HomeMy WebLinkAbout971976.tiffRESOLUTION
RE: APPROVE CONTRACT FOR CHILDREN WITH SPECIAL NEEDS WITH THE
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 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 October 1, 1997, and
ending June 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 the Contract 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 Chair 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 8th day of September, A.D., 1997.
BOARD OF COUNTY COMMISSIONERS
AT
BY
DeVUly-elg K to the Board
Dale K. Hall
APP' ' • fa AS TO F a RM:
y
WELD COUNTY, COLORADO
Georg € E. Baxter, Chair
Constance L. Harbert,
EXCUSED DATE OF SIGNING
Barbara J. Kirkmeyer
k)
W. H. Webster
(AYE)
971976
HL0023
RECEIVED N0V 2 4 1997
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. Laboratory and Radiation Services Division
Denver, Colorado 80246-1530 8100 Lowry Blvd.
Phone (303) 692-2000 Denver CO 80220-6928
Located in Glendale, Colorado (303) 692-3090
http://www.cdphe.state.co.us
Health Care Program for Children with Special Needs (HCP)
Telephone: (303) 692-2370; FAX: (303) 782-5576
November 19, 1997
Ms. Judy Nero
Contract Coordinator
Weld County Health Department
1517 16th Avenue Court
Greeley, Colorado 80631
Colorado Department
of Public Health
and Environment
Re: The Health Care Program For Children With Special Needs (HCP) Contract,
Encumbrance Number FAA HCP9807510
Dear Ms. Nero:
Enclosed please find a fully executed copy of the above referenced contract for your files.
This contract covers the period from October 1, 1997 through and including June 30, 1998.
This contract's budget of $127,114.00 consists of 100 percent Federal funds. Should you
have any questions please contact me.
Sincerely,
Peggy Williams
Contract Administrative Assistant
Health Care Program For Children With Special Needs (HCP)
(303) 692-2404
enclosure
cc: Cheryl Weinmeister, Weld HCP Regional Office Teamleader
J:\CLERICAL\PEGGY\CONTRACT\CONTY-RO\FY98\W ELD98FE. LTR
971976
DEPARTMENT OR AGENCY NAME
HEALTH
DEPARTMENT OR AGENCY NUMBER
FAA
CONTRACT ROUTING NUMBER
9807510
CONTRACT
THIS CONTRACT, Made this 1st day of October 1997, 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 HCP9807510 in Fund Number 100, Appropriation Account
611, 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.
Page 1 of 10 pages
971976
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 Systems Development 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.
4. The Program will, in consideration of said services by the Contractor, cause
to be paid to the Contractor an amount not to exceed ONE HUNDRED TWENTY-
SEVEN THOUSAND ONE HUNDRED FOURTEEN DOLLARS AND ZERO CENTS
($127,114.00) for the period from October 1, 1997 through June 30, 1998.
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 personnel expenses, fringe benefits expenses, contracted
services, operating expenses, travel expenses, and administrative/indirect
costs. Said reimbursement statement shall set forth dates, brief description
of expenditures, amounts, and total reimbursement requested.
Reimbursement shall be conditioned upon affirmation by the Program that
said services were rendered in accordance with the terms and conditions of
this contract.
b. The budget, ATTACHMENT C and by this reference made a part
hereof, shall govern the expenditure of funds between October 1, 1997 and
June 30, 1998 by the Contractor, as well as the subsequent reimbursement
by the Program.
c. Transfer of funds from one line item to another must have written
approval by the Program.
Page 2 of 10 pages
971976
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 FOUR
HUNDRED THOUSAND DOLLARS AND ZERO CENTS ($1,400,000.00) 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;
iii. 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.
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
Page 3 of 10 pages
971976
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:
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 State and Contractor agree that additional funds may be awarded to
expand or extend contract activities. Should such funds become available, they will
be awarded by an amendment to this contract.
7. 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.
8. 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
Page 4 of 10 pages
971976
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 subcontractors shall sign and agree accordingly.
9. No charges will be made to families by the Contractor for care coordination/
case management regardless of a family's income.
10. Charges for attendance and services at medical specialty clinics sponsored
by the Program must conform to the Sliding Fee Schedule For HCP Clinics,
ATTACHMENT E and any subsequent amendments thereto, and by this reference
made a part hereof.
11. 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.
Page 5 of 10 pages
971.976
12. 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).
13. 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.
14. 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 minors 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.
15. This Contract is subject to and contingent upon the continuing availability of
Federal funds for the purposes hereof.
16. The term of this contract is from October 1, 1997 and ending June 30, 1998.
Page 6 of 10 pages
971976
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT- hereinafter, under the General Contract
Provisions, referred to as "CDPHE".
GENERAL CONTRACT 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 AND LOCAL HEAD TAX ON ANY MONIES
PAID PURSUANT TO THIS CONTRACT. CONTRACTOR ACKNOWLEDGES THAT THE CONTRACTOR AND ITS
EMPLOYEES ARE NOT ENTITLED TO UNEMPLOYMENT INSURANCE BENEFITS UNLESS THE CONTRACTOR OR
A THIRD PARTY PROVIDES SUCH COVERAGE AND THAT THE STATE DOES NOT PAY FOR OR OTHERWISE
PROVIDE SUCH COVERAGE. CONTRACTOR SHALL HAVE NO AUTHORIZATION, EXPRESS OR IMPLIED, TO BIND
THE STATE TO ANY AGREEMENTS, LIABILITY, OR UNDERSTANDING EXCEPT AS EXPRESSLY SET FORTH
HEREIN. CONTRACTOR SHALL PROVIDE AND KEEP IN FORCE WORKERS' COMPENSATION (AND SHOW PROOF
OF SUCH INSURANCE) AND UNEMPLOYMENT COMPENSATION INSURANCE IN AMOUNTS REQUIRED BY LAW,
AND SHALL BE SOLELY RESPONSIBLE FOR THE ACTS OF THE CONTRACTOR, ITS EMPLOYEES AND AGENTS.
2. Contractor authorizes CDPHE, 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-110, whichever is applicable;
b) the Hatch Act (5 U.S.C. 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 U.S.C. 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 U.S.C. 6101 et seq, 42 U.S.C. 2000d, 29 U.S.C. 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;
Page_7 of 10 Pages
Rev. 05/07/97 (GEN)
971.976
GENERAL CONTRACT PROVISIONS -- Page 2 of 2 pages
e) the Americans with Disabilities Act (Public Law 101-336; 42 U.S.C. 12101, 12102, 12111 - 12117, 12131 - 12134,
12141 - 12150, 12161 - 12165, 12181 - 12189, 12201 - 12213 and 47 U.S.C. 225 and 47 U.S.C. 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); and
g) when applicable, the contractor is in compliance with the provisions of the "Uniform Administrative Requirements
for Grants and Cooperative Agreements to State and Local Governments" (Common Rule).
6. By signing and submitting this contract the contractor states that:
a) the contractor is in compliance with the requirements of the Drug -Free Workplace Act (Public Law 100-690 Title V,
Subtitle D, 41 U.S.C. 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 CDPHE 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 federal funds in an aggregate amount per year from CDPHE which exceeds the applicable threshold
dollar amount specified in the Office of Management and Budget Circulars A-128 or A-133, 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 CDPHE 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 CDPHE 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 CDPHE 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 8 of 10 Pages
Rev. 05/07/97 (GEN)
971.976
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
nutty will pay the same in an amount not exceeding the sum specified in the bond, together with interest at the rate of eight per cent per annum. Unless such
bond is executed, delivered and filed, no claim in favor of the contractor arising under such contract shall be audited, allowed or paid. A certified or cashier's
check or a bank money order payable to the Treasurer of the State of Colorado may be accepted in lieu of a bond. This provision is in compliance with CRS
38-26-106.
INDEMNIFICATION
4. To the extent authorized by law, the contractor shall indemnify, save, and hold harmless the State, its employees and agents, against any and all claims,
damages, liability and court awards including costs, expenses, and attorney fees incurred as a result of any act or omission by the contractor, or its employees,
agents, subcontractors, or assignees pursuant to the terms of this contract.
DISCRIMINATION AND AFFIRMATIVE ACTION
5. The contractor agrees to comply with the letter and spirit of the Colorado Antidiscrimination Act of 1957, as amended, and other applicable law respecting
discrimination and unfair employment practices (CRS 24-34-402), and as required by Executive Order, Equal Opportunity and Affirmative Action, dated April
16, 1975. Pursuant thereto, the following provisions shall be contained in all 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.
(e) 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
flora 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.
(0 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.
(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
Fonn 6 -AC -02B (GEN060197) Revised 06/01/97
Page 9 of 10 pages
971976
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 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 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. Pursuant to CRS 24-30-202.4 (as amended), the state controller may withhold debts owed to state agencies under the vendor offset intercept system for.
(a) unpaid child support debt or child support arrearages; (b) unpaid balance of tax, accrued interest, or other charges specified in Article 22, Title 39, CRS;
(c) unpaid loans due to the student loan division of the department of higher education; (d) owed amounts required to be paid to the unemployment compensation
fund; and (e) other unpaid debts owing to the state or any agency thereof, the amount of which is found to be owing as a result of final agency determination
or reduced to judgment as certified by the controller.
10. 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
11. 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
i6OY ROMER, GOVERNOR
Contractor:
(Full Legal N
By ) of Cattmissioners
Position p to 1r;r..c:Y:.-R r?
ty Health Department
If Corporation,
Attest (Aff
rate Secretary, or
ATTORNEY
By
Ga
Fenn 6 -AC -02C (GEN060t97)
I.D. Number
rtort
mey Generat
Department
of
James E. Martin
Assistant AttQlZley Ge he last of 10 pages
Revised°610157 State S(I'� y
PUBLIC HEALTH N
PROGRAM APPROVAL:
WELD C
B
4IS )OHNPP KIEL MISS H.
APPROVABUM
STATE CONTRCQLLE
CONTROLLER R CLIFFO
By
Clifford W. Hal
971976
ATTACHMENT A
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
EFFECTIVENESS INDICATORS FOR 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 agencies 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 clinics, EPSDT, WIC, respite care, Head Start, hospitals, churches,
libraries, recreation centers and community health centers and managed care
organizations.
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 providers and support resources including
translation, transportation and respite care.
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, and Immunizations by using local media, posters and attendance at
health fairs, etc.
5. Distribute the local 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
available to children with special needs, and to establish a network for working
together to eliminate gaps or duplication of services and supports.
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971976
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 using available resources such as
Colorado Responds To Children With Special Needs (CRCSN), NICU Consortium,
Universal Newborn Hearing Screening Programs, and hospital discharge
planners, to identify children who may need support, care coordination and/or
referral to community resources.
INDICATOR 2: CARE COORDINATION
HCP staff will assure either directly or indirectly an appropriate 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. HCP staff 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 Form.)
2. Assist families who have insurance coverage, including managed care and
Medicaid managed care, to understand their benefits and their disenrollment and
grievance procedures.
3. 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.
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971976
4. 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 EPSDT benefits have been explained and an EPSDT
screen has been completed and billed.
5. Initiate or participate in the development of a Care Plan or IFSP (Individual
Family Service Plan) with 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. The process for the development of a care plan or
IFSP should include all the disciplines involved with the child's care, i.e.,
audiologist, CHIP therapist, social worker, family advocate, OT/PT, dietitian,
speech therapist, etc.
6. 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.
7. 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.)
8. 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 meet, assure that children are
enrolled in the program.
9. Meet periodically with staff from local agencies such as social services,
representatives from the Community Centered Board, mental health and special
education services from local schools to collaborate around services to individual
children and their families.
10. Work with the older children and their families to facilitate transition from
pediatric services to adult health care services. (To begin at about age 12
years.)
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971976
11.
Work with NICU Consortium 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.
12. 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.
INDICATOR 3: CLINIC MANAGEMENT
HCP staff will participate, in partnership with the HCP State office 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.
The Program promotes the concept of multi -disciplinary clinical services and
encourages the attendance of therapists, social workers, nutritionists, educators,
audiologists and family advocates to all HCP clinics.
Process Criteria:
1. Designs and maintains a clinic structure including identifying and scheduling
clinic providers, facilities, and equipment. Sets clinic dates. Seeks referrals by
contacting local doctors, Child Find, interagency councils, and Community
Center Boards to inform them of the clinics.
2. Organizes, schedules and staffs each clinic using guidelines provided in the HCP
Procedure Manual. Obtains a HCP Registration on each child scheduled for
clinic and a consent for service signed by the parent or legal guardian. Provides
the clinician with Medicaid and private insurance billing information and collects
clinic fees from over -income families who do not have health insurance.
3. Completes a Clinic Encounter Form for each clinic patient. After each clinic
submits Encounter Forms, a copy of the attendance list (schedule) and the
dictation to the assigned Regional Office.
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971976
4. Assures that families have transportation to each clinic and that appropriate and
competent interpretation services are available.
5. Depending on the complexity of the child's condition and the needs of the
family, appropriate team members will attend and participate in the multi -county
clinics.
6. Evaluates the clinic caseload, waiting list and summaries yearly to determine the
number and type of specialty clinics needed. Reports findings to the Regional
Office Team Leader.
INDICATOR 4: PROGRAM MANAGEMENT
Policy:
HCP staff will maintain and continue to build on a community -based program for
children with special health care needs. Included in the Program responsibilities will be
eligibility determination, enrollment, care coordination, records management, tracking,
referral, community needs assessment and program evaluation. The HCP manuals will
be the sources of information and documentation for all policies and procedures.
Rationale: HCP is committed to assuring services for all children with special health
care needs. Paid services are provided to children who are uninsured or underinsured
and who fall within set income and diagnostic eligibility guidelines. Based on the belief
that services are best provided in the local community, all of the components of the
program are located in the community (except bill paying) in the local public health
agencies. HCP participates in the Early Childhood Connections' Colorado Interagency
Coordinating Council (CICC) and embraces the CICC Values Statements in the
development and implementation of health programs.
Process Criteria:
1. Maintain a system for processing HCP applications as described in the HCP
Procedure Manual.
2. Develop a process which assists families in applying for Medicaid and SSI
benefits.
3. Assist families in identifying specialist providers and managed care organizations
which best meet the needs of their child.
4. Maintain a current Health Record for each HCP child, using guidelines in the
Procedure Manual.
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971976
5. Coordinate with the local public health nurse and regional discipline coordinators
to authorize and encumber funds according to guidelines for appropriate
hospitalizations, surgical procedures, hearing aids, therapies or appliances.
6. Assure that all appropriate team members are involved in developing individual
treatment plans for HCP patients.
7. Periodically contact community physicians and other providers for feedback on
HCP services and policies.
8. Assure that HCP services are provided in a family -centered, culturally -competent
environment. Written materials will be appropriate for the reader in reading level
(the standard is 6t' grade level) and language. Interpretation services will be
available by trained , professional or paraprofessional as needed.
9. Coordinate and/or participate in conducting a community needs assessment
which identifies problems or voids within the service delivery system for
children with special health care needs, defines the problems and determines the
services or changes necessary to meet the identified needs. Elements involved
in this process include:
a. Involvement in tracking and data collection efforts of the community
concerning the number of children with special health needs, the types
of services needed, the types of services available, the accessibility of
services, the quality of the services, whether the services are culturally
competent and family centered, and a method to receive customer
feedback about the services.
b. Awareness of and collaboration with other community agencies and
projects regarding data that is being collected and use of the data to
most effectively enhance the community service system for children with
special needs.
c. Coordination with other agencies and organizations to jointly survey the
community including families, providers and human service agencies.
d. Assessing needs of the population regarding cultural sensitivity of
services provided.
10. Coordinate and/or participate in the community planning process to develop
goals and objectives based on the community needs assessment.
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9'71976
Assure that HCP staff is trained in Early Childhood Connections (Part C of IDEA)
including the CICC Values Statements (see attached), IFSPs, Procedural
Safeguards and eligibility criteria.
12. Assure that HCP staff is trained in the eligibility criteria and referral procedures
for Medicaid, SSI, Children's Medical Waiver 200, Children's Home Care Based
Services Waiver (Katie Beckett - Model 200 Waiver), and EPSDT. Assure that
EPSDT case managers are knowledgeable about HCP services.
13. Assure that training opportunities are provided to staff on cultural competency
and family -centered care.
INDICATOR 5: PARENT AND FAMILY INVOLVEMENT AND SUPPORT
HCP staff will work in partnership with families to assure ongoing participation of
families in all aspects of the Program. HCP staff will include input from families in
policy development, planning, implementation, and evaluation of HCP programs. HCP
also recognizes the need to include parents who represent the diversity of the region
that the program serves. This includes parents with cultural and linguistic diversity as
well as parents with different life views and/or experiences with health care.
Rationale: HCP believes that parents have the primary responsibility for the care,
development and well being of their child with a special health care need. HCP
recognizes that working in partnership with families will strengthen the Program and
the families it serves.
Process Criteria:
1. Establish a mechanism for including input from parents regarding current
services, planning, policy development, implementation and evaluation of HCP
Programs. The process should include a means to provide feedback to families
about decisions made in these areas.
2. Develop and maintain a system of parent support that includes:
a. Parent to parent support and/or support groups;
b. Internal practices that support advocacy for family needs and problem
solving;
c. Information and education;
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971976
d. Linkages with community agencies to assure the availability and
adequacy of resources to support the needs of families.
INDICATOR 6: SYSTEMS DEVELOPMENT
Each agency will demonstrate efforts in systems development to assure quality,
comprehensive, community based, 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 or maintain interagency collaboration through periodic meetings with
representatives of the local human services agencies, 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 community.
2. Participate actively in a community interagency council (ICC) by meeting
regularly for the purpose of planning and policy development. (These 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.
3. Help to identify community service system needs by collecting data, conducting
surveys and focus groups, and observing target populations. Solicit information
from agencies, providers, and families. Work collaboratiively to develop and
maintain community resources.
4. Assure that there is community parent representation from families who have
children with special needs in the community ICC efforts. (For example,
attending meeting, contacting representatives, providing input into quality and
quantity of local services.)
H: \CONTRACT\CONTY-RO\FY98\ W ELD98. EIC
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971976
5. Participate in the community early child identification process as an active
member of the community team. This participation could include assigning 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.
H:\CONTRACT\CONTY-RO\FV 98\W ELD98.EIC
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971976
INSERT YOUR HEALTH DEPARTMENT'S NAME
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
FAMILY ASSESSMENT TOOL
CURRENT FAMILY STATUS PROFILE
Date Completed: / /
Child's Name Date of Birth:
Child's Address:
/ I
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?
❑ YES ❑ NO
If YES: Who is your child's regular doctor or care provider?
How often does your child see his/her regular doctor or care provider?
What medications and/or treatments has your child's doctor recommended?
Are you able to get the medications and/or treatment your child needs? 0 YES 0 NO
Have you had any difficulties getting your child's medicines? 0 YES 0 NO
Have you had any problems getting the treatments that your doctor has
recommended? 0 YES 0 NO
Are your child's shots (immunizations) up-to-date? 0 YES 0 NO
Do you have a copy of your child's shot records and could we have a copy? 0 YES 0 NO
4. What other people or organizations are involved in your child's care?
971976
5. Is there anyone involved who is helping you to pull these people and services
together?
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?
❑ YES ❑ NO
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? ❑ YES ❑ NO
13. Are you able to go to the doctor if you need to? ❑ YES ❑ NO
14. Are you and your family covered by Medicaid or health insurance? ❑ YES ❑ NO
15. Is there anything else we could assist you with?
OBJECTIVE DATA OBSERVED (if on -site interview conducted) use additional paper if needed
971976
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
School District
Community Center Board
Social Services
W.I.C.
Parent Support team
Support Group
EPSDT
Medicaid
Public Health Nurse
Other (specify)
/ /
/ /
/ /
/ /
I /
! /
/ I
/ /
/ /
/ /
/ /
/ I
Family does not want interventions, Follow-up
Follow-up with family in one year or P.R.N. per HCP Standards.
Other (specify)
! I
Completed by
Signature
Reviewed by R.N.
Signature
ptatool.wpf (cre. 06/I 3/93 rev. 06/I 2/971pw
Title
971976
INVOICE NUMBER
=az
is m'❑❑
a
0 F
P..
w
w4,4
wz
F
Reimbursement
Amount Requested
Local Agency Match
Description of Expenditure
GRAND TOTAL
and we are requesting reimbursement for s
This is to certify that the above expenses were incurred per Contract #
H
A
SIGNATURE (CONTRACTOR):
C
a
AUTHORIZED DESIGNEE (STATE):
971976
ATTACHMENT C
APPLICANT: Weld County Health Department
Special Needs (HCP)
JUNE 30, 1998
PROJECT: Health Care Program for Children with
FOR THE PERIOD: OCTOBER 1,1997 through
Annual
Salary
Rate
Full
Time
Equivalent
Total
Source of Funds
Amount
Required
*Applicant
and Other
Requested
from CDPFIE
PERSONNEL EXPENSES:
Social Worker (Aurora Cura)
31,093
0.50
11,660
11,660
CHN II (Cheryl Weinmeister)
36,419
1.00
27,314
27,314
CHN II (Kris Embree)
36,295
0.80
21,777
6,261
15,516
Office Tech III (Eva Hammond)
20,557
0.90
13,876
13,876
Office Tech II (Luana Quiroz)
17,583
0.40
5,275
2,638
2,637
Office Tech II (Doris Rulla)
16,580
0.40
4,974
4,974
CHN II (Becky McMahan)
35,949
0.13
3,505
3,505
CHN II (vacant)
35,165
0.50
13,187
6,066
7,121
CHN Supervisor (Kathy Shannon)
42,373
0.15
4,767
4,767
Fringe Benefit Rate and Expenses:
25.00%
26,584
7,053
19,531
Total Personnel Expenses
4.78
132,919
35,264
97,655
CONTRACTED SERVICES:
OT/PT Regional Coordinator (Rose Thompson)
1,445
1,445
Audiology Regional Coordinator (Cheryl Johnson)
4,104
4,104
Speech Regional Coordinator (Sharon Carey)
1,445
1,445
Parent Advocate @ $7/hr. 20 hrs./wk.
7,280
7,280
Sub -total Contracted Services
14,274
14,274
OPERATING EXPENSES:
(include only costs not part of indirect)
Respite, Transportation and Interpretation Special Project
375
375
Printing and Postage
200
200
Dedicated Phone Line (2 lines)
1,200
300
900
Minor Equipment (modem)
200
200
Staff Development
750
750
Sub -total Operating Expenses
2,725
500
2,225
TRAVEL:
HCP State Office Meetings
850
850
Regional Office Travel
1,300
1,300
Sub -total Travel Expenses
2,150
2,150
EQUIPMENT:
Sub -total Equipment Costs
Administrative/Indirect Rate and Costs
Indirect Cost Rate: (salaries and fringe) (HCP 22%) 11.07%
14,714
3,904
10,810
TOTAL PROJECT COSTS
166,782
39,668
127,114
*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?
39,668 **
39,668
YES NO XX
971.976
ATTACHMENT
STATE OF COLORADO
Roy, Governor
Patti Shwaydet, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S. Laboratory Sodding
Denver, Colorado 80222-1530 4210 611th Avenue Phone (303) 692-2000 Denver, Colorado 80220.3716
(303) 691-4700
, 1997
State Fiscal Year 19 -
. Contract Routing Number
Colorado Department
of Public Health
and Environment
Change Order Letter No.
In accordance with Paragraph _ of the contract with routing number and contract numbs . (as amended
by Orange Order Letter rotting number , and/or Renewal Letter routing number natter referred to
as the Original Contract (copy attached and by this reference made a part hereof) between the SEfe DECD orado, Department
of Public Health and Environment ( Division) and c .! covering the period
of .199_ through 199_, the parties - , the maximhim am6unt payableby the State
for the eligible services in Paragraph _ of the Original Contract is being' • .. . -• Gym- ;
DOLLARS (S_____) to a new total of D�Or }T S t4 ' otladance with the
revised work plan attached hereto as Attachment A and revised budget attached h- - eritt,di incorporated
herein. The first sentence in Paragraph _ of the Original Contract is hereby modified .. • :r 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 ''r ` bit in no event shall it be
deemed valid until it shall have been approved by the State Controller or sWi`ch assistant u ie may designate.
Please sign, date and return all _ originals of this letter as soon as poss . r�
Mail Code:
4300 Cherry Creek Driver`S6ouiti
Denver, Colorado 80224-1530
One original of this letter will be returned to yo �i`�'Ev heir uIlY approved.
Contractor: • State of Colorado:
Full Contractor Name Roy Romer, Governor
By:
Print Name:
`Stguature
t
Title:
i
s
By:
For the Executive Director
Colorado Department of Public Health
and Environment
APPROVALS: APPROVALS:
PROGRAM CONTROLLER
By: By:
Clifford W. Hall
971976
ATTACHMENT E
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
HEALTH CARE PROGRAM FOR CHILDREN WITH SPECIAL NEEDS (HCP)
SLIDING FEE SCHEDULE FOR HCP CLINICS - Page 1 of 3 pages
The Health Care Program for Children with Special Needs (HCP) is committed to the
Clinic System. We want to ensure that throughout Colorado families have access
to the HCP Clinics.
The sliding fee schedule affects those families without insurance that have an HCP
financial rating of +1 or more. The clinic physician will always bill Medicaid and
private insurance for all children who have Medicaid or private insurance
benefits.
Clinics. Fees, and Services
Cerebral Palsy, Hearing, Orthopedic, Pediatric Cardiology, Pediatric
Neurology, Plastic, and Scoliosis Clinics
1. Clients with an HCP financial rating of 0 will continue to receive:
• diagnostic evaluations (to include one follow up visit to
interpret the results) at no cost to the family,
• continuing clinic visits at no cost to the family for children
who are diagnostically eligible, and
• labs and X-rays at no cost to the family.
2. Clients with an HCP financial rating of +1 and +2 will receive:
• diagnostic evaluations (to include one follow up visit to
interpret the results) at no cost to the family,
• labs and x-rays for the diagnostic evaluation at no cost to
the family,
971976
SLIDING FEE SCHEDULE FOR HCP CLINICS - Page 2 of 3 pages
• continuing clinic visits for children who are diagnostically
eligible at a fee for service (previously these visits were at
no cost to the family). The family will be assessed a:
o $10 fee per visit for a rating of +1
o $20 fee per visit for a rating of +2 and
o labs and x-rays for the continuing clinic visits are
the financial responsibility of the family.
3. Clients with a rating of +3 and above will:
• pay a fee for service for both diagnostic evaluations and
continuing clinic visits (previously the diagnostic
evaluations were at no cost to the family). The family will
be assessed a:
o $30 fee per visit for a rating of +3
o $40 fee per visit for a rating of +4
o $50 fee per visit for a rating of +5
o $60 fee per visit for a rating of +6
o etc.
• and will pay for all labs and x-rays ordered out of clinic
(previously these were at no cost to the family for the
diagnostic evaluation).
4. All clinic patients must be registered with HCP and complete a financial
statement.
971.976
SLIDING FEE SCHEDULE FOR HCP CLINICS - Page 3 of 3 pages
5. HCP is recommending that the clinic sites keep the clinic fees
collected from the families. The fees collected are to support HCP
clinic activities such as: clinic supplies, clinic equipment, clinic
furniture or parent/ professional stipends.
Pediatric Clinics
Children attending an HCP Pediatric Clinic without an HCP eligible diagnosis:
1. If the child's PCP requests continuing consultation from the
pediatrician, the child may be seen in the HCP Pediatric Clinic and pay
fee for service according to the established sliding fee.
2. Families with a financial rating of 0 will be required to pay at the +1
level. (HCP is providing access for these families, but not paying for
services to children who are not diagnostically eligible.)
3. Family pays all labs and x-rays ordered out of clinic.
Developmental Evaluation Clinics
This policy does not address the state-wide Developmental Evaluation Clinic
System. HCP is billed by each Developmental Evaluation Clinic on a fee for
service basis for children with HCP benefits.
971976
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
YES
Column B
TO SOME
DEGREE
Column C
NO
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 in 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:
971976
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COLORADO
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George Baxter, Chairman
To Board of County Commissioners
From
Subject:
Date
John Pickle, Director, Health Departme
September 4,,1997
Health Care Program for Children With Special Needs 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 contract authorizes WCHD to provide case finding, community outreach, care coordination,
clinic management, program management, parent and family involvement and support, and
interagency collaboration. In return for these services, WCHD will be paid an amount not to
exceed $127,114 for the time period October 1, 1997 through June 30, 1998. This contract
represents a 67% increase in funding as compared to the same time period last year. It will
provide for the hiring of an additional half-time nurse as well as increased contracted services
and operating supplies at no additional cost to the County.
I recommend your approval of this contract.
Enclosures
971976
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