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Home My WebLink About992662.tiff RESOLUTION RE: APPROVE TASK ORDER FOR MATERNAL AND CHILD HEALTH SERVICES PROGRAM AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with a Task Order for the Maternal and Child Health Services Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment, and the Colorado Department of Public Health and Environment, commencing October 1, 1999, and ending September 30, 2000, with further terms and conditions being as stated in said task order, and WHEREAS, after review, the Board deems it advisable to approve said task order, a copy of which is attached hereto and incorporated herein by reference. NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that the Task Order for the Maternal and Child Health Services Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Weld County Department of Public Health and Environment, and the Colorado Department of Public Health and Environment be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said task order. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 3rd day of November, A.D., 1999, nunc pro tunc October 1, 1999. BOARD OF COUNTY COMMISSIONERS COUNTY, COL IRA.• ATTEST: iO ��/I • !.�� ,/ �&l IAa' �' �`,�w4Wac K. Hall, Chair / Weld County Clerk to the .. / arbar J. Kirkmeyer, ro-Tem BY: .�� . I .� S K Deputy Clerk to the BoarW Geor E. axer APPROVED AS TO FORM: J eile ounty Attorn y y y// i1 Glenn Via: 992662 rn HL0025 COLORADO MEMORANDUM TO: Dale K. Hall, Chairman, Board of County Commissioners FROM: John S. Pickle, Director, Department of Public Health and Environment cal ,/J SUBJECT: Maternal and Child Health Services Task Order 7 DATE: October 29, 1999 Enclosed for Board review and approval is the Maternal and Child Health Services Task Order between the Colorado Department of Public Health and Environment (CDPHE) and Weld County Department of Public Health and Environment (WCDPHE). In the past, the CDPHE has entered into two separate contracts with the WCDPHE for Maternal and Child Health Services. One contract was for the Well Child Program and the other was for the Prenatal Program. Beginning with this year, the funding is being combined into one task order under the five year master contract with CDPHE. This funding is basically continuation funding for these two programs and will be used to provide prenatal and postpartum care, including education and counseling and Prenatal Plus enhanced services for low income women. The funding used in the Child Health Program will provide well child clinic services to clients aged 0 to 16 years. These services include health and psychosocial history, age appropriate screenings, physical exams, immunizations, teaching of risk-reducing behaviors to parents, and referrals to appropriate resources for children exhibiting actual or potential physical or emotional problems. For these services, WCDPHE will receive a total reimbursement of$166,518 for the period October 1, 1999 through September 30, 2000. This is a decrease of$8,174 in State funding from the combined reimbursements of last year's contracts. However, appropriate reductions in services have been made to accommodate this decrease in funding. I recommend your approval of this task order. Enc. 992662 tic 00,25 Department or Agency Name COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Department or Agency Number FAA Contract Routing Number 00-00750 TASK ORDER This TASK ORDER is made this 30TH day of SEPTEMBER, 1999,by and between:the State of Colorado, for the use and benefit of the COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal place of business is 4300 Cherry Creek Drive South.Denver.Colorado 80246,hereinafter referred to as"the State";and,the WELD COUNTY DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT,whose address or principal place of business is 1555 North 17th Avenue.Greeley,CO 80631, hereinafter referred to as"the Contractor". FACTUAL RECITALS The State has received Title V funds from the United States Department of Health and Human Services(HHS)under the Maternal and Child Health Services Block Grant(MCH). The State's Division of Family and Community Health Services is charged with the administration of funds from Title V of the MCH Block Grant. The State has formulated a comprehensive statewide plan to carry out a Maternal and Child Health Services program(Program), funded by Title V MCH funds. This comprehensive statewide plan allocates Title V MCH funds to the implementation of the Program through various participating agencies in order to provide these health care services to the people of Colorado. Title V MCH funds are to be used for the purpose of enabling each State: (A)to provide and to assure mothers and children(in particular those with low income or with limited availability of health services)access to quality maternal and child health services; (B)to reduce infant mortality and the incidence of preventable diseases and handicapping conditions among children,to reduce the need for inpatient and long-term care services,to increase the number of children(especially preschool children)appropriately immunized against disease and the number of low income children receiving health assessments and follow-up diagnostic and treatment services,and otherwise to promote the health of mothers and infants by providing prenatal,delivery,and postpartum care for low income, at- risk pregnant women, and to promote the health of children by providing preventive and primary care services for low income children; (C) to provide rehabilitation services for blind and disabled individuals under the age of 16 receiving benefits under Title XVI,to the extent medical assistance for such services is not provided under Title XIX;and, (D)to provide and to promote family-centered,community-based,coordinated care(including care coordination services as defined in subsection(b)(3))for children with special health care needs and to facilitate the development of community-based systems of services for such children and their families"(Title V of the Social Security Act, Sec. 501.[42 U.S.C.701](1)A); Section 29-1-201,9 C.R.S. as amended,encourages governments to make the most efficient and effective use of their powers and responsibilities by cooperating and contracting with each other to the fullest extent possible to provide any function,service,or facility lawfully authorized to each of the cooperating or contracting entities,and to this end all State contracts with its political subdivisions are exempt from the State's personnel rules and the State procurement code. Funding is to be allocated through task order contracts with local health agencies. As to the Page 1 of 11 99aLeCt2- State,authority exists in the Law and Funds have been budgeted,appropriated and otherwise made available and a sufficient uncommitted balance thereof remains available for subsequent encumbering and payment of this Task Order in Fund Number 10,Appropriation Accounts$85,and Organization Codes 6710 and 6530 under Master Contract Routing Number 00 FAA 00008 and Task Order Encumbrance Number PO FAA MCH00000750. 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: As EFFECTIVE DATE AND TERM. The effective date of this Task Order is October 1,1999,or on the date this Task Order is approved by the State Controller,whichever is later. The term of this Task Order shall commence on October 1, 1999,and continue through and including September 30,2000,unless sooner terminated by the parties pursuant to the terms and conditions of the Master Contract. The total term of this Task Order, including any renewals or extensions hereof,may not exceed five(5)years. PURPOSE. The purpose of this Task Order is to support community-based determinations as to the use of Title V MCH funds while contributing to a coordinated,efficient,statewide Program for the use of those funds. Local public health agencies,such as the Contractor,shall provide leadership,in coordination with public and private community partners,in the development of county or district maternal and child health plans. The State shall provide: guidance and technical assistance to the Contractor to support the development and implementation of its MCH plan;and,an evaluation of the Contractor's plan to develop effective programs or strategies to address the priority needs of the parties. The plans are to be based on an assessment of the health status needs of the maternal-child populations and of the health system resources of a community. These plans are further designed to: a.contribute to the accomplishment of the State's priorities,performance measures,and outcome measures,as identified in "Attachment A",which is incorporated herein by this reference,made a part hereof,and attached hereto; b.move a local public health agency out of the direct personal care provider role when it is possible for other community providers to provide quality primary and preventive care; c.provide for the continuation of the core public health services of assessment,policy development,and assurance on behalf of the maternal-child populations; d. assure access to direct care and services for vulnerable women,children,and adolescents,such as those who are low-income,uninsured,underinsured,or who live in rural or undeserved areas or who are from ethnic or cultural minority communities and may experience language or cultural barriers to services;and, e. contribute to a comprehensive health improvement plan as described in "Healthy People 2010","Public Health Infrastructure Development Objective 11", if such a health improvement plan is developed by a local public health agency. Every state which receives MCH funds from the HHS must demonstrate to the HHS that it has served three (3)distinct population groups with those MCH funds. These three(3)distinct population groups are: "the perinatal population",which is defined to include women of childbearing age,pregnant women,and mothers;the"child and adolescent population",which is defined to include infants,children,and adolescents from birth through age twenty(20);and,"children with special health care needs population", which is defined to include those children who have,or might have,special health care needs. Under this Contract,the Contractor is only required to serve the prenatal population and the child and adolescent population because the State's health care program for children with special health care needs currently provides services to the children with special health care needs population through separate contracts with Page 2 of 11 local public health agencies. As such,services for this third group are not included in the this Contract. Under this Task Order,the Contractor shall provide the core public health services of assessment,policy development,and assurance on behalf of the perinatal population and the child and adolescent population through the provision of:direct care services,enabling services,population based services,and/or infrastructure building activities as described and defined in"Attachment B","Core Public Health Services Delivered by MCH Agencies",which is incorporated herein by this reference,made a part hereof,and attached hereto. The decision by the Contractor to provide or not to provide direct patient care services should be based on an assessment of the capacity of the community's public and private providers to meet the direct health care needs of its perinatal population and child and adolescent population. The services or activities under this Task Order may be carried out by the Contractor itself,or through subcontracts with other providers,or through collaborative partnerships with other community partners. C. DUTIES AND OBLIGATIONS OF THE CONTRACTOR. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order,shall perform and complete, in a timely and satisfactory manner,the following: 1. The Contractor shall prepare and submit two(2)plans under this Task Order. The first plan is a "Preliminary Maternal and Child Health Services Plan"for those services and activities which will be delivered or occur in federal fiscal year 1999-2000(October 1, 1999,through September 30, 2000). The second plan is a"One to Three Year Local Public Health Agency Maternal and Child Health Services Plan"for those services and activities which will be delivered or occur in federal fiscal years 2000-2001 (October 1,2000,through September 30,2001),2001-2002(October 1, 2001,through September 30,2002),2002-2003 (October 1,2002 through September 30,2003). A. On or before December 15, 1999,the Contractor shall develop and implement a "Preliminary Maternal and Child Health Services Plan"(Preliminary Plan)to utilize available MCH funds in federal fiscal year 1999-2000. On or before December 15, 1999, the Contractor shall submit a copy of this Preliminary Plan to the State. This Preliminary Plan shall: describe those services or activities that shall be provided to the perinatal population and the child and adolescent population;and,explain why those services or activities were chosen. A sample format,which the Contractor may use, is attached hereto as"Attachment C",incorporated herein by this reference,and made a part hereof. B. On or before December 15, 1999,the Contractor shall submit to the State a"Budget Estimate Form" for the Preliminary Plan. A sample format,which the Contractor may use, is attached hereto as"Attachment D", is incorporated herein by this reference and made a part hereof. C. On or before September 30,2000,the Contractor shall evaluate the effectiveness of its Preliminary Plan to determine its impact: on the health status of the prenatal and child and adolescent populations;and,the needs of the community's health system. D. If the Contractor intends to submit a Multi-year Plan,then the Contractor shall modify that proposed Multi-year Plan to appropriately address its evaluation of: its assessed needs;and,the effectiveness of its Preliminary Plan. E. If the Contractor elects to submit a Multi-year Plan,then on or before May 15,2000,the Contractor shall submit that proposed Multi-year Plan to the State for review and Page 3 of 11 approval. The Multi-year Plan may encompass one or more of the following federal fiscal years:2000-2001,2001-2002,and 2002-2003. A sample format,which the Contractor may use,is attached as"Attachment G" is incorporated herein by this reference and made a part hereof. The Multi-year Plan shall be based on qualitative and quantitative data. This Multi-year Plan shall: 1. assess and prioritize the health status needs of women of childbearing age, pregnant women,mothers,infants,children, and adolescents of the county, district, or area served by the Contractor; 2. in collaboration with local stakeholders and consumers,assess the health system and related service resources of the community served by the Contractor; 3. prioritize the needs of the community to be addressed by the Contractor;and, 4. describe the activities or services to be carried out under the Multi-year Plan, utilizing the descriptors of direct care services,enabling services,population based services,or infrastructure building activities, as defined in Attachment B. The services or activities may be:current services or activities which effectively address identified needs of the community;or,new services or activities designed to address unmet or emerging needs of the community. These current or new services or activities may include the provision of direct health care services, information and referral services, follow up services,case management services; injury or disease prevention activities or initiatives,or health promotion activities. These current or new services or activities may also include projects designed to build the Contractor's,or local infrastructure,whichever is appropriate, for effective health status improvement,such as creating a community planning structure to develop needed health care resources,or carrying out a needs assessment. The services or activities chosen by the Contractor should be best practices or evidence based approaches as identified by a review of the applicable literature,through the Contractor's past successful experience,or innovative approaches based on a review of the applicable literature and consultation with experts. F. If the Contractor elects to submit a Multi-year Plan,then on or before May 15,2000,the Contractor shall also submit to the State for review and approval a Budget Estimate Form for that Multi-year Plan. Attachment D is a sample format which the Contractor may use to prepare this Budget Estimate Form. G. Within forty-five(45)calendar days after the date of submission,a Multi-year Plan and accompanying Budget Estimate Form shall be reviewed by the State. Within forty-five (45)calendar days of the date this review has been completed,the Contractor and State program staff shall negotiate an agreement,if necessary,regarding any recommendations or requirements for changes or additions to the Multi-year Plan and Budget Estimate Form. An approved Multi-year Plan and Budget Estimate Form shall be incorporated as an attachment into a new maternal and child health services Task Order beginning October 1,2000. 2. The Contractor shall provide public health services to enhance the health status of women of childbearing age. All pregnant women seeking prenatal care shall be provided with information Page 4 of 11 about,and be referred to, comprehensive prenatal care services. The Contractor shall also ensure that all individuals seeking reproductive health services are:provided information about pregnancy planning,advised of the consequences of unintended pregnancies;and,referred to comprehensive family planning services that ensure confidentiality. 3. If the Contractor chooses to provide medical prenatal and postpartum care under this Task Order, then the Contractor shall: A. Provide prenatal and postpartum care, including education and counseling, in accordance with the"Prenatal Care Guidelines",a copy of which has been made available to the Contractor by the State as of the effective date of this Task Order. B. Offer the following program components to pregnant women: 1. coordinated care between medical providers and the Contractor including assistance in securing delivery services; 2. referrals and assistance in seeking continuous infant and child health care; 3. free pregnancy testing in order to provide appropriate medical referrals for women with positive tests;and, 4. free pregnancy testing in order to provide contraceptive education,medical referrals,and non-prescriptive contraceptives, if appropriate,to women with negative pregnancy tests,and referral for a local family planning provider; C. Individual records on each prenatal patient shall be maintained by the Contractor and are subject to audits,either self or independent,to be determined by the State. D. The Contractor shall use all program income generated from the collection of patient fees and patient or third party donations only for perinatal services which further the objectives of the legislation under which this Task Order is entered into. In accordance with Title V, Section 501 (b)(2)and Section 505(2)(d),the Contractor shall not impose any charge for services provided to patients at or below 100%of the poverty level. As of the effective date of this Task Order,federal poverty guidelines have been provided to the Contractor by the State. The Contractor may charge patients who are between 100%and 185%of the poverty level on a sliding fee scale. The Contractor shall instruct patients at or below 133%of poverty level to apply for Medicaid. 4. If the Contractor chooses to provide direct health care services for infants,children,or adolescents, then its public health nursing assessments and interventions shall be consistent with the recommendations for child health care as delineated in the State's"Child Health Manual"and other policies and guidelines which have or will be made available to the Contractor. These direct health care services may include: A. Child and adolescent health clinic services,as indicated and appropriate, including: 1. a complete health and psychosocial history and unclothed physical exam; 2. age-appropriate screening, including but not limited to developmental screening Page 5 of 11 by the providers or other appropriate community resources; 3. age-appropriate immunizations; 4. age-appropriate anticipatory guidance and teaching of risk-reducing behaviors to parents,children and adolescents, including but not limited to,teaching injury prevention techniques,prevention of motor vehicle injury and death through the use of infant and child car seats and seat belts; 5. nursing management and/or referral(s)to appropriate resources for children exhibiting actual or potential problems in their physical and/or,developmental and/or psychosocial/emotional status,and, 6. an assessment of adolescent protective and risk-taking behaviors including the use of alcohol,tobacco,and other drugs;depression and school adjustment; sexual activity; involvement as either victim or perpetrator of violence;motor vehicle safety;and provision of intervention or referral when appropriate. B. Home visitation services as indicated to infants and children and their families,the primary purpose of which is public health nursing intervention designed to reduce the risk of injury and disease to the child and to strengthen child and family development. C. Case finding(s)and medical referral(s)through the above child health activities for children eligible for the State's Health Care Program for Children with Special Needs. D. Appropriate referrals for all children who fail screening tests or who are in need of medical or other diagnosis or treatment. The Contractor shall document its attempts to follow up on these referrals. 5. The Contractor shall: A. Inform potentially eligible applicants or recipients that the "Colorado Baby Care/Kid's Care Program"(CBC/KCP),a program within Medicaid,exists and that these potentially eligible applicants or recipients should apply for coverage under that program through the local county department of social services; B. Inform potentially eligible applicants or recipients that the Colorado Child Health Plan Plus+(CCHP+)exists; C. Inform potentially eligible applicants or recipients that CBC/KCP and CCHP+may be a potential source of payment for a child's care; D. Inform potentially eligible applicants or recipients that in order to receive continuing coverage under CBC/KCP and/or CCHP+they must complete an application as soon as possible(CBC/KCP allows for up to sixty(60)calendar days of presumptive eligibility for pregnant women who are registered with Medicaid.); - E. Obtain from Medicaid and the CCHP+,and have present at its facility,current information regarding eligibility for,and services provided under CBC/KCP;and, F. Have registration forms for CCHP+available at all times. Page 6 of 11 6. If the Contractor is providing direct child and adolescent health clinic services,then on or before January 15,2001,the Contractor shall submit to the State,the following documentation: A. A copy of the aggregate results of a qualitative audit completed on at least ten percent (10%)of the Contractor's active child health clinic records,using the State's"Child Health Impact Tool",or a similar audit approved by the State, indicating that seventy-five (75%)of all problems,identified through public health nursing assessments have been appropriately referred, improved,or resolved. B. Evidence that ninety percent(90%)of all two(2)year old children enrolled at the Contractor's child health clinics for at least one(1)year are current on all recommended immunizations,including but not limited to Hemophilus B. 7. On or before January 15,2001,the Contractor shall submit a"Year End Progress Report",to the State. This report shall contain:a narrative progress report,a completed"Number of Individuals Served(Unduplicated)Under Title V Report",utilizing Table 1 (7 AR),which is attached hereto as"Attachment E",which is incorporated herein by this reference and made a part hereof,for those services provided by the Contractor in federal fiscal year 1999-2000; and,a final fiscal expenditures report,reporting actual expenditures and match separately for the perinatal and child health programs showing both the maternal and child health spending and associated match and signed by a certified official, following the format attached hereto as"Attachment F",which is incorporated herein by this reference and made a part hereof. 8. The State authorizes the Contractor to subcontract some,or all,of the services which are to be performed under this Task Order. However, a subcontractor is subject to all of the terms and conditions of this Task Order. Additionally,the Contractor remains ultimately responsible for the timely and satisfactory completion of all work performed by a subcontractor under this Task Order. If the contractor desires to subcontract some,or all,of the services which are to be performed under this Task Order,then the Contractor shall obtain the prior, express,written consent of the State before entering into any subcontract. 9. 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). 10. The Contractor shall not charge for services those individuals of families who are at or below the official poverty line as defined by the Office of Management and Budget(OMB) in accordance with Title V, Section 501 (B)(2)and Section 505(2)(d). The 100%of poverty income guideline for farm or non-farm families is currently at$8,240 for an individual;$11,060 for a family of 2; $13,880 for a family of 3;$16,700 for a family of 4;$19,520 for a family of 5; $22,340 for a family of 6;$25,160 for a family of 7;$27,980 for a family of 8. For families of more than eight, the Contractor shall add$2,820 for each additional member to determine the appropriate poverty income guideline These poverty income guidelines may change during the term of this Task Order. If new poverty income guidelines are received by the State from the OMB,then the State shall forward these new poverty income guidelines to the Contractor. The Contractor shall use these new poverty income guideline upon receipt. Page 7 of 11 I I. If the Contractor imposes any charges for services to clients who are above 100%of poverty level, then such charges must be based on a sliding fee scale which takes into account the client's family size, income,and available resources. These charges and the sliding fee scale must be made available to all clients and the general public,and must be based on the Contractor's usual and customary cost for the service. Clients must understand that they will not be denied services because of an inability to pay any of the sliding fee charges. 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 Contract,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 applicant's or recipient's parent or guardian or,as otherwise properly ordered by a court of competent jurisdiction. The Contractor shall have written policies governing the access to,and duplication and dissemination of,all such information. The Contractor shall advise its employees, agents, servants,and subcontractors, if any,that they are subject to these confidentiality requirements. 13. The Contractor shall provide all services to all program participants and employees in a smoke- free environment. In accordance with Public Law 103-227,also known as the Pro-Children Act of 1994,smoke-free shall mean that smoking is not permitted in any portion of any indoor facility owned, leased,or otherwise contracted for by the Contractor if that facility is routinely or regularly used for the provision of child care or health services to any child under the age of 18 when those services are funded all or in part with Federal funds. 14. The Contractor shall ensure that the provisions of Section 601 of Title VI of the Civil Rights Act of 1964 are carried out. That Act states that"no person in the United States shall on the ground of race,color,or national origin,be excluded from participation in,be denied the benefits of,or be subjected to discrimination under any program or activity receiving Federal financial assistance", The Office of Civil Rights has concluded that it is the responsibility of any program which is a recipient of funds from the Department of Health and Human Services to ensure that clients who do not speak or understand English well,be provided interpretation services to ensure that the service provider and the client can communicate effectively. The Contractor shall have policies and procedures to ensure that interpretation services are available for clients with Limited English Proficiency and will advise such clients that an interpreter will be provided for them. If a client has their own interpreter,they shall be advised that the Contractor will provide an interpreter if the client so chooses. D. DUTIES AND OBLIGATIONS OF THE STATE. In consideration of those services timely and satisfactorily performed by the Contractor under this Task Order,the State shall cause to be paid to the Contractor an amount not to exceed ONE HUNDRED SIXTY SIX THOUSAND FIVE HUNDRED AND EIGHTEEN DOLLARS, (5166.518.00)for the period between October 1, 1999,and September 30,2000. Of this total financial obligation of the State to the Contractor under this Task Order,$166.518.00 are identified as attributable to a funding source of the United States and$0.00 are identified as attributable to a funding source of the State of Colorado. Page 8 of 11 A. Payments under this Task Order are subject to verification by the State that the Contractor has fully and satisfactorily complied with the terms and conditions of this Task Order. Payments under this Task Order shall be made either through the Electronic Payment System or,through automatic State Warrants. The Contractor shall be reimbursed under this Task Order on a monthly basis in an amount equal to one-twelfth (1112)of the total amount payable under this Task Order. B. The Contractor shall maintain original documentation for all costs related to its performance under this Task Order 2. On or before February 1,2000,the State shall provide a service area specific Maternal and Child Health services data set to be utilized by the Contractor in developing its multi-year Plan, if any. 3. The State shall provide on-going consultation services to the Contractor on the use of the maternal and child health services data set in the Contractor's assessment and planning process. 4. The State shall research data sources to obtain additional service area specific data,particularly any race or ethnic health disparity data,to add to the maternal and child health services data set and provide updated information to the Contractor by September 30,2000. 5. The State shall provide consultation services to the Contractor regarding community-based assessment and planning resources, including model tools and processes. 6. The State shall provide consultation services to the Contractor regarding"Best Practice"and "Evidence-Based"activities or interventions to address the Contractor's identified health status needs. 7. The State may prospectively increase or decrease the amount payable under this Task Order through a"Task Order Change Order Letter",a sample of which is incorporated herein by this reference,made a part hereof,and attached hereto as"Attachment H". To be effective,the Task Order Change Order Letter must be:signed by the State and the Contractor;and,approved by the State Controller or an authorized designee thereof. Additionally,the Task Order Change Order Letter shall include the following information: A. Identification of this Task Order by its Task Order contract routing number, and the 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 Task Order Change Order Letter shall not be valid until Page 9 of 11 approved by the State Controller or such assistant as he may designate. Upon proper execution and approval,the Task Order Change Order Letter shall become an amendment to this Task Order. Except for the General and Special Provisions of the Master Contract,and the Additional Provisions of this Task Order,if any,the Task Order Change Order Letter shall supersede this Task Order in the event of a conflict between the two. It is expressly understood and agreed to by the parties that the task order change order letter process may be used only for increased or decreased levels of funding,corresponding adjustments to service or program levels,and any related budget line items. Any other changes to this Task Order,shall be made by a formal amendment to this Task Order executed in accordance with the Fiscal Rules of the State of Colorado. If the Contractor agrees to and accepts the proposed change,then the Contractor shall execute and return the Task Order Change Order Letter to the State by the date indicated in the Task Order Change Order Letter. If the Contractor does not agree to and accept the proposed change,or fails to timely return the partially executed Task Order Change Order Letter by the date indicated in the Task Order Change Order Letter,then the State may,upon written notice to the Contractor, terminate this Task Order twenty(20)calendar days after the return date indicated in the Task Order Change Order Letter has passed. 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 their respective duties and obligations under this Task Order until the effective date of termination has occurred. Increases or decreases in the level of contractual funding made through this change order letter process during the initial or renewal terms of this Task Order may be made under the following circumstances: F. If necessary to fully utilize appropriations of the State of Colorado and/or non- appropriated federal grant awards; G. Adjustments to reflect current year expenditures; H. Supplemental appropriations,or non-appropriated federal funding changes resulting in an increase or decrease in the amounts originally budgeted and available for the purposes of this Task Order; I. Closure of programs and/or termination of related contracts; J. Delay or difficulty in implementing new programs or services;and, K. Other special circumstances as deemed appropriate by the State. E. ATTACHMENTS. All attachments to this Task Order are incorporated herein by this reference-and made a part hereof as if fully set forth herein. In the event of any conflict or inconsistency between the terms and conditions of this Task Order and those of any attachment hereto,the terms and conditions of this Task Order shall control. Page 10 of 11 IN WITNESS WHEREOF,the parties hereto have executed this Task Order as of the day first above written. CONTRACTOR: Weld County Board of STATE: Commissioners WELD COUNTY DEPARTMENT STATE OF COLORADO OF PUBLIC HEALTH&ENVIRONMENT Bill Owens.Governor By: By: Name: FOr the Executive Director Title: Colorado Department of FEIN: _ _ Public Health t and Environment 1E1Via`. ATTEST: Selo ( PROGRAM APPROVAL: i p►` By: ilu. " By: �txtta�x ;'�?ra�tr� Deputy Clerk to the Board APPROVALS: COLORADO DEPARTMENT OF LAW COLORADO DEPARTMENT OF PERSONNEL OFFICE OF THE ATTORNEY GENERAL OFFICE OF THE STATE CONTROLLER Ken Salazar,Attorney General Arthur L. Barnhart,State Controller KEN SALAZAR Y GE By: ,1 JAMES F MARTIN, JR. By: ASSISTANT ATTORNEY GENERAL STATE SERVICES SECTION WELD C0U HE DEPART N • . PICK E, M.S.E.H. DIRECTOR Page 11 of 11 ATTACHMENT A LIST OP MCH PRIORITY NEEDS I. Reduce teen pregnancy and unintended pregnancy in women of all ages. 2. Improve perinatal outcomes. 3. Reduce child and adolescent morbidity. 4. Increase health and safety in child care settings. 5. Improve efforts to reduce unintentional and intentional injury,addressing motor vehicle crashes,suicide,child abuse and other violence. 6. Improve immunization rates for all children. 7. Increase access to health care(including behavioral health care). 8. Improve state and local infrastructure by increasing capacity to analyze data,carry out evaluations,develop quality standards,and assure availability of services to all children,including children with special health care needs. 9. Reduce substance abuse(alcohol, tobacco,and drugs). 10. Improve oral health and access to oral health care. National Performance Measures The percent of state SSI beneficiaries less than 16 years old receiving rehabilitative services from the state CSHCN Program 2. The degree to which the state Children with Special Health Care Needs(CSHCN) Program provides or pays for specialty and subspecialty services, including care coordination, not otherwise accessible or affordable to its clients 3. Percent of children with special health care needs in the state who have a "medical home" 4. Percent of newborns in the state with at least one screening for each of PKU, hypothyroidism, galactosemia, hemoglobinopathies 5. Percent of children through age 2 who have completed immunizations for measles, mumps, rubella, polio,diphtheria,tetanus, pertussis, haemophilus influenza, and hepatitis B 6. The rate of birth (per 1,000) for teenagers aged 15 through 17 years 7. Percent of third grade children who have received protective sealants on at least one permanent tooth molar 8. The rate of deaths to children aged 1-14 caused by motor vehicle crashes per 100,000 children 9. The percent of mothers who breastfeed their infants at hospital discharge 10. Percentage of newborns who have been screened for hearing impairment before hospital discharge 11. Percent of children with special health care needs in the state CSHCN Program with a source of insurance for primary and specialty care l2. Percent of all children in the state without health insurance 13. Percent of potentially Medicaid-eligible children who have received a service paid for by the Medicaid Program 14. The degree to which the state assures family participation in program and policy activities in the state CSHCN program IS. Percent of very low birth weight live births 16. The rate(per 100,000)of suicide deaths among youths age 15-19 17. Percent of very low birth weight infants delivered at facilities for high-risk deliveries and neonates 18. Percent of infants born to pregnant women receiving prenatal care beginning in the first trimester. State Performance Measures 1. The proportion of high school students reporting having drunk alcohol in the past month. 2. The proportion of all pregnancies that are unintended. 3. The incidence of maltreatment of children younger than 18 (including physical abuse, sexual abuse, emotional abuse, and/or neglect). 4. The proportion of child care settings with access to comprehensive health and safety consultation and training. 5. The rate of deaths to adolescents age 15-19 caused by motor vehicle crashes per 100,000 children. 6. The proportion of high school students reporting regular use of tobacco products. 7. The proportion of children and adolescents attending public schools who have access to basic preventive and primary, physical and behavioral health services through school-based health centers. 8. The percent of Medicaid-eligible children who receive dental services as part of their comprehensive services. 9. The percentage complete of an integrated data system for maternal and child health programs(to improve ability to monitor and assess health needs of women and children),beginning with the Children with Special Health Care Needs program. 10. The rate of homicides among teens 15-19 and among black male teens. State Outcome Measure 1. The low birth weight rate National Outcome Measures I. The infant mortality rate per 1,000 live births 2. The ratio of the black infant mortality rate to the white infant mortality rate 3. The neonatal mortality rate per 1,000 live births 4. The-postneonatal mortality rate per 1,000 live births 5. The perinatal mortality rate per 1,000 live births 6. The child death rate per 100,000 children aged I-14. State Outcome Measure 1. The low birth weight rate per 1,000 live births ATTACHMENT B CORE PUBLIC HEALTH SERVICES DELIVERED BY MCH AGENCIES DIRECT HEALTH CARE SERVICES: (GAP FILLING) Examples: Basic Health Services, and Health Services(or CSHCN ENABLING SERVICES: Examples: Transportation,Translation,Outreach, Respite Cue,Health Education,Family Support Services,Purchase of Health Insurance, Case Management,Coordination with Medicaid, WIC,and Education POPULATION-BASED SERVICES: Examples: Newborn Screening, Sudden Infant Death Syndrome Counseling,Miea„ Oral Health Injury Nutrition and Outreach/PublliicEducation INFRASTRUCTURE BUILDING SERVICES: ExamNeeds Assessment,Evaluation,PI s. Coordination,Quality Assurance,Stands Planning, Development,lMonitoring, Training,Applied Research,Systems of Care,and Information System WWCH81OSCH 10120197 Definitions of the Four Types of Services by Which the Core Public Health Services are Provided by Maternal and Child Health Programs as Defined by the Maternal and Child Health Bureau Direct health care services are defined as basic health services. Such services are generally delivered"one on one"between a health professional and a patient in an office, clinic or emergency room. Basic services include what most consider to be ordinary medical care, inpatient and outpatient medical services, allied health services, drugs, laboratory testing, x-ray services,dental care, and pharmaceutical products and services. State Title V programs support services such as prenatal care, child health, school health and family planning by directly operating programs or by funding local providers. Direct health care services also include health care services for children with special needs. Enabling services are defined as services that allow or provide for access to and the derivation of benefits from the array of basic health care services. Enabling services include transportation, translation, outreach, respite care, health education, family support services,purchase of health insurance, case management, and coordination of care. These kinds of services are especially necessary for the low-income population which is disadvantaged, geographically or culturally isolated, and for those with special and complicated health needs. Population-based services are defined as services which are intended and available for the entire population,rather than for a selected group of individuals. Disease, prevention, health promotion and statewide outreach come under this heading. Oral health, injury prevention, nutrition and outreach and public education are topics which also belong in this category. Population-based services are generally available for women and children regardless of whether they receive care in the public or private sector or whether or not they have health insurance. Infrastructure Building services are defined as those services that are directed at improving and maintaining the health status of a population. Included among those services are development and maintenance of health systems, standards, and guidelines,training, data, and planning. Needs assessment,evaluation, policy development, quality assurance, information systems, and applied research are all contained within the infrastructure umbrella. ATTACHMENT C Preliminary Plan for Utilization of Maternal and Child Health Block Grant Funds by Local Public Health Agencies There are three population groups for which Maternal and Child Health services are to be provided and for which we are asked to account, the Perinatal Population, Child and Adolescent Population, and the Children with Special Health Care Needs Population. The scope of this Preliminary Plan is for the Perinatal Population and the Child and Adolescent Population. Please provide a preliminary proposal for how you would utilize the MCH Block Grant Funds for these two groups. Under each population group, please describe the level or levels of services which you would be using the MCH funds to provide, i.e. direct, enabling, population-based or infrastructure-building. And, under each population group, please provide the rationale for the services you would use the MCH funds to provide. Preventive and primary care services for child-bearing age women, pregnant women, and mothers. 1) What direct services, if any, will you use the MCH funds to provide? What enabling services, if any, will you use the MCH funds to provide? What population-based services, if any,will you use the MCH funds to provide? What infrastructure-building services or activities, if any, will you use the MCH funds to provide? 2) Why do you choose these services? (Please address such issues as those that follow. What is the unmet need? What other community resources address this need? Is there insufficient capacity to provide quality services? Is there an emerging need? Is there a vulnerable population whose needs would not otherwise be met? Is there a plan to develop other community resources to address the need?) Preventive and primary care services for children and adolescents 1) What direct services, if any,would you use the MCH funds to provide? What enabling services, if any, would you use the MCH funds to provide? What population-based services, if any, would you use the MCH funds to provide? What infrastructure-building services or activities, if any, would you use the MCH funds to provide? 2) What is the rationale for selecting these services? Please address such issues as those suggested under#2 above. ATTACHMENT D BUDGET ESTIMATE FORM MATERNAL AND CHILD HEALTH REPORTING FOR THE CORE PUBLIC HEALTH SERVICES INCLUDING CHILD HEALTH AND PERINATAL HEALTH PROGRAMS Based on your county plan, please estimate the following based on your MCH contract amounts: AMOUNT AND PERCENTAGE ALLOCATED TO: DOLLARS PERCENTAGE CHILD HEALTH PERINATAL HEALTH TOTAL 100 % Please also fill out the following core public health table for both child health and perinatal health (one table for each program): CHILD HEALTH PERCENTAGE ALLOCATED TO: DIRECT SERVICES ENABLING SERVICES POPULATION-BASED SERVICES INFRASTRUCTURE BUILDING SERVICES TOTAL 100 % PERINATAL HEALTH PERCENTAGE ALLOCATED TO: DIRECT SERVICES ENABLING SERVICES POPULATION-BASED SERVICES INFRASTRUCTURE BUILDING SERVICES TOTAL 100 % NOTE: Administrative costs can be allocated to each of the above categories as appropriate. CD Ec . 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S O N . a � 8 ,t O CO .- E— cv ° mL a) o 3 m :1510 :c ,C° a) x- -13 Fs 0. 0 W + 3 'c 2 N c O IL ATTACHMENT F FINAL EXPENDITURE REPORT for MATERNAL AND CHILD HEALTH PROGRAMS PROGRAM: PERIOD: TOTAL EXPENDITURES APPLICANT AND MATERNAL AND OTHER CHILD HEALTH FROM CDPHE SOURCE OF APPLICANT AND OTHER LOCAUCOUNTY** $ MEDICAID $ PATIENT FEES $ OTHER $ TOTAL $ "MAY THESE LOCAUCOUNTY FUNDS BE USED TO MATCH THE MATERNAL AND CHILD HEALTH BLOCK GRANT YES NO SIGNATURE OF DIRECTOR OR AUTHORIZED REPRESENTATIVE NOTE: Even though CDPHE, Maternal and Child Health Services program is no longer requesting that contractors report actual expenditures by individual line items, contractor is responsible for maintaining expenditure information in sufficient detail so that they can meet the requirements of an audit. H:MCHEXPRPT ATTACHMENT G MULTI-YEAR COUNTY MCH PLAN This County MCH Plan asks the local public health agency to assess and prioritize the health status needs of the Perinatal Population and of the Child and Adolescent Population and to identify how the MCH funds will be used to address the priority needs. The Plan is to categorize the activities or services which will be used to address the needs by four types of services, i.e. direct care services, enabling services,population-based services or infrastructure-building activities as defined by the Maternal and Child Health Bureau in"Core Public Health Services Delivered by MCH Agencies". Quantitative and qualitative data gathered at the state and local levels should be used in assessing health status needs. The resources available in the community to meet the needs should also be assessed and considered in establishing the priorities to be addressed. Local public health agencies are encouraged to collaborate with public and private partners in the development of the Maternal and Child Health Plans. Colorado has identified ten MCH priorities to be addressed with MCH Block Grant funding. The services or activities provided under the MCH funding should be responsive to one or more of the priorities. There is no ranking of the ten priorities. They are as follows: I. Reduce teen pregnancy and unintended pregnancy in women of all ages. 2. Improve perinatal outcomes. 3. Reduce child and adolescent morbidity. 4. Increase health and safety in child care settings. 5. Improve efforts to reduce unintentional and intentional injury, addressing motor vehicle crashes, suicide,child abuse and other violence. 6. Improve immunization rates for all children. 7. Increase access to health care(including behavioral health care). 8. Improve state and local infrastructure by increasing capacity to analyze data, carry out evaluations, develop quality standards, and assure availability of services to all children, including children with special health care needs. 9. Reduce substance abuse (alcohol,tobacco; and drugs). 10. Improve oral health and access to oral health care. Please use the following format to describe your county or district's plan to address the health needs of the women and children of your community: I. PERINATAL POPULATION - Preventive and primary care for childbearing age women, pregnant women, and mothers 1 A. Statement of Need -- What are the priority needs of the Perinatal population in the County or District, based on an assessment of the health status needs and of the resources to address the needs? (2 pages) 1.) Health Status Indicators-- What information about the health status of the women in your county or district were used to select the priority needs? • Cite county-specific data(quantitative and/or qualitative), such as data for the following MCH Measures and for any others which you may identify to explain how the priority needs were identified: * The rate of birth(per 1,000) for teenagers age 15 - 17 years * The percent of infants born to pregnant women receiving prenatal care beginning in the first trimester * The percent of mothers who breast-feed their infants at hospital discharge * The percent of low birth weight births * The percent of very low birth weight births * The percent of very low birth weigh infants delivered at facilities for high-risk deliveries (Level 3 facilities) • Cite any racial or ethnic disparities which may exist in your county for the indicators listed above or for other health indicators you have identified. • Once these data have been collected, your data analysis will reveal which of these indicators are significant for your county or district. Priority should be given to indicators which indicate a health status problem or there should be an explanation of why it is not necessary or possible to use MCH resources to address that issue. • There may be a health status indicator for which the county has a good measure because the county has directed resources to address that issue. In such a situation, it may be a priority to continue to address that health.need under the MCH Plan. The Plan could include that need as one of the priorities that is to be addressed and provide information as to why it is necessary to maintain funding for activities to address that issue. 2 2.) Resources to address the health status needs -- What are the resources in the community which are needed to address the priority needs? pages) needs? (1-2 a.) Direct Care Service Needs -- What are the resources in the community which provide prenatal medical care and family planning services? Are there gaps or unmet needs in such direct care services? Are there issues of availability and accessibility? Present such information as the availability and accessibility of prenatal medical care and family planning services. If you are planning on using funding for direct prenatal care, describe the need for the gap-filling role and note your plan for transitioning these services to other providers. b.) Enabling Service Needs--Are enabling services, i.e. transportation, interpretation and translation, outreach, health education, family support services, purchase of health insurance, case management, coordination with other related services needed to address any of the identified priority needs? c.) Population-Based Service Needs -- What population-based services are needed to address the identified priority needs? Present information regarding the need for population-based services, such as unintentional pregnancy prevention initiatives, healthy lifestyle promotions, disease prevention education initiatives, etc., which would address any of the identified priority needs. d.) Infrastructure-Building Service or Activity Needs -- What infrastructure-building services or activities are needed to address the priority needs? Present information regarding the need for services or activities such as planning activities, needs assessments,program evaluation, policy development, program coordination, quality assurance activities, standards development, monitoring, training, research, developing systems of care and related services, or information systems which are needed to address identified priority needs. B. Plan-- Objectives, Activities, Monitoring and Evaluating (3 - 5 pages) Need Identify the need(s) which will be addressed 3 Objective State the objective or objectives which will address the need(s). All objectives should be reasonable specific, time frame ..., time-framed and measurable. Activities Describe the specific activities that will be carried out to achieve each objective. Include"Best Practice"or"Evidence-Based" interventions or activities whenever possible. Categorize the activities according to the level or type of MCH service being carried out(i.e., direct health care, enabling, population-based, or infrastructure-building). Activities or strategies may address more than one need or objective. Monitoring Describe your methods of monitoring to assure quantity of service (numbers of clients and services)and quality of service (measured through use of protocols, chart audits,policy procedure manuals, etc.). Infrastructure-building activities or services may be monitored by tracking the completion of planned activities or whether benchmarks have been realized or protocols or policy procedures put in place. Evaluation Describe your methods of evaluating the effectiveness of your activities in addressing the identified need. II. CHILD AND ADOLESCENT POPULATION --preventive and primary health care services for children and adolescents A. Statement of Need -- What are the priority needs of the Child and Adolescent Population in the county or district, based on an assessment of the health status needs and of the resources to address the needs? (2 pages) 1.) Health Status Indicators -- What information about the health status of the children and adolescents in your county or district was used to select the priority needs? • Cite county-specific data(quantitative and/or qualitative) such as data for the following MCH Measures and for any other indicators which you may identify to explain how the priority needs were identified: * The percent of children through age 2 who have completed immunizations for measles, mumps, rubella,polio, diptheria,tetanus, pertussis haemomphilus influenza, and Hepatitis B. 4 * The rate of deaths (per 100,000) to children aged 1-14 caused by motor vehicle crashes * The incidence of maltreatment of children younger than 18 (including physical abuse, sexual abuse, emotional abuse, and/or neglect) * The rate of birth(per 1,000) for teenagers aged 15 through 17 years * The rate (per 100,000)of suicide deaths among youths age 15-19 * The rate (per 100,000) of deaths to adolescents age 15-19 caused by motor vehicle crashes * The rate of homicides among teens 15-19 and among black male teens (when population permits) * The proportion of high school students reporting having drunk alcohol in the past month * The proportion of high school students reporting regular use of tobacco products * The injury hospitalization rate, by cause, for children and adolescents ages 1-9, 10-14, and 15-19 * The percent of children and adolescents in poverty • Cite any racial or ethnic disparities which may exist in your county for the indicators listed above or for other health status indicators you have identified. • Once these data have been collected,your data analysis will reveal which of these indicators are significant for your county or district. Some priority should be given to indicators which indicate a health status problem or there should be an explanation of why it is not necessary or possible to use MCH resources to address that issue. • There may also be a health status indicator for which the county has a good measure because the county has directed resources to address that issue. In such a situation it may be a priority to continue to address that health need under the MCH Plan. The Plan could include that need as one of the priorities that is to be addressed and provide information regarding the need to maintain funding to address that issue. 5 2.) Resources to address the health status needs -- What are the resources in the community which are needed to address the priority needs? (1-2 pages) a.) Direct Care Service Needs -- What are the resources in the community which provide primary and/or preventive health care services for children and adolescents? Consider such information as that listed below: * The percent of eligible children and adolescents enrolled in Medicaid and CHP+ * The availability of providers who participate in Medicaid and CHP+ * The availability of confidential care for teens * The availability of pediatric and adolescent-trained providers * The availability and accessibility of pediatric and adolescent mental health services * The availability and accessibility of substance abuse treatment for adolescents * The availability of school health and school-based health center services * The percent of children without health insurance * The availability of direct care services, including home visiting * The availability and accessibility of dental care b.) Enabling Service Needs --Are enabling services, i.e. transportation, interpretation and translation, outreach, respite care, health education for individuals, family support services, purchase of health insurance, case management, coordination with other related services, etc., needed to address the identified priority needs and the barriers to receipt of services? c.) Population-Based Service Needs-- What population-based services are needed to address the priority needs? Present information regarding the need for population-based services, such as injury prevention initiatives, teen pregnancy prevention initiatives, school health and health education programs, suicide prevention activities, violence prevention activities, including child abuse prevention, and youth"assets"building programs, etc., which would address any of the identified priority needs. d.) Infrastructure-Building Service or Activity Needs -- What infrastructure- building services or activities are needed to address the priority needs? Present information regarding the need for such services or activities as child mortality review committees, processes for needs assessments, planning, and evaluation,policy development,program coordination, quality assurance activities, standards development, monitoring, training, 6 research, developing systems of care and related services, immunization tracking systems, or other information systems, etc., to address the identified priority needs. B. Plan-- Objectives, Activities, Monitoring and Evaluating(3-5 pages) Need Identify the need(s) which will be addressed Objective State the objective or objectives which will address the need(s). All objectives should be reasonable, specific, time-framed and measurable. Activities Describe the specific activities that will be carried out to achieve each objective. Include"Best Practice"or"Evidence-Based" interventions or activities whenever possible. Categorize the activities according to the level or type of MCH service being provided (i.e., direct health care, enabling,population-based, or infrastructure-building). Activities or strategies may address more than one need or objective. Monitoring Describe your method of monitoring to assure quantity of service (numbers of client and services) and quality of service (measured through use of protocols, chart audits, policy procedure manuals, etc.). Infrastructure-building activities may be monitored by tracking the completion of planned activities or whether benchmarks have been realized or protocols or policy procedures put in place. Evaluation Describe your methods of evaluating the effectiveness of your activities in addressing the identified need. 7 ATTACHMENT H STATE OF COLORADO Bill Owens,Governor Jane E.Norton,Executive Director of Dedicated to protecting and improving the health and environment of the people of Colorado 4300 Cherry Creek Dr.S. Laboratory and Radiation Services Division * C:4 * * Denver,Colorado 80246-1530 8100 Lowry Blvd. •' '876 Phone(303)692-2000 Denver CO 80230-6928 Located in Glendale,Colorado (303)692-3090 Colorado Department http://www.cdphe.state.co.us of Public Health and Environment [Date] Sample Task Order Change Order Letter Attachment H State Fiscal Year 19** - **, Task Order Change Order Letter Number***, Contract Routing Number*«***** Pursuant to paragraph **of the Task Order with contract routing number*«***** and contract encumbrance number *********** (as amended by Task Order Renewal Letter's**,contract routing number*«*****,and/or Task Order Change Order Letter**,contract 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 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 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 assistant as he may 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 you when fully approved. Contractor's Legal Name STATE OF COLORADO (legal type of entity) Bill Owens,Governor By: By: For the Executive Director Print Name: DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Title: FEIN: APPROVALS: CONTROLLER: PROGRAM: By: By: Arthur L. Barnhart Hello