HomeMy WebLinkAbout940937.tiff RESOLUTION
RE: APPROVE CONTRACT FOR HANDICAPPED CHILDREN'S PROGRAM BETWEEN HEALTH
DEPARTMENT AND COLORADO DEPARTMENT OF PUBLIC 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 Contract for the Handicapped
Children's Programmbetween the County of Weld, State of Colorado, by and through
the Board of County Commissioners of Weld County, on behalf of the 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 Contract for the Handicapped Children's 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 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 28th day of September, A.D. , 1994.
BOARD OF COUNTY COMMISSIONERS
ATTEST: Mr414 WELD COUNTY, COLORADO
Weld County Clerk to the Board )/ }, / / )l
}' W. H. Webster, Ch irm
BY: �I J
eputy ClCl rk to the Board Da e Hall, Prq-- eiL
APPROVE S TO FORM: at _ 6. 2-,
Geo . Baxter
74
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County Att rney Constance L. Harbert
�,51tGc /
arbara J. Kirkmey r
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/4 l 940937
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ISnintirri OR AGENCY NAME
HEALTH
ONVAR'INImc OR AGENCY NUMBER
FAA
OUNIRACT.ROMINC NUN@ER
CONTRACT
THIS CONTRACT, Made this 1st day of October 199 4 , by and between the
State of Colorado for the use and benefit of the Department of *7 Public Health
& Environment. 4300 Cherry Creek Drive South. Denver. Colorado 80222-1530
hereinafter referred to as the State, and *2 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 uncommitted balance
thereof remains available for encumbering and subsequent payment of this contract
under Encumbrance Number FAA HCP950471 in Fund Number 100 , Appropriation
Account 606 , and Organization 6820 ; and
WHEREAS, required approval , clearance and coordination has been
accomplished from and with appropriate agencies; and
WHEREAS, *3the State is charged with operating the Health Care Program For
Children With Special Needs (HCP) formerly the Handicapped Children's Program/
Children With Special Health Care Needs (HCP/CSHCN) (hereinafter referred to as
the Program) and do so through its Family and Community Health Services Division,
(hereinafter, the State and its Family and Community Health Services Division
will be referred to collectively as the State); and
WHEREAS, the State, through the Program, has been mandated to provide care
coordination services for eligible children; and
WHEREAS, said Program allocates funds to other agencies in order to provide
these care coordination services to the people of Colorado; and
WHEREAS, the Contractor is considered by the State to be an appropriate
agency to provide the services to the program as herein set forth.
WHEREAS, the Program either directly or through interagency collaboration
provides prevention, identification, assessment, and treatment services to
children with special health care needs and their families in a culturally
respectful manner building on community-based resources.
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:
I. *4The Contractor will provide Case Finding and Community Outreach, Care
Coordination, Clinic Management, Program Management, Parent and Family
Involvement and Support, and Interagency Collaboration as described in
Page 1 of 7 pages
*(See instructions on reverse of last page)
94093"
ATTACHMENT A, Effectiveness Indicators For Weld County Health Department
and by this reference made a part hereof.
2. The Contractor will serve State recipients and recipient families who
are determined to be eligible for Program services. Recipients served will
be children residing or whose families have residence in Weld County.
3. The Contractor will cooperate with and provide all requested records
regarding recipients for whom services were provided under this contract
at the time that periodic chart audits occur.
4. The Program will , in consideration of said services by the Contractor,
cause to be paid to the Contractor an amount not to exceed NINETY-SEVEN
THOUSAND SIX HUNDRED FIFTY-FIVE DOLLARS AND ZERO CENTS ($97,655.00) for the
period from October 1, 1994 through September 30, 1995. Reimbursement
shall be conditioned upon affirmation by the Program that said services
were rendered in accordance with the terms and conditions of this contract,
as follows:
A. Upon receipt of a signed monthly statement, ATTACHMENT B, Contract
Reimbursement Statement and by this reference made a part hereof,
submitted in duplicate by the Contractor to the State, requesting
reimbursement for salaries, fringe benefits, software & equipment,
travel expenses, operating expenses, and indirect expenses. Said
reimbursement statement shall set forth dates, brief description of
expenditures, amounts, and total reimbursement requested.
Reimbursement shall be conditioned upon affirmation by the Program
that said services were rendered in accordance with the terms and
conditions of this contract.
B. The budget, ATTACHMENT C and by this reference made a part hereof,
shall govern the expenditure of funds between October 1, 1994 and
September 30, 1995 by the Contractor, as well as the subsequent
reimbursement by the Program. Transfer of funds from one line item
to another must have written approval by the Program.
5. Payment pursuant to this contract will be made as expenses are
incurred and billed monthly by the Contractor. It is understood and agreed
that the maximum amount of State funds available for the contract period
is SIX HUNDRED FIFTY THOUSAND DOLLARS AND ZERO CENTS ($650,000.00) The
liability of the State, at any time, for such payments shall be limited to
the unencumbered amount remaining of such funds.
It is agreed that additional funds may be awarded to expand or
increase activities. Should such funds become available, they will be
awarded by an amendment to this contract.
6. 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 environment remains smoke-free.
Page 2 of 7 pages
940937
7. No charges will be made to families by the Contractor for care
coordination/case management regardless of a family's income.
8. Charges for attendance and services at medical specialty clinics
sponsored by the Program must conform to the Clinic Charge Schedule,
ATTACHMENT D and any subsequent amendments thereto, and by this reference
made a part hereof.
9. No Federal appropriated funds have been paid or will be paid by or on
behalf of the State, 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 contract, and the extension,
continuation, renewal , amendment, or modification of any contract, grant,
loan or cooperative agreement that utilizes Federal funds.
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 in connection with this Federal contract, grant, loan,
or cooperative agreement, the Health shall complete and submit Standard
Form - ILL, "Disclosure Form to Report Lobbying", in accordance with its
instructions.
10. 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) .
11. The Contractor certifies, by submission of this contract, that neither
it nor its principals is presently debarred, suspended, proposed for
debarment, declared ineligible, or voluntarily excluded from participation
in this transaction by any Federal department or agency.
12. The Contractor shall protect the confidentiality of all applicant or
recipient records and other materials that are maintained in accordance
with this contract. Except for purposes directly connected with the
administration of this Program, no information about or obtained from any
applicant or recipient shall be disclosed in a form identifiable with the
applicant or recipient without the prior written consent of the applicant
or recipient or a minor's parent or guardian or as otherwise properly
ordered by a court of competent jurisdiction. The Contractor shall have
written policies governing access to duplication and dissemination of all
such information. The Contractor shall advise its employees, agents,
servants, and subcontractors, if any, that they are subject to these
confidentialities.
13. This Contract is subject to and contingent upon the continuing
availability of Federal funds for the purposes hereof.
14. The term of this contract is beginning October 1, 1994 and ending
September 30, 1995.
Page 3 of 7 pages
94093'7
COLORADO DEPARTMENT OF HEALTH - hereinafter, under the General Provisions referred to as
"Health".
GENERAL PROVISIONS -- page 1 of 2 pages
1. 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 withholding. shall provide and keep in force
worker's 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 embodies herein in writing. No subsequent
novation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodies in a written contract executed and approved pursuant to the State
Fiscal Rules.
5. If this contract involves the expenditure of federal funds, this contract is contingent
upon continued availability of federal funds for payment pursuant to the 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,
which ever 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 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
Rev. 06/01/92
940937
GENERAL PROVISIONS--Page 2 of 2 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 the 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 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
940937
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 be may designate.This
provision is applicable to any contract involving the payment of money by the State.
FUND AVAII.ABIIATY
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 REQUIItE]NFNf
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 works 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 conditional upon the faithful performance of the contract,and in addition,shall provide that if the contractor or his subcontractors fall 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 machioay,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 e baok 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 3&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 torus of this contract.
DISCRI UNATION 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. Parma*thereto,the following provisions shall be contained In ail State 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,treed,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 employed,and that employees
are treated daring employment,without regard to the above mentioned characteristics.Such action shall include,but not be limited to the following:employment,
upgrating,demotion,or transfer,recruitmentor recruitment advertising;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 applicants
consideration forqualifiedahandicap,
.p,wil receive
employment without regard to race,creed.color,national origin.sex,marital status,religion,ancestry,mental or physical handicap,or age.
(c) 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
,regulation,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-02B
Revised 1/93
395-53-01-1022
page 6 of 7 page
OAnoO►`l
(g) In the event of the contractor's non-compliance with the non-discrimination clauses of this contractor or with any of such odes,regulations,or orders,this
contract may be canceled,terminated or suspended in whole or in part 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.
(It)The contractor will include the provisions of paragraph(a)through min every sub-contract and subcontractor purchase order unless exempted by rules,
regulations,or orders issued pursuant to Executive Order,Equal Opportunity and Affirmative Action of April 16,1975,so that such provisions will be binding
u pon 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 non-compliance;provided,however,that in the event the contractor becomes involved
is.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 inter into such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a.Provisions of CRS 8-17-101&102 for preference of Colorado labor are applicable to this contract if public works within the State are undertaken hereunder
and are financed in whole or in part 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 required 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 came 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)
CEI®tAL
7. The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation,execution,and enforcement of this
coatract. My 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
refereed 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,defense,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 contract 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,soles,and regulations that
ban bee or may hereafter be established.
f. The aigoataries aver that they are familiar with CRS 18-8-301,et.seq.,(Bnbery and Corrupt Influences)and CRS 18-8-401,et.seq.,(Abase of Public Office),
sad that no violation of sack 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 property described herein:
IN WITNESS WHEREOF,the parties hereto have executed this Contract on the day first above written.
Contractor.
(Full Legal Name) Board of County Commissioners STATE OF COLORADO
offir Coupty.coluyado ROY RO -GOVERNOR
Position(Tide) Chasm / nA,I9y Ey yt //U-c—CS;✓ for
84-6000813 'spr' VE DIRECTOR
Social Security Number or Federal I.D.Number
LeM
�,aY/�,// DEPARTMENT
(H Corporation:) �wi! OF PUBLIC HEALTH&ENVIRONMENT
Attest(See
By /5���� ////��jj /I ) WELD COUNTY ALTH EPARTMENT
7L(... et /� lit p 194-7
Corporate Secretaryt Equivalent,Town/City/County Clerk JOHN S. PICKLE, M.S.E.H.
APPROVALS DIRECTOR
VERIFIED INFORMATION CC-'
ATTORNEY GENERAL CONTROLLER
The original and two copies of this
By By have been signed by II State G;:;_,.. .
tmwuhud Ly Iaw ivituv wnbd�ta tForm 6-AC-02C Page 7 which is the last of 7 pages
Revised 1/93 Kea
`ol""'a.,ran...
395-53-01-1030 PROGRAM APPROVAL: AA) (In�( 111:1(/// 94_`10917
ATTACHMENT A
Revised August 8, 1994
HEALTH CARE PROGRAM
FOR CHILDREN WITH SPECIAL NEEDS (HCP)
EFFECTIVENESS INDICATORS
For Weld County Health Department
INDICATOR 1: CASE FINDING AND COMMUNITY OUTREACH
HCP staff in collaboration with families and other community agencies will identify
service and support needs of children with special health care needs through
community outreach and case finding.
Rationale: HCP is committed to facilitating early entry into health care services and
into family supports for children with special health care needs. A key role of public
health nursing involves the identification of potential recipients to assure enrollment
and continuity of care. Another role of public health is to develop strong referral
networks which include families, health care providers and community resource
agencies. Community resource agencies may include any or all of the following:
schools, BOCES, Child Find, mental health, social services, Community Center Boards,
child health clinic, EPSDT,WIC, respite care, Head Start, hospitals,churches, libraries,
recreation centers and community health centers.
Process Criteria:
1. Know the target population of children who are potentially eligible for HCP
services, and the actual number of children currently registered with HCP. The
target population is determined by using a formula in conjunction with census
data. Analyze large discrepancies between target and actual caseloads.
2. Identify existing health care and support resources.
3. Work with the community resource agencies to create/improve/expand a system
for identification and referral of children and youth for needed services.
4. Promote public health services available to children, i.e., HCP, WIC, Well Child,
EPSDT, by using local media, posters and attendance at health fairs, etc.
5. Distribute the HCP clinic schedule to appropriate agencies and individuals.
6. Develop and maintain liaisons with the local community resources to maintain
open communication, to promote the services of HCP and other services
Page 1 of 13 pages
nino-n
available to children with special needs and to establish a network for working
together to eliminate gaps or duplication of services and supports.
7. Maintain communication with local HCP providers for the purpose of problem
solving, monitoring quality and recruiting new providers.
•
8. Develop referral and follow-up care systems with the Colorado Registry for
Children with Special Needs (CRCSN), hospital discharge planners and contacts
with the NICU to identify children who are returning to the community from a
hospital setting who may need care coordination and/or referral to community
resources.
INDICATOR 2: CARE COORDINATION
HCP staff will assure some level of care coordination to all families with children with
special health care needs. HCP staff will provide care coordination for children
enrolled with HCP and will be involved with other community agencies and individuals
in assuring care coordination for those children with special health care needs who are
not on HCP.
Rationale: HCP is committed to establishing supportive, collaborative partnerships
with families of children with special health care needs to assure that the needs of
both the children and the families are met in a coordinated way. The provision of
comprehensive services, including early identification services (diagnostic and
evaluation),treatment, rehabilitation,family support and health education services will
be, to the extent possible, community-based. As much as possible HCP care
coordinators will be placed in the community to assure coordinated linkages between
families, primary health care providers, other providers of local services, HCP
specialists and tertiary medical centers.
Process Criteria:
1. Conduct an initial interview with all new families to help them determine their
need for information, referral and/or care coordination using a standard tool such
as the "Patient Status Profile". (See attached Patient Status Profile.)
2. Refer families to agencies and services for which they are eligible and assist
them with the registration or application process, ( WIC, Baby Care/Kids Care,
Medicaid, SSI, etc.). Follow-up with the family to assure the family was able
to make the suggested contacts.
Page 2 of 13 pages
940913
3. Determine the status of primary care and immunizations and make appropriate
referrals. Work in collaboration with the EPSDT outreach worker if the child is
on Medicaid to assure that an EPSDT screen has been completed and billed.
4. Initiate (or be an active part of) a Care Plan or IFSP (Individual Family Service
Plan) for the family when it has been determined that a family would benefit
from care coordination. This includes a statement of the family's strengths and
needs as identified by the family and strategies for enhancing the child's
development. Include a statement of major outcomes to be achieve by the child
and family. State the criteria, procedures and time lines. Document periodic
statements of progress towards meeting family goals and the need for
modifications or revisions.
5. Follow-up with family according to plans written on Care Plan or IFSP. Should
HCP staff have no direct role in the IFSP or are not doing care coordination,
assure that a contact with each family is made at least once a year to assure
that the child and family are receiving necessary services and that the family is
aware of community resources available to them.
6. Make home visits when appropriate. (Situations might include complex medical
or surgical conditions or when resources or help can be provided relating to the
home environment.)
7. Integrate Home Intervention and PHN IFSPs into one management plan for
infants and toddlers with hearing impairments. Facilitate periodic
communication between HCP and HIP providers. Include HIP progress notes in
the child's HCP record.
8. Assure that audiology,nutrition, social work, speech and language,occupational
and physical therapy, and medical providers are included, as appropriate, in the
IFSP process. Assure that a parent advocate is included in the IFSP process, as
appropriate.
9. Work in concert with the EPSDT outreach worker to review monthly listing of
SSI recipients and contact SSI families to assure that health care needs are
being met. If there are needs which HCP can help meet, assure that children are
enrolled.
10. Meet periodically with staff from local agencies including: social services,
representatives from the Community Center Board, mental health and special
education services from local schools to collaborate around services to individual
children and their families.
11 . Work with the client and his or her family to facilitate transition from pediatric
services to adult health care services. (To begin at about age 12 years.)
Page 3 of 13 pages
940911
12. Work with NICU staff contacts in hospitals to identify needs of newborns as the
child prepares to leave the hospital to return to the community. Make contact
with other community resources as needed.
13. Work with community staff receiving Colorado Registry for Children with Special
Needs (CRCSN) referrals to assure the needs of the families are being met.
INDICATOR 3: CLINIC MANAGEMENT
HCP staff will participate, in partnership with the state agency and specialist health
care providers, in providing medical specialty care clinics in local communities where
these resources are not available.
Rationale: HCP is committed to providing children and families access to specialty
medical clinics when specialists are not available in the local community. This
situation occurs when there are no specialty services at all and when the specialists
in the community are not available to families due to the families' lack of insurance,
long waiting lists, or the specialists lack of expertise in working with pediatric
patients.
Process Criteria:
1. Designs (or enhances) a clinic structure including identifying clinic providers,
facilities and equipment, setting clinic dates, seeking referrals (by contacting
local doctors, Child Find, interagency councils, Community Center Boards and
by advertising), and scheduling patients. Develops a clinic list of patients and
determines the source of payment for each patient (Medicaid, HCP, private
insurance, no resources). Assures appropriate clinic set up and flow to allow
adequate time for clinic providers and families.
2. Maintains a tracking system for identifying children attending the clinics. The
tracking system will list the name of the child and parent (caregiver),their phone
number, their local source of medical care, the dates of the clinic visit, and the
individual responsible for follow up or care coordination. (The tracking system
could be a tickler file, a loose leaf notebook or a computerized system such as
CoTrack.)
3. Maintain an individual or family health record for each child which contains an
HCP registration with a signed consent for service form, past and current
medical reports, Clinic Encounter Forms, serial growth chart,the Well Child Flow
sheet, treatment plan, progress notes and documentation of missed
appointments. The record will be organized in a uniform manner.
Page 4 of 13 pages
9409'!?
4. At each clinic obtain the child's height and weight. Record on the serial growth
chart to assess the child's pattern of growth at each clinic visit. Head
circumference should be measured and recorded at all neurology clinics.
5. The clinic nurse will complete the HCP Clinic Encounter Form for each child's
visit. Document the nursing diagnosis, assessment and plan for nursing action,
referrals to other agencies or disciplines. The attendance list will be reviewed
by the clinic staff following each clinic and the number of missed appointments
noted. The nurse will determine the need for follow up or reappointment.
6. Complete and submit an attendance list, i.e., clinic schedule, CoTrack screen,
to the Denver office after each clinic with the completed Clinic Encounter Forms
and dictation.
7. Assure that families have transportation to each clinic and that appropriate and
competent interpretation services are available.
8. Assist families with necessary arrangements to attend clinics held out of the
county. Assist families with follow-up recommendations made during the
clinics. The Public Health Nurse, Family Support/Parent Advocate or other
service coordinator will attend and participate in the clinic depending on the
complexity of the child's condition and the needs of the family.
9. Evaluate the clinic caseload, waiting list and summaries yearly to determine the
number and type of specialty clinics needed.
INDICATOR 4: PROGRAM MANAGEMENT
HCP staff will, to the extent possible, implement a community-based program for
children with special health care needs including eligibility determination, enrollment,
care coordination, records management, tracking, referral, community needs
assessment and evaluation. The HCP manual will be the source of documentation for
all policies and procedures.
Rationale: HCP is committed to providing a program for payment of specialty medical
services for those children with special health care needs who have no other source
of payment. Priority is given to those children who are uninsured or underinsured and
who fall within set income guidelines. Based on the belief that services are best
provided in the local community, the program is working to move all components of
the program (except bill paying) into the local public health agencies.
Page 5 of 13 pages
940917
Process Criteria:
1 . Develop a system to process applications to the program by accepting
registration forms from families, providers and schools, assisting families in
completing the registration form (when help is needed),explaining HCP services,
and determining financial and diagnostic eligibility.
2. Input registration information into the VAX.
3. Obtain needed medical records when they are needed to confirm eligibility or to
assist in writing a treatment plan.
4. Assist families who are potentially eligible for Medicaid and SSI benefits with
the registration process by helping families complete the forms, facilitating
transportation or meeting with families, Social Services, or Social Security.
Assure that the Medicaid Verification Form is completed.
5. Assist families in identifying specialist providers when necessary by offering
them a choice from a number of HO' providers.
6. Determine an appropriate treatment plan for each child eligible for services.
Record the plan VAX computer system.
7. Write Participating Payment Agreements (PPAs) with families who qualify.
8. Input client contact information into Co-Track or other computerized case
management system.
9. Maintain a current health record for each HCP child. The record will be
integrated with the Child Health Record when appropriate. The record will
contain copies of the HCP registration, relevant medical, therapy and laboratory
records as needed for care coordination. The current acceptance letter/
treatment plan, Clinic Encounter Forms, a serial growth chart, nursing notes,
and IFSPs. Families will be encouraged to have duplicate copies of these
records.
10. Coordinate with the regional or central HCP office to authorize and encumber
funds for appropriate hospitalization,surgical procedures,hearing aids,therapies
or appliances.
11 . Periodically contact community physicians and providers for feedback on HCP
services and policies.
12. Assure that HCP services are provided in a family-centered, culturally-competent
environment. Written materials will be appropriate for the reader in reading level
Page 6 of 13 pages
94 097
and language. Interpretation services will be available by trained professional
or paraprofessional, when needed.
13. Contact families who have not sent in their HCP financial renewal form after
receiving the first 30 day notice. Encourage families to return the renewal form
if they need to continue services.
14. Participate in conducting a community needs assessment which identifies
problems or voids within the service delivery system for children with special
health care needs, define the problems, and determine the services or changes
necessary to meet the identified needs. Elements involved in this process
include:
a. Involvement in the tracking and data collection efforts of the community
around the number of children with special health care needs, the types
of services needed, the types of services available, the accessibility of
services, the quality of services, whether the services are culturally
competent and family centered, and customer feedback about the
services.
b. Awareness of and collaboration with other community agencies and
projects regarding data that is being collected and what is being done
with the data to use it most effectively to enhance the community
service system.
c. Coordination with other agencies and organizations to jointly survey the
community (families, providers, agencies, etc.)
15. Be involved in the community planning process to develop goals and objectives
based on community needs assessment.
INDICATOR 5: PARENT AND FAMILY INVOLVEMENT AND SUPPORT
HCP staff will provide families with information and work to assure that support
services are available. HCP Staff will include input from families in all areas of policy
development, planning, implementation and evaluation, assuring that the families
which provide input are from culturally diverse backgrounds which reflect the
community.
Rationale: HCP believes that the family is the pivotal center of a child's life and that
support to that family is an integral role of the program. HCP is committed to
including families in all areas of policy development and service planning because
Page 7 of 13 pages
940917
families know best what their needs are. By including families as full partners, the
program will be able to provide better services.
Process Criteria:
1. Have a mechanism for providing families with information about a variety of
issues and available resources (newsletters, health/education fairs, parent
support networks).
2. Assure that families are assisted in identifying and accessing groups or
individuals which provide parent to parent support or foster the development of
such groups or relationships, when needed.
3. Establish a process to solicit and receive input from parents regarding planning,
implementation and evaluation of services.
INDICATOR 6: INTERAGENCY COLLABORATION
Each agency will demonstrate interagency collaboration to assure quality, efficient
services for families.
Rationale: HCP is committed to collaborating with other services and agencies to
achieve mutually agreed upon goals which benefit families and children. Because
children with special health care needs receive services from health, education, social
services, and numerous community agencies, it is imperative that those agencies work
together to provide comprehensive, coordinated services to families which are cost
effective, efficient and avoid duplication.
Process Criteria:
1. Establish periodic meetings with representatives of the local social services
agency, the Community Center Board, the mental health agency and special
education services from the school district to understand their services, to learn
about their eligibility criteria, and to provide them with information about HCP
and other resources within the local health agency.
2. Participate actively in a community interagency coordinating council (ICC) by
meeting regularly for the purpose of planning and policy development. (The ICC
can be a formal or informal group of agencies, providers and parents who are
interested in working together to discuss services for children with special
needs, to identify barriers and gaps in the service delivery system, to develop
Page 8 of 13 pages
4anQ? v
collaborative plans for removing the barriers and gaps including writing
community-based grants for improvement of local systems. By Law ICCs
currently apply to the birth - 3 population, but ideally should cover all children.)
3. Participate in the local ICC to identify community service needs by collecting
data, conducting surveys and focus groups and observing target populations.
Solicit information from agencies, providers and families.
4. Assure that there is parent representation from families who have children
enrolled in HCP in the community ICC efforts. (For example, attending meeting,
contacting representatives, providing input into quality and quantity of local
services.)
5. Participate actively in the community early child identification process as an
active member of the community team. This participation could include
donating staff time to directly participate in a community sponsored
identification process or coordinating the agency's services such as Well Child,
EPSOT, HCP and WIC, with other efforts so as to provide on-going systems of
early identification for children 0-21 years.
Page 9 of 13 pages
COLORADO DE_ ..RTMENT OF PUBLIC HEALTH & _AIVIRONMENT
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) • m
PATIENT ASSESSMENT TOOL
CURRENT PATIENT STATUS PROFILE
Date Completed: / /
Child's Name Date of Birth: / /
Child's Address:
County:
Mother's Name:
Father's Name:
Legal Guardian's Name:
Guardian's Employer:
Home #: Work #: Message #:
SUBJECTIVE DATA
1. How can we help you?
2. What do you think are your child's health problems?
3. Is your child visiting a doctor or clinic on a regualar basis? ❑ YES ❑ NO
If YES: Who is your child's regular doctor or care provider?
How often does your child see his/her regular doctor or care provider?
What medications and/or treatments has your child's doctor recommended?
Are you able to get the medications and/or treatment
your child needs? ❑ YES ❑ NO
Does your child take the medications and get the
treatments like his/her doctor recommended? ❑ YES ❑ NO
Are your child's shots (immunizations) up-to-date? ❑ YES ❑ NO
Can I have a copy of your child's shot records? ❑ YES ❑ NO
4. What other people or organizations are involved in your child's care?
If any, what do they do for you and/or your child?
Page 10 of 13 pages
5. Is there anyone invol who is helping you to pull th people
and services together? ❑ YES ❑ NO
If YES, What is his or her name?
and
What is his or her relationship to you?
6. How do you feel about your child's needs?
7. How do your child's needs affect you and your family?
8. What are your plans and dreams for your child?
Long-term:
Short-term:
9. What are your child's plans and dreams for him or herself? (if applicable)
Long-term:
Short-term:
10. What is being done to help your child and your family to reach those plans and
dreams?
11. What do you feel are your strengths as a family?
12. Do you or your family have any other concerns that we can help you with?
13. Are there any problems with housing? ❑ YES ❑ NO
14. Do you have enough food? ❑ YES ❑ NO
15. Do you and your family have warm clothes? ❑ YES ❑ NO
16 Are you able to get away from the house to do things for yourself
if you need to? ❑ YES ❑ NO
17. Are you able to go to the doctor if you need to? ❑ YES ❑ NO
18. Are you and your family covered by Medicaid or health insurance? ❑ YES ❑ NO
19. Is there anything else I could do for you?
OBJECTIVE DATA OBSERVED (if on-site interview conducted) continue on back of page if
needed
Page 11 of 13 pages
940937
ASSESSMENT FORM
This form should only be used as a guide for assessment. Further studies are needed in
order to quantify assessment guide and assess for validity and reliability.
ASSESSMENT (place check mark in appropriate column of each question)
Column A Column B Column C
YES TO SOME DEGREE NO
r Family understands medical condition?
Family following medical treatment plan
including follow-up appointments?
Community resources accessed?
Care coordination in place?
Goals set?
Goals being pursued?
Support systems in place?
Family strengths identified?
Child's needs are being met?
Family's needs are being met?
1. If all answer■ fall in Column A -- may only need to follow-up in one year or a■ needed.
2. If most answers fall im Column A, some answers in Column B or C - may need additional follow-up and/or referrals.
3. If all answers fall in Columns B and/or C will need further assessment and determination of why. and I.F.S.P.
ASSESSMENT FINDINGS:
Page 12 of 13 pages
4angg7
FOLLOW-UP PLAN
(place check mark by appropriate items)
Information given only (specify)
1.
2.
3.
4.
DATE TIME
Conference scheduled for I .F.S.P. development.
Home Visit scheduled
Clinic Appointment made / /
Referral made to (document date referral made)
Childfind
School District / /
Community Center Board / 1
Social Services / /
W.I.C. / /
Parent Support team / /
Support Group / /
EPSDT
Public Health Nurse
Other (specify)
/ /
/ /
Family does not want interventions, Follow-up
Follow-up with family in one your or P.R.N. per HCP/CSHCN Standards.
Other (specify)
Completed by
Signature Title
Reviewed by R.N.
Signature
Page 13 of 13 pages ^ 0977
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ATTACHMENT C
Applicant: WELD COUNTY HEALTH DEPARTMENT
Project: HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS(HCP)
For the Period of: OCTOBER 1, 1994 through SEPTEMBER 30, 1995
Annual Full Total Source of Funds
Salary Time Amount *Applicant Requested
Rate Equivalent Required and Other from HCP
Personal Services:
Social Worker(Harris) 27,930 0.50 13,965 13,965
Office Tech. (Patty Isakson) 19,394 1.00 19,394 3,879 15,515
CHN(Cheryl) 31,600 1.00 31,600 31,600
CHN-(Chris) 31,600 0.40 12,640 12,640
CHN-Clinics(Chris) 31,600 0.16 5,200 5,200
Office Tech. 15,840 0.20 3,168 3,168
Fringe Benefits 17% 16,901 5,633 11,268
Supervising Personnel:
Nurse Supervisor(Kathy) 38,115 0.20 7,623 7,623
Director of Nursing(Glenda Schneider) 48,558 0.12 5,827 5,827
Sub-total Personal Services 3.38 116,318 38,770 77,548
Software&Equipment 4,100 4,100
Travel 500 500
Operating Expenses:
Printing and Postage 200 200
Staff Development 750 750
Dedicated Phone Line 600 600
Sub-total Operating Expenses 1,550 200 1,350
Indirect Expenses 18.00% 21,136 6,979 14,157
Total Project Costs 143,604 45,949 97,655
'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
94091.
ATTACHMENT D
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
Health Care Program For Children With Special Needs (HCP)
CLINIC CHARGE SCHEDULE
Families at and above a +7 financial eligibility level are charged a fee at the clinic site
for attending any medical specialty clinic sponsored by the Health Care Program For
Children With Special Needs (HCP). Checks and/or money orders are to be made
payable to "Colorado Department of Health" and are to be forwarded to the Health
Care Program For Children With Special Needs (HCP).
The current schedule of clinic fees to be collected is as follows:
CLINIC TYPE FEE
Pediatric Cardiology Clinic $ 35.00
Pediatric Neurology Clinic $ 35.00
Orthopedic Clinic including $ 27.00
Scoliosis and Cerebral Palsy
Hearing Clinic $ 27.00
Plastic Clinic $ 27.00
Developmental Evaluation Clinic $ 27.00
The Health Care Program For Children With Special Needs (HCP) will provide funding
for all diagnostic and laboratory tests ordered in the first clinic visit only. Families at
and above a + 1 financial eligibility level are responsible for the payment of diagnostic
and laboratory tests ordered in clinic, as of the second clinic visit. Payment for these
tests is made, by the family, directly to the provider of these services.
Page 1 of 1 page
940917
flçJflQAflDUJ man
YI�`,P�• Board of County Commissioners Septembers <1994 i s 1 7
To Date
COLORADO John Pickle, Director, Health Department ` ' CLEF C
From1. , T11- r = on
Subject: Handicapped Children's Program Contract
Enclosed for board review is a proposed contract between the Colorado Department of Public
Health and Environment and the Weld County Health Department. This contract is for the
continuance and enhancement of the Handicapped Children's Program for the period
October 1, 1994 through September 30, 1995.
Funding for this program has been increased by$13, 699 over last year's contract for a total
amount of$97, 655. This increased funding is for computer equipment and for .16 FTE nurse
time. The computer equipment is needed to tie directly with the State for data collection, and the
increased nurse time is to coordinate the computer system with the case management system. If
you approve this contract, we will process a request to authorize the hiring of this part-time nurse
position.
I recommend your approval of this contract.
Enclosure
940937
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