the health status needs and of the
resources to address the needs? (2 pages)
1.) Health Status Indicators -- What information about the health status of the
women in your county or district were used to select the priority needs?
• Cite county-specific data(quantitative and/or qualitative), such as data for
the following MCH Measures and for any others which you may identify
to explain how the priority needs were identified:
* The rate of birth (per 1,000) for teenagers age 15 - 17 years
* The percent of infants born to pregnant women receiving prenatal
care beginning in the first trimester
* The percent of mothers who breast-feed their infants at hospital
discharge
* The percent of low birth weight births
* The percent of very low birth weight births
* The percent of very low birth weigh infants delivered at facilities
for high-risk deliveries (Level 3 facilities)
• Cite any racial or ethnic disparities which may exist in your county for the
indicators listed above or for other health indicators you have identified.
• Once these data have been collected, your data analysis will reveal which
of these indicators are significant for your county or district. Priority
should be given to indicators which indicate a health status problem or
there should be an explanation of why it is not necessary or possible to use
MCH resources to address that issue.
• There may be a health status indicator for which the county has a good
measure because the county has directed resources to address that issue. In
such a situation, it may be a priority to continue to address that health need
under the MCH Plan. The Plan could include that need as one of the
2
priorities that is to be addressed and provide information as to why it is
necessary to maintain funding for activities to address that issue.
2.) Resources to address the health status needs -- What are the resources of
the public health agency and of other agencies in the community which
address the priority needs?
a.) Direct Care Service Needs -- What are the resources in the
community which provide prenatal medical care and family
planning services? Are there gaps or unmet needs in such direct
care services? Are there issues of availability and accessibility?
Present such information as the availability and accessibility of
prenatal medical care and family planning services. If you are
planning on using funding for direct prenatal care, describe the
need for the gap-filling role and note your plan for transitioning
these services to other providers.
b.) Enabling Service Needs -- Are enabling services, i.e.
transportation, interpretation and translation, outreach, health
education, family support services, purchase of health insurance,
case management, coordination with other related services needed
to address any of the identified priority needs?
c.) Population-Based Service Needs -- What population-based services
are needed to address the identified priority needs? Present
information regarding the need for population-based services, such
as unintentional pregnancy prevention initiatives, healthy lifestyle
promotions, disease prevention education initiatives, etc., which
would address any of the identified priority needs.
d.) Infrastructure-Building Service or Activity Needs -- What
infrastructure-building services or activities are needed to address
the priority needs? Present information regarding the need for
services or activities such as planning activities, needs
assessments, program evaluation,policy development,program
coordination, quality assurance activities, standards development,
monitoring, training, research, developing systems of care and
related services, or information systems which are needed to
address identified priority needs.
3.) Continuing or unmet needs—Considering the health status needs and the
resources which address the needs that were identified above,what are the
3
continuing or unmet needs for direct care, enabling, population-based
and/or infrastructure building services?
B. Perinatal Plan
1.) Priority Needs for use of MCH funds--Considering the priority needs
identified in the Statement of Need (Section A) and the available MCH
funds, what are the priority needs of the perinatal population for which
MCH funding will be used? Explain your rationale for selecting these
needs to be the ones addressed with the MCH funds.
2.) Operational Plan--Objectives, Activities, Monitoring and Evaluating
Need Restate each of the needs that will be addressed with MCH
funding
Objective State the objective or objectives (one to four objectives
suggested) that will address this need. All objectives
should be reasonable, specific, time-framed and
measurable.
Activities Describe the specific activities that will be carried out to
achieve each objective. Include "Best Practice"or
"Evidence-Based" interventions or activities whenever
possible. Categorize the activities according to the level or
type of MCH service being carried out (i.e., direct health
care, enabling, population-based, or infrastructure-
building).
Monitoring Describe your methods of monitoring to assure quantity of
service(numbers of clients and services) and quality of
service (measured through use of protocols, chart audits,
policy procedure manuals, etc.). Infrastructure-building
activities or services may be monitored by tracking the
completion of planned activities or whether benchmarks
have been realized or protocols or policy procedures put in
place.
Evaluation Describe your methods of evaluating the effectiveness of
your activities in addressing the identified need.
4
IL CHILD AND ADOLESCENT POPULATION--preventive and primary health care
services for children and adolescents
A. Statement of Need-- What are the priority needs of the Child and Adolescent Population
in the county or district, based on an assessment of the health status needs and of the
resources to address the needs? (2 pages)
1.) Health Status Indicators -- What information about the health status of the
children and adolescents in your county or district was used to select the priority
needs?
• Cite county-specific data(quantitative and/or qualitative) such as data for the
following MCH Measures and for any other indicators which you may identify to
explain how the priority needs were identified:
* The percent of children through age 2 who have completed immunizations
for measles, mumps, rubella, polio, diptheria, tetanus,pertussis
haemomphilus influenza, and Hepatitis B.
* The rate of deaths (per 100,000) to children aged 1-14 caused by motor
vehicle crashes
* The incidence of maltreatment of children younger than 18 (including
physical abuse, sexual abuse, emotional abuse, and/or neglect)
* The rate of birth (per 1,000) for teenagers aged 15 through 17 years
* The rate(per 100,000) of suicide deaths among youths age 15-19
* The rate (per 100,000) of deaths to adolescents age 15-19 caused by motor
vehicle crashes
* The rate of homicides among teens 15-19 and among black male teens
(when population permits)
* The proportion of high school students reporting having drunk alcohol in
the past month
* The proportion of high school students reporting regular use of tobacco
products
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* The injury hospitalization rate, by cause, for children and adolescents ages
1-9, 10-14, and 15-19
* The percent of children and adolescents in poverty
• Cite any racial or ethnic disparities which may exist in your county for the
indicators listed above or for other health status indicators you have identified.
• Once these data have been collected, your data analysis will reveal which of these
indicators are significant for your county or district. Some priority should be
given to indicators which indicate a health status problem or there should be an
explanation of why it is not necessary or possible to use MCH resources to
address that issue.
• There may also be a health status indicator for which the county has a good
measure because the county has directed resources to address that issue. In such a
situation it may be a priority to continue to address that health need under the
MCH Plan. The Plan could include that need as one of the priorities that is to be
addressed and provide information regarding the need to maintain funding to
address that issue.
2.) Resources to address the health status needs -- What are the resources of the
public health agency and of other agencies in the community which address the
priority needs?
a.) Direct Care Service Needs -- What are the resources in the community
which provide primary and/or preventive health care services for children
and adolescents? Consider such information as that listed below:
* The percent of eligible children and adolescents enrolled in
Medicaid and CHP+
* The availability of providers who participate in Medicaid and
CHP+
* The availability of confidential care for teens
* The availability of pediatric and adolescent-trained providers
* The availability and accessibility of pediatric and adolescent
mental health services
* The availability and accessibility of substance abuse treatment for
adolescents
* The availability of school health and school-based health center
services
* The percent of children without health insurance
* The availability of direct care services, including home visiting
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* The availability and accessibility of dental care
b.) Enabling Service Needs -- Are enabling services, i.e. transportation,
interpretation and translation, outreach, respite care, health education for
individuals, family support services, purchase of health insurance, case
management, coordination with other related services, etc., needed to
address the identified priority needs and the barriers to receipt of services?
c.) Population-Based Service Needs -- What population-based services are
needed to address the priority needs? Present information regarding the
need for population-based services, such as injury prevention initiatives,
teen pregnancy prevention initiatives, school health and health education
programs, suicide prevention activities, violence prevention activities,
including child abuse prevention, and youth "assets" building programs,
etc., which would address any of the identified priority needs.
d.) Infrastructure-Building Service or Activity Needs -- What infrastructure-
building services or activities are needed to address the priority needs?
Present information regarding the need for such services or activities as
child mortality review committees, processes for needs assessments,
planning, and evaluation, policy development, program coordination,
quality assurance activities, standards development, monitoring, training,
research, developing systems of care and related services, immunization
tracking systems, or other information systems, etc., to address the
identified priority needs.
3.) Continuing or unmet needs—Considering the health status needs and the resources
which address the needs that were identified above, what are the continuing or
unmet needs for direct care, enabling, population-based and/or infrastructure
building services?
B. Child and Adolescent Plan
1.) Priority needs for use of MCH funds—Considering the priority needs
identified in the Statement of Need (Section A) and the available MCH
funds, what are the priority needs of the child and adolescent population
for which MCH funding will be used? Explain your rationale for selecting
these needs to be the ones addressed with the MCH funds.
2.) Plan--Objectives, Activities, Monitoring and Evaluating
Need Restate each of the needs that will be addressed with MCH
funding
7
Objective State the objective or objectives that will address the need.
All objectives should be reasonable, specific, time-framed
and measurable.
Activities Describe the specific activities that will be carried out to
achieve each objective. Include"Best Practice" or
"Evidence-Based"interventions or activities whenever
possible. Categorize the activities according to the level or
type of MCH service being provided (i.e., direct health
care, enabling, population-based, or infrastructure-
building).
Monitoring Describe your method of monitoring to assure quantity of
service (numbers of client and services) and quality of
service (measured through use of protocols, chart audits,
policy procedure manuals, etc.). Infrastructure-building
activities may be monitored by tracking the completion of
planned activities or whether benchmarks have been
realized or protocols or policy procedures put in place.
Evaluation Describe your methods of evaluating the effectiveness of
your activities in addressing the identified need.
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III. CHILDREN WITH SPECIAL HEALTH CARE NEEDS POPULATION
A. Statement of Need—What are the priority needs of the Children with Special
Health Care Needs population in the County or District, based on an assessment
of the health status needs and of the resources to address the needs?
1.) Health and related service needs—What information about the health and
related service needs of the children with special health care needs in your
county or district were used to select the priority needs?
2.) Resources to address the health and related service needs— What are the
resources of the public health agency and of other agencies in the
community which address the health and related service needs of children
with special health care needs in your community?
a.) Direct Care Service Needs—What are the resources in the
community which provide direct health care services for the
children who have conditions or illnesses which are diagnostically
eligible for direct care payment by the Health Care Program for
Children with Special Health Care Needs? Are there gaps or
unmet needs in such direct care services? Are there issues of
availability and accessibility?
b.) Enabling Services—What are the resources in the community
which provide enabling services, i.e. transportation, interpretation
and translation, outreach, health education, family support services,
case management and service coordination with other related
services? Are there gaps or unmet needs?
c.) Population-Based Service Needs—What are the resources which
provide population-based services for children with special health
care needs in the community, i.e. newborn hearing screening or
vision screening services?
d.) Infrastructure-Building Services or Activity Needs—What
infrastructure-building services, resources or activities are needed
to promote the development of community-based systems of
services for children with special health care needs and their
families? Present information regarding the need for activities
such as planning activities,needs assessments, program evaluation,
policy development,program coordination, quality assurance
activities, standards development, monitoring, training, research,
developing systems of care and related services, or development of
information systems.
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3.) Unmet or continuing needs—Considering the health and related service
needs and the resources which address the needs that were identified
above, what are the continuing or unmet needs for direct care, enabling,
population-based and/or infrastructure building services?
C. Children with Special Health Care Needs Plan
1.) Priority Needs for use of CSHCN funds—Considering the unmet or
continuing needs identified in the Statement of Need(Section A), what are
the priority needs of the children with special health care needs population
for which CSHCN funding under the contract with the Health Care
Program for Children with Special Needs (HCP) will be used? Explain
your rationale for selecting these needs to be the ones addressed with the
CSHCN funds.
2.) Operational Plan—Objectives, Activities, Monitoring and Evaluating
Need Restate each of the needs that will be addressed with
CSHCN funding
Objective State the objective or objectives (one to four objectives
suggested) that will address this need. All objectives
should be reasonable, specific, time-framed and
measurable.
Activities Describe the specific activities that will be carried out to
achieve each objective. Include"Best Practice"or
"Evidence-Based" interventions or activities whenever
possible. Categorize the activities according to the level or
type of service being carried out (i.e., direct health care,
enabling, population-based, or infrastructure-building).
Monitoring Describe your methods of monitoring to assure quantity of
service (numbers of clients and services) and quality of
service (measured through use of protocols, chart audits,
policy procedure manuals, etc.). Infrastructure-building
activities or services may be monitored by tracking the
completion of planned activities or whether benchmarks
have been realized or protocols or policy procedures put in
place.
Evaluation Describe your methods of evaluation the effectiveness of
your activities in addressing the identified need.
to
ATTACHMENT I
BUDGET ESTIMATE FORM FOR THE PERIOD:
CONTRACTOR:
MATERNAL AND CHILD HEALTH REPORTING FOR THE CORE PUBLIC HEALTH SERVICES
INCLUDING CHILD HEALTH, PERINATAL HEALTH AND CHILDREN WITH
SPECIAL NEEDS PROGRAMS
Section I
Based on your county plan, please estimate the following based on your MCH funding formula contract amount
DOLLARS PERCENTAGE
AMOUNT AND PERCENTAGE ALLOCATED TO:
CHILD HEALTH
PERINATAL HEALTH
TOTAL 100%
CHILD HEALTH PERCENTAGE ALLOCATED TO:
DIRECT SERVICES
ENABLING SERVICES
POPULATION-BASED SERVICES
INFRASTRUCTURE BUILDING SERVICES
TOTAL 100 %
PERINATAL HEALTH PERCENTAGE ALLOCATED TO:
DIRECT SERVICES
ENABLING SERVICES
POPULATION-BASED SERVICES
INFRASTRUCTURE BUILDING SERVICES
TOTAL 100 %
Section II
DOLLARS
AMOUNT OF FUNDS ALLOCATED TO:
CHILDREN WITH SPECIAL NEEDS
CHILDREN WITH SPECIAL NEEDS PERCENTAGE ALLOCATED TO:
DIRECT SERVICES
ENABLING SERVICES
POPULATION-BASED SERVICES
INFRASTRUCTURE BUILDING SERVICES
TOTAL 100 %
NOTE: Administrative costs can be allocated to each of the above categories as appropriate.
h:lmchreprtNursing.wb2
STATE OF COLORADO
Bill Owens,Governor ifi co
Jane E.Norton,Executive Director 4: ;-' zoq�.,
Dedicated to protecting and improving the health and environment of the people of Colorado N ::_ w'
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division * , . ,: *
*
Denver,Colorado 80246-1530 8100 Lowry Blvd. .1876
Phone(303)692-2000 Denver CO 80230-6928 ---
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
and Environment
intp://www.cdphe.state.cons
[Date] Sample Contract Change Order Letter Attachment J
State Fiscal Year 20**-**. Contract Change Order Letter Number**. Contract Routing Number**-*****
Pursuant to paragraph**of the contract with contract routing number**-*****and contract encumbrance number
***********,(as amended by Contract Renewal Letter**, contract routing number**-*****,and/or Contract Change
Order Letter**, contract routing number**-*****, if any),hereinafter referred to as the"Original Contract"(a copy of
which is attached hereto and by this reference incorporated herein and made a part hereof)between the State of Colorado,
Department of Public Health and Environment and Contractor's Legal Name for the term from ********* ** ****
through********* **, ****,the parties agree that the maximum amount payable by the State for the eligible services
referenced in paragraph** of the Original Contract is increased/decreased by dollar amount DOLLARS, ($*.**)for a new
total financial obligation of the State of dollar amount DOLLARS (5*.**). The revised work plan,which is attached
hereto as"Attachment 1", and the revised budget,which is attached hereto as"Attachment 2",are incorporated herein by
this reference and made a part hereof. The first sentence in paragraph** of the Original Contract is hereby modified
accordingly. All other terms and conditions of the Original Contract are hereby reaffirmed. This amendment to the Original
Contract is intended to be effective as of********* **,****. However, in no event shall this amendment be deemed valid
until it shall have been approved by the State Controller or such assistant as he may designate.
Please sign,date,and return all ** originals of this Contract Change Order Letter by ********* **,**** to the attention of:
************ ************,Colorado Department of Public Health and Environment,4300 Cherry Creek Drive
South,Denver,Colorado 80246,Mail Code: *****-**. One original of this Contract Change Order Letter will be
returned to you when fully approved.
Contractor's Legal Name STATE OF COLORADO
(legal type of entity) Bill Owens,Governor
By: By:
For the Executive Director
Print Name: DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Title:
FEIN:
APPROVALS:
FOR THE STATE CONTROLLER: PROGRAM:
Arthur L.Barnhart
By: By:
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