HomeMy WebLinkAbout20002002.tiff RESOLUTION
RE: APPROVE TASK ORDER FOR COLORADO WOMEN'S CANCER CONTROL
INITIATIVE 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 Colorado
Women's Cancer Control Initiative 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 August 15, 2000, and ending August 14, 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 Colorado Women's Cancer Control
Initiative 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 21st day of August, A.D., 2000, nunc pro tunc August 15, 2000.
BOARD OF COUNTY COMMISSIONERS
4" " ' r
DCOUNTY, COL RADO
ATTEST: I� /��JV .S/,I /ice%^ ' Barbara J irkmey r, Chaim
Weld County Clerk to thrBi ( �`r�3
�- / M. . . Geile, Pro-Tem
BY: d 44 Deputy Clerk to the Bo. . ! t EXCUSED
t1r e E. Baxter
A ED ASTOF
„pi I; Dale K. Hall
unty Attorne A II/ t.ti
Glenn Vaa
2000-2002
HL0027
Depattrnent or Agency Name
COLORADO DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONMENT
Department or Agency Number
FLA
Task Order Routing Number
0100102
TASK ORDER
This TASK ORDER is made this 31s` day of July,2000 by and between: the State of Colorado, for the use and
benefit of the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal
place of business is 4300 Cherry Creek Drive South,Denver,Colorado 80246,hereinafter referred to as "the
State"; and,I;«OF COUNTY COMMISSIONERS,WELD COUNTY,(a political subdivision of the
state of Colorado).whose address or principal place of business is 91510r"Street,3rd Floor,Greeley,CO 80631
for the use and benefit of the Weld County Department of Public Health and Environments whose address or
principal place of business is 1555 North 17r"Avenue,Greeley,CO 80631, hereinafter referred to as "the
Contractor".
FACTUAL RECITALS
The State has entered into a Cooperative Agreement with the Centers for Disease Control and Prevention(CDC) for
a project entitled the "Colorado Women's Cancer Control Initiative" (CWCCI) to provide breast cancer screening,
cervical cancer screening,and diagnostic services. The intent of the Cooperative Agreement is to increase
screening and diagnosis among low income older women who are uninsured and under insured including those who
are racial, ethnic, and cultural minorities, such as American Indians,African Americans, Hispanics,Asian/Pacific
Islanders, Lesbians,women with disabilities,and women who live in hard to reach communities in urban and rural
areas.
As of the made date of this Task Order, the State has a currently valid Group II purchasing delegation agreement
with the division of finance and procurement within the Colorado Department of Personnel. This procurement i5.
exempt from the Colorado Procurement Code and Rules because the Contractor is a governmental entity.
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 paymenr
of this Task Order in Fund Number 100, Appropriation Account 773,and Organization Code 7340,under Task
Order Encumbrance Number PO FLA PPG01CWCCI,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 TERMINATION. The effective date of this Task Order is
August 15,2000, or on the date this Task Order is approved by the State Controller,whichever is later. The initial
term of this Task Order shall commence on August 15,2000, and continue through and including August 14.2001,
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 extensions or renewals hereof,may not exceed five(5)
years.
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B. SCOPE OF WORK.
The Contractor shall provide, in a timely and satisfactory manner, the services described in the
attached Statement of Work(SoW), which is incorporated herein by this reference,made a part
hereof, and attached hereto as "Attachment A".
2. The Contractor shall provide all matching funds information which is required to maintain the
State's covenants under the federal grant from the CDC. The State shall request this information
at least once each year. The matching funds shall normally be of an in-kind nature.
3. The State shall have the authority to conduct annual program performance reviews and/or audits of
all services provided by the Contractor under this Task Order. Administrative and clinical records
of patients receiving services from the Contractor under this Task Order shall be made available tr
the State's reviewers for this purpose.
4. In accordance with Public Law 101-354,patient charges for services provided by the Contractor
shall be made according to a schedule of charges that is made available to the public,and is
adjusted to reflect the income of the women involved. No patient charges shall be imposed on and
woman who has an income of 250%or less of the federal poverty line. The current percent of
poverty and federal poverty guidelines have been provided to the Contractor. If the guidelines
and/or percentages are updated in future years that information shall be provided to the Contractor
by the State. The State shall inform the Contractor of the effective date of the new guidelines of
percentages.
5. Any income generated or received by the Contractor,e.g.,donations, shall be used by the
Contractor for cancer prevention and control purposes which further the objectives of the
legislation under which this Task Order is made.
C. COMPENSATION.
Payment pursuant to this Task Order shall be made as earned, in whole or in part,from available
State funds in an amount not to exceed One million eight hundred thirty thousand,five
hundred fifty eight Dollars,($1,830,558)_for the purchase of breast and cervical cancer
screening and diagnostic services. It is further understood and agreed that the maximum amount
of State funds available for the period of August 15 2000 through August 14,2001 for the
purchase of breast and cervical cancer screening and diagnostic services is£1,830,558. The
liability of the State, at any time, for such payments shall be limited to the remaining unexpended
amount of such finds.
2. Medicare rates, which are changed at least annually, shall be used to establish the State's
reimbursement rates for breast and cervical cancer screening and diagnostic services. These rates
for those services provided by the Contractor under this Task Order are listed in the Schedule of
Services(SoS), which is incorporated herein by this reference, made a part hereof, and attached
hereto as "Attachment B" If,during the initial,renewal, or extension term of this Task Order, (a)
change(s) in(a) Medicare reimbursement rate(s)occurs,then the State shall inform the Contracto'
of the new Medicare reimbursement rate(s)and the effective date of the change(s).
3. Payments under this Task Order shall be made by the State based on the Contractor's submission
of required forms indicating what services were rendered and what the results of those services
were. Monthly reports shall be generated from the State's Fiscal Management System. The first
report shall indicate the total number of services rendered by each procedure. The second report
shall provide specific details on the women served and the procedures performed. The State shall
monitor statewide activity to ensure that the total funding available is not exceeded and that the
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Contractor shall receive full payment for all services timely and satisfactorily rendered by the
Contractor which are reimbursable under this'Cask Order.
4. The State may prospectively increase or decrease the amount payable under this Task Order
through a"Change Order Letter", a sample of which is incorporated herein by this reference,
made a part hereof, and attached hereto as "Attachment C" To be effective, the Change Ordet
Letter must be: signed by the State and the Contractor; and, approved by the State Controller or
an authorized designee thereof. Additionally, the Change Order Letter shall include the
following information:
A. Identification of this Task Order by its Task Order number and affected 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 Change Order Letter shall not be valid until approved by
the State Controller or such assistant as he may designate.
Upon proper execution and approval, the Change Order Letter shall become an amendment to
this Task Order. Except for the General and Special Provisions of this Task Order, the 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 change order leiter process may be
used only for increased or decreased levels of funding, corresponding adjustments to service of
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 Change Order Letter to the State by the date indicated in the Change Order
Letter. If the Contractor does not agree to and accept the proposed change, or fails to timely
return the partially executed Change Order Letter by the date indicated in the 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 Change Order Letter has passed
Such 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 he relieved of their respective duties
and obligations under this Task Order until the effective date of termination has occurred.
Increases or decreases in the level of Task Order funding made through this change order lettef
process during the initial or renewal terms of this Task Order may be made under the tbllowing
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;
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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;
[. Closure of programs and/or termination of related Task Orders;
.f. Delay or difficulty in implementing new programs or services; and,
K. Other special circumstances as deemed appropriate by the State.
5. The State may renew this Task Order through a "Task Order Renewal Letter", a sample
of which is incorporated herein by this reference, made a part hereof, and attached
hereto as "Attachment D". 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 this Task Order by its Task Order number and affected
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 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
Task Order, 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. Such 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
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their respective duties and obligations under this Task Order until the effective date of
termination has occurred.
D. ADDITIONAL PROVISIONS
1. By executing this Task Order, the Contractor hereby acknowledges, to the best of its
knowledge and belief, that:
A. No Federal appropriated funds have been paid or will be paid.,by or on behalf of
the Contractor,to any person for influencing or attempting to influence an
officer or employee of any agency,a Member of Congress, an officer or
employee of Congress, or an employee of a Member of Congress in connection
with the awarding of any Federal Task Order, the making of any Federal grant,
the making of any Federal loan,the entering into of any cooperative agreement,
and the extension, continuation, renewal, amendment,or modification of any
Federal Task Order,grant, loan.or cooperative agreement.
B. If any funds other than Federal 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,a Member of Congress, an officer or employee of
Congress, or an employee of a Member of Congress in connection with a
Federal Task Order,grant,loan. or cooperative agreement, then the Contractor
shall complete and submit Standard Form-LLI., "Disclosure Form to Report
Lobbying," in accordance with its instructions.
C. The Contractor shall require that the language of this certification be included in
the award documents for all subawards at all tiers(including subTask Orders,
subgrants,and Task Orders under grants,loans and cooperative agreements)and
that all subrecipients shall certify and disclose accordingly.
D. AT'T'ACHMENTS. All attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. In the event of any conflict of inconsistency
between the terms of this Task Order and those of any attachment hereto, the terms and
conditions of this Task Order shall control.
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IN WITNESS WHEREOF, the parties hereto have executed this Task Order on the day first above
written.
CONTRACTOR: STATE:
BOARD OF COUNTY COMMISSIONERS STATE OF COLORADO
WELL) OUNTY Bill Owens, Governor
By: An'. _`V' %y Al By:
Title: Barbara J. Kirkmeyer, Chair For the EJ cutive Dir tor :...y
FEIN: 846000813 (08/21/00) DEPARTMENT PUBLIC
HEALTH AND ENVIRONME T
If Corpora n, 'T /C' / o •.'.fit: • : PROGRAM APPROVAL:
AIIEST ( xs ✓V' �9 . ! -7tic.-oc.q- • ,'--- .�
By: : - .�. .1'� ���il ►�4..:d Esoncsatitmazwattac
Deputy Clerk to
�
ill
APPROVALS:
COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL
OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER
Ken Salazar, Attorney General I' Arthur L. Barnhart, State Controller
l ?
By: I By:
WELD COUNTY DEPARTMENT OF
PUBLIC HEALTH AND ENVIRONM T
V"x
BY: i I 1 eA
Mark E. Wallace, MD, MPH-Director
Page 6 of 6
ATTACHMENT A
STATEMENT OF WORK
Colorado Women's Cancer Control Initiative
1. The Contractor shall provide breast and cervical cancer screening and diagnostic services to all identified
eligible women age 40 years and older in accordance with the "Schedule of Services", which is
incorporated herein by this reference, made a part hereof, and attached hereto as "Attachment B".
2. The Contractor shall only request reimbursement from the State for allowable screening and diagnostic
services for a woman who meets all of the following eligibility criteria:
A. The woman lives in Colorado, or lives in a state bordering Colorado and receives breast and/or
cervical health care in Colorado:
B. The woman's family has a family income at or below 250% of the current federal poverty
guidelines established by the United States Department of Health and Human Services. 'The
Contractor must verify the reported family income by appropriate documentation from all
participating women to ensure that their income qualifies them for participation in the program;
C. Not have health insurance that would cover these services (women with Medicare-Parr 8
coverage are not eligible for these services); and
D. Not have had a mammogram or Pap test in the past 12 months.
3. The Contractor shall utilize the following guidelines as the standard for breast and cervical cancer
screening, rescreening and diagnostic services:
A. Breast Cancer Screening
An annual clinical breast examination for women age 40 years and older.
Annual screening mammograms shall be targeted to women age 50 years and older.
Ai least 75% of the women enrolled for mammography in the CWCCI shall be age 50 years and
older. Women age 40-49 years shall not exceed 25% of the women enrolled for mammography.
For women age 40-49 years, priority for mammography shall be given to those women who
have any of the following risk factors:
1. A first-degree relative(mother, sister, daughter) who developed breast cancer prior to
age 50 years;
2. Two or more first degree relatives (mother, sister, daughter) who developed breast
cancer at any age;
3. A personal history of breast cancer; or,
4. A clinical breast examination symptomatic for cancer.
1
The Contractor shall use the "Assessment and Management of Breast Complaints" and
the CWCCI "Breast Imaging Algorithm" as guidelines Mr following women with breast
abnormalities contained in the CWCCI Service Provider Manual provided by the State
to the Contractor. Additionally, the Contractor shall use the "Evaluation of Common
Breast Problems: A Primer for Primary Care Providers" as a guide for following
women with breast abnormalities.
B. Cervical Cancer Screening
An annual Pap test and pelvic examination for women with an intact cervix who are age
40 years and older. After three (3) or more consecutive annual satisfactory normal Pap
tests, the interval shall be increased to every three (3) years at the discretion of the
provider. The Contractor shall use the "Cervical Screening and Follow-up Algorithm"
as a guideline for following women with cervical abnormalities. Additionally, the
Contractor shall use the American College of Obstetricians and Gynecologists (ACOG)
Technical Bulletin #183, August 1993, "Cervical Cytology: Evaluation and
Management of Abnormalities" and the Journal of the American Medical Association
(JAMA 1994; 271; 1866-9) article"Interim Guidelines for the Management of
Abnormal Cervical Cytology" as a guide for tracking women with cervical
abnormalities. These documents are also contained in the CWCCI Service Provider
Manual provided by the State to the Contractor.
C. Rescreening Services
The Contractor shall counsel all women about the purpose of breast and cervical cancer
screening and the recommended rescreen intervals when they enter the program. The
counseling shall emphasize that rescreening can lead to reduced mortality. The
Contractor shall establish and maintain a system for notifying women when they are
eligible for a breast and cervical cancer rescreen examination.
D. Diagnostic Services Reimbursed through CWCCI
The Contractor shall provide all reimbursable diagnostic services directly or develop
written agreements with other providers to offer these services. All reimbursed
diagnostic services shall be performed in an outpatient setting. The Contractor is
eligible for reimbursable diagnostic services only for those women who were screened
through the CWCCI.
E. Diagnostic and Treatment Services Not Reimbursable through CWCCI
The Contractor shall identify all available sources of diagnostic and treatment services
not reimbursed through this Task Order, and shall refer all women with abnormal
findings who require these services to appropriate medical practitioners for prompt
diagnosis, evaluation, and treatment.
F. CWCCI Reimbursement. The Contractor shall accept CWCCI reimbursement for
allowable screening and diagnostic services in accordance with the Schedule of Services
as payment in full for those services. The Contractor shall not bill a woman for the
difference between its normal billing charge and the CWCCI reimbursement rate.
2
G. Ilse of Qualified Personnel Only. The Contractor shall use only qualified personnel
who are licensed or certified professionals to conduct medical examinations, operate
equipment, conduct tests, and interpret results. Medical personnel performing the
clinical breast examinations shall: be physicians, nurse practitioners, physician
assistants, or nurse midwives; or, be deemed qualified by the Contractor's Medical
Director only after receiving sufficient formal medical training to perform these clinical
services.
H. Cytology laboratories shall comply with the federal Clinical Laboratory Improvement
Act of 1988 (CLIA-88).
I. Mammography centers shall be certified by the Food and Drug Administration(FDA)
and shall comply with the Mammography Quality Standards Act of 1992.
4. The Contractor shall notify the CWCCI whenever it enters into agreements with, or changes,
providers of mammography and cytology laboratory services.
5. The Contractor shall provide culturally sensitive services to the target priority populations as
defined by the CWCCI. The target priority populations are: uninsured and under-insured older
women who are racial, ethnic, or cultural minorities, including but not limited to, African
Americans, American Indians, Asian/Pacific Islanders, Hispanics, and Lesbians; women with
disabilities; and, women who live in hard to reach communities in urban and rural areas.
6. The Contractor shall provide data to the CWCCI on forms designated by the CWCCI. The data
shall include, but is not limited to: the total number of women screened for breast and cervical
cancer: the clinical results of all exams; and, the results from tracking and follow-up for
symptomatic women, or women with a screen detected abnormality. This data shall be
integrated into the Service Delivery System, the Tracking and Follow-up System, the Case
Compliance Summary System, and the Fiscal Management System, all of which are maintained
by the Cli1/CCI.
7. Funding for a Case Manager is provided in the Schedule of Services. This funding is to
facilitate client enrollment, data completion, and data submission to the CWCCI. This funding
is Fifty Dollars ($50.00) for each case annually and is based upon the Contractor's compliance
with the following standards of performance by the Contractor. Failure to accept funding for
the Case Manager does not exempt the Contractor from meeting these compliance standards.
A. Use of Case Enrollment Forms. Case Enrollment Forms (Personal History Form,
Consent and Release of Medical Information and Clinical Services Form) shall be
submitted to the CWCCI for 90% or more of the cases within 60 days of the date of the
most recent service performed and shall be submitted with essential information
properly completed in 90% or more of the cases.
B. Submission of Test Results. Mammogram results shall be submitted to the CWCCI in
90% or more of the cases within 60 days of the service being provided and shall have
the essential information reported properly and accurately in 90% or more of the cases
submitted. This information shall be submitted on the CWCCI designated form, which
includes all required data elements.
C. Tickler System. The Contractor shall have a system in place to assure clients who need
short interval rescreening procedures (i.e., 3 - 6 months) are reminded of the need for
these procedures and shall assist those clients as needed in obtaining those services.
3
8. Funding for Intensive Case Management Services is also provided in the Schedule of Services.
This funding is to facilitate follow-up activities for women with abnormal screening results
(when diagnostic testing is not completed during the initial screening visit) andior a diagnosis of
cancer. Abnormal results qualifying for services are defined as follows:
Clinical Breast Examinations- discrete palpable mass, bloody or serous nipple discharge, nipple
or areolat scaliness and/or skin dimpling or retraction.
Mammogtaphy - suspicious abnormality, biopsy should be considered; highly suggestive of
malignancy, appropriate action should be taken; or assessment is incomplete, need additional
imaging evaluation.
PAP Test- high-grade squamous intra epithelial lesion (HSIL), squamous cell carcinoma,
atypical glandular cells of undetermined significance(AGUS), and/or adenocarcinoma.
This funding is an additional $150 per abnormal finding per client and is based upon consistent
adherence to the following standards of performance by the Contractor.
A. The Contractor shall assure or document attempts to assure that women with abnormal
screening results receive all appropriate diagnostic services within 60 days of the
abnormal finding.
B. The Contractor shall assure that treatment services are available to all women with a
diagnosis of cancer regardless of the woman=s ability to pay for those services.
C. 1['he Contractor shall develop a care plan using the CWCCI designated form per
abnormal finding per client assessed to need Intensive Case Management services.
Each care plan will:
. Address client's needs and be reassessed and revised as needed upon receipt of
diagnostic results;
2. Set goals with time frames and delineate who is responsible for meeting these
goals;
3. Document efforts made to meet the identified needs; and,
4. Be developed by the Case Manager, nurse coordinator, provider, or other staff
with the appropriate skills in collaboration with the client. The client shall
acknowledge her agreement with and commitment to the plan.
:i. Be submitted to the state, within 60 days of the abnormal finding, along with
the Radiological Report form in the case of mammography abnormality and/or
the Clinical Services form in the case of CBE or cervical abnormality.
D. Diagnostic follow-up information for all women, including those referred to outside
health care providers for these diagnostic procedures, shall be provided to the CWCCI
on the Breast or Cervical Diagnostic Follow-up Report forms. Timeliness standard:
90% or more of the cases shall be submitted within 60 days of the date of detection of
the abnormality; accuracy standard: 90% or more of the cases shall be submitted with
essential information properly complete; lost to follow standard: no more than 10% of
women shall be lost to follow-up. A copy of the documented follow-up efforts shall he
4
submitted to the CWCCI with the appropriate diagnostic follow-up form. Minimum
follow-up efforts shall be those defined in the CWCCI follow-up policies.
E. The CWCCI computer generated breast and cervical follow-up forms shall be
accurately completed and submitted for 90% or more of the cases within 60 days of the
date of form production.
F. All women with a cervical final diagnosis of CIN 11 or more severe, or a breast
malignancy, shall have treatment status information submitted to the CWCCI.
Timeliness, accuracy and lost-to-follow standards as defined in paragraph D above shall
also apply.
Payment of the Case Manager fee and/or Intensive Case Management services fee is predicated
on the Contractor's continued compliance with the above standards. Any of the above standards
on which there has been non-compliance shall require the Contractor to develop, submit and
adhere to a remediation plan and bring the standard(s) into compliance within thirty days. More
than two breaches of compliance regardless of remediation, or any one without an approved
remediation plan within thirty days during the term of this Task Order may result in cessation of
funding for the Case Manager and/or Intensive Case Management Services or termination of the
Task Order for default without liability of any kind to the State.
9. Any Contractor that provides services to 15 or more women per year shall send at least one
agency representative to the annual Service Provider meeting at the State's expense. Expenses
for additional representatives from an agency must have prior approval from the State.
Agencies that provide services to less than 15 clients per year may also send a representative to
the annual meeting, but shall do so at their own agency's expense.
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Attachment B
SCHEDULE OF SERVICES
Fiscal Year 2001
SCREENING REIMBURSEMENT
RATE
Mammogram $ 67.81
Clinical Breast Exam $ 43.35
Pelvic Exam $ 43.35
Pap Lab (by Cytotech) $ 14.60
Pap Lab (when physician interpretation required) $ 25.41
DIAGNOSTIC
GYN Consultation $ 113.79
Diagnostic Mammogram/Additional Views $ 81.89
Breast Ultrasound $ 67.37
Surgical Consultation $ 113.79
Cyst Aspiration $60.10
Fine Needle Aspiration (FNA) S241.31
U/S Guided FNA $ 393.11
Stereotactic Core Biopsy $ 766.12
Ultrasound Guided Core Biopsy $483.02
Excisional Biopsy $ 687.86
Colposcopy without Biopsy $ 77.88
Colposcopy with Biopsy $ 174.68
Tracking and Follow--up @ 15% of total services provided.
Patient Travel Allowances (Please provide receipts/documentation on agency letterhead).
Case Manager Fee at $50.00 per new screen.
Intensive Case Manager Fee @ $150.00 per abnormal finding per client
for designated abnormal findings _
h:/reimbOl.thl
[Dated Sample Task Order Change Order Letter Attachment C
State Fiscal Year 19** - **, Task Order Change Order Letter Number **, Task Order Routing Number *******
Pursuant to paragraph ** of the Task Order with Task Order routing number **-*****and Task Order encumbrance
number ***********, (as amended by Task Order Renewal Letter **, Task Order routing number **-*****, and/or Task
Order Change Order Letter **, Task Order routing number **-*****, if any), hereinafter referred to as the "Original Task
Order" (a copy of which is attached hereto and by this reference incorporated herein and made a part hereof) between the
State of Colorado,Department of Public Health and Environment and Contractofs Legal Name, for the term from
********* **, ****, through ********* **. ****the parties agree that the maximum amount payable by the State Foi the
eligible services referenced :n paragraph ** of the Original Task Order is increased/decreased by dollar amount
DOLLARS, ($*.**) 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 Task
Order is hereby modified accordingly. All other terms and conditions of the Original Task Order are hereby reaffirmed.
This amendment to the Original Task Order 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 assist. I as he limy
designate.
Please sign, date, and return all ** originals of this Task Order 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 Task Order Change Order
Letter will be returned to ycu when fully approved.
Contractor's Legal Name STATE OF COLORADO
(legal type of entity) Bill Owens, Governor
By: By:
For the Executive Director
Prini Name: DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
Title:
FEIN:
APPROVALS:
CONTROLLER: PROGRAM:
By: By: --
Arthur L. Barnhart
[Date] Sample Task Order Renewal Letter Attachment D
State Fiscal Year 19*'* - **, Task Order Renewal Letter Number **, Task Order Routing Number *******
Pursuant to paragraph ** of the Task Order with Task Order routing number **-*****and Task Order encumbrance
number ***********, (as amended by Task Order Change Order Letter ** Task Order routing number **-*****, and/or
Task Order Renewal Letter * , Task Order routing number **-*****, if any), hereinafter referred to as the "Original Task
Order" (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. ********* **, ****, through ********* **. ****the parties agree that the maximum amount payable by the State
for the eligible services referenced in paragraph ** of the Original Task Order is increased/decreased by dollar amount
DOLLARS, ($*.**) for a new total financial obligation of the State of dollar amount DOLLARS ($*.**). The rep ised
work plan, which is attached: hereto as "Attachment I", 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 Task
Order is hereby modified accordingly. All other terms and conditions of the Original Task Order are hereby reaffirmed.
This amendment to the Original Task Order 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 u y
de i,Hate.
Please sign, date, and return all ** originals of this Task Order Renewal Letter by ********* **`***, to the attention of:
************ ****"*****", Colorado Department of Public Health and Environment, 4301) Cherry Creek Drihe
South, Denver, Colorado 80246, Mail Code: *****-**. One original of this Task Order 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 HEALI'II
AND ENVIRONMENT
Title:
FEIN:
APPROVALS:
STATE CONTROLLER: PROGRAM:
By: ._ By:
Arthur L. Barnhart
(7-et `\I
willk MEMORANDUM
COLORADO
TO: Barbara J. Kirkmeyer, Chair, Board of County Commissioners
FROM: Mark E. Wallace, MD,MPH, Director, Department of Public flea
Environment , q &L
SUBJECT: Colorado Women's Cancer Control Initiative Task Order
DATE: August 16, 2000
Enclosed for Board review and approval is a task order to become part of the Master Contract
between the Weld County Department of Public Health and Environment and the Colorado
Department of Public Health and Environment for the Colorado Women's Cancer Control
Initiative. The intent of this task order is to increase breast and cervical cancer screenin; and
diagnosis among low income older women who are uninsured anc under insured including those
who are racial, ethnic and cultural minorities. For these services.. WCDPHE will be paid the
approved Medicare reimbursement rate. A schedule of these rates is included in the task order H;
scope of work.
The term of this task order is from August 15, 2000 through August 14, 2001. I recommend y'or
approval.
Enc.
2000 n t):'
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