HomeMy WebLinkAbout20001760.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR EARLY AND PERIODIC SCREENING, DIAGNOSTIC,
AND TREATMENT (EPSDT) 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 Early and Periodic
Screening, Diagnostic, and Treatment (EPSDT) Program between the County of Weld, State of
Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the
Weld County Department of Public Health and Environment, and the Colorado Department of
Public Health and Environment, commencing July 4, 2000, and ending June 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 Early and Periodic Screening, Diagnostic.
and Treatment (EPSDT) 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 26th day of July, A.D., 2000, nunc pro tunc July 4, 2000.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
7 '! , EXCUSED DA OF SIGNING
ATTEST: ��:;�.'�-'�'=�-� (AYE)-
�qr`-y b� Barbara J. meyer, Chair
Weld County Clerk to t :�:•: , G'19� �.
_ eile, Pro-Te - --
Deputy Clerk to the B ---
/° Georg E. Baxter
APPROVI AS TO FFSRM: EXCUSED DATE OF SIGNING (AYE)
Dale . Hall
1.24
fati-q64 Altai/416S
Glenn Vaaci--
2000-1760
CAL; , /S/2 HL0027
Department or Agency Name
COLORADO DEPARTMENT OF PUBLIC
HEALTH AND ENVIRONMENT
Department or Agency Number
FAA
Contract Routing Number
01-00214
TASK ORDER
This TASK ORDER is made this 30TH day of JUNE, 2000 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 Colorado Department of Health Care Policy and Financing(CDHCPF) is responsible for the administrai ion of
the federal Medicaid program in the state of Colorado. The CDHCPF has awarded the State with federal Medicaid
program monies to implement an Early and Periodic Screening. Diagnostic, and Treatment(EPSDT)program in the
state of Colorado. A federal mandate requires that the State's EPSDT program provide administrative case
management,outreach,and support services to all eligible EPSDT recipients. Thus,the State must provide I FPSDT
services under this Medicaid program to needy individuals under twenty-one(21)years of age. The State, therefore,
must provide care coordination services to eligible women and children through its EPSDT Program.
In order to carry out its lawful powers,duties, and responsibilities under the federal mandate and section 26-4-104.
C.R.S.,as amended;and,to effectively utilize all legislative appropriations made and provided therefore, the State
has determined that public health services are desirable in Weld County,Colorado. The State has formulated a
comprehensive State plan,with associated budgets, relative to the State's programs and services which allocates
funds to local health agencies in order to provide certain purchased services to the citizens of the state of Colorado
This funding is to be allocated through task orders with local health agencies. Section 29-1-201,C.R.S. as
amended,encourages governments to make the most efficient and effective use of their powers and responsibilities
by cooperating and contracting with each other to the fullest extent possible to provide any function,service. or
facility lawfully authorized to each of the cooperating or contracting entities. All State contracts with its political
subdivisions are exempt from the State's personnel rules and the state of Colorado procurement code.
It is the express intent of the parties that eligible clients shall be provided with administrative case management and
outreach services through this Task Order in a manner that encourages the participation of these eligible clients in
the EPSDT Program. The State and the Contractor mutually agree that the most efficient and effective way to
provide these EPSDT services at the local level is to authorize the Contractor to exercise administrative control over
the delivery of these EPSDT services. Therefore,the State through this Task Order contracts with the Contractor to
provide eligible clients with EPSDT administrative case management and outreach activities in such a way as to
encourage their participation in the EPSDT Program.
Page 1 of 8
°et -/76,-
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 6020,Appropriation Code 653,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 July 4,2000 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 July 4,2000 and continue through and including
June 30,2001 unless sooner terminated by the parties pursuant to the terms and conditions of the Mastei
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. SCOPE OF WORK. 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 EPSDT
administrative case management, outreach,and support services as more fully described in the EPSDT
program guidelines,which are incorporated herein by this reference,made a part hereof,and attached
hereto as"Attachment A". These services shall be performed in accordance with any additional
guidelines and/or training provided by the State in Weld County.
C'. COMPENSATION. In accordance with the budget, which is incorporated herein by this reference, made
a part hereof, and attached hereto as"Attachment B",the State shall cause to be paid to the Contractor an
amount not to exceed SEVENTY NINE THOUSAND NINE HUNDRED AND THREE AND NO/100
DOLLARS AMOUNT, ($79,903.00)under this Task Order for those services timely and satisfactorily
completed by the Contractor. Of this total amount,$39,951.50 are identified as attributable to a funding
source of the federal government and, $39,951.50 are identified as attributable to a funding source of the
state of Colorado. To receive compensation under this Task Order,the Contractor shall submit a"Task
Order Reimbursement Statement". A sample"Task Order Reimbursement Statement" is incorporated
herein by this reference, made a part hereof, and attached hereto as"Attachment C". All Task Order
Reimbursement Statements: shall reference the related Master Contract by its contract routing number and
this Task Order's contract routing number; both of which numbers appear on the first page of each
document; shall be based upon the costs of the work and services performed during the term of this Task
Order; and,shall be supplemented or accompanied by supporting data and subcontractor invoices, if any,
covering the work shown on the Task Order Reimbursement Statement. 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.
D. PAYMENT MECHANISM. Payments under this Task Order shall be made either through the Electronic
Payment System or,upon the Contractor's monthly submission of duplicate invoices requesting
reimbursement for those services provided in the previous month.
Page 2 of 8
E. ADDITIONAL PROVISIONS.
The Contractor shall provide EPSDT administrative case management services based upon a
projected monthly average of 5579 eligible clients and shall ensure that these services are
supervised by a professional registered nurse.
2. The Contractor shall ensure that all personnel assigned to perform EPSDT administrative outreach
and case management services are available for all scheduled training,beginning with initial
training,within a reasonable time period after being assigned to perform EPSDT duties under this
Task Order.
3. The Contractor shall cooperate with the State to ensure that the program planning,evaluation, and
monitoring requirements described in Attachment A are met. This cooperation includes, but is not
limited to,participation in mutually agreed upon site reviews at the Contractor's location and,any
other meetings required by the State.
4. The Contractor is responsible for maintaining an inventory of all equipment purchased with State
funds. This inventory shall include: serial number(s),type(s)of equipment, location(s),and any
other appropriate identifying information. The Contractor shall provide the State with a written
inventory by June 30,2001,for the initial term of this Task Order and,on each June 30th
thereafter for each renewal or extension term of this Task Order.
5. The Contractor shall protect the confidentiality of all applicant/recipient records and other
materials that are maintained pursuant to this Task Order. Except for purposes directly connected
with the administration of this Task Order,no information about or obtained from any
applicant/recipient,which information is in the possession of the State,shall be disclosed in any
form which identifies an applicant/recipient without the prior,express,written consent of that
applicant/recipient or a the parent or legal guardian of a minor applicant/recipient or,as may
otherwise be properly ordered by a court of competent jurisdiction. The Contractor shall have
written policies governing the access to,and the duplication and dissemination of,all such
information. The Contractor shall advise its employees,agents, servants, and subcontractors, ii
any,that they are subject to these confidentiality requirements.
6. The Contractor shall comply with the EPSDT documentation requirements described in
Attachment A. The Contractor shall submit documentation for those services provided by the
Contractor on a monthly basis. This documentation shall show those services which have been
provided to EPSDT clients by the Contractor. This monthly documentation shall be submitted on
the"Monthly Report" form, which is incorporated herein by this reference, made a part hereof,
and attached hereto as"Attachment D". The Contractor shall submit an annual,unduplicated
total of all households and eligible clients receiving EPSDT administrative case management
services upon request by the State.
7. If requested by the State,the Contractor shall submit an annual summary of the hours expended
by the Contractor's registered professional nurses in the supervision of EPSDT program activities.
The Contractor's required in kind match, if any,shall be as shown on the budget,Attachment B.
8. Within sixty(60)calendar days after the end of the initial,or any renewal or extension,term of
this Task Order,the Contractor shall submit to the State a document which shows the totals for all
eligible households and clients receiving EPSDT administrative case management, outreach,or
support services.
Page 3 of 8
9. Within sixty(60)calendar days after the end of the initial,or any renewal or extension, term of
this Task Order,the Contractor shall submit to the State an actual accounting of its expenditures
for that term of this Task Order, in a format substantially similar to the budget,using the"Actual
Expenditures"form,which is incorporated herein by this reference,made a part hereof, and
attached hereto as"Attachment E".
10. The Contractor shall 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 prohibits smoking in any portion of any indoor facility owned,
leased,or otherwise contracted for by a contracting 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 eighteen(18)years, 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 of
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 shall require
that the language of the Act be included in any subcontracts which contain provisions for
children's services and that all subcontractors shall sign and agree accordingly.
11. 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 award 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.
12. Section 504(b)(6)of Title V mandates that 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, Pdaternal
and Child Health,or Social Services Block Grant programs).
Page 4 of 8
13. The Contractor shall not charge for services to those individuals of families at or below the
official poverty line as defined by the Office of Management and Budget(OMB)in accordance
with Title V,Section 50I(B)(2)and Section 505(2)(d). The 100%of poverty income guideline
for farm or nonfarm 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,
add$2,900 for each additional member. These 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 guidelines to the Contractor and should be used by the Contractor
upon receipt.
14. If any charges are imposed for services to clients who are above the 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 shall be made available to the general public
and to all clients and shall be based on the agency's usual and customary cost for the service.
Clients must understand they will not be denied services for inability to pay any of the sliding fee
charges.
15. The Contractor shall: (I)inform potentially eligible recipients that the "Colorado Baby Care/Kid's
Care Program"(CBC/KCP)exists and that potentially eligible recipients should apply for
coverage under that program through the local county department of Social Services; (2) inform
the potential recipient that CBC/KCP may be a potential source of payment for their child's care;
and(3) inform the potential recipient that in order to receive continuing coverage under CBC/KCP
they be encouraged to complete an application fully as soon as possible(CBC/KCP allows for u(,
to 60 days of presumptive eligibility for pregnant women who are registered with Medicaid.); and
(4)obtain from Medicaid and have present at their facility current information regarding eligibility
and services under CBC/KCP.Potentially eligible recipients are pregnant women, up to two
months postpartum, and children up to 6 years of age,who are reasonably believed to meet.
CBC/KCP family financial requirements.
16. 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 F".
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. Addis ionally,
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
Page 5 of 8
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;
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.
17. The State may renew this Task Order through a"Task Order Renewal Letter". A sample 1 ask
Order Renewal Letter is incorporated herein by this reference, made a part hereof, and attached
hereto as"Attachment G". To be effective,the Task Order Renewal 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 Renewal Letter shall include the following information:
A. Identification of the related Master Contract by its contract number and this Task Order
by its contract routing number,and the affected Task Order paragraph number(s):
B. The type(s)of service(s)or program(s), if any, increased or decreased and the new level
of each service or program for the renewal term;
C. The amount of the increase or decrease, if any, in the level of funding for each service or
Page 6 of 8
program and the new total financial obligation;
D. The intended effective date of the renewal; and,
E. A provision stating that the Task Order Renewal Letter shall not be valid until approved
by the State Controller or such assistant as he may designate.
Upon proper execution and approval,the Task Order Renewal Letter shall become an amendment
to this Task Order. Except for the General and Special Provisions of this Master Contract,the
Task Order Renewal 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 renewal letter
process may be used only to: renew this Task Order; increase or decrease levels of funding related
to that renewal;make corresponding adjustments to service or program levels,and,adjust any
related budget line items. Any other changes to this Task Order, other than those authorized by
the change order letter process described above, 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 renewal term,then the Contractor shall
execute and return the Task Order Renewal Letter to the State by the date indicated in the Task
Order Renewal Letter. If the Contractor does not agree to and accept the proposed renewal term,
or fails to timely return the partially executed Task Order Renewal Letter by the date indicated in
the Task Order Renewal 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 Renewal 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 7 of 8
IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS
OF WELD COUNTY
For the use and benefit of the
WELD COUNTY DEPARTMENT OF STATE OF COLORADO
PUBLIC HEALTH AND ENVIRONMENT
(a political subdivision of the state of Colorado) Bill Owens.Governor
By:, `='�i' �iA�� ' 'aP,fis �' By:
Barbara J. Kirknfeyer For the Executive Directo
Chair (07/26/2000) Colorado Department of
FEIN: 84-6000813 Public Health and Environ nt
If Corporatio Town/ ity/ ount or E. ivalent: PROGRAM APPROVAL:
f
ATTEST(Affix Sea Y \
rsct ifTh
Fl YT
By I)nagoatneettoxinatmapi *mu
Deputy Clerk to the Board — -
APPROVALS:
COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL
OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER
Ken Salazar,Attorney General Arthur L. Barnhart,State Controller
By: By: �,t�'lo C- 6'rt,Lfkr()-k-
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT
40199e1 C�
Mark E. Wallace, D, MPH-Director Page 8 of 8
ATTACHMENT A
EPSDT PROGRAM ADMINISTRATIVE
OUTREACH AND CASE MANAGEMENT
ACTIVITIES
FISCAL PERIOD
7/1/00 - 6/30/01
7/1/00 - 6/30/01
The following definitions and functions are intended to serve as guidelines for contracting
agencies to utilize in meeting their required EPSDT administrative outreach and case
management functions.
DEFINITIONS
A. At-risk client: The EPSDT-eligible client with identified actual and/or potential
health care needs, which may require outreach and case management efforts more
intensive than the non-at-risk EPSDT-eligible clients. The at-risk or priority
clients may include clients in families with no established linkage to health care
and/or assistance with provider selection, newborns and infants up to age two,
teenagers, particularly those newly enrolled in Medicaid, pregnant EPSDT
eligible clients, refugee children in need of EPSDT administrative and case
management services, children and youth requiring preventive health and
corrective treatment services or assistance with referral services for children with
special health care needs, pregnant women eligible for enhanced prenatal services
and clients identified by EPSDT subsystem reports as being in need of follow up
and referral services.
B. Early Childhood Connections for Infants, Toddlers and Families: The statewide.
coordinated system of-services made available through the Individual Disabilities
Education Act, Infant and Toddler Section, as governed by the Colorado
Department of Education. Services include an early intervention system of
supports and services that are directed at meeting the needs of infants and toddlers
with disabilities and their families.
C. Enrollment Facilitator: A non governmental agency contracted with Colorado
Medicaid to enroll or disenroll Medicaid clients in a managed care plan.
D. EPSDT outreach and case management: The EPSDT administrative outreach and
case management services provided by the EPSDT Outreach and Case Manager
which are complementary to health care services provided by the Medicaid
provider. The health care services are aimed at the promotion of health, the
prevention of disease and improved access to health care services. The EPSDT
administrative service includes, but may not be limited to: (1) contacting
EPSDT-eligible clients to provide in-depth explanation of the EPSDT Program
and its importance in the medical benefits which are available. (2) offering
assistance and information to the EPSDT-eligible client which will facilitate
overcoming barriers which might impede the client's access to EPSDT services;
(3) clarifying, if needed, the role of the primary care provider and, when
appropriate, the managed care/prepaid health plan, including Health Maintenance
Organizations, (4) promoting the client's responsibility to maintain the linkage
Page 1 of 8
between the child/youth and the primary care physician; (5) maintaining periodic
contact, as needed and feasible, with the EPSDT client to encourage the utilization
of EPSDT services needed or promoted by referrals and assisting with referrals as
needed; (6) initiating collaborative activities with other child-related health and
social services agencies and resources within each county and referring EPSDT
clients as needed to those agencies and resources. (7) In selected counties,
services provided by the EPSDT outreach and case manager shall include
assistance with the EPSDT and managed care inform process, including referral to
the Enrollment Facilitator, at the time of application for Medicaid in local social
service agencies and presumptive eligibility sites.
E. EPSDT Outreach and Case Manager: The individual responsible for providing the
EPSDT Program administrative services of outreach and case management to
EPSDT -eligible children and their families.
F. EPSDT-enrolled client: Any individual under the age of 21 declared as eligible for
Medicaid by the appropriate county department of social services pursuant to
federal and state laws and regulations.
G. Medicaid Provider/vendor: Any entity or individual who has met the certification
requirement established by the State to participate in the Colorado Medicaid
Program, and who provides covered EPSDT medical/dental services, goods
and/or devices in accordance therewith.
H. Prenatal Plus Program. The health care program option that includes a package of
enhanced Medicaid prenatal services addressing nutritional and psychosocial
behaviors that could impact pregnancy outcome.
Prepaid Health Plan (PPHP): A commercial health care plan contracting with
Colorado Medicaid to provide comprehensive health care services, coordination,
and monitoring of patient utilization of services through the utilization of primary
care physicians. The primary care physicians agree to serve as gatekeepers for
comprehensive health services, including EPSDT services, as provided to
Medicaid clients.
Primary Care Physician (PCP): A Colorado Medicaid enrolled physician who has
agreed to serve as the "gatekeeper" for all medical care received by Medicaid
clients, who have chosen him/her within the Primary Care Physician Program or
Health Maintenance Organization. EPSDT medical screenings are conducted by
the selected primary care physician or a qualified provider upon referral from the
PCP, when applicable.
K. Primary Care Physician Program (PCPP): The health care program option in
which EPSDT-eligible clients select a physician who agrees to enroll or has
enrolled in the Primary Care Physician Program Under this program, the
Page 2 of 8
physician accepts the responsibility of the clients' health care, guaranteeing a 24
hour access arrangement. Under this program the physician shall also refer the
EPSDT-eligible client to other Medicaid providers, for medical care, and other
health care services as needed.
L. Provider Interface: The responsibility of the EPSDT Outreach and Case Manager
to work with local Medicaid providers. This process may include: (I) identifying
providers in a local county or adjacent client-accessible counties, who will deliver
medical screening, diagnostic and treatment services, dental, orthodontia, vision,
hearing, or other services to the EPSDT-eligible client; (2) explaining to the
providers the nature and intent of the EPSDT Program, including the PCP referral
requirement; (3) referring interested providers to the coordinator of the Primary
Care Physician Program at HCPF for assistance in acquiring more information
concerning the role of the primary care physician; (4) acting as a resource to
providers who have identified families in need of assistance with EPSDT
administrative case management services; and (5) educating providers about the
importance of the completion of the screening component of the EPSDT claim
form.
M. Screening: An EPSDT medical service provided to EPSDT-eligible clients by a
Medicaid primary care physician, or alternatively, by a provider qualified to
furnish medical screening services upon referral from the primary care physician
or managed care system, or by other qualified providers in areas without available
primary care physicians.
The EPSDT medical service screening includes (a partial EPSDT screening is any
screen less than all of the 5 required components):
Comprehensive health and developmental history with physical and
mental health components
Comprehensive unclothed physical examination -
-
Appropriate immunizations according to age and health history
Laboratory tests, including blood lead levels
Health education, including anticipatory guidance
N. Subcontract: A written agreement between Health and local health tagencies
and/or other local agencies that shall serve as a basis for EPSDT administrative
outreach and case management activities at the local level.
O. Training and Technical Assistance: Work performed under the direction of Health
to assist Medicaid providers in developing and providing enhanced prenatal
services.
Page 3 of 8
P. Expanded Services: Federally defined optional medical services not included
within the Colorado State Medicaid Plan.
II. EPSDT ADMINISTRATIVE OUTREACH/CASE MANAGEMENT
The EPSDT Outreach and Case Manager offers and provides, when requested and/or
necessary:
A. Provides outreach and/or case management activities for the EPSDT-eligible
client upon written or verbal request by the client or upon referral from Medicaid
providers or other agencies. The administrative activities may include, but not he
limited to, the following types of responsibilities:
1. Initiate face-to-face, telephone or mail contacts to explain the EPSDT
Program and the administrative case management role, assist in the
identification of health care needs, assist in requests for referrals for well-
child supervision, diagnosis and treatment services; assist in clarification.
and/or answering questions, including, where applicable,
questions/information regarding managed care.
2. Provide mailings, as indicated, that include descriptions of all basic
EPSDT services, screening schedules, brochures and case management
information (hours of operation and business cards). Work with the local
social service agencies, outreach sites, and other agencies where individual
families apply for Medicaid to assure that such materials are available.
3. Maintain and update a list of the names, addresses and telephone numbers
of managed care organizations from whom EPSDT dental, hearing and
vision care as well as speciality providers may be obtained.
4. Facilitate provider interface by promoting the linkage of the EPSDT
eligible client with the primary care physician or HMO and through
EPSDT advocacy efforts in the provider community, and through other
activities as defined in Section I of this exhibit.
5. Coordinate with nurse supervisor and initiate and/or participate in
interagency coordination with public health and other human resource
agencies as appropriate upon consultation with the nurse supervisor.
6. Upon consultation with the nurse supervisor make home visits to difficult-
to-reach EPSDT-eligible clients or coordinate for this service with other
community agencies that also provide home visitation services.
Page 4 of 8
7. Facilitate, upon request of client or provider, referrals for Medicaid
covered services.
B. In selected counties agreed upon by CDPHE and local agencies, EPSDT
administrative case management staff will provide assistance with the EPSDT
inform process in local social service agencies and presumptive eligibility sites.
C. The EPSDT Outreach and Administrative Case Manager will utilize data provided
by HCPF and local social service agencies which provide information for the
provision of EPSDT administrative outreach and case management activities and
will notify the State EPSDT office in writing of any errors, discrepancies,
inaccuracy or unavailability of information received from the State or local social
service agency which impede the provision of EPSDT administrative outreach and
case management activities.
D. The EPSDT Administrative Case Manager works under the supervision of a
registered nurse currently licensed in Colorado. The designated nurse supervisor
assures that the EPSDT Outreach and Case Manager's activities are performed as
identified in this Exhibit B.
III. EPSDT PROGRAM SUPPORT SERVICES
A. The EPSDT Outreach and Case Manager offers and provides, when requested
and/or necessary:
1. Assistance with scheduling appointments for EPSDT Program screening
services.
2. Assistance with scheduling appointments for follow-up diagnostic and
treatment services, including medical, dental, vision care and hearing
services.
3. Information to the EPSDT-eligible client concerning the availability of
transportation assistance which is offered through the local county
department of social services or the Colorado Foundation for Medical Care
(CFMC).
4. Referral assistance to the local county department of social services for the
EPSDT-eligible client requiring transportation assistance
5. Assistance with speciality provider selection as appropriate and when
resources permit which includes, but is not limited to, expanded services.
B. The EPSDT Outreach and Case Manager provides the additional support services
of:
Page 5 of 8
1. Maintaining the lists of the names, addresses and telephone numbers of
agencies or human resource groups who have expressed a willingness to
furnish uncovered services at little or no expense to the EPSDT-eligible
client and/or family.
2. Referring clients in all categories of the WIC target population to the local
WIC Program available within each county.
3. Initiation and promotion of collaborative activities, including the
exploration for opportunities to conduct cross-training, with Head Start,
Early Childhood Connections, Family Healthline, Family Resource
Centers, Bright Beginnings, the Colorado Child Health Plan Plus
(CCHP+), waiver programs, school districts, school based health centers
and other child health related social agencies that are available within each
local county to promote the availability and utilization of the services.
C. The EPSDT Case Manager works with the regional and local coordinators of the
Health Care Program for Children with Special Needs (HCP) whereby families
and EPSDT-enrolled clients will be informed of the availability of HCP services
and referred for these services as appropriate.
D. The EPSDT Case Manager facilitates the referral of EPSDT-eligible clients
needing uncovered treatment, health services or social services,and clients who
lose Medicaid eligibility to community and rural health centers, CC'HP+
Colorado Indigent Care Program, Title V agencies, or other community agencie..
that provide assistance, either at no cost or on a sliding fee scale, to low income
populations.
IV. EPSDT PROGRAM DOCUMENTATION REQUIREMENTS
A. The EPSDT Case Manager maintains documentation that identifies EPSDT
administrative outreach/case management activities on behalf of the EPSDT
eligible client.
B. The EPSDT Case Manager assures that documentation of the outreach and case
management activities occurs and that the documentation includes the following:
1. Written materials utilized by the EPSDT Outreach and Case Manager to
facilitate the administrative services provided for the EPSDT-eligible
clients (brochures, reminder cards, etc.).
Page 6 of 8
2. Written or computerized documentation of all administrative EPSDT
outreach and case management activities which occurred during the last
three (3) year period.
C. The EPSDT Case Manager shall assure that these materials and/or client
documentation are available to HCPF or Federal reviewers upon written request
and shall submit to the State monthly a computerized summary of EPSDT
activities.
D. The EPSDT Outreach and Case Manager maintains up-to-date program manuals,
records, and/or procedures that:
1. Describe the methods used to assure that outreach and administrative case
management services are provided appropriately and in a timely manner
2. Describe the function of written and/or computerized documentation
available at the local agency and/or health offices.
3. Describe the means by which information is available to local agencies
and/or health offices that can be accessed for determination of compliance
with State plan requirements.
4. Describe how all activities performed by the EPSDT Outreach and Case
Manager are monitored by the local RN supervisor, or by a nurse
consultant at CDPHE.
V. PLANNING, EVALUATION, MONITORING
A. Site reviews by Colorado Department of Health EPSDT staff will be arranged of
a mutually agreed upon basis with local EPSDT staff Site reviews will include:
I. Names of agency sites reviewed with listing of the assigned EPSDT
Outreach and Case Manager(s) and the designated RN supervisor.
2. Review of EPSDT outreach and case management activities, including
written materials, designed to assure that EPSDT clients receive requested
assistance in a timely manner.
Page 7 of 8 •
3. Review of EPSDT Procedure Manual for accuracy and content of required
materials.
4. Review of collaborative activities with medical providers including
managed care organizations, WIC, HCP, Child Find, Family Healthline,
Family Resource Centers, Bright Beginnings, Early Childhood
Connections, and other child health related social agencies.
5. Review of compliance status with standards developed for mandated
activities. This includes review of computerized documentation for
completeness and accuracy.
6. Review of agency written protocols/guidelines for outreach and case
management, including at-risk client definitions. Review of measures to he
taken to bring activities into compliance with federal requirements.
7. Review of agency written protocols for nurse supervision.
8. Discussion of EPSDT Case Manager needs, concerns and requests.
9. Input from the nurse supervisor on EPSDT issues, needs, etc.
10. Training activities provided to EPSDT Outreach and Case Managers
and/or RN supervisor as needed.
Page 8 of 8
ATTACHMENT B
Final
APPLICANT: Weld County Health Department
PROJECT: EPSDT
DETAILED BUDGET FOR THE PERIOD: July 1,2000 to June 30,2001
Annual Number Total Source of CDH Funds
DIRECT COST Salary Months %Time Amount Applicant Requested - EPSDT refugee Other TGT'
Rate Budget Required and Other from CDH CDH CDH
PERSONNEL SERVICE 2.80
Martinez,D. 19,640 12 100% 19,640 19,640 19,640 19,640
Korgan,C. 19,640 12 100% 19,640 19,640 19,640 19,640
Salazar,D. 19,221 12 80% 15,377 15,377 15,377 15,377
Contractual/Fee for Service:
Supervising Personnel:
Weinmeister,C. 46,792 12 5% 2,340 2,340 0 0 0
Fringe Benefits 17,099 702 16,397 16,397 16,397
Total Personnel Services 74,096 3,042 71,054 71,054 0 0 71,054
OPERATING EXPENSES:
(includes Building/Facility
Cost not part of Indirect)
Operating 1,622 1,622 1,622 1,622
Subtotal Operating 1,622 0 1,622 1,622 0 0 1,622
TRAVEL:
2,000 2,000 2.000 2,000
Subtotal Travel 2,000 0 2,000 2,000 2,000
EQUIPMENT:
0 0 0 0
Subtotal Equipment 0 0 0 0 0
Total Direct Costs(Personnel+Operating+Travel+Equip) 77,718 3,042 74,676 74,676 0 0 74,676
Administrative/Indirect Cost-10.77%TDC- _ 5,440 213 5,227 5,227 0 0 5,227
TOTAL PROJECT LOST - 83,158 3,255 79,903 0 79,903
Source of Funding for"Applicant and Other"
I 3.255 I
'Total Applicant and Ot $3,255
"This contract will pay the actual approved rate for indirect costs finalized by the Colorado Department
"This contract will pay the actual approved rate for indirect costs finalized by the Colorado Department
ni Heath and c, oi :n tn.maximum rates rilFeWen ,.v Tee Pami v?nn: n i .. , Health S'enireec
Division.Colorado Department of Health. The finalized rate will be retroactive to the beginning of the contract.
INVOICE NUMBER
REUwmuRSEMENT STATEMENT
TO: FCIiSD FROM:
FAX: ( ) DATE OF EXPRNDMIRF<j
TYPE OF FROM: Final
PROGRAM: Bill?
FEDERAL ID TO: 0 Yes
NUMBER: 0 No
Description of Expenditure Local Agency Match Reimbursement Total
Arrjount Requested
ci
E-
Z
cC
F
F _
GRAND TOTAL
This is to certify that the above expenses were incurred per Contract # and we are requesting reimbursement for same.
SIGNATURE (CONTRACTOR): DATE:
I hereby certify that all contractrequirements have _
been .::e', and the a.^inU ntc are _ ..ec.. Payment is authorized.
AUTHORIZED DESIGNEE (STATE): DATE:
Carlos MAUW.f W.Iw..a Neat Q.q.7
0 r. ❑s. w:ua
ATTACHMENT 0
EPSDT Statistical Report
•
Report For :
Date Completed :
County :
NEW HOUSEHOLDS REQUESTING SERVICE
Service Request Form:
Baby Care/Kids Care Form:
SPA (TANF Application) :
Direct: Contact by HH/Client :
TOTAL:
- - - -- - - - - - - - - -
SPECIAI, REFERRAL SOURCES
WIC :
Other Agencies (not Social Services) :
Accretions List :
Partial Registrations :
New Households Requesting Service (Previous Month) -
No Contact :
Total Contacts :
Total Households Served :
Unduplicated Clients in Households Served:
Referrals Household::
Referrals to PCP :
Referrals to Public Health Nurse :
Referrals to Other Primary Health/
Medical Provider:
Referrals to Dentist :
Referrals to Vision :
Referrals to Hearing :
Referrals to HMO :
Referrals to WIC:
Referrals to Social Services
for Transportation:
Referrals to Other Programs :
Contacts Households
Scheduling Assistance :
Reminders/Follow Up Contacts :
Assistance to Providers
on Behalf of Clients :
Assistance to Non-EPSDT Clients :
EPSDT Program Activities :
Changes in Office Location, Phone Number, or Staff :
ATTACHMENT E
APPLICANT:
PROJECT: ABSTINENCE EDUCATION
,ACTUAL EXPENDITURES FOR THE PERIOD:
Annual Number Total Source!df•Fttrid1S.
Salary Months Amount "Appilcant Requested
Rate Budget Expensed and Other from°DPHE'
PERSONAL SERVICES: (X.XX FTE)
Contractual/Fee for Service:
Fringe Benefits: Rate=
Sub total Personal Svcs.
OPERATING EXPENSES: -
(include only costs not part of indirect)
Sub total Operating
TRAVEL:
Sub total Travel
EQUIIPMENT:
Sub total Equipment
Indirect Cost
�yp{ �
fs.'^ SA m..�.'. s'.y: :.. C , ...Y..tw wi 3M k �,.;..e, ._„..:r
"SOURCE OF FUNDING FOR THE MATCH
Local: $
In-kind: $ �'—
Other(Itemize): $
TOTAL: $
*May the non-federal funds be used to match this grant? YES NO -=
X
Signature of Director or Authorized Representative
ATTACHMENT F
STATE OF COLORADO
Bill Owens,Governor "_--------
Jane E.Norton,Executive Director
Dedicated O �•
'
to protecting and improving the health and environment of the people of Colorado re
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division *k••
.fii�.-j 4
Denver,Colorado 80246-1530 8100 Lowry Blvd. •18 76
Phone(303)692-2000 Denver CO 80230-6928
1DD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphe.state.co.us and Environment
[Date] Sample Contract Change Order Letter Attachment F
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********* '1* ****
********* ** ****
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,($*.* ) for a new
tolal fmancial obligation of the State of dollar amount DOLLARS ($*.**). 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:
FEN:
APPROVALS:
CONTROLLER: PROGRAM:
By: By:
Arthur L. Barnhart
Page 20 of 21
ATTACHMENT C
STATE OF COLORADO
Bill Owens,Governor — ---
Jane E.Norton, Executive Director i;OF•Coto
Dedicated to protecting and improving the health and environment of the people of Colorado „i z
4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division * *
Denver,Colorado 80246-1530 8100 Lowry Blvd. **1876
Phone(303)692-2000 Denver CO 8023O.6928 _
TDD Line(303)691-7700 (303)692-3090 Colorado Department
Located in Glendale,Colorado of Public Health
http://www.cdphestate.co.us and Environment
[Date] Sample Contract Renewal Letter Attachment G
State Fiscal Year 20** - **, Contract Renewal Letter Number**, Contract Routing Number **-*****
Pursuant to paragraph ** of the contract with contract routing number**-*****and contract encumbrance number
*********** (as amended by Contract Change Order Letter**, contract routing number**-***** and/or Contract
Renewal 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 renewal term from **"****** **
***k,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 ($*.**j for a new
total financial obligation of the State of dollar amount DOLLARS ($*.**). 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 Renewal 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 Renewal 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: .
STATE CONTROLLER: PROGRAM:
By: By:
Arthur L. Barnhart
Page 21 of 21
eMEMORANDUM
COLORADO
•
TO: Barbara J. Kirkrneyer, Chair, Board of County Commissioner
FROM: Mark E. Wallace, MD, McH, Department of Public Health ani I
Environment kiltiodit
SUBJECT: EPS]DT Task Order
DATE: July 24, 2000
Enclosed for Board review and approval is a task order which, if approved, will become part o.
the Master Contract between the Weld County Department of Public Health and Environincnt
(WCDPHE) and the Colorado Department of Public Health and Environment for the EPS1''['
Program.
This task order is for renewal funding for the time period July 4, 2000 through June 30, 2tn)I H
will authorize WCDPHE to provide case management, outreach, and support services for
children ages 0 to 21 who are on Medicaid. Emphasis is on educating families about well rhil l
services that are age appropriate and helping them to utilize these services that are availabI in
our community. For these services. WCDPHE will he reimbursed a sum not to exceed S7'',90
for the time period.
I recommend your approval of this task order.
Enc.
20j )- 1 (.0
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