HomeMy WebLinkAbout972366.tiffRESOLUTION
RE: APPROVE CHILD HEALTH PROGRAM CONTRACT RENEWAL LETTER #1 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 Contract Renewal Letter #1 for the
Child Health Program between the County of Weld, State of Colorado, by and through the
Board of County Commissioners of Weld County, on behalf of the Health Department and the
Colorado Department of Public Health and Environment, commencing October 1, 1997, and
ending September 30, 1998, 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 Contract Renewal Letter #1 for the Child Health Program between
the County of Weld, State of Colorado, by and through the Board of County Commissioners of
Weld County, on behalf of the 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 Chair be, and hereby is, authorized
to sign said renewal letter.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 5th day of November, A.D., 1997, nunc pro tunc October 1, 1997.
ATTEST
tJ
Weld CdDA
BY:
Deputy 'Ore
e Board
APP' : ' • S TO ; • RM:
CL: hiLj3T
972366
BOARD OF COUNTY COMMISSIONERS
WEL COUNTY7ORADO
/Georg
E. Baxter, Chair
Constance L. Harbert, Pro-Tem
Thalia
Dal K. Hall H
Barbara J. Kirkmeyer
//
W. H. Webster
HL0023
STATE OF COLORADO
Roy Romer, Governor
Patti Shwayder, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S.
Denver, Colorado 80246-1530
Phone (303) 692-2000
Located in Glendale, Colorado
http://www.cdphe.state.co.us
Laboratory and Radiation Services Division
8100 Lowry Blvd.
Denver CO 80220-6928
(303) 692-3090
September 15, 1997
State Fiscal Year 19 97 - 98
Contract Renewal Letter No. 1
Colorado Department
of Public Health
and Environment
Contract Routing Number 07653
In accordance with Paragraph 14 of the contract with routing number 9705807 and contract number WCH9705807
hereinafter referred to as the Original Contract (copy attached and by this reference made a part hereof) between the State of
Colorado, Department of Public Health and Environment (Family and Community Health Services Division) and The Weld
County Health Department the parties hereby agree the Original Contract is hereby renewed for the period of October I
1991_ through September 30 , 199 8 . The parties agree that the maximum amount payable by the State for the eligible
services during this renewal period is THIRTY-SEVEN THOUSAND, ONE HUNDRED, NINETY TWO DOLLARS
($37,192.00). The terms of conditions of the Original Contract are hereby reaffirmed and shall continue in full force and
effect throughout this renewal period unless otherwise stated.
This amendment to the Original Contract is intended to be effective as of October 1 199 7 , but in no event shall it 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 4 originals of this letter as soon as possible to:
Lee Joseph
Colorado Department of Public Health and Environment
Family and Community Health Services Division
Mail Code: FCHSD A-4
4300 Cherry Creek Drive South
Denver, Colorado 80246-1530
One original of this letter will be returned to you when fully approved.
Contractor: Weld County Board of Commissioners State of Colorado:
Full Contractor Name Roy Romer, Governor
By:
Signature
Print Name: Ceorgp E 'Baxter
Title: Chair
APPROVALS:
PROGRAM
By:
By:
WELD CO :,, HEAL DEPARTMENT
FIN S. PICKLE, M.S.E.H.
-"lith*rtrOR
For the Executive Director
Colorado Department of Pu
and Environment
APPROVALS:
CONTROLLER
c Health
By: Ca U Q-�
Cliffor . Hall
Department or Agency Number:
FAA(CDPHE)
APPROVED WAIVER FORM
Contract Routing Number:
9705807
CONTRACT
THIS CONTRACT, made this 1st day of October, 1996, by and between the State of Colorado for
the use and benefit of the Department of Public Health and Environment, 4300 Cherry Creek Drive So.,
Denver, Colorado, 80222, hereinafter referred to as the State and WELD COUNTY HEALTH DEPT,1517
16th Avenue Court, GREELEY, CO 80631 586, 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
in and subsequent payment of this contract under Encumbrance No.WCH9705807 in Fund number 100,
Appropriation Accounts 585 and 085, and Organization 6710; and
WHEREAS, required approval, clearance and coordination has been accomplished from and with
appropriate agencies: and
WHEREAS, the State has formulated a comprehensive State Plan to carry out a Maternal and
Child Health Program, funded by Federal Health and Human Services funds; and
WHEREAS, said comprehensive State Plan and Federal budget allocates funds to be utilized for
the implementation of the program through various agencies in order to provide these health care services
to the people of Colorado; and
WHEREAS, the Contractor is considered by the State to be an appropriate agency to provide
these services as herein set forth.
NOW THEREFORE, it is hereby agreed that for and in consideration of their mutual promises to
each other, hereinafter stated, the parties hereto agree as follows:
1. The Contractor will provide Child Health Services to clients 0-16 years of age through public
health nursing prevention and health promotion activities designed to enhance the health status of
children. Public health nursing assessments and interventions shall be consistent with recommendations
for child health care as delineated in the Colorado Department of Public Health and Environment Child
Health Manual, Screener Manual, and other policies and guidelines which have or will be made available
to the contractor and shall include:
a. Child Health Clinic Services as indicated to include:
(1) A complete health and psychosocial history and unclothed physical exam
(2) Age -appropriate screening, including developmental screening
(3) Age -appropriate immunizations
(4) Age -appropriate anticipatory guidance and teaching of risk -reducing behaviors to
parents, including injury prevention
(5) . Nursing management and/or referral to appropriate resources of children
exhibiting actual or potential problems in physical and/or psychosocial/emotional
status
b. Home visiting 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
page 1 of 8 pages
972366
c. activities in which staff have taken a leadership role and/or have actively participated that
have as their goal the improved health of children in the communities served. Such
activities will be consistent with one or more core public health functions of assessment,
assurance and policy development and implementation
d. evidence that 92% of all 2 year old children who have been enrolled in Contractor's Child
Health Clinics for at least one year are current on recommended immunizations, including
Hemophilus B
e. a description of at least two activities, the primary purpose of which is the prevention of, or
early intervention in, child abuse and neglect, which the Contractor has implemented or in
which the Contractor has played an active role
case finding and referral through above Child Health activities for children eligible for the
Health Care Program for Children with Special Needs
a description of efforts to enhance collaboration and sharing of resources to improve
services to children in the community
2. The Contractor will, whenever possible, use para-professional Screeners to perform screening
components of Child Health Services. The preferred developmental screening tool is the Denver II.
Screeners using the Denver II will be trained and evaluated as determined appropriate by the State
Screening Program Manager. Contractor will assign public health nurse(s) to provide day-to-day
supervision for these screeners.
3. The Contractor will submit monthly to the State screening data utilizing the CoTrack data system,
or other system as may be approved by the State.
4. By September 30, 1997 and September 30, 1998 a qualitative audit will be done on 10% of
currently enrolled and active Child Health Clinic records, using the State Child Health Impact Tool or
similar paper or computerized audit format approved by the Child Health Program Director. A copy of the
aggregate audit results shall be submitted to the Child Health Program Director and shall demonstrate that
75% of the problems identified in Child Health Clinic clients have shown resolution and/or improvement.
5. By September 30, 1997 and September 30, 1998, the Contractor will provide to the State in
writing the total dollar amount that was reimbursed to them for EPSDT/Medicaid screenings provided to
children seen in the agency.
6. Title V funds may not be used to pay for any item or service (other than an emergency item or
service) furnished by an individual or entity convicted of a criminal offense under the Medicare or any
State health care program (i.e., Medicaid, Maternal and Child Health, or Social Services Block Grant
Programs).
7. The Contractor shall: (1) inform potentially eligible recipients that the "Colorado Baby Care/Kid's
Care Program" (BC/KC) exists and that potentially eligible recipients should apply for coverage under that
program through the local county department of Social Services; (2) inform the potential recipient that
BC/KC may be a potential source of payment for their child's care; and (3) inform the potential recipient
that in order to receive continuing coverage under BC/KC they be encouraged to complete an application
fully as soon as possible (BC/KC allows for up to 60 days of presumptive eligibility for pregnant women
who are registered with Medicaid.); and (4) obtain from Medicaid and have present at their facility current
information regarding eligibility and services under BC/KC. Potentially eligible recipients are pregnant
women, up to two months postpartum, and children up to 6 years of age, who are reasonably believed to
meet BC/KC family financial requirements.
8. By September 30,1997 and September 30,1998, the Contractor will submit to the State federally
required data on the number of patients served and the number of visits by: category of patient (mothers
and infants, children and adolescents, children with special health care needs and others); source of
payment (Medicaid, insurance, no coverage, or unknown); and race (1. white, black, American Indian,
Pacific Islander, other or unknown and 2. Hispanic origin yes or no). Estimates must be provided until
page 2 of 8 pages
97231+
such time as actual numbers can be submitted.
9. The Contractor will not charge for services to those individuals of families at or below the official
poverty line as defined by the Office of Management and Budget 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 $7,740 for an individual; $10,360 for a family of 2; $12,980 for a family of 3; $15,600 for a
family of 4; $18,220 for a family of 5; $20,840 for a family of 6; $23,460 for a family of 7; $26,080 for a
family of 8. For families of more than eight, add $2,620 for each additional member. These guidelines will
change during the contract year. When the new poverty income guidelines are received by the State from
the office of Management and Budget, they will be forwarded to the Contractor and should be used upon
receipt.
10. If any charge are imposed for services to clients who are above the 100% of poverty level, such
charges must be on a sliding scale which takes into account the client's family size, income and
resources. These charges and the sliding fee scale must be made available to the general public and to
all clients and must be based on the agency's usual and customary cost for the service. Clients must
understand they will not be denied services for inability to pay any of the sliding fee charges.
11. The Contractor shall protect the confidentiality of all applicant/recipient records and other
materials that are maintained in accordance with this contract. Except for purposes directly connected
with the administration of this Program/Project, no information about or obtained from any
applicant/recipient shall be disclosed in a form identifiable with the applicant/recipient without the prior
written consent of the applicant/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.
12. Contractor agrees to provide services to all program participants and employees in a smoke -free
environment. In accordance with PL 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 or leased or contracted
for by the contractor if said 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.
13. The Contractor will submit to the State an accounting of actual expenditures for this project on
standardized forms (Attachment A, which by this reference is made a part hereof) or similar format. Such
accounting of actual expenditures for the contract period is to be sent to the Family and Community Health
Services Division, attention Administrative Section, before December 31, 1997 and December 31, 1998.
Because this information will be used in part to match Federal funds, the source of "Applicant and Other"
funding must be detailed in the space provided on the form and noted as to whether these funds are used
to match other funding, and signed by a certified official.
14. The State will, in consideration of said services by the Contractor, cause to be paid to the
Contractor an amount not to exceed thirty six thousand, one hundred seventy dollars ($36,170.00) for
the period between October 1, 1996 and September 30, 1997, upon receipt of signed monthly statements,
(Attachment B, which by this reference is made a part hereof), submitted in duplicate, to the FAMILY AND
COMMUNITY HEALTH SERVICES DIVISION, ADMINISTRATIVE SECTION requesting reimbursement
in the following manner:$3,522.22 per month for the first nine months and $1,490.00 per month for the
final three months for the period between 10/01/96 and 09/30/97. Funding for the subsequent funding
periods will be set forth in a Letter of Renewal (sample attached and by this reference made a part hereof
as Attachment C) to be signed by the State and the Contractor and approved by the State Controller (or
an authorized designee).
15. This contract includes $18,290.00 which represents the contractor share of the Maternal and Child
Health funds appropriated by the legislature to local health departments. Receipt of these funds requires
local match that is subject to specific audit which in this case amounts to $13,718.
page 3 of 8 pages
972365
16. 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, subject to the following conditions:
a. The Change Order Letter ("letter") shall include the following:
(1) Identification of contract by contract number and affected paragraph number(s);
(2) Identification of any service level increases or decreases and the new service level if
applicable;
(3) Amount of the increase or decrease in the level of funding and the total;
(4) Intended effective date of the funding change;
(5) A provision stating that the Change shall not be valid until approved by the State Controller or
such assistant as he may designate;
(6) 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.
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 return the executed letter in a timely manner, 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:
(1) If necessary to fully utilize Colorado State appropriations and/or appropriated federal grant
awards.
(2) Adjustments to reflect current year expenditures.
(3) 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
program.
(4) Closure of programs and/or termination of related contracts.
(5) Delay or difficulty in implementing new programs or services.
(6) Other special circumstances as deemed appropriate by the State
17. The term for this contract is beginning October 1, 1996 and ending September 30, 1998.
page 4 of 8 pages
9'7236
COLORADO DEPARTMENT OF HEALTH - hereinafter, under the General Provisions referred to as "Health".
GENERAL PROVISIONS -- page 1 of 2 pages
1. The contractor shall perform its duties hereunder as an independent contractor and not as an employee. Neither the
contractor nor any agent or employee of the contractor shall be or shall be deemed to be an agent or employee of the state.
Contractor shall pay when due all required employment taxes and income tax withholding, shall provide and keep in force
workers' compensation (and show proof of such insurance) and unemployment compensation insurance in the amounts required
by law. Contractor will be solely responsible for its acts and the acts of its agents, employees, servants and subcontractors
during the performance of this contract.
2. Contractor authorizes Health, or its agents, to perform audits and to make inspections for the purpose of evaluating
performance under this contract.
3. Either party shall have the right to terminate this agreement by giving the other party thirty days notice by registered
mail, return receipt requested. If notice is so given, this agreement shall terminate on the expiration of the thirty days, and the
liability of the parties hereunder for the further performance of the terms of this agreement shall thereupon cease, but the
parties shall not be relieved of the duty to perform their obligations up to the date of termination.
4. This agreement is intended as the complete integration of all understandings between the parties. No prior or
contemporaneous addition, deletion, or other amendment hereto shall have any force or effect whatsoever, unless embodied
herein in writing. No subsequent novation, renewal, addition, deletion, or other amendment hereto shall have any force or
effect unless embodied in a written contract executed and approved pursuant to the State Fiscal Rules.
5. If this contract involves the expenditure of federal funds, 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 -11O, whichever is applicable;
b) the Hatch Act (5 USC 1501-1508) and Public Law 95-454 Section 4728. These statutes state that federal funds
cannot be used for partisan political purposes of any kind by any person or organization involved in the administration of
federally -assisted programs;
c) the Davis -Bacon Act (40 Stat. 1494, Mar. 3, 1921, Chap. 411, 40 USC 276A -276A-5). This act requires that all
laborers and 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, 1O1 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)
97236
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, Local Match is to be submitted on the monthly payment statements, in the column provided, as required
by the funding source.
9. If Contractor receives $25,000.00 or more per year in federal funds in the aggregate from Health, Contractor agrees to
have an annual audit, by an independent certified public accountant, which meets the requirements of Office of Management
and Budget Circular A-128 or A-133, whichever applies. If Contractor is required to submit an annual indirect cost proposal
to Health for review and approval, Contractor's auditor will audit the proposal in accordance with the requirements of OMB
Circular A-87, A-21 or A-122. Contractor agrees to furnish one copy of the audit reports to the Health Department Accounting
Office within 30 days of their issuance, but not later than nine months after the end of Contractor's fiscal year. Contractor
agrees to take appropriate corrective action within six months of the report's issuance in instances of noncompliance with
federal laws and regulations. Contractor agrees to permit Health or its agents to have access to its records and financial
statements as necessary, and further agrees to retain such records and financial statements for a period of three years after the
date of issuance of the audit report. This contract does 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
Rev. 06/01/92 (GEN070595)
97236S
SPECIAL PROVISIONS
CONTROLLER'S APPROVAL
1 . This contract shall not be deemed valid until it shall have been approved by the Controller of the State of Colorado or such assistant as he may designate.
This provision is applicable to any contract involving the payment of money by the State.
FUND AVAILABILITY
2. Financial obligations of the State of Colorado payable after the current fiscal year are contingent upon funds for that purpose being appropriated, budgeted,
and otherwise made available.
BOND REQUIREMENT
3. If this contract involves the payment of more than fifty thousand dollars for the construction, erection, repair, maintenance, or improvement of any building,
road. bridge, viaduct, tunnel, excavation or other public work for this State, the contractor shall, before entering upon the performance of any such work included
in this contract, duly execute and deliver to the State official who will sign the contract, a good and sufficient bond or other acceptable surety to be approved
by said official in a penal sum not less than one-half of the total amount payable by the terms of this contract. Such bond shall be duly executed by a qualified
corporate surety conditioned upon the faithful performance of the contract and in addition, shall provide that if the contractor or his subcontractors fail to duly
pay for any labor, materials, team hire, sustenance, provisions, provendor or other supplies used or consumed by such contractor or his subcontractor in
performance of the work contracted to be done or fails to pay any person who supplies rental machinery, tools, or equipment in the prosecution of the work the
surety will pay the same in an amount not exceeding the sum specified in the bond, together with interest at the rate of eight per cent per annum. Unless such
bond is executed, delivered and filed, no claim in favor of the contractor arising under such contract shall be audited, allowed or paid. A certified or cashier's
check or a bank money order payable to the Treasurer of the State of Colorado may be accepted in lieuof 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 action shall include, but not be limited to the following: employment
upgrading, demotion, or transfer, recruitment or recruitment advertisings; lay-offs or terminations; rates of pay or other forms of compensation; and selection
for training, including apprenticeship. The contractor agrees to post in conspicuous places, available to employees and applicants for employment, notices to
be provided by the contracting officer setting forth provisions of this non-discrimination clause.
(b) The contractor will, in all solicitations or advertisements for employees placed by or on behalf of the contractor, state that all qualified applicants will receive
consideration for employment without regard to race, creed, color, national origin, sex, marital status, religion, ancestry, mental or physical handicap, or age.
(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.
(e) A labor organization will not exclude any individual otherwise qualified from full membership rights in such labor organization, or expel any such individual
from membership in such labor organization or discriminate against any of its members in the full enjoyment of work opportunity because of race, creed, color,
sex, national origin, or ancestry.
(f) A labor organization, or the employees or members thereof wilt 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 (GEN070595)
Revised 1/93
395-53-01-1022
page 7 of 8 pages
97236
(g) In the event of the contractor's non-compliance with the non-discrimination clauses of this contract or with any of such rules, regulations, or orders, this
contract may be canceled, terminated or suspended in whole or in part and the contractor may be declared ineligible for further State contracts in accordance
with procedures, authorized in Executive Order, Equal Opportunity and Affirmative Action of April 16, 1975 and the rules, regulations, or orders promulgated
in accordance therewith, and such other sanctions as may be imposed and remedies as may be invoked as provided in Executive Order, Equal Opportunity and
Affirmative Action of April 16, 1975, or by rules, regulations, or orders promulgated in accordance therewith, or as otherwise provided by law.
(h) The contractor will include the provisions of paragraphs (a) through (h) in every sub -contract and subcontractor purchase order unless exempted by rules,
regulations, or orders issued pursuant to Executive Order, Equal Opportunity and Affirmative Action of April 16, 1975, so that such provisions will be binding
upon each subcontractor or vendor. The contractor will take such action with respect to any sub -contracting or purchase order as the contracting agency may
direct, as a means of enforcing such provisions, including sanctions for non-compliance; provided, however, that in the event the contractor becomes involved
in, or is threatened with, litigation, with the subcontractor or vendor as a result of such direction by the contracting agency, the contractor may request the State
of Colorado to enter into such litigation to protect the interest of the State of Colorado.
COLORADO LABOR PREFERENCE
6a. Provisions of CRS 8-17-101 & 102 for preference of Colorado labor arc 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 the 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.
Contractor: State of Colorado
(Full Legal Name) Weld County Health Dept ROY ROMER, GOVERNOR
By
Position (Title) By
846000813
Social Security Number or Federal I.D. Number Department
of PUBLIC HEALTH AND ENVIRONMENT
If Corporation, Town/City/County, or Equivalent:
Attest (Affix Seal)
By
Corporate Secretary, or Equivalent, Town/City/County Clerk
APPROVALS
ATTORNEY GENERAL CONTROLLER
By By
Gale A. Norton Clifford W. Hall
Form 6 -AC -02C (GEN070595)
Revised 1193
395-53-01-1030
Page 8 which is the last of 8 pages
PROGRAM APPROVAL:
972364S
Actual Annual Expenditure Report Attachment A
Applicant:
Project:
Actual Expenditures for the period:
Total
Amount
Expended
Source of Funds
*Applicant
and Other
Received
from CDPHE
Personal Services:
Contractual/Fee for Service:
Supervising Personnel:
Fringe Benefits: Rate =
Personal Services
Operating Expenses:
(includes Building/Facility
Cost not part of Indirect)
Operating
Travel:
Travel
Equipment:
Equipment
Total Direct Costs (Personnel+Operating+Travel+Equp)
Administrative/Indirect Cost *
TOTAL PROJECT COST
F —
Indirect = % of
Exclude equipment from indirect calculations.
*Source of Funding for "Applicant and Other"
Local:** $
Medicaid: $
Patient Fees: $
Other: S
Total Applicant and Other $
"Are these local funds used to match any other grant? yes
_no
Signature of Director or Authorized Representative
97236
Attachment B
INVOICE NUMBER
EMENT STATEMENT
O
o F•
Reimbursement
An1ount Requested Total
Local Agency Match
r
Description of Expenditure
F
O
H
and we are requesting reimbursement for same.
This is to certify that the above expenses were incurred per Contract #
F"
Q
O
F-
SIGNATURE (CO
C
I hereby certify that all contract requirements have been met and the amounts are correct.
>-
AUTHORIZED DESIGNEE (STATE):
97236g
Attachment C
, 1996
State Fiscal Year 19 -
Contract Renewal Letter No.
Contract Routing Number
In accordance with Paragraph _ of the contract with routing number and contract number (as amended
by Change Order Letter routing number and/or Renewal Letter routing number ) hereinafter referred to
as the Original Contract (copy attached and by this reference made a part hereof) between the State of Colorado, Department
of Public Health and Environment ( Division) and the parties hereby
agree the Original Contract is hereby renewed for the period of 199 through 199_ The
parties agree that the maximum amount payable by the State for the eligible services during this renewal period is
DOLLARS ($ ) according to the work plan attached hereto as Attachment A and the budget
attached hereto as Attachment B, both incorporated herein. The terms of conditions of the Original Contract are hereby
reaffirmed and shall continue in full force and effect throughout this renewal period unless otherwise stated.
This amendment to the Original Contract is intended to be effective as of 199 but in no event shall it 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 letter as soon as possible to:
Colorado Department of Public Health and Environment
Division
Mail Code:
4300 Cherry Creek Drive South
Denver, Colorado 80222-1530
One original of this letter will be returned to you when fully approved.
Contractor: State of Colorado:
Full Contractor Name Roy Romer, Governor
By:
Signature
By:
Print Name: For the Executive Director
Colorado Department of Public Health
Title: and Environment
APPROVALS: APPROVALS:
PROGRAM CONTROLLER
By: By:
Clifford W. Hall
97236c
Attachment D
,1996
State Fiscal Year 19 -
Change Order Letter No.
Contract Routing Number
In accordance with Paragraph _ of the contract with routing number and contract number (as amended
by Change Order Letter routing number and/or Renewal Letter routing number ), hereinafter referred to
as the Original Contract (copy attached and by this reference made a part hereof) between the State of Colorado, Department
of Public Health and Environment ( Division) and covering the period
of 199_ through 199_, the parties agree that the maximum amount payable by the State
for the eligible services in Paragraph _ of the Original Contract is being increased/decreased by
DOLLARS ($ ) to a new total of DOLLARS ($ ) in accordance with the
revised work plan attached hereto as Attachment A and revised budget attached hereto as Attachment B, both incorporated
herein. The first sentence in Paragraph _ of the Original Contract is hereby modified accordingly. All other terms of
conditions of the Original Contract are hereby reaffirmed.
This amendment to the Original Contract is intended to be effective as of , 199 but in no event shall it 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 letter as soon as possible to:
Colorado Department of Public Health and Environment
Division
Mail Code:
4300 Cherry Creek Drive South
Denver, Colorado 80222-1530
One original of this letter will be returned to you when fully approved.
Contractor: State of Colorado:
Full Contractor Name Roy Romer, Governor
By:
Signature
By:
Print Name: For the Executive Director
Colorado Department of Public Health
Title: and Environment
APPROVALS: APPROVALS:
PROGRAM CONTROLLER
By: By:
Clifford W. Hall
972366
PROJECT NAME: CDH CHTT,D HEALTH PROGRAM
PROJECT NUMBER:SW-1
COLORADO DEPARTMENT OF HEALTH
MCH BLOCK GRANT
APPLICATION FOR CONTINUING PROJECT
OCTOBER 1, 1997 - SEPTEMBER 30, 1998
STAGE II
AGENCY: COLORADO DEPARTMENT OF HEALTH
ADDRESS:
CONTACT PERSON: COURTNEY A. THOMAS
TELEPHONE NUMBER: (303) 692-2374
PROJECT SUMMARY:
THE OUANTITY AND OUATITV OF PRFVENTTVF CHTT,D HEAT,TH SERVICES PROVTDFJ)
TN COUNTY NURSTNG SERVTCRS AND LOCAL ORGANIZED HEALTH DEPARTMENTS
5SERVING LOW INCOME CHILDREN IS ENHANCED THROUGH MCH BLOCK GRANT
,SUPPORT OF THOSE AGENCIES. THROUGH BLOCK SUPPORT OF LOCAL CHILD
PROGRAMS nGENCIE WT BE ABLE TO MAINTAIN AND /OR INCREASE THE NUMBER
OF CHILDREN TO WHOM THEY PROVIDE COMPREHENSIVE WELL CHILD SERVICES AND
ADHERENCE TO ESTABLISHED STANDARDS FOR WELT, CHILD CARE WTT,L BE
ASSURED. AGENCIES WILL ALSO BE SUPPORTED IN EFFORTS TO ENGAGE IN
COMMUNITY -BASED PUBLIC HEALTH ACTIVITIES THAT WILL BENEFIT THE HEALTH
OF CHILDREN IN THE COMMUNITY. THROUGH THE SCREENING COMPONENT OF THIS
PROJECT. SCREENERS WILL IDENTIFY AND REFER POTENTIALLY HANDICAPPING
CONDITIONS. THROUGH THE MEDICAL REFERRAL COMPONENT. PHYSICIANS WILL
DIAGNOSE AND TREAT CHILDREN REFERRED FROM PUBLI HEATTH CLINTCS WHO
WOULD OTHERWISE NOT GET EARLY CARE FOR PROBLEMS TDENTTFTED BY TOCAT,
PURT,TC HEALTH NURSES.
June 4, 1997
A:\9798CVR.WPD
972Nc
STAGE II MCH BLOCK GRANT APPLICATION
CHILD HEALTH PROGRAM SUPPORT FY 97-98
1. STATEMENT OF NEED
In the past year there have been several developments which have affected, and will continue to affect,
the need for local public health agencies to reassess their priorities in the provision of public health
services in their communities. The expansion of Medicaid managed care in some parts of the state, and
growth of the Colorado Child Health Plan (currently at 7000 enrollees statewide) have resulted, in some
areas, in a reduction in the need for local public health agencies to provide direct clinic service as a "safety
net" provider. This is still not true of most of the state, however, and the need for quality preventive
services to low income children, in particular, remains great in most areas. A minimal change in the
Medicaid asset test for children receiving TANF (formerly AFDC) benefits may allow for some previously
ineligible children over age 1 to receive Medicaid benefits but those numbers are expected to be small.
Please also note that Las Animas/Huerfano District Health Department has been added to the Child
Health Program grant as the agency no longer functions as a Children and Youth Project and will be
providing limited preventive clinic services and other community activities on behalf of children with
MCH funds.
Those agencies no longer providing direct clinic services to children, specifically Boulder and Delta
counties, have continued to utilize their MCH funds to support a myriad of community -based activities,
including home visitation, on behalf of children and families. Each of the other health departments
continue to use at least part of their MCH dollars to support core public health activities other than direct
service in their communities. (See 1996 Final Report and 1997 Six-month Report.) Information in last
year's needs statement concerning the role of local public health agencies with respect to implementation
of core public health functions remains unchanged and the need for MCH support continues to be high.
One of the above agencies, Delta County is considering reinstituting some preventive services as the
community health center in their region closed abruptly after only one year in operation and a survey of
WIC clients seems to indicate that there are gaps in accessibility of well child services for low income
children in the county.
A note of interest: the state Child Health/EPSDT and Health Care Program for Children With Special
Needs (HCP) programs developed and distributed a customer survey to local constituents of the 3
programs in the Fall of 1996. Two hundred responses were received and tabulated; a copy of the survey
and follow-up memo to locals are included. Overall, results were extremely positive and indicated
continued great need and appreciation for not only funds sent to local public health providers, but also
for the level of support and technical consultation provided by the state programs themselves.
2. ADMINISTRATIVE STRUCTURE
At the state level, the Child Health Program has been combined in an administrative unit with the
Adolescent Health Program, the School -based Health Center Initiative and the School Nurse Consultant
position. This is a recent move and to date has not resulted in any substantive change in focus or
activities for the Child Health staff. Over the next year, efforts will be made to coordinate the
development of MCH objectives for the involved programs and to work toward a unified funding request
for the 1998-99 fiscal year. There have been no significant administrative changes locally other than the
fact that, due to adequate primary care resources in the community, the Las Animas Huerfano Health
Department no longer has a Children and Youth project but is now a part of the Child Health Program
9'7236c
grant and support in primarily focused on public health nursing services in the community and some
preventive clinic activities.
3. OBJECTIVES/MONITORING AND EVALUATION
GOAL: The goal of the Child Health Program is to support local public health efforts to protect and
promote the health of Colorado's children.
Principal Child Health Objective: By September 30, 1998, children, including those with special health
care needs, in communities served by local public health departments will be at reduced risk for injury and
disease by receiving age -appropriate preventive health services through those health departments. These
activities will be provided primarily by public health nurses and will be supported by MCH funds. It is
estimated that 10,000 children will receive direct services through local Child Health clinics and related
activities
Colorado 5 -year
MCH objective
Program objective
Activity
Monitoring
Evaluation
Increase immunization to at least 90% among children under age
2 by 1996 (date as set by state)
By September 30, 1998, 92% of 2 -year olds who have attended
child health clinics in participating agencies for at least one year
will be current on recommended immunizations, including
hemophilus b and 70% will be current on hepatitis b
Provide up-to-date immunization information to local agencies
(in collaboration with CDPHE Immunization Program); provide
Flow Sheets for documentation; update and provide CoTrack
software to locals to use for tracking and reminders and work
with Immunization Program to assure that software
enhancements are congruent with their reporting needs;
encourage review of immunization status of children enrolled in
the HCP program with updating of immunizations as indicated,
through TA and consultation, support local public health agency
efforts to contract to provide immunizations for Medicaid
managed care providers and the Colorado Child Health Plan
Assess documentation at site visits as time allows, utilize reports
from Immunization Program to monitor local agency
performance; work with HCP staff at state and local levels to
encourage review and updating of immunization status of
children with special needs
Each agency will complete a Child Health Impact Tool audit of
records at end of the year and/or utilize CoTrack or other
computerized data system to report immunization levels
2. Colorado 5 -year MCH Maintain below 25.2/1000 the incidence of maltreatment of
objective children under age 18
9'7236R
Program objective
Activity
Monitoring
Evaluation
By September 30, 1998, each participating agency will describe
at least two activities, the primary purpose of which is the
prevention of or early intervention with child abuse and neglect,
which they have implemented or in which they have played a
major role
CDPHE staff will provide participating agencies with materials
that describe the scope of child abuse/neglect as well as current
information on strategies for recognition, referral and
intervention for children at risk; work with Department of
Human Services Child Welfare staff and CDPHE Prevention
Program staff to develop a written guideline for local agencies to
use to develop their own policies for identification, reporting and
follow-up of suspected child abuse and neglect; provide
consultation to local agencies as requested; assure that
anticipated changes in the Colorado Children's Code are
provided to locals; CDPHE staff to continue participation on
Child Fatality Review Team and use team discussion as a way of
developing local prevention strategies, including working with
locals to establish their own CFR teams; work with HCP staff to
assure that information as outlined above also reaches local HCP
staff; stress importance of PHN role through regional pediatric
updates, site visits, etc.
Assess progress at site visits to local agencies as well as during
other consultation opportunities
Evaluate at site visits, require narrative report of activities as part
of final report, continue to monitor data and trends locally and
statewide for increases/decreases in abuse/neglect incidence
3. Colorado 5 -year MCH Establish a statewide network of comprehensive, community -
objectives based systems of health and related services
Assure that Colorado is one of the states with service systems for
children with chronic and disabling conditions
Program objectives
By September 30, 1998, each participating agency will describe
at least 2 activities in which staff has taken a leadership role that
have as their goal the improved health of children in the
communities served. Such activities will be consistent with one
or more core public health functions of assessment, assurance
and policy development/implementation. Agencies will continue
to provide direct services to children and indicated by community
need
97236f;
See principal Child Health objective above
By September 30, 1998, an expected 3,500 potentially
handicapping conditions will be identified from children receiving
age -appropriate developmental and sensory screening, including
hearing screening, in local public health agencies
By September 30, 1998, 900 children will be identified by public
health nurses as needing medical diagnosis and treatment for
conditions. identified by those nurses and will be referred for
same utilizing a medical voucher. Included will be referrals for
children with suspected acute and chronic otitis media who are
at risk for hearing loss. In addition, 75 children identified in local
public health clinics as eligible for the Colorado Child Health
Plan and unable to afford the $25 CCHP annual co -payment will
have that co -payment paid with MCH funds
By September 30, 1998, 75% of problems identified through
clinic services by public health nurses and screeners will
demonstrate resolution and/or improvement as a result of early
identification and intervention by local staff, including referral to
other resources, including private physicians and the Health Care
Program for Children with Special Needs
Activity
Locals will participate in community -based planning activities
with the support of CDPHE staff, including Child Health and
Community Nursing and SSDI staff. Activities will focus on
assessment of current health care delivery systems in the
community and collaboration to improve or modify those
systems including, as appropriate, participation in the
development and implementation of Family Resource Centers;
local agencies will continue to sub -contract with Medicaid
HMO's and the CCHP; CDPHE Child Health staff will continue
their interagency networking with key state agencies and
programs, including Medicaid, and will continue participation in
the MCH-funded State Systems Development Initiative (SSDI)
to assure access to care for all children; CDPHE and local staff
will participate in planning for the Colorado Child Health Plan
expansion and implementation of the Children's Basic Health
Plan in FY 1999; CDPHE and local staff will participate in
activities toward implementation of Medicaid managed care as
specified in SB 5; CDPHE staff will continue to work with key
state constituents, including child care experts, to identify and
implement public health roles in issues related to health and
safety in child care at the state and local levels
Complete and partial assessments, including health histories for
risk factors, will be provided to children in child health clinics
and during home visits utilizing standards and forms developed
or approved by CDPHE Child Health consultants; new CDPHE-
9723F!S
Monitoring
Evaluation
developed home visitation guidelines will be distributed and their
use encouraged; Child Health and HCP consultants will work
together to encourage local staff to assess preventive health
status of HCP-enrolled children in their agencies; HCP staff at
CDPHE will continue efforts to implement newborn hearing
screening at Colorado hospitals; CDPHE staff will continue to
fund 2 -day Child Health Assessment training throughout the year
for local public health nurses providing child health and HCP
services; screeners and public health nurses will receive training
and proficiency review as appropriate; medical referrals will be
utilized by local nurses and screeners as needed; CoTrack for
Child Health encounters will be released and it's use encouraged
as a way to track children in need of services and follow-up;
problem list and flow sheet will be on each child's chart and kept
current; referrals will be made by locals to Medicaid, private
physicians, the Colorado Child Health Plan, Part H, etc.
Site visits as appropriate and time allows; screeners will submit
screening data, including number of abnormal developmental,
hearing and vision screens, on a monthly or quarterly basis from
the CoTrack system or other approved system; medical referral
usage will be monitored by CDPHE staff for appropriateness or
possible increased funding need if Medicaid $ are reduced by
Federal or State actions; locals will submit reports at 6- and 12
months indicating numbers served and types of services provided
as well as describing community based activities designed to
develop comprehensive health care systems for children; through
Child Health and SSDI written communication and updates, state
staff will keep local staff informed of state progress in the above
activities.
Child Health Impact tool will be used to evaluate charts in each
agency; reports from locals will be evaluated for appropriateness
of activities; HCP Quality Indicators will be evaluated by HCP
staff; state staff activities will be noted in SSDI progress reports;
CCHP staff will report numbers of MCH-referred children who
have their co -pay paid with MCH dollars
4. Colorado 5 -year MCH Reduce motor vehicle deaths among children 0-9 from 6.2 in
objective 1992 to 5.5
Reduce deaths due to drowning among children 0-4 from 3.0 in
1992 to 2.3
Program objectives See principal Child Health objective above
Activity
Local activities as appropriate by agency, including direct
services as described above with anticipatory guidance on use of
car seats and seat belts and drowning prevention to parents and
children; community assessment and intervention programs
9723C45
focused on injury prevention; parenting and child care provider
classes; state activities to include regular dissemination by Child
Health staff and Prevention Programs of injury prevention
information from sources such as Children's Safety Network,
Consumer Product Safety Commission, AAP injury prevention
materials (TIPP, etc.), Dept. of Highway Safety of NHTSA
information to locals; participation with CDPHE Prevention
Programs, Colorado Safe Kids Coalition, EMS and Consumer
Protection staff to develop a stronger focus for childhood injury
prevention at the CDPHE and to seek funding sources for local
injury prevention activities; interface with and support activities
of new CDPHE Childhood Injury Prevention Coordinator,
including having Child Health director and Coordinator present
a workshop on community strategies for childhood injury
reduction at the Fall, 1997, CPHA conference
Monitoring
Evaluation
4. RESOURCES
Site visits as appropriate and time allows, reports at 6- and 12
months on local activities; minutes/reports of CDPHE activities;
copies of newsletters, mailings, etc. to locals from CDPHE staff
Reports from locals; Child Health Impact Tool audit of
anticipatory guidance activities locally; progress by CDPHE
inter -divisional staffs, including review of available mortality and
morbidity data on childhood motor vehicle and drowning
accidents; reports from locals; Child Health Impact Tool audit of
anticipatory guidance activities locally; progress by CDPHE
inter -divisional staffs, including review of available mortality and
morbidity data on childhood motor vehicle and drowning
accidents
There have been no significant changes in resources available to the CDPHE Child Health program. We
have been able to put some MCH funds into Prevention Programs to support .5 FTE for Childhood Injury
Prevention activities. This was much needed and should help improve the regularity with which local
agencies receive important childhood injury information, including how to access funding resources for
local injury prevention activities. The Department has also hired a new Director of Community Nursing
who has expressed interest in changing the role of the Community Nursing consultants and giving them
greater responsibility for assisting with MCH activities in small county public health nursing agencies.
This could include some role in training, technical assistance around child health issues and system
changes, monitoring and evaluation which could relieve the Child Health staff of some of those
responsibilities.
972a&
5. COLLABORATION
There have been no significant changes in the philosophy, approach, or implementation of collaborative
activities at the state or local levels since last year. If anything, we have all seen an increase in our efforts
in this area with the advent of welfare reform, Medicaid managed care expansion, and the increases in
the Child Health Plan allocation. State and local staff are participating in state and local activities related
to each of these important initiatives.
Collaboration is the cornerstone of the public health delivery system in Colorado, and local public health
child health services are no exception. Every participating agency is expected to assume an active role
in the development and implementation of collaborative community efforts to improve the health and
well-being of children and their families, including access to care, and all do this in ways appropriate to
their community needs. Most agencies have been involved in some way in local restructuring efforts and
in community efforts to develop appropriate health care systems for low income children. Some of the
strongest linkages are with Family Resource Centers (see appendix in last year's Stage II), Part H, Child
Protection teams, Headstart, health maintenance organizations where appropriate (expanded efforts this
year thanks to collaboration among state MCH staff on the SSDI Coordinating Committee), the Colorado
Child Health Plan, local immunization initiatives, Bright Beginnings, community health centers in some
areas, schools, hospitals, particularly in the area of discharge planning, and family preservation initiatives.
Participating public health agencies appreciate now having the flexibility to utilize MCH Child Health
dollars to support collaborative activities directed toward assessment and planning efforts designed to
improve the health status of children in their communities. Although the concept of "single point of
entry" is a laudable one, most communities have found that a more reasonable approach to achieving
better service coordination for families is through the development of an effective referral system
although several Family Resource Centers do "co -locate" services, including children's health services.
An area of great need that we will continue to focus efforts on as resources allow is that of childhood
injury prevention. There are a number of ways in which local public health agencies can become involved
in community -based activities to reduce the morbidity and mortality of childhood and adolescent injury
(Safe Kids, Headstrong, etc.) but local funds to support these efforts are very limited and MCH dollars
specifically targeted to childhood injury prevention efforts at the state and local levels have just not been
available.
Medicaid managed care has indeed impacted the delivery of services but in varying degrees from areas
to where the impact on direct public health child health services has been virtually none (Northeast Health
Department) to those where the child health well child clinic program has essentially ceased to exist
(Delta and Boulder Counties). Unfortunately, a number of agencies were relying on their Medicaid
reimbursement to help support services to uninsured children and the loss of Medicaid dollars has had
an adverse impact on the ability of some local agencies to serve non -Medicaid children as well. There
will continue to be children who are not Medicaid eligible and for whom the Colorado Child Health Plan
is not an option; these children will continue to need services from local public health agencies. This
seems to be particularly true in more rural areas as well as those locales where local primary care
providers are simply overwhelmed and unable to take new patients. The payment source for these
services is a major worry for local public health officials as local dollars are dwindling and MCH funds
are so limited. For those agencies that have found themselves no longer in the business of providing
direct services to children, particularly infants and toddlers, we have responded by encouraging them to
use their MCH dollars to fund services to older children who are no longer eligible for Medicaid, to
support interagency collaborative efforts on behalf of children (see above) and to implement other core
public health activities such as assessment and assurance. At the present time, most agencies find
themselves still in the business of providing some needed direct services to children; unfortunately many
of these children are uninsured and the issue of how long local communities can continue to support
these services is of very great concern. In addition, state Child Health staff, working with the MCH-
funded State Systems Development Initiative coordinator and others, including local public health staff,
have been working at the state and local level to assure that managed care organizations are aware of,
refer to, and utilize the services of local public health entities. For instance, several local health
departments have contracts with managed care providers such as Rocky Mountain HMO or Colorado
ACCESS to provide immunizations, prenatal and home health care and newborn home visits in their
areas. This is an activity we intend to continue to pursue.
6. BUDGET DESCRIPTION AND JUSTIFICATION
A. See attached Budget Form for a breakdown of dollars in this project, including substantial local
support (note that local support is calculated only for organized health departments and not for county
nursing support of screeners and local physician "underwriting" of medical referrals).
Total funds required are $1,710,951 with $502,184 requested from the Block. Dollars requested from
the Block Grant will be used to provide direct preventive health care to children in public health agencies,
as well as to enhance the quality and comprehensiveness of those services through the provision of paid
paraprofessional screeners and physician reimbursement for medical referrals. In addition, local agencies
will continue to use MCH funds to support other community -based core public health interventions, such
as assessment and assurance of access to primary care services, on behalf of children and families.
The requested budget is higher than the Stage I request by approximately $50,000 and reflects, among
other things, dollars to support public health nursing services in Las Animas-Huerfano District Health
Department. In addition, dollars freed up by cancellation of the dental program in that agency (they have
been unable to recruit a dental hygienist after nearly a year of searching), are reflected as an inflationary
increase for all participating agencies; the first in several years for this program that is largely supported
with local funds. Finally, we have requested that we continue to receive dollars equal to the percentage
of MCH funds that have been going to local agencies as per capita dollars for the past 4 years to support
child health services. Those dollars have now been returned to us for our distribution (instead of the
Legislatures') although there are fewer of them ($313,000 vs. $413,000). Some agencies have expressed
concern that their now General Fund per capita dollars may not continue to be available to them for
maternal and child health activities (as was required when those MCH dollars were coming to them as
per capita) in the face of competing county priorities, and we wish to assure that these agencies can at
least receive some fair share of the $313,000 that remains of the available MCH funds in order to
maintain services and activities on behalf of children without interruption.
The CDPHE Screening Program will contract with county nursing services to perform age appropriate
screening services, particularly developmental screening, for all children who receive well child care
through agency clinics. In addition, screeners participate in Child Find and Headstart screenings in some
communities. Screening funds for the remaining organized health departments are now a part of their
Child Health budgets. The local agencies will use these funds to pay approximately 75 certified
paraprofessional screeners. Screeners are also paid for training and proficiency testing time to become
certified by the State. Training materials and proficiency testing supplies and equipment are provided by
the Screening Program. Local agencies provide their own supplies for individual programs.
Medical Referral dollars will be used to reimburse local physicians for medical diagnosis and treatment
of children referred by local PHN's. This much needed and effective program has stabilized in growth
due to Medicaid expansion. The program is well accepted by local physicians including many who do not
accept Medicaid or participate in the Colorado Child Health Plan. Reimbursement rates are presently set
9'234 og
at $28 per visit and some laboratory tests, including blood lead testing, are also reimbursed if done in the
physician's office. Overall medical referral utilization is very appropriate and nurses report that they and
their families are grateful for this important service. In addition, $1875 will be provided again this year
to the Colorado Child Health Plan so that 75 children referred by public health nurses to the CCHP but
unable to afford the $25 enrollment can have that enrollment fee paid using MCH funds. Thus, for the
cost of one medical referral, a child can receive a year of CCHP coverage for all primary care services.
We have worked closely with the CCHP to implement this activity and they have monitored utilization
for us. So far, over 50 children whose families could not afford the $25 enrollment fee have been
sponsored by MCH funds and the number is increasing rapidly with CCHP expansion.
The impact of Medicaid expansion and CCHP implementation has resulted in some decline in usage of
medical referrals over the past couple of years, particularly in the birth to 5 -year age group. Certainly
children on Medicaid should have their illness care reimbursed under that program and nurses have been
advised not to use medical referrals for Medicaid clients. Nurses report, however, that there is a
significant unmet need for clients above 133% of poverty, including those with inadequate or high
deductible insurance plans, for older children and for children below 133% of the poverty level who fail
to qualify for Medicaid because of the imposed assets test. We have therefore recently expanded
eligibility in the Medical Referral program to children up to 18 years of age and have included one time
mental health consults and emergency dental visits as well. Parents of all children issued a medical
referral are given information on Baby Care/Kids Care Medicaid and on the CCHP when the referral is
issued so that they may apply for these programs and perhaps not need to use medical referrals in the
future.
Dollars are requested to help fund a statewide or regional Child Health/EPSDT (possibly including
Adolescent Health and HCP) meeting in 1998. Some operating dollars are requested to support the state
office as payment of operating cost is now the responsibility of each individual program within the
Division.
7. RESPONSE TO REVTFW OF STAGE II FOR FY 96-97
There were no recommendations from the review committee last year. Comments and questions were
addressed verbally at the review. There appeared to be a question about what services are included in
a Child Health visit - these are spelled out in the FY 97 Stage II application and in great detail in the Child
Health Manual (available from the Child Health office). Hospitalization is not a covered service; children
with those needs who are without insurance must rely on the Colorado Resident Discount Program or
some other source. The Colorado Child Health Plan does not cover hospitalization at the present time.
8. RESPONSE TO REVIEW OF FINAL PROGRESS REPORT FOR FY 95-95
There were no recommendations noted.
A:\9798MCH. WPD
972360E
COLORADO
mEmoRanuum
George Baxter, Chairman
To Board of County Commissioners
From
Subject:
Date
John Pickle, Director, Health Depart
Child Health Program Contract
November 3, 1997
Enclosed for Board approval is a contract between Weld County Health Department (WCHD)
and the Colorado Department of Public Health and Environment (CDPHE) for the Child Health
Program.
WCHD will provide well child clinic services to clients aged 0 to 16 years. These services will
include health and psychosocial history screening, physical exams, immunizations, teaching of
risk -reducing behaviors to parents, and referrals to appropriate resources of children exhibiting
actual or potential physical psychosocial/emotional problems.
For these services, WCHD will receive a total reimbursement of $37,192 for the period October
1, 1997 through September 30, 1998. This funding is an increase of $1,022 over the prior year's
contract.
I recommend you approval of this contract.
Enclosure
9722 c
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