HomeMy WebLinkAbout940885 RESOLUTION
RE: APPROVE PRENATAL PROGRAM CONTRACT WITH COLORADO DEPARTMENT OF HEALTH AND
ENVIRONMENT AND AUTHORIZE CHAIRMAN 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 Prenatal Program Contract
between the County of Weld, State of Colorado, by and through the Board of County
Commissioners of Weld County, on behalf of Weld County Health Department, and the
Colorado Department of Public Health and Environment, commencing October 1, 1994,
and ending September 30, 1995, with further terms and conditions being as stated
in said contract, and
WHEREAS, after review, the Board deems it advisable to approve said
contract, a copy of which is attached hereto and incorporated herein by
reference.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Prenatal Program Contract between the County of Weld,
State of Colorado, by and through the Board of County Commissioners of Weld
County, on behalf of Weld County Health Department, and the Colorado Department
of Public Health and Environment be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is,
authorized to sign said contract.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 21st day of September, A.D. , 1994.
A BOARD OF COUNTY COMMISSIONERS
ATTEST: IlLeMGL2 WELD COUNTY, COLORADO
Weld County Clerk to the Board J)& \1 //i'/'� ,/Pr-
c bster, Ch irman
BY: lU ��ty e / yf,(,th,„
Deputy 'Clerk to the Board Dale IC Hall, P o-
J
OV AS O_FORM: /C/C., -t '/y jamy
/,F'eorge }'✓ Baxter
o my Attorney Constance L. Harbert
Barbara S. Kir eyer
940885
bfGi'C;.> c_d , NZ ( 'Lc J )
DEPARTMENT OR AGENCY NUMBER
Health -- FAA
CONTRACT ROUTING NUMBER
950536
CONTRACT
THIS CONTRACT, made this lst day of October 1994, by and between the State
of Colorado for the use and benefit of the Department of 7UBLIC HEALTH AND
ENVIRONMENT , 4300 Cherry Cree)cDrive South. Denver, Colorado, 80222 hereinafter
referred to as the State, and WELD COUNTY HEALTH DEPARTMENT, 1517 16th Avenue
Court, Greeley, Colorado 80631 hereinafter referred to as the contractor.
WHEREAS, authority exists in the Law and Funds have been budgeted,
appropriated and otherwise made available and a sufficient unencumbered balance
thereof remains available for payment in Fund Number 100 , APPR code 585 ,
Contract Encumbrance Number FAA PRN950536; and
WHEREAS, required approval, clearance and coordination has been
accomplished from and with appropriate agencies; and
WHEREAS, the State has formulated a comprehensive State plan relative to
the Maternal and Child Health Division, Prenatal Program; and
WHEREAS, said comprehensive State plan and federal budget allocates funds
to other agencies in order to provide these health care services to the people
of Colorado; and
WHEREAS, the Contractor is considered by the State to be an appropriate
agency to fulfill the requirements of the program as herein set forth.
NOW THEREFORE, it is hereby agreed that for and in consideration of their
mutual promises to each other, hereinafter stated, the parties hereto agree as
follows:
1. The Contractor will provide prenatal and postpartum care, including
education and counseling, in accordance with the "Prenatal Care
Guidelines", a copy of which has been made available to the
Contractor. The Contractor will be reimbursed $400 for each patient
with no other payor source, who has completed at least one visit
that included medical care and the required laboratory work. The
Contractor sill be reimbursed at the end of the patient's pregnancy,
or otherwise negotiated with the state.
2. The Contractor will offer the following program components to
pregnant women:
a) Coordinated care between medical providers and the local
health agency including assistance in securing delivery
services.
b) Referrals and assistance in seeking continuous infant and
child health care.
c) Up to two home visits per woman, one of which must be a
postpartum assessment of mother and newborn within 48 hours of
hospital discharge, or otherwise described in the guidelines.
The second home visit may be postpartum or during the prenatal
period.
d) Diagnostic tests.
Page 1 of 7
940885
e) Free pregnancy testing in order to provide referrals for women
with positive tests; and contraceptive education, referral,
and if appropriate non-prescriptive contraceptives to women
with negative pregnancy tests.
3. Individual records on each maternity patient will be maintained by
the Contractor and are subject to audits, either self or
independent, to be determined by the State. Data on each prenatal
patient will be submitted on forms supplied by the State hereto
attached as Attachment A.
4. Payment for patients who transfer from one Contractor to another
will be negotiated between the two Contractors, with assistance from
the State.
5. The Contractor agrees to maintain at least the same level of
local/county funding for the Prenatal Program as in the previous
year, as reported on the final expenditure/revenue report.
6. Program income generated from patient fee collections and donations
must be used by the program only for prenatal services which further
the objectives of the legislation under which this contract is made.
In accordance with Title V, Section 501 (b) (2) and Section 505 (2)
(d) no charges shall be made for services provided to patients at or
below 100% of the poverty level. Federal poverty guidelines have
been provided to the Contractor. Patients between 100% and 185% of
poverty may be charged on a sliding fee scale. Patients at or below
133% of poverty must be instructed to apply for Medicaid.
7. In accordance with Title V, Section 504 (b) (6) Title V funds may
not be used to pay for any item or service (other than an emergency
item or service) furnished by an individual or entity convicted of
a criminal offense under the Medicare or any State health care
program (i.e. Medicaid, Maternal and Child Health, or Social
Services Block Grant programs) .
8. The Contractor agrees to provide services to all program
participants and employees in a smoke-free environment. Smoking may
not be permitted in waiting areas, examination rooms, formal
sessions providing education, therapy, or similar services.
Designated smoking areas may be established for staff, program
participants, family members,and visitors. These designated areas
should be well ventilated in order that the waiting area and the
service delivery environment remains smoke free.
Page 2 of 7
940885
9. The State will pay Thirty-two thousand (532,000) Dollars to
administer the program, purchase medical supplies and
pharmaceuticals, and to provide medical, laboratory, education and
counseling to 80 patients; Zero (S-0-) Dollars for -0- home
visits; Sixteen thousand (516,000) Dollars for diagnostic tests
including pregnancy tests; Ninety thousand (590,000) Dollars for
Helping Moms Enhanced services to 225 patients; and Four hundred
(5400) Dollars for annual meeting and other travel expenses. In
consideration of said services by the Contractor and conditioned
upon affirmation by the Women's Health Section Prenatal Program that
services were rendered in accordance with this contract, the State
will cause to be paid to the Contractor a sum not to exceed One
hundred thirty-eight thousand four hundred (5138,400) Dollars as
follows:
a) Contractor will request reimbursement each month of 1/12 of the
total contract amount on a signed Contract Reimbursement Statement
hereto attached as Attachment B.
b) The Contractor will submit to the State a semi-annual report of
total expenses and revenues by April 30 and November 15 using the
form hereto attached as Attachment C.
10. This contract amount may be increased or decreased based on
increases or decreases in the final Maternal and Child Health Block
Grant award from the Public Health Service.
11. Changes in total reimbursement amounts for the above named services
in consideration of increased or decreased levels of utilization
from the levels funded in the original contract shall be made with
approval of the Contractor, the State (Prenatal Program), and the
State Controller as evidenced by a mutually signed Contract Change
Letter (sample attached and by reference made a part hereof as
Attachment D) which shall include the following:
a. Identification of Contract by Contract number and number of
affected paragraph;
b. Amount of increase or decrease in funding;
c. Amount of increase or decrease in utilization;
d. Effective date of the funding change;
e. Authorized signatures of the State, the Contractor and the
State Controller. It is understood that no change except
funding amounts and resulting changes in utilization shall be
made through the letter of approval.
12. This Contract is effective beginning October 1, 1994 and continuing
through September 30, 1995 and is renewable at the state's option
for 1 additional one year period by Contract Renewal Letter in the
form attached hereto as Attachment E. Dollar amounts and patient
numbers for any renewal period are subject to change from prior
contract period based on actual funding appropriations and
legislative approval for each state fiscal year.
Page 3 of 7
940885
•
COLORADO DEPARTMENT OF HEALTH - hereinafter, under the General Provisions referred to as
"Health" .
GENERAL PROVISIONS -- page 1 of 2 pages
I. The contractor shall perform its duties hereunder as an independent contractor and
not as an employee. Neither the contractor nor any agent or employee of the contractor
shall be or shall be deemed to be an agent or employee of the state. Contractor shall
pay when due all required employment taxes and income tax withholdinz. shall provide and
keep in force workers' compensation (and show proof of such insurance) and unemployment
compensation insurance in the amounts required by law. Contractor will be solely
responsible for its acts and the acts of its agents, employees, servants and
subcontractors during the performance of this contract.
2. Contractor authorizes Health, or its agents, to perform audits and to make
inspections for the purpose of evaluating performance under this contract.
3. Either party shall have the right to terminate this agreement by giving the other
party thirty days notice by registered mail, return receipt requested. If notice is so
given, this agreement shall terminate on the expiration of the thirty days, and the
liability of the parties hereunder for the further performance of the terms of this
agreement shall thereupon cease, but the parties shall not be relieved of the duty to
perform their obligations up to the date of termination.
4. This agreement is intended as the complete integration of all understandings
between the parties. No prior or contemporaneous addition, deletion, or other amendment
hereto shall have any force or effect whatsoever, unless embodied herein in writing. No
subsequent novation, renewal, addition, deletion, or other amendment hereto shall have
any force or effect unless embodied in a written contract executed and approved pursuant
to the State Fiscal Rules.
5. If this contract involves the expenditure of federal funds, et this
contract
ct tis
contingent upon continued availability of federal funds for paym pursuant
terms of this agreement. Contractor also agrees to fulfill the requirements of:
a) Office of Management and Budget Circulars A-87, A-21 or A-122, and A-102 or
A-110, 'whichever is applicable;
b) the Hatch Act (5 USC 1501-1508) and Public Law 95-454 Section 4728. These
statutes state that federal funds cannot be used for partisan political purposes of any
kind by any person or organization involved in the administration of federally-assisted
programs;
c) the Davis-Bacon Act (40 Stat. 1494, Mar. 3, 1921, Chap. 411, 40 USC
276A-276A-5) . This act requires that all laborers and and mechanics employed by
contractors or sub-contractors to work on construction projects financed by federal
assistance must be paid wages not less than those established for the locality of the
project by the Secretary of Labor;
d) 42 USC 6101 et seq, 42 USC 2000d, 29 USC 794. These acts require that no
person shall, on the grounds of race, color, national origin, age, or handicap, be
excluded from participation in or be subjected to discrimination in any program or.
activity funded, in whole or in part, by federal funds; and
Page 4 of 7 Pages
Rev. 06/01/92
940995
GENERAL PROVISIONS--Page 2 0 pages
e) the Americans with Disabilities Act (Public Law 101-336; 42 USC 12101, 12102,
12111 - 12117, 12131 - 12134, 12141 - 12150, 12161 - 12165, 12181 - 12189, '12201 - 12213
and 47 USC 225 and 47 USC 611.
f) if the contractor is acquiring real property and displacing households or
businesses in the performance of this contract, the contractor is in compliance with the
Uniform Relocation Assistance and Real Property Acquisition Policies Act, as amended
(Public Law 91-646, as amended and Public Law 100-17, 101 Stat. 246 - 256) ;
g) when applicable, the contractor is in compliance with the provisions of the
"Uniform Administrative Requirements for Grants and Cooperative Agreements to State and
Local Governments (Common Rule) .
6. By signing and submitting this contract the contractor states that:
a) the contractor is in compliance with the requirements of the Drug-Free
Workplace Act (Public Law 100-690 Title V, Subtitle D, 41 USC 701 et seq. ) ;
b) the contractor is not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by any federal
department or agency.
7. To be considered for payment, billings for payment pursuant to this contract must
be received within 60 days after the period for which payment is being requested and
final billings on the contract must be received by Health within 60 days after the end
of the contract term.
8. If applicable, Local Match is to be submitted on the monthly payment statements, in
the column provided, as required by the funding source.
9. If Contractor receives $25,000.00 or more per year in federal funds in the
aggregate from Health, Contractor agrees to have an annual audit, by an independent
certified public accountant, which meets the requirements of Office of Management and
Budget Circular A-128 or A-133, whichever applies. If Contractor is required to submit
an annual indirect cost proposal to Health for review and approval, Contractor's auditor
will audit the proposal in accordance with the requirements of OMB Circular A-87, A-21
or A-122. Contractor agrees to furnish one copy of the audit reports to the Health
Department Accounting Office within 30 days of their issuance, but not later than nine
months after the end of Contractor's fiscal year. Contractor agrees to take appropriate
corrective action within six months of the report's issuance in instances of
noncompliance with federal laws and regulations. Contractor agrees to permit Health or
its agents to have access to its records and financial statements as necessary, and
further agrees to retain such records and financial statements for a period of three
years after the date of issuance of the audit report. This contract "does 100%"
contain federal funds as of the date it is signed. This requirement is in addition to
any other audit requirements contained in other paragraphs within this contract.
10. Contractor agrees to not use federal funds to satisfy federal cost sharing and
matching requirements unless approved in writing by the appropriate federal agency.
•
} Page 5 of 7 Pages
Rev. 06/01/92
940A95
•
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
1.This contract shall not be deemed valid until it shall have been approved by the Controller of the State of Colorado or such assistant as he may designate. This
provision is applicable to any contract involving the payment of money by the State.
FUND AVAILABILITY
•
2. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated,budgeted,
and otherwise made available.
BOND REQUIREMENT
3. If this contract involves the payment of more than fifty thousand dollars for the construction,erection,repair,maintenance,or improvement of any building,
road. bridge,viaduct.tunnel,excavation or other public work for this State,the contractor shall.before entering upon the performance of any such work included
in this contract.duly execute and deliver to the State official who will sign the contract,a good and sufficient bond or other acceptable surety to be approved by
said official in a penal sum not less than one-half of the total amount payable by the terms of this contract.Such bond shall be duly executed by a qualified corporate
surety conditioned upon the faithful performance of the contract and in addition,shall provide that if the contractor or his subcontractors fail to duly pay for any
labor,materials.team hire.sustenance,provisions,provendor or other supplies used or consumed by such contractor or his subcontractor in performance of the work
contracted to be done or fails to pay any person who supplies rental machinery,tools,or equipment in the prosecution of the work the surety will pay the same in
an amount not exceeding the sum specified in the bond,together with interest at the rate of eight per cent per annum. Unless such bond is executed,delivered and
filed,no claim in favor of the contractor arising under such contract shall be audited,allowed or paid.A certified or cashier's check or a bank money order payable
to the Treasurer of the State of Colorado may be accepted in lieu of a bond.This provision is in compliance with CRS 38-26-106.
INDEMNIFICATION
4. To the extent authorized by law,the contractor shall indemnify, save, and hold harmless the State, its employees and agents, against any and all claims,
damages. liability and court awards including costs,expenses,and attorney fees incurred as a result of any act or omission by the contractor, or its employees,
agents,subcontractors,or assignees pursuant to the terms of this contract.
DISCRIMINATION AND AFFIRMATIVE ACTION
5. The contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957, as amended, and other applicable law respecting
discrimination and unfair employment practices(CRS 24-34-402).and as required by Executive Order,Equal Opportunity and Affirmative Action,dated April 16.
1975.Pursuant thereto,the following provisions shall be contained in all Slate contracts or sub-contracts.
•
During the performance of this contract,the contractor agrees as follows:
(a) The contractor will not discriminate against any employee or applicant for employment because of race, creed, color, national origin, sex,
marital status, religion,ancestry,mental or physical handicap,or age.The contractor will take affirmative action to insure that applicants are empioyed,and that
employees are treated during employment, without regard to the above mentioned characteristics. Such action shall include,but not be limited to the following:
employment upgrading,demotion,or transfer,recruitment or recruitment advertisings; lay-offs or terminations;rates of pay or other forms of compensation;and
selection for training. including apprenticeship.The contractor agrees to post in conspicuous places,available to employees and applicants for employment,
notices to be provided by the contracting officer setting forth provisions of this non-discrimination clause.
(b)The contractor will,in all solicitations or advertisements for employees placed by or on behalf of the contractor,state that all qualified applicants will
receive consideration for employment without regard to race,creed,color,national origin,sex,marital status.religion,ancestry,mental or physical handicap.
or age.
Icl The contractor will send to each labor union or representative of workers with which he has a collective bargaining agreement or other contract or
understanding.notice to be provided by the contracting officer,advising the labor union or workers'representative of the contractor's commitment under the
Executive Order,Equal Opportunity and Affirmative Action,dated April 16. 1975,and of the rules,regulations-and relevant Orders of the Governor.
(d)The contractor and labor unions will furnish all information and reports required by Executive Order,Equal Opportunity and Affirmative Action of April
16. 1975. and by the rules, regulations and Orders of the Governor,or pursuant thereto,and will permit access to his books,records, and accounts by the
contracting agency and the office of the Governor or his designee for purposes of investigation to ascertain compliance with such rules,regulations and orders.
(e)A labor organization will not exclude any individual otherwise qualified from full membership rights in such labor organization,or expel any such individual
from membership in such labor organization or discriminate against any of its members in the full enjoyment of work opportunity because of race,creed.color,
sex,national origin,or ancestry.
(f) A labor organization.or the employees or members thereof will not aid,abet,incite,compel or coerce the doing of any act defined in this contract to be
discriminatory or obstruct or prevent any person from complying with the provisions of this contract or any order issued thereunder;or attempt.either directly
or indirectly,to commit any act defined in this contract to be discriminatory.
•
Form 6-AC-026
Revised 1/93
395-53-01-1022
6
page of 7 pages
940SR5
•
(g)In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rules,regulations,or orders,
- this contract may be canceled,terminated or suspended in whole or in pan and the contractor may be declared ineligible for further State contracts in
accordance with procedures,authorized in Executive Order.Equal Opportunity and Affirmative Action of April 16. 1975 and the rules,regulations,or
orders promulgated in accordance therewith,and such other sanctions as may be imposed and remedies as may be invoked as provided in Executive Order,
Equal Opportunity and Affirmative Action of April 16, 1975, or by rules,regulations,or orders promulgated in accordance therewith, or as otherwise
provided by law.
•
(h)The contractor will include the provisions of paragraphs(a)through(h)in every sub-contract and subcontractor purchase order unless exempted by
rules,regulations,or orders issued pursuant to Executive Order.Equal Opportunity and Affirmative Anion of April 16,1975.so that such provisions will
be binding upon each subcontractor or vendor.The contractor will take such action with respect to any sub-contracting or purchase order as the contracting
agency may direct,as a means of enforcing such provisions,including sanctions for noncompliance:provided,however,that in the event the contractor
becomes involved in.or is threatened with,litigation,with the subcontractor or vendor as a result of such direction by the contracting agency,the contractor
may request the State of Colorado to enter into such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a.Provisions of CRS 1-17-101 A 102 for preference of Colorado labor am applicable to this contract if public works within the State am undertaken hereunder and
are financed in whole or in pan by State funds.
b.When a construction contract for a public project is to be awarded to a bidder,a resident bidder shall be allowed a preference against a non-resident bidder from
a state or foreign country equal to the preference given or requited by the state or foreign country in which the non-resident bidder is a resident.If it is determined by
the officer responsible for awarding the bid that compliance with this subsection.06 may cause denial of federal funds which would otherwise be available or would
otherwise be inconsistent with requirements of Federal law,this subsection shall be suspended.but only to the extent necessary to prevent denial of the moneys,or to
eliminate the inconsistency with Federal requirements(CRS 8-19.101 and 102)
GENERAL
7.The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation,execution, end enforcement of this
contract.Any provision of this contract whether or not incorporated herein by reference which provides for arbitration by any extra-judicial body or person or which
is otherwise in conflict with said laws,rules,and regulations shall be considered null and void.Nothing contained in any provision incorporated herein by reference
which purports to negate this or any other special provision in whole or in part shall be valid or enforceable or available in any action at law whether by way of complaint,
defence,or otherwise.Any provision rendered null and void by the operation of this provision will not invalidate the remainder of this contract to the extent that the
contact is capable of execution.
8.At all times during the performance of this contract,the Contractor shall strictly adhere to all applicable federal and state laws,rules,and regulations that have
been or may hereafter be established.
9.The signatories aver that they an familiar with CRS 18.8.301.et.seq..(Bribery and Corrupt Influences)and CRS 18-8.401.et.seq.,(Abuse of Public Office).
and that no violation of such provisions is present.
10.The signatories aver that to their knowledge,no state employee has any personal or beneficial interest whatsoever in the service or pmpeny described herein:
IN WITNESS WHEREOF,the panics hereto have executed this Contract on the day first above written.
Contractor:
(Full Legal Name) Weld ty Board of Commissioners STATE OF COLORADO
O149 �k �[� ROY ROMER,GOVERNOR
(-926-1:2)
W. I Webster 1� /
By for
•5 EXECUTIVE DIRECTOR
Position(Title) Chairman
846000813
Scanty Nib II. Namaer DEPARTMENT
If Corporation:) OF HEALTH
Attest(Seal) r
WELD CUia "A D ARTNIENT
By
.9r sac TawwCrrylCaw,ry C B .
1 N S. PICKL , M.S.E.H.
APPROVALS DIRECTOR
ATTORNEY GENERAL CONTROLLER
By By
Form 6-AC-02C Past 7 which it the list of 7 cages
Revised I/93 IN3
J15•SJ-a1.16J0 See instructions on reverse side. /, � pp
PROGRAM APPROVAL: ,U(t.LLLttLLLt 2-7
• AAA'nen•-.
Document RBFBEI Attachment "A"
Rev. 12/93
CO: nRADO DEPARTMENT OF HEALTH
F .cNATAL MONTHLY DATA FORM
(Submit to WHS by the 15th of each month)
COMPLETE FOR EACH PATIENT WHO DELIVERS OR TERMINATES
Deliverer 01
Terminator 02
Clinic Patient Number Used Trans. Patient Name
Code by Clinic Code
•
Gesrabonal Weekot
Soaai Sewn t4umber Mtm?t lrrop ne Couniy• Mar Span Rdca OdiariPnm P:.{ogrrm. Program
Code i Stet Ckg t;4eCpcat. ''R.eg Me�cat
Smoking Alcohol Dabs Nutmaom ; Paycfiosoaal At Deitvety W. 1,94 Pn� Para Pay
14.]P?0 Rj 2§.28 36 Rtsk 262K .36x AtSk2$t28 '4 1$sk4k 2629 36 ucaho . > .fug' FP001: `..nwnl
1790* <8$64!+ ;8749 tkrre Numbernt Dateott)ellvery BirthWeght 040790Oate:otTermir. lion. Tetm
•timw�7 ' e. l As- Prenatal Ageat Rea-
sass ,,::<::?;••,.:::::::: ::::: ].., tjay Year Pounds Ounces 8xdt Mon71 Year son
Canprcatwne _ ment ..?
„,..„„-:.,,ma:,-:rxi.a 649.6
(Gsaa1:{ i s.!: ce tnenri6l
.................................... .... .......... .
Deliverers Only
'Deliverers Only I I Terminators Only
"Terminators Only
•
Document RBFBE 1
Rev. 12/93
COLORADO DEPARTMENT OF HEALTH
PRENATAL MONTHLY DATA FORM
(Submit to WHS by the 15th of each month)
COMPLETE FOR EACH PATIENT WHO DELIVERS OR TERMINATES
Deliverer 01
Terminator 02
Clinic Patient Number Used Trans. Patient Name
Code by Clinic Code
Gestational Weekol
Soaai 9ewrty14amber Annual Income County Mar. Span Race gthe::: -::r Program' Program
Code: Slat R.eg . ' ::Metiaat.:
r'
PTL PPq Smokng Alcohol Drugs Nutrmom : PaY�osoa•al Atbenvery W{C FPR Para Pay,
Risk 2629 38 Rtsk 26 26 .96 RWc 2&26 38 Filth
2G�28 St Risk 2&28 36 Ed aSoa nten 1
-� 656 A"" ;6749 ., tL, rkaYlkia nlr =ry�,��,+: ,Dataoii3ellvsls+ -.� Birth Jetgtit. CaHstapP.i �'3 leP1 mkiaW* :. Term
�t tielwM ? +n As prenatal.ft Ageat Flea-
•
"vc l '..arl(JC1Cah011s Seas l 6Sts„_D Mo*dlt DaY.: '1ear Pounds Ow1r S E!"klli v, tYtontfl'. Year son
6697::;1 86t6 '649.6 ' ment,
t :-:] tiAutisrn tab&cwl '..• I
Deliverers Only I Deliverers Only —}— Terminators Only
"Terminators Only I
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940995
ATTACHMENT "C"
APPLICANT:
PROJECT:
ACTUAL EXPENDITURES
FOR THE PERIOD:
<Annuai dumber Total Source!of Farads .
Salary Months Amount.,? 'Applicant ! Requested
Rate Budget Requii ed, Fand Other from GDH..
PERSONAL SERVICES:
ContractualFee for Service:
Supervising Personnel:
Fringe Benefits: Rate=
Sub total Personal Services
OPERATING EXPENSES:
(includes Building/Facility
Cost not part of Indirect)
Sub total Operating
TRAVEL:
Sub total Travel
EQUIPMENT:
Sub Total Egiupment
Administrative/Indirect Cost
TOTAL PROJECT COST
'Source of Funding for'Applicant and Other'
Local:** $ **
Medicaid: $
Patient Fees: $
Other: $
Total Applicant and Other $
**Are these local funds used to match any other grant? - -Yes No
Signature of Director or Authorized Representative
940A%35
STATE OF COLORADO
Roy Romer,Governor
Patricia A.Nolan,MD,MPH,Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr.S. Laboratory Building a•%e3,.
*
Denver,Colorado 80222.1530 4210 E.11th Avenue •1876•
Phone(303)692-2000 Denver,Colorado 802 20-3 71 6
(303)691-4700 Colorado Department
of Pub' filth
and Environment
Attachment "D"
CONTRACT CHANGE LETTER #_
STATE FISCAL YEAR
Date
TO
Pursuant to Paragraph 12 of the Prenatal Contract, Contract # PRN , [as
amended] , covering the period October 1, 199_ to September 30, 199_, the Colorado
Department of Public Health and Environment hereby notifies that
the maximum amount of reimbursement from the Prenatal Program is hereby
increased/decreased by Dollars (S ) to a new total of
Dollars (S ) (Page 3, Paragraph 10) .
The number of patients to be served is to be increased/decreased by
patients to a new total of patients; Home visits are to be
increased/decreased by to a new total of _; Diagnostic testing dollars
are to be increased/decreased by to a new total of and
Helping Moms Enhanced services are to be increases/decreased by _ to a new
total of patients.
This contract change letter is intended to be effective , but in
no event shall it be deemed valid until it is approved by the State Controller
or his designee.
Please sign and return all copies of this notification to the Prenatal Program.
A fully executed copy will be returned to you.
Sincerely,
Lee Thielen Contractor
Assistant Director
Colorado Department of Public By
Health and Environment Title
Program Approval APPROVED:
State Controller, Clifford W. Hall
By
Ray Campbell
CDPHE PRN 9/94 Colorado Department of Public Health
and Environment
940A95
• Attachment "E"
STATE OF COLORADO
Roy Romer,Governor
Patricia A.Nolan,MD,MPH,Execuive Director
Dedizated to protecting and improving the health and environment of the people of Colorado 'G.,
4300 Cheny Creek Dr.S. Laboratory Building
Denver,Colorado 80222-1530 4210 E.11th Avenue
Phone(303)692-2000 Denver,Colorado 80220-3716
(303)691-4700 —C��Department
of Public Health
and Environment
CONTRACT RENEWAL LETTER
DATE
TO:
The Colorado Department of Public Health and Environment hereby notifies
that pursuant to paragraph 13 of contract number
PRN , the state will exercise its option to renew this contract for an
additional one year period beginning October 1, 199_ through September 30, 199_.
Paragraph 10 of the contract is deleted and replaced with the following
(paragraphs l0a and lOb remain unchanged) :
The State will pay ($ ) Dollars to administer the program, screen
patients, and to provide education and counseling to _ patients; ($
Dollars for _ home visits; (S ) Dollars for diagnostic
tests, including pregnancy tests; (S ) Dollars for Helping
Moms Enhanced services to patients, and (S ) Dollars for
annual meeting expenses. In consideration of said services by the Contractor and
conditioned upon affirmation by the Women's Health Section Prenatal Program that
services were rendered in accordance with this contract, the State will cause to
be paid to the Contractor a sum not to exceed
($ ) Dollars as follows:
This contract renewal letter is intended to be effective October 1, 199_, but in
no event shall it be deemed valid until it is anvroved by the State Controller
or his designee.
Please sign and return all copies of this notification. A fully executed copy
will be returned to you.
Sincerely,
Lee Thielen
Assistant Director
Colorado Department of Public Contractor
Health and Environment By
Title
Program Approval APPROVED
State Controller, Clifford W. Hall
By
Ray Campbell, Controller,
Colorado Department of Public
CDPHE PRN 9/94 Health and Environment
9408%5
mEmoRAnDum
W ILD 0 To Cm
W.H. Webster, Chairman
an
Board of County sionersDete September 16 1994
COLORADO From John Pickle, Director, Health Department ��l�J
Subject: Prenatal Program Contract
Enclosed for Board approval is a contract between the Weld County Health
Department and the Colorado Department of Public Health and Environment for
our prenatal program.
The Health Department will receive $138,400 to provide prenatal care for the
period October 1, 1994 through September 30, 1995. The Health Department will
provide prenatal and postpartum care, including education and counseling for
80 non-Medicaid clients and enhanced services for 225 clients.
I recommend your approval of this contract.
Enclosure
r
940885
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