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Home My WebLink About960049.tiff RESOLUTION RE: APPROVE CONTRACT FOR HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS 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 Health Care Program for Children with Special Needs 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, commencing January 1, 1996, and ending September 30, 1996, 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 Health Care Program for Children with Special Needs 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 10th day of January, A.D., 1996, nunc pro tunc January 1, 1996. BOARD OF COUNTY COMMISSIONERS G%� WE COUNTY, COLORA7D e4 ALL. L./A ' • arbara J. Kirkmeyer, Weld County Clerk to the Board B \ ‘Th �Vln e FlBa ter, Pr Tem 446 Deputy Clerk t( the Board 1 1 Dale K. Hall AP AS TO FOfiM j E ✓'vf�7� Constance L. Harbert / Coin y Attorney W. H. Webster 960049 C� : Hc, .s'c [e(/) HL0022 DEPARTMENT OR ACEaCY NAME HEALTH DEBARMENT OR AGENCY NUMBER FAA CONTRACT RUINING NUMBER 960294 CONTRACT THIS CONTRACT, Made this 1st day of January 199 6 , by and between the State of Colorado for the use and benefit of the Department of Public Health & Environment. 4300 Cherry Creek Drive South. Denver. Colorado 80222-1530 hereinafter referred to as the State, and Weld County Health Department. 1517 16th Avenue Court.Greeley,Colorado 80631 hereinafter referred to as the contractor, WHEREAS, authority exists in the Law and Funds have been budgeted, appropriated and otherwise made available and a sufficient uncommitted balance thereof remains available for encumbering and subsequent payment of this contract under Encumbrance Number FAA HCP960294 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, the State is charged with operating the Health Care Program For Children With Special Needs (HCP) (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: 1. The 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 ATTACHMENT A, Effectiveness Indicators For The Weld HCP Regional Office 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. Page 1 of 8 pages 360049 4. The Program will, in consideration of said services by the Contractor, cause to be paid to the Contractor an amount not to exceed SEVENTY-ONE THOUSAND NINE HUNDRED TWENTY-FIVE DOLLARS AND ZERO CENTS ($71,925.00) for the period from January 1, 1996 through September 30, 1996. 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 January 1, 1996 and September 30, 1996 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 ONE MILLION TWO HUNDRED THOUSAND DOLLARS AND ZERO CENTS ($1,200,000.00) The liability of the State, at any time, for such payments shall be limited to the unencumbered amount remaining of such funds. Because of the uncertainty of Maternal and Child Health Block Grant funding, the State may prospectively increase or decrease the amount payable under this contract through a "Change Order Letter', approved by the State Controller or his designee, in the form attached hereto as ATTACHMENT D, by this reference is made a part hereof, subject to the following conditions: a. The Change Order Letter("letter') shall include the following: i. Identification of contract by contract number and affected paragraph number(s); ii. Identification of any service level increases or decreases and the new service level, if applicable; Hi. Amount of the increase or decrease in the level of funding and the total; iv. Intended effective date of the funding change; v. A provision stating that the Change shall not be valid until approved by the State Controller or such assistant as he may designate; vi. Authorized signatures of the State, the Contractor, and the State Controller or his designee. b. Upon proper execution and approval, such Letter shall become an amendment to this contract and, except for the General and Special Provisions of the contract, the Letter shall supersede the contract in the event of a conflict between the two. It is understood and agreed that the Letter may be used only for increased or decreased funding, and corresponding adjustments to service levels and any budget line items. Page 2 of 8 pages 960049 c. If the Contractor agrees to and accepts the Change,the Contractor shall execute and return the Letter to the State by the date indicated in the Letter. In the event the Contractor does not accept the change, or fails to timely return the executed Letter, the State may, upon notice to the Contractor,terminate this contract effective at any time after twenty(20)days following the return deadline specified in the Letter. Such notice shall specify the effective date of termination. In the event of termination,the parties shall not be relieved of their obligations up to the effective date of termination. d. Increases or decreases in the level of contractual funding made through the Letter process during the term of this contract may be made under the following circumstances: i. If necessary to fully utilize Colorado State appropriations and/or appropriated federal grant awards. ii. Adjustments to reflect current year expenditures. iii. Supplemental appropriations or appropriated federal funding changes resulting in an increase or decrease in the amounts originally budgeted and available for the purposes of this Program. iv. Closure of programs and/or termination of related contracts. v. Delay or difficulty in implementing new programs or services. vi. Other special circumstances as deemed appropriate by the State. 6. The Contractor agrees to notify the Program of any changes in personnel and any anticipated vacancy savings if the vacancy is expected to exist for one month or longer. 7. The Contractor agrees to provide services to all Program participants and employees in a smoke-free environment according to Public Law 103-227, also known as the Pro-Children Act of 1994 (Act). Public Law 103-227, also known as the Pro-Children Act of 1994 (Act), requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed,operated, or maintained with such Federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or Medicaid; or facilities where WIC coupons are redeemed. Failure to comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. a. By signing this contract, the Contractor certifies that the Contractor will comply with the requirements of the Act and will not allow smoking within any portion of any indoor facility used for the provision of services for children as defined by the Act. b. The Contractor agrees that it will require that the language of the Act be included in any subcontracts which contain provisions for children's services and that all subcontractor shall sign and agree accordingly. Page 3 of 8 pages s600 '9 8. No charges will be made to families by the Contractor for care coordination/case management regardless of a family's income. 9. Charges for attendance and services at medical specialty clinics sponsored by the Program must conform to the Clinic Charge Schedule,ATTACHMENT E and any subsequent amendments thereto, and by this reference made a part hereof. 10. 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 - LLL, "Disclosure Form to Report Lobbying", in accordance with its instructions. 11. 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, Matemal and Child Health, or Social Services Block Grant programs). 12. 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. 13. 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. 14. This Contract is subject to and contingent upon the continuing availability of Federal funds for the purposes hereof. 15. The term of this contract is beginning January 1, 1996 and ending September 30, 1996. Page 4 of 8 pages AA 9600'9. COLORADO DEPARTMENT OF HEALTH-hereinafter,under the General Provisions referred to as "Health". GENERAL PROVISIONS --page 1 of 2 pages I. The contractor shall perform its duties hereunder as an independent contractor and not as an employee. Neither the contractor nor any agent or employee of the contractor shall be or shall be deemed to be an agent or employee of the state. Contractor shall pay when due all required employment taxes and income tax withholding.shall provide and keep in force worker's compensation (and show proof of such insurance) and um lov^nent compensation insurance in the amounts reauired 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 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). Page 5 of 8 Pages Rev. 06/01/92 (GEN070595) 9600 q':9 GENERAL PROVISIONS--Page 2 of 2 pages 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,I anc'I 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 6 of 8 Pages Rcv. 06/01/92 (GEN070595) 9600,t9 SPECIAL PROVISIONS CONTROLLER'S APPROVAL 1.This contract shall not be deemed valid until it shall have been approved by the Controller n loo er f the State of Colorado or such assistant as he may designate. This provision is applicable to any contract involving the payment of Y by the State. FUND AVAILABILITY 2.Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon hinds for that purpose being appropriated, budgeted,and otherwise made available. BOND REQUIREMENT 3.If this contract involves the payment of more than fifty thousand dollars for the construction,erection,repair,maintenance,or improvement of any building, road, bridge, viaduct, tunnel, excavation or other public 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�y not less one-half of the total amount payable by the terms of this the faithful performance of the contract,and in addition, shal pro Such e bond shall duly executed his byu a n qualified s fail corporate provendor or shall provide that if the mcontractord his subcontractors fail to duly pay for any ynce of the work con hire, ctted sustenance,e provisions,fails to pay any person whoru es used a or consumed by such equipmer nt in his subcontractor prosecution in performance the same in an amount not exceeding the sum who supplies maclgether tools, t test at the in the eight p lion the work the suretynUnless will pay specified in the bond,together with interest at the rate of eight per cent per annum. Unless such bond is executed,delivered and filed,no claim in favor of the contractor arising under such contract shall be audited,allowed or paid. A certified or cashier's check or a bank money order payable to the Treasurer of the State of Colorado may be accepted in lieu of a bond.This provision is in compliance with CRS 38-26-106. INDEMNIFICATION 4.To the extent authorized by law,the contractor shall indemnify,save,and hold harmless the State,its employees and agents,against any and all claims,damages,liability and court awards including costs,expenses,and attorney fees incurred as a result of any act or omission by the contractor, or its employees,agents,subcontractors,or assignees pursuant to the terms of this contract. DISCRIMINATION AND AFFIRMATIVE ACTION 5.The contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957,as amended,and other applicable law respecting discrimination and unfair employment practices(CRS 24-34-402,and as required by Executive Order,Equal Opportunity and Affirmative Action,dated April 16,1975. Pursuant thereto,the following provisions shall be contained in all 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,creed,color,national origin,sex,marital status,religion,ancestry,mental or physical handicap,or age.The contractor will take affirmative action to insure that applicants are employed, and that employees are treated during employment,without regard to the above mentioned characteristics.Such�moon shall ti include,but not be limited to the following:employment,upgrading,demotion,or transfer,recruitment or recruitment advertising; y in conspicuousplaces, o f pay or other forms of compensation; and selection for training,including apprenticeship.The contractor agrees to postW available to employees and applicants for employment, notices to be provided by the contracting officer setting forth provisions of this non- discrimination clause. (b)The contractor will,in all solicitations or advertisements for employees placed by or on behalf of the contractor,state that all qualified applicants will receive consideration for employment without regard to race,creed,color,national origin,sex,marital status,religion,ancestry,mental or physical handicap,or age. (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, regulations,and orders. ion or discriminate against any of its members in the full enjoyment of work opportunity because (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 organize 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(GFN070595) Revised 1/93 395-53-01-1022 page Z of$page 9600:1:9 (g) In the event of the contractor's non-compliance with the non-discrimination clauses of this contractor or with any of such rules,regulations,or orders,this contract may be canceled,terminated or suspended in whole or in part and the contractor may be Action of declared ineligible ril 16, 9fo and the rules, contracts in accordance with procedures,authorized in Executive Order,Equal Opportunity and 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. ted (h) The contractor will include the provisions of paragraph(a)through(h)in every sub-co tr ct and Affirmative t actor purchaseof AprilAprilr order unless 1975,so exempted by rules, regulations, or orders issued pursuant to Executive Order,Equal Opportunity pport Y a provisions will be binding upon each subcontractor or vendor. The contractor will take such action with respect to any sub-contracting or however, e order as the contracting agency may direct,as a means of enforcing such provisions,including sanctions for non-compliance;pr that in the event the contractor becomes involved in,or is threatened with,litigation,with the subcontractor or vendor as a result of such direction by the contracting agency, the contractor may request the State of Colorado to enter into such litigation to protect the interest of the State of Colorado. COLORADO LABOR PREFERENCE 6a.Provisions of CRS 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 cause denial of federal funds which would otherwise be available or would otherwise be inconsistent with requirements of Federal law,this subsection shall be suspended,but only to the extent necessary to prevent denial of the moneys or to eliminate the inconsistency with Federal requirements(CRS 8-19-101 and 102) GENERAL 7. The laws of the State of Colorado and rules and regulations issued pursuant thereto shall be applied in the interpretation, execution, and enforcement of this contract. Any provision of this contract whether or not incorporated herein by reference which provides for arbitration by any extra-judicial body or person or which is otherwise in conflict with said laws,rules,and regulations shall be considered null and void. Nothing contained in any provision incorporated herein by reference which purports to negate this or any other special provision in whole or in part shall be valid or enforceable or available in any action at law whether by way of complaint,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,rules, and regulations that have been or may hereafter be established. 9. The signatories aver that they are familiar with CRS 18-8-301,et.seq.,(Bribery and Corrupt Influences)and CRS 18-8-401,et.seq., (Abuse of Public Office),and that no violation of such provisions is present. 10. The signatories aver that to their knowledge,no state employee has any personal or beneficial interest whatsoever in the service or property described herein: IN WITNESS WHEREOF,the parties hereto have executed this Contract on the day first above written. State of Colorado g Contractor: ROY ROMER,GOVERNOR (Full al Name) Weld County a[ltbDeoartment u.-By .11---d it--- (,� /5X/r—L -tom A d teuzgtY Board of Commiq6loners 01/10/96 � e�. ilload=(Ti/le)Nlyhairnerson By I , AA"' d4-6000813 ' ` De artment Social Security Number or Federal I.D.Number of p PUBLIC HEALTH ANDENVIRONMENT If Corporation,To y/C o t: Att Seal) �^�� WELD COUNTY HEALTH DEPARTMENT By VVn t . A /1A Pas _ l , deputy BY. ��./� �S7tiRKXCblt7fty/County Clerk to Board j N S. PICKLE, M.S.E.H. APPROVALS DIRECTOR ATTORNEY GENERAL CONTROLLER By By Clifford W.Hall ' r ' .. .. Gale A.Norton r - ea Form 6-AC-02C(GN7Vo'i0595) Page 8 which is the last of 8 pages J Revised 1/93 395-53-01-to30 PROGRAM APPROVAL: yli I//V i 3600.f:9 ATTACHMENT A Revised August 8, 1994 HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) EFFECTIVENESS INDICATORS For The Weld HCP Regional Office 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 9500.f 9 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 "Family Status Profile". (See attached Family 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 9600 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 9600 9 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 9500•t3 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 9600 ",9 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 HCP 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 Page-6 of 13 pages 9600' :9 reading level 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 families know best what their needs are. By including families as full partners, the program will be able to provide better services. Page 7 of 13 pages 96©0'x'9 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 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.) Page 8 of 13 pages 9600.41-9 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, EPSDT, 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 9600 "a WELD COUNTY HEALTH DEPARTMENT HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) o00 a FAMILY ASSESSMENT TOOL °�� CURRENT FAMILY 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 are your concerns about your child's health issues? 3. Is your child visiting a doctor or clinic on a regular basis? O YES O 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? O YES O NO Have you had any difficulties getting your child's medicines? O YES O NO Have you had any problems getting the treatments that your doctor has recommended? O YES O NO Are your child's shots (immunizations) up-to-date? O YES O NO Do you have a copy of your child's shot records and could we have a copy? ❑ YES O NO 4. What other people or organizations are involved in your child's care? Page 10 of 13 pages 9600 "'3 5. Is there anyone involved who is helping you to pull these people and services together? ❑ YES 0 NO If YES, What is his or her name? and What is his or her relationship to you? 6. How do your child's needs affect you and your family? 7. What are your plans and hopes for your child? Long-term: Short-term: 8. What are your child's plans and hopes for him or herself? (if applicable) Long-term: Short-term: 9. What is being done to support your child and your family to be successful with those plans? 10. What do you see as strengths in your family? 11. We know that many times families have needs that are not necessarily medical, but make it difficult to care for their family. Do you or your family have any other issues that we can help you with, i.e., housing, food, clothing? 12 Are you able to get away from the house to do things for yourself if you need to? 0 YES 0 NO 13. Are you able to go to the doctor if you need to? ❑ YES 0 NO 14. Are you and your family covered by Medicaid or health insurance? 0 YES 0 NO 15. Is there anything else we could assist you with? OBJECTIVE DATA OBSERVED (if on-site interview conducted) use additional paper if needed Page 11 of 13 pages 9600:':,_9 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 NO DEGREE 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? NOTES: 1. If all answers fall in Column A — may only need to follow-up in one year or as 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 9600 -4.9 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) Child Find I / School District / / Community Center Board / / Social Services / I W.I.C. I I Parent Support team I / Support Group / / EPSDT / I Medicaid / / Public Health Nurse / / Other (specify) / / / / / / Family does not want interventions, Follow-up / / _ Follow-up with family in one year or P.R.N. per HCP Standards. Other (specify) Completed by Signature Title Reviewed by R.N. Signature Page 13 of 13 pages .a di 2 4 7@ � I / it. aon C) k ! / \ f] / \ � \2 \ C:4 2 � § g ..< |� \ CI El� 2 ; o 4 o E tg G C § _ _ E = H a \ / Ha.H CC H \ 5 ) oz § g 0 E. @ & G . � ° C 2 } • ED § E-4 \ ) , I \ ° ( . ] H 7 . / \ \ / Ce E.( \ • E / ) / \ } ( ) til j N 5 & CU F / a % /z i ^ ° o t Q 4.3 RI \ .0 § \ '— g) } \ ) ) \ \ ) § l ) 0 ) § , g o ± 2 y. _ a)§ § § § � / j / § WO ) m Cl)_/ / › ° Ha / / \ ) \ \ \ \ 360939 ATTACHMENT C Applicant: WELD COUNTY HEALTH DEPARTMENT (revised 12/27/95) Project: HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP) For the Period of: JANUARY 1, 1996 through SEPTEMBER 30, 1996 Annual Full Total Source of Funds Salary Time Amount *Applicant Requested Rate Equivalent Required and Other from HCP Personal Services: Social Worker(Aurora Cura) 27,372 0.50 10,265 10,265 Office Tech. (Patty Isakson) 20,758 0.80 15,569 3,114 12,455 CHN- (Cheryl Weinmeister) 33,446 1.00 25,085 25,085 CHN - (Kris Embree) 33,446 0.14 14,047 10,535 3,512 Office Tech. (Deby Dominguez) 16,432 2,465 2,465 Fringe Benefit Rate: 17% 11,463 2,739 8,724 Supervising Personnel: Nurse Supervisor(Kathy Shannon) 40,021 6,003 6,003 Director of Nursing (Glenda Schneider) 50,986 4,589 4,589 Sub-total Personnel Expenses 2.44 89,486 29,445 60,041 Travel 525 150 375 Operating Expenses: Staff Development 150 47 103 Dedicated Phone Line 450 450 Sub-total Operating Expenses 600 47 553 Indirect Cost Rate: 18.00% 16,283 5,327 10,956 Total Contract Expenses 106,894 34,969 71,925 *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 9600 -n-9 STATE OF COLORADO Roy Romer,Governor of Co Patti Shwayder,Acting Executive Director e Dedicated to protecting and improving the health and environment of the people of Colorado • � .; A » 4300 Cherry Creek Dr.S. Laboratory Building » Denver,Colorado 80222-1530 4210 E.11th Avenue r'/g76� Phone(303)692-2000 Denver,Colorado 80220-3716 (303)691-4700 Colorado Department Health Care Program For Children With Special Needs(HCP) of Public Health Telephone:(303)692-2370;FAX:(303)782-5576 and&tvironment ATTACHMENT D CHANGE ORDER LETTER CHANGE ORDER LETTER#_ STATE FISCAL YEAR 199_ Pursuant to paragraph_of Contract Routing No. , dated 199_the Colorado Department of Public Health and Environment Health Care Program For Children With Special Needs (HCP) hereby notifies that the maximum reimbursement from the State of Colorado Department of Public Health and Environment for the period , 199_through , 199_is hereby by $ to a new total of . The contract amount on page_, paragraph_shall read This Change Order Letter amends the contract and is intended to be effective 199_but in no event shall this Change Order Letter be deemed valid until it shall have been approved kv the State Controller or such assistant as he may designate. Please sign and return all copies of this Change Order Letter. Sincerely, Lee Thielen, Assistant Director Colorado Department of Public Health and Environment Program Approval Contractor By Title Approved State Controller, Clifford W. Hall By Page 1 of 1 page 9600 TS ATTACHMENT E 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 9600:P 9 4,1111 mEmoRAnDur ,_ 17 Barbara Kirkmeyer, Chair 1 ' To Board of County Commissioners Date January R% COLORADO TO From John Pickle, Director, Health Department Subject: HCP Contract Enclosed for Board approval is a contract between the Weld County Health Department (WCHD) and Colorado Department of Public Health and Environment (CDPHE) for the Health Care Program for Children With Special Needs. This program was previously called the Handicapped Children's Program. The time frame for last year's contract was originally October 1, 1994 through September 30, 1995. However, due to uncertainty of federal funding, the CDPHE amended the contract and extended the term an extra three months to end December 31, 1995. CDPHE is offering this contract for a nine month period from January 1, 1996 through September 30, 1996 fora total amount of$71, 925 which is $1,758 more than 75% of the previous year's contract. Because of the uncertainty of Maternal and Child Health Block Grant funding, the State may prospectively increase or decrease the amount payable through a "Change Order Letter." However, at this time, the State is expecting funding at the same level as the previous year. The contract authorizes WCHD to provide case finding, community outreach, care coordination, clinic management, program management, parent and family involvement and support and interagency collaboration. I recommend approval of this contract. Enclosures 9600.°',9 Hello