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Home My WebLink About20194665.tiffRESOLUTION RE: APPROVE CONTRACT AMENDMENT #2 FOR WOMEN'S WELLNESS CONNECTION CANCER PREVENTION AND EARLY DETECTION PROGRAM AND AUTHORIZE CHAIR TO SIGN WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board has been presented with Contract Amendment #2 for the Women's Wellness Connection Cancer Prevention and Early Detection Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment, and the Colorado Department of Public Health and Environment, commencing upon full execution of signatures, and ending June 29, 2020, with further terms and conditions being as stated in said amendment, and WHEREAS, after review, the Board deems it advisable to approve said amendment, 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 Amendment #2 for the Women's Wellness Connection Cancer Prevention and Early Detection Program between the County of Weld, State of Colorado, by and through the Board of County Commissioners of Weld County, on behalf of the Department of Public Health and Environment, and the Colorado Department of Public Health and Environment, be, and hereby is, approved. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said amendment. CG:I-ILCrG) laiosir9 2019-4665 HL0051 CONTRACT AMENDMENT #2 FOR WOMEN'S WELLNESS CONNECTION CANCER PREVENTION AND EARLY DETECTION PROGRAM PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 30th day of October, A.D., 2019. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO ATTEST: dj vo EXCUSED Barbara Kirkmeyer, Chair Weld County Clerk to the Board ty A : rney Date of signature: 11/05/19 Mike Freeman, Pro-Tem Sean P. Conway Steve Moreno 2019-4665 HL0051 On-frac-+ .1 14c3DoD Memorandum TO: Barbara Kirkmeyer, Chair Board of County Commissioners FROM: Mark E. Wallace, MD, MPH Executive Director Department of Public Health & Environment DATE: October 25, 2019 SUBJECT: Women's Wellness Connection - Cancer Prevention & Early Detection Contract Amendment #2 with CDPHE For the Board's approval is contract amendment #2 between the Colorado Department of Public Health and Environment and the Board of County Commissioners for the County of Weld, State of Colorado, on behalf of the Weld County Department of Public Health and Environment (WCDPHE) for the Women's Wellness Connection (WWC) Cancer Prevention & Early Detection (CPED) program. The purpose of this contract amendment is to minimize the number of annual budget adjustments/contract modifications needed as screening needs change in Weld County. This will be accomplished by changing the funding mechanism to a single General Accounting Encumbrance (GAE) for all funding that goes directly to provide medical services for individual clients. This amendment reflects the shifting of $52,660 from the original FY 19-20 contract budget into the GAE which will remain fully available to reimburse WCDPHE for providing direct services to our clients. As Weld serves more clients (which is what has historically occurred in each fiscal period), the GAE will allow for WCDPHE to easily receive additional funding to compensate us for these services to our citizens. The WWC program provides low-income, uninsured and underserved women, who are lawfully present in Colorado, access to timely, high quality screening and diagnostic services to detect breast and cervical cancer at the earliest stages. In addition, the Targeted Outreach component of the program helps recruit qualifying women and reduce barriers to screenings, while providing education about the importance of breast, cervical and colorectal cancer screenings to all eligible women. In 2018, the Targeted Outreach program contacted 1,610 clients in the community and Clinical Services provided screenings to 165 women, detecting three cases of breast cancer that resulted in successful treatment. This amendment was approved for placement on the Board's agenda via pass -around dated October 18, 2019. I recommend approval of this contract amendment #2 with CDPHE for the WWC program. 10913© 2019-4665 HLOOSI CONTRACT AMENDMENT #2 SIGNATURE AND COVER PAGE(S) State Agency : Colorado Department Of Public Health and Environment PSD - WWC 4300 Cherry Creek Drive South Denver, CO 80246 Original Contract Number 18 FHLA 104208 Contractor : Amendment Contract Number Board of County Commissioners of Weld County 2018*3282 Amendment #2 1150 O Street Greeley, Colorado 80631 For the use and benefit of the Weld County Department of Public Health and Environment 1555 North 17th Avenue Greeley, Colorado 80631 Contract Performance Beginning Date : Current Contract Expiration Date : January 1, 2018 June 29, 2020 CONTRACT MAXIMUM AMOUNT TABLE Document Federal Funding State Funding Other Contract Number Funding Term (dates) Total Type Amount Amount Amount Original Contract 18 FHLA 104208 $6,650.00 $73,514.00 $0 1/1/2018-6/29/2018 $80,164.00 GFCL #1 18 FHLA 110269 $35,850.00 $144,321.00 $0 6/30/2018 -6/29/2019 $180,171.00 Option Letter #1 2018*3282 Option Letter #1 - $1,526.00 - $20,104.00 $0 4/1/2018 - 6/29/2019 - $21,630.00 Contract Amendment #1 2018*3282 Amendment #1 $31,037.00 $124,317.00 $0 6/30/19 - 6/29/2020 $155,354.00 Contract Amendment #2 2018*3282 Amendment #2 - $29,267.00 - $23,393.00 $0 10/31/19 - 6/29/2020 - $52,660.00 Current Contract Maximum Cumulative Amount $341,399.00 THE PARTIES HERETO HAVE EXECUTED THIS AMENDMENT Each person signing this Amendment represents and warrants that he or she is duly authorized to execute this Amendment and to bind the Party authorizing his or her signature. Amendment Contract Number: 2018*3282 Amendment #2 Page 1 of 3 version 31.1.19 CONTRACTOR Board of County Commissioners of Weld County for the use and benefit of the Weld County Department of Public Health and Environment Mike Freeman, Chair Pro-Tem By: Print Name & Title Date: OCT 3 0 2013 STATE OF COLORADO Jared S. Polis, Governor Colorado Department Of Public Health and Environment Jill Hunsaker Ryan, MPH Executive Director By: Lisa McGovern, Procurement and Contracts Section Director, CDPHE Date: By: PROGRAM APPROVAL Colorado Department of Public Health and Environment Signature of Authorized CDPHE Program Approver Date: U� q Lek In accordance with §24-30-202 C.R.S., this Amendment is not valid until signed and dated below by the State Controller or an authorized delegate. By: STATE CONTROL Robert ro CPA, MICA, i D D id No , ontroller, C Amendment Effective Date: t. PARTIES This Amendment (the "Amendment") to the Original Contract shown on the Signature and Cover Page for this Amendment (the "Contract") is entered into by and between the Contractor, and the State. 2. TERMINOLOGY Except as specifically modified by this Amendment, all terms used in this Amendment that are defined in the Contract shall be construed and interpreted in accordance with the Contract. 3. AMENDMENT EFFECTIVE DATE AND TERM A. Amendment Effective Date This Amendment shall not be valid or enforceable until the Amendment Effective Date shown under the State Controller Signature. The State shall not be bound by any provision of this Amendment before that Amendment Effective Date, and shall have no obligation to pay Contractor for any Work performed or expense incurred under this Amendment either before or after of the Amendment term shown in §3.B of this Amendment. B. Amendment Term The Parties' respective performances under this Amendment and the changes to the Contract contained herein shall commence on the Amendment Effective Date shown under the State Amendment Contract Number: 2018*3282 Amendment #2 Page 2 of 3 version 31.1.19 a/9-#6ei (,) Controller Signature or October 31, 2019, whichever is later and shall terminate on the termination of the Contract. 4. PURPOSE The Parties entered into the agreement that serves to implement strategies to address cancer prevention and early detection at one or more levels of the socio-ecologcial framework, depending on the needs of the underserved population served by and living within the service area. The Parties now desire to delete Exhibit E., Grant Funding Change Letter; decrease funding and update Exhibit G., Additional Provisions, for the following reason: remove eCaST funding amount from Exhibit I., Budget. 5. MODIFICATIONS The Contract and all prior amendments thereto, if any, are modified as follows: A. The Contract Maximum Amount is deleted and replaced with the Current Contract Maximum Amount shown on the Signature and Cover Page for this Amendment. B. The Amendment and all prior amendments thereto, if any, are modified as follows: i. The Parties now agree to delete Exhibit E., Grant Funding Change Letter. ii. The Parties now agree to modify Exhibit G., Additional Provisions, of the original agreement. Exhibit G., Additional Provisions, is deleted and replace in its entirety with Revised Exhibit G., Additional Provisions. iii. The Parties now agree to modify Exhibit I., Budget, of the original agreement. Exhibit I., Budget, is deleted and replaced in its entirety with Revised Exhibit I., Budget. 6. LIMITS OF EFFECT AND ORDER OF PRECEDENCE This Amendment is incorporated by reference into the Contract, and the Contract and all prior amendments or other modifications to the Contract, if any, remain in full force and effect except as specifically modified in this Amendment. Except for the Special Provisions contained in the Contract, in the event of any conflict, inconsistency, variance, or contradiction between the provisions of this Amendment and any of the provisions of the Contract or any prior modification to the Contract, the provisions of this Amendment shall in all respects supersede, govern, and control. The provisions of this Amendment shall only supersede, govern, and control over the Special Provisions contained in the Contract to the extent that this Amendment specifically modifies those Special Provisions. Amendment Contract Number: 2018'3282 Amendment #2 Page 3 of 3 version 3l .1.19 Revised Exhibit G ADDITIONAL PROVISIONS To Contract Dated 9/27/2017 — To Original Contract Routing Number 18 FHLA 104208 Contract Routing Number 2018*3282 Amendment 2 These provisions are to be read and interpreted in conjunction with the provisions of the Contract specified above. 1. This Contract contains federal and state funds (see Catalog of Federal Domestic Assistance (CFDA) numbers 93.898 and 93.800). 2. The United States Department of Health and Human Services ("USDHHS"), through the Centers for Disease Control and Prevention ("CDC") has awarded as of 09/11/2019 anticipated federal funds of $10,636,435.00 under Notice of Cooperative Agreement Award, hereinafter "NCAA", number 6 NU58DP006347-03-01, to perform the following — Colorado Cancer Prevention and Control. The United States Department of Health and Human Services ("USDHHS"), through the Centers for Disease Control and Prevention ("CDC") has awarded as of 05/20/2019 anticipated federal funds of $3,460,545.00 under Notice of Cooperative Agreement Award, hereinafter "NCAA", number NU58DP006082-05-00, to perform the following — Organized Approaches to Increase Colorectal Cancer Screenings. If the underlying Notice of Cooperative Agreement Award "NCAA" authorizes the State to pay all allowable and allocable expenses of a Contractor as of the Effective Date of that NCAA, then the State shall reimburse the Contractor for any allowable and allocable expenses of the Contractor that have been incurred by the Contractor since the proposed Effective Date of this Contract. If the underlying NCAA does not authorize the State to pay all allowable and allocable expenses of a Contractor as of the Effective Date of that NCAA, then the State shall only reimburse the Contractor for those allowable and allocable expenses of the Contractor that are incurred by the Contractor on or after the Effective Date of this Contract, with such Effective Date being the later of the date specified in this Contract or the date the Contract is signed by the State Controller or delegee. 3. To receive compensation under the Contract, the Contractor shall submit a signed Monthly CDPHE Reimbursement Invoice Form. This form is accessible from the CDPHE internet website https://www.colorado.gov/pacific/cdphe/standardized-invoice-form-and-links and is incorporated and made part of this Contract by reference. CDPHE will provide technical assistance in accessing and completing the form. The CDPHE Reimbursement Invoice Form and Expenditure Details page must be submitted no later than forty-five (45) calendar days after the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work and Budget. Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email the scanned invoice and Expenditure Details page to: Cancer Prevention and Early Detection Contracts Monitor via email at cdphe Cancer@state.co.us Final billings under the Contract must be received by the State within a reasonable time after the expiration or termination of the Contract; but in any event no later than forty-five (45) calendar days from the effective expiration or termination date of the Contract. Contract_Exhibit-A_AdditionalProvisions_17.5.3 Page 1 of 5 Revised Exhibit G Unless otherwise provided for in the Contract, "Local Match", if any, shall be included on all invoices as required by funding source. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless approved in writing by CDPHE. If applicable, the Contractor shall be reimbursed for the purchase of allowable Health Navigation and Clinical Services supplies/operating costs identified in the Women's Wellness Connection (WWC) Health Navigation and Clinical Services Allowable Purchases document. This document is located at the following website www.cdphecancer.org and is incorporated and made part of this Contract by reference. 4. To receive compensation for Health Navigation and Clinical Services provided to eligible individual clients as identified in the Statement of Work under this Contract, the Contractor shall: a. Navigate eligible low-income women to timely and complete breast and cervical cancer screening procedures (Health Navigation); and/or, b. Provide CDPHE-funded breast and cervical cancer screening and/or diagnostic procedures (Clinical Services), to eligible clients. Colorectal cancer screening and diagnostic services are not eligible for Health Navigation or Clinical Services reimbursement. a. eCaST Data System Data entered into the electronic cancer surveillance and tracking (eCaST) data system are the basis for calculating reimbursement for each client receiving Health Navigation or Clinical Services. To be considered for payment, all Cancer Prevention and Early Detection Health Navigation and Clinical Services related cancer screening and diagnostic procedures shall be entered into eCaST within thirty (30) days of service being performed. Health Navigation or Clinical Services cases that exceed sixty (60) calendar days in screening length and negatively affect WWC's Performance Indicators may not be reimbursed at the discretion of the State. Reimbursement is determined by the clinical outcome of each case; therefore, cases must be clinically complete or administratively closed before reimbursement occurs. Contractors shall only be paid for cases that meet eligibility, performance, and data requirements. Based on performance, the Cancer Prevention and Early Detection Program may unilaterally change the groups of eligible clients who may be served with eCaST funding. b. Bundled Payment System (BPS) The Contractor shall be paid for Health Navigation or Clinical Services to individual clients in accordance with rates as outlined in the Cancer Prevention and Early Detection Bundled Payment System for Cancer Prevention and Early Detection Health Navigation and Clinical Services. This document is incorporated and made a part of this Contract by reference and is available on the following website at www.cdphecancer.org . Contract_._Exhibit-A_AdditionalProvisions_17.5.3 Page 2 of 5 Revised Exhibit G Rates may be revised or updated during the contract term. Reimbursement policies are defined in the Cancer Prevention and Early Detection Program Manual. This manual is located at the following website www.cdphecancer.org and is incorporated and made part of this Contract by reference. The Contractor shall not charge the Cancer Prevention and Early Detection program for Clinical Services not listed on the CPT Code List. This document is incorporated and made part of this Contract by reference and is available on the following website: www.cdphecancer.org. c. Payment Procedures Payment to Contractor for Health Navigation and Clinical Services provided to eligible individual clients is made from available funds encumbered and shared across multiple contractors. The State may increase or decrease the total funds encumbered at its sole discretion and without formal notice to Contractor. No minimum payment is guaranteed to Contractor. The liability of the State for such payments is limited to the encumbered amount remaining of such funds. Payment to Contractor for expenses not included in the BPS for Cancer Prevention and Early Detection Health Navigation and Clinical Services is made from available funds encumbered and in accordance with the Statement of Work and Budget set forth under this Contract. d. Expenditure Cap for Health Navigation and Clinical Services Services to Individual Clients CDPHE will set the expenditure cap for Health Navigation and Clinical Services Services to individual clients for the Contractor for each budget period. CDPHE may increase or decrease the Contractor expenditure cap at its sole discretion based on the Contractor's spending rate. The Contractor may request to ithcrease or decrease this expenditure cap. Once the expenditure cap is reached or the share program funds are fully expended, the State will not reimburse for additional expenses incurred by Contractor unless CDPHE opts to increase the cap. 5. Time Limit For Acceptance Of Deliverables. a. Evaluation Period. The State shall have fifteen (15) calendar days from the date a deliverable is delivered to the State by the Contractor to evaluate that deliverable, except for those deliverables that have a different time negotiated by the State and the Contractor. b. Notice of Defect. If the State believes in good faith that a deliverable fails to meet the design specifications for that particular deliverable, or is otherwise deficient, then the State shall notify the Contractor of the failure or deficiencies, in writing, within fifteen (15) calendar days of: 1) the date the deliverable is delivered to the State by the Contractor if the State is aware of the failure or deficiency at the time of delivery; or 2) the date the State becomes aware of the failure or deficiency. The above time frame shall apply to all deliverables except for those deliverables that have a different time negotiated by the State and the Contractor in writing pursuant to the State's fiscal rules. c. Time to Correct Defect. Upon receipt of timely written notice of an objection to a completed deliverable, the Contractor shall have a reasonable period of time, not to exceed fifteen (15) calendar days, to correct the noted deficiencies. 6. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination. Contract_Exhibit-A_AdditionalProvisions_ I 7.5.3 Page 3 of 5 Revised Exhibit G The State has determined that this Contract does not constitute a Business Associate relationship under HIPAA. 7. This award does not include funds for Research and Development. 8. The State, at its discretion, shall have the option to extend the term under this Contract beyond the Initial Term for a period or for successive periods, of 1 year at the same rates and under the same terms specified in the Contract. In order to exercise this option, the State shall provide written notice to Contractor in as form substantially equivalent to Exhibit D. If exercised, the provisions of the Option Letter shall become part of and be incorporated in the original contract. The total duration of this contract shall not exceed 5 years. 9. The State, at its discretion, shall have the option to increase or decrease the statewide quantity of Goods and/or Services based upon the rates established in this Contract, and increase the maximum amount payable accordingly. In order to exercise this option, the State shall provide written notice to Contractor in a form substantially equivalent to Exhibit D. Delivery of Goods and/or performance of Services shall continue at the same rates and terms as described in this Contract. 10. If Contractor indicates full expenditure of funds under this Contract by March 29 of each grant year and the full expenditure does not occur, CDPHE has the option to reduce current or upcoming Contract by said amount or a percent deemed reasonable by CDPHE. CDPHE will notify the Contractor of the potential need to decrease the current or upcoming budget. If the Contractor indicates at a later date than March 29 of each grant year an expectation of surplus of funds or inability to fully expend said funds for unforeseen circumstances that Contractor had not anticipated by March 29, CDPHE will reallocate unspent funds without any penalties to the Contractor. Upon receipt of timely written notice of an objection by the State for inability to fully expend funds, the Contractor shall have a reasonable period of time not to exceed ten (10) calendar days to respond to the action. If no dispute is received by the State within ten (10) calendar days, the State has the option to reduce the current budget for the current year and any upcoming budget for future contractual agreements. 11. The Contractor shall request prior approval in writing from the Cancer Prevention and Early Detection Program for any modification to the eCaST budget line item. 12. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or for any modification to the direct costs in excess of twenty-five percent (25%) of the total budget for direct costs. Any request for modifications to the Budget in excess of twenty-five percent (25%) of the total budget for direct costs shall be submitted to the State at least ninety (90) days prior to the end of the contract period and may require an amendment in accordance with General Provisions, Section 16, Contract Modifications, of this Contract. 13. All data collected, used or acquired shall be used solely for the purposes of this Contract. The Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell, or otherwise make known any such data to unauthorized persons without the express prior written consent of the State or as otherwise required by law. This includes a prior written request by the Contractor to the State for submission of abstracts or reports to conferences, which utilize data collected under this Contract. Contract_Exhibit-A_AdditionalProvisions_17.5.3 Page 4 of 5 Revised Exhibit C Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or work papers necessary to perform its duties under this Contract and in accordance with professional standards. 14. Neither the U.S. Department of Health and Human Services (HHS) nor the Centers for Disease Control (CDC) logo may be displayed on any conference materials if such display would cause confusion as to the conference source or give false appearance of Government endorsement. Use of the HHS name or logo is governed by U.S.C. 1320b-10, which prohibits misuse of the HHS name and emblem in written communication. A non-federal entity is unauthorized to use the HI -IS name or logo governed by U.S.C. 1320b-10. The appropriate use of the HHS logo is subject to review and approval of the Office of the Assistant Secretary for Public Affairs (OASPA). 15. The Contractor agrees to provide services to all Program participants and employees in a smoke - free environment in accordance with Public Law 103227, also known as "the ProChildren Act of 1994", (Act). Public Law 103227 requires that smoking not be permitted in any portion of any indoor facility owned or leased or contracted for by an entity and used routinely or regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by Federal programs either directly or through State or local governments, by Federal grant, contract, loan, or loan guarantee. 16. Notwithstanding the terms contained in the General Provisions, Section 10, Confidential or Proprietary Information, Contractor shall protect the confidentiality of all applicant or recipient records and other materials that are maintained in accordance with this Contract. Except for purposes directly connected with the administration of this Contract, no information about or obtained from any applicant or recipient shall be disclosed in a form identifiable with the applicant or recipient without the prior written consent of the applicant or recipient, or the parent or legal guardian of a minor applicant or recipient with the exception of information protected by Colorado Statute as it applies to confidentiality for adolescent services in which case the adolescent minor and not the parent or legal guardian must provide consent or as otherwise properly ordered by a court of competent jurisdiction. Contractor shall have written policies governing access, duplication, and dissemination of all such information. Contractor shall advise its employees, agents, servants, and any subcontractors that they are subject to these confidentiality requirements. 17. The Contractor affirms that it maintains no affiliations or contractual relationships, direct or indirect, with tobacco companies, owners, affiliate, subsidiaries, holding companies, or companies involved in any way in the production, processing, distribution, promotion, sales, or use of tobacco. 18. The State of Colorado, specifically the Colorado Department of Public Health and Environment, shall be the owner of all equipment as defined by Federal Accounting Standards Advisory Board (FASAB) Generally Accepted Accounting Principles (GAAP) purchased under this Contract. At the end of the term of this Contract, the State shall approve the disposition of all equipment. 19. Contractor shall not use state or federal funds provided under this Contract for the purpose of lobbying as defined in Colorado Revised Statutes (C.R. S.) 24-6-301(3.5)(a). Contract_Exhibit-A_AdditionalProvisions_17.5.3 Page 5 of 5 Revised Exhibit I., Budget For CDPHE Use Only - GAE FHLA 2020*2197 COLORADO Department of Public Health & Environment PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Routing # CT-2®18*32828 Amendment #2 Contractor Name Weld County Department of Public Health and Environment Budget Period 06/30/2019 - 06/29/2020 Project Name Cancer Prevention and Early Detection (CPED) Targeted Community Outreach (TCO) Health Navigation and Clinical Services (HN&CS) Program Contact Name, Title, Phone and Email Cynthia Horn, Clinical Manager 970-400-2433 chorn@weldgov.com Fiscal Contact Name, Title, Phone and Email Tanya Geiser, Director, Admin. Services 970-400-2122, tgeiser@weldgov.com Contract/Encumbrance Number CT FAAA FHLA 201800003282 GAE Funding Expenditure Categories Budget Totals Personal Services Salaried Employees Original Contract Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Position Title Description of Work and Justification for Revision Supervisor Provide supervision and oversight to the TCO staff and program; assist with progress reports, evaluation of program; participate in webinars and site visits; provide input and assistance for completion of the contiuing application for Targeted Community Outreach. No changes. $3,256.82 $3,256.82 Clinical Manager Provide Clinical supervision and grant oversight; assure clinic is prepared to serve clients; complete progress reports, program evaluations, participate in webinars, site visits and chart audits; complete continuing appication, review recommendations and implement tool for Health Navigation and Clinical Services. No changes. $3,684.70 $3,684.70 Services Hourly Employees Original Budget Modification to Budget in Amendment! GFCL/Option Letter Total AmountPersonal Requested from CDPHE Position Title Description of Work and Justification for Revision Targeted Community Health Outreach Worker Attend community events and work with community agencies to provide outreach and education about breast, cervical and colon cancer screenings, provide information about local resources, and provide eligible women direct assistance in obtaining cancer screenings. Assist with progress reports, participate in webinars, site visits and required trainings; provide input & assistance for completion of the contiuing application. For Targeted Community Outreach. No changes. $60,294.51 $60,294.51 Office Technician Support Health Navigation/Clinical Services (Make copies, answer phones, interpret as needed). Administrative program support; answering phone calls, clerical support to assist TCO program. No changes. $2,398.13 $2,398.13 Patient Navigator Assist with progress reports, chart audits, program evaluation and site visits for Health Navigation and Clinical Services. No changes. $1,546.01 $1,546.01 4. :,. ' - +'Eq . . :..• Total Personal Services ... .r ...• • -• ' l..b a'<" 'msn �`,.,§7tiD�;:. !_/i,ilP0oi7 ..•1 .. . •' . i,.* :Y •ri,_.Ili, (including fringe benefits) . i. �j9 1 fM� 1 $0.00 % Q(� 1 % $/1,1i.Ji1/.i/ Page 1 of 4 Revised -November 2013 Revised Exhibit I., Budget For CDPHE Use Only - GAE FHLA 2020*2197 PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Ruting # CT-2018*3282, Amendment #2 Contractor Name Weld County Department of Public Health and Environment Budget Period 06/30/2019 - 06/29/2020 Project Name Cancer Prevention and Early Detection (CPED) Targeted Community Outreach (TCO) Health Navigation and Clinical Services (HN&CS) Program Contact Name, Title, Phone and Email Cynthia Horn, Clinical Manager 970-400-2433 chorn@weldgov.com Fiscal Contact Name, Title, Phone and Email Tanya Geiser, Director, Admin. Services 970-400-2122, tgeiser@weldgov.com Contract/Encumbrance Number CT FAAA FHLA 201800003282 GAE Funding Supplies 8t Operating Expenses Original Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Misc. Operating & Office Supplies Office and outreach supplies to support Targeted Community Outreach and/or A/P process (not included in indirect). May include allocations and/or small items of equipment for Targeted Community Outreach. No changes. $150.00 $150.00 Printing Printing costs for culturally and liguistically appropriate relevent small media to be distributed for educational benefits of the community. This includes appropriate and approved education materials for breast, cervical, and colorectal cancer screening and early prevention for Targeted Community Outreach. No changes. $250.00 $250.00 Outreach and Education Expenses Development and purchase of education materials and outreach supplies to promote awareness of breast, cervical, and colorectal cancer prevention and early detection as well as the availability of direct assistance. This includes items to improve engagement of the community during outreach events for Targeted Community Outreach. No changes. $500.00 $500.00 Postage Postage for mailing of small media to targeted zip codes, reminder letters and follow-up questions for Targeted Community Outreach. No changes. $60.00 $60.00 Registration Registration costs for Targeted Community Outreach staff to attend relevant trainings such as health navigation or motivational interviewing training. No changes. $200.00 $200.00 Translation Services Translation of outreach materials as needed for culturally and liguistically appropriate relevent small media and education materials to be distributed for educational benefits of the community for Targeted Community Outreach. No changes. $25.00 $25.00 Electronic Medical Record (EMR) Fees The TCO worker will take a laptop to outreach events and will utilize EMR to schedule screening appointments for clients who qualify for direct assistance ($15 monthly fee x 12 months) for Targeted Community Outreach. No changes. $180.00 $180.00 Phone Services The program will use a cell phone for outreach and contacting clients who qualify for direct assistance; in addition, the phone will be used as a WIFI hot spot when at community events ($70 monthly fee x 12 months) for Targeted Community Outreach. No changes. $840.00 $840.00 Program supplies Coffee/food for area coalition meetings and community orgnizations to promote direct assistance and available clinical services for Targeted Community Outreach. No changes. $200.00 $200.00 Operating/supplies Allowable purchase of supplies/operating items listed on the Health Navigation and Clinical Services allowable purchase document on the Cancer Prevention and Early Detection website: https://www.colorado.gov/pacific/cancerplan/invoicing-and-fiscal-management No changes. $2,500.00 $2,500.00 $0.00 Total Supplies Eiz Operating Expenses 54,905.00 50.00 $4,905.00 Page 2 of 4 Revised -November 2013 Revised Exhibit I., Budget For CDPHE Use Only - GAE FHLA 2020*2197 PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATISN FORM Contract Routing # CT-2018*3282, Amendment #2 Contractor Name Weld County Department of Public Health and Environment Budget Period 06/30/2019 - 06/29/2020 Project Name Cancer Prevention and Early Detection (CPED) Targeted Community Outreach (TCO) Health Navigation and Clinical Services (HN&CS) Program Contact Name, Title, Phone and Email Cynthia Horn, Clinical Manager 970-400-2433 chorn@weldgov.com Fiscal Contact Name, Title, Phone and Email Tanya Geiser, Director, Admin. Services 970-400-2122, tgeiser@weldgov.com Contract/Encumbrance Number CT FAAA FHLA 201800003282 GAE Funding Travel Original Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Participant travel expenses Gas cards (5 x $10) to assist participants in traveling to health system for screening for Targeted Community Outreach. No changes. $50.00 $50.00 Mileage to outreach events Mileage to attend community events and meetings, and visit community organizations to promote breast, cervical & colorectal screenings and offer direct assistance to women who are identified as eligible and in need. Current mileage rate is $0.56/mile. No changes. $1,678.04 $1,678.04 Meals Per diem for meals for (2) staff to attend in -person training and overnight meetings. Per diem is $20 per person per day (estimated 2 people x 2 meals x $20 per meal x 2 days) for Targeted Community Outreach and Health Navigation and Clinical Services. No changes. $160.00 $160.00 Mileage Mileage for staff to attend in -person training and meetings (estimated 480 miles) and to travel to other community and clinic locations (estimated 90 miles) as needed. Current mileage reimbursement rate is $.56/mile for Targeted Community Outreach and Health Navigation and Clinical Services. No changes. $319.20 $319.20 Lodging Lodging for staff to attend in -person overnight training and overnight meetings for Targeted Community Outreach and Health Navigation and Clinical Services. (estimated 3 people @ $200/night). No changes. $600.00 $600.00 Travel Travel expenses for staff to attend cancer/clinical conference, as listed on the Patient Navigation & Clinical Services allowable purchase document on the Cancer Prevention & Early Detection website: www.cdphecancer.org for Health Navigation and Clinical Services. No changes. $500.00 $500.00 Total Travel $3,307.24 $0.00 $3,307.24 Contractual (payments to third parties or entities) Original Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Item Subcontractor Entity Name and/or Description of Item TBD Work with local media outies and advertisers to promote breast, cervical and colorectal cancer screening for Targeted Community Outreach. No changes. $300.00 $300.00 North Colorado Health Alliance EMR vendor support for reports and data collection to complete continuing application for Health Navigation and Clinical Services. No changes. $200.00 $200.00 $0.00 Total Contractual $500.00 $0.00 $500.00 Page 3 of 4 Revised -November 2013 Revised Exhibit I., Budget For CDPHE Use Only - GAE FHLA 2020*2197 PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM Contract Routing # CT -2018'3282, Amendment #2 Contractor Name Weld County Department of Public Health and Environment Budget Period 06/30/2019 - 06/29/2020 Project Name Cancer Prevention and Early Detection (CPED) Targeted Community Outreach (TCO) Health Navigation and Clinical Services (HN&CS) Program Contact Name, Title, Phone and Email Cynthia Horn, Clinical Manager 970-400-2433 chorn@weldgov.com Fiscal Contact Name, Title, Phone and Email Tanya Geiser, Director, Admin. Services 970-400'2122, tgeiser@weldgov.com Contract/Encumbrance Number CT FAAA FHLA 201800003282 CAE Funding eCaST Original Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Item Description of Item and Justification for Revision Patient Navigation with Clinical Services Procedures Billed in eCaST through 6/29/20 for Eligible Uninsured/Underinsured Clients Ages 21 - 39 eCaST billing for eligible Uninsured/Underinsured Client ages 21- 39 funding is being removed from organization's contract budgets. Instead, eCaST reimbursement for all eligible women will be charged to a single General Accounting Encumbrance (GAE) containing available eCaST funds of all Health Navigation and Clinical Services contracts for services to individual clients. Because all organization contracts will be linked to the GAE for eCaST Health Navigation and Clinical Services reimbursement, the amount available to your organization in the eCaST GAE will no longer be indicated on your contract or contract budget. Each organization will instead receive a separate, individual notification of its annual eCaST amount. Contract budgets will now only contain non-eCaST funding that may be used for activities not included in the Bundled Payment System. $10,400.00 ($4,360.00) $6,040.00 Patient Navigation with Clinical Services Procedures Billed in eCaST through 6/29/20 for Eligible Uninsured/Underinsured Clients Ages 40 - 64 eCaST billing for eligible Uninsured/Underinsured Client ages 40 - 64 funding is being removed from organization's contract budgets. Instead, eCaST reimbursement for all eligible women will be charged to a single General Accounting Encumbrance (GAE) containing available eCaST funds of all Health Navigation and Clinical Services contracts for services to individual clients. Because all organization contracts will be linked to the GAE for eCaST Health Navigation and Clinical Services reimbursement, the amount available to your organization in the eCaST GAE will no longer be indicated on your contract or contract budget. Each organization will instead receive a separate, individual notification of its annual eCaST amount. Contract budgets will now only contain non-eCaST funding that may be used for activities not included in the Bundled Payment System. $48,300.00 ($48,300.00) $0.00 Total eCaST (eCaST budget amounts are fixed amount awards and will not be included in the indirect total below) $58,700.00 ($52,660.00) $6,040.00 SUB -TOTAL BEFORE INDIRECT $138,592.41 ($52,660.00) $85,932.41 Indirect Original Budget Modification to Budget in Amendment/ GFCL/Option Letter Total Amount Requested from CDPHE Item Description of Item CDPHE Negotiated Indirect Cost Rate Indirect costs, not including eCaST lines. CDPHE negotiated rate for CY2019: 20.98% TDC excluding capital. No changes. $16,761.59 $0.00 $16,761.59 Total Indirect $16,761.59 $0.00 $16,761.59 TOTAL I $155,354.00 ($52,660.00) $102,694.00 Page 4 of 4 Revised -November 2013 New Contract Request Entity Narne* COLORADO DEPT OF PUBLIC HEALTH/ENVIRONMENT Contract Name* WOMEN'S WELLNESS CONNECTION TARGETED COMMUNITY OUTREACH PROGRAM FY20 TASK ORDER AMENDMENT #2 Entity ID* 0001926 Contract Status LEGAL REVIEW Contract Description* TASK ORDER CONTRACT AMENDMENT #2 FOR THE WOMENS WELLNESS CONNECTION M1NC) TARGETED COMMUNITY OUTREACH PROGRAM FY19-20; 2018=3282A2 Contract ID 3202 Contract TGEISER Contract Lead Email tgeiser@co.weld _co.us ❑ New Entity? Parent Contract ID Requires Board Approval. YES Department Project # Contract Description 2 PREVIOUS CONTRACT NUMBER 18 FHLA 104208 PREVIOUS CONTRACT NUMBER 17-99140 PREVIOUS CONTRACT NUMBER 15-75542 Contract T GRANT Amount* $1O2.694.00 Rene NO Automatic Renewal Grant YES Department HEALTH Department Email CM -Health tJz�Jweldgov.corrr Department Head Email CM -Health- DeptHead@weldgov.com County Attorney GENERAL COUNTY A l I ORNEY EMAIL County Attorney Email CM- COUNTYA I I ORNEY ei'WELD GOV.COM Grant Deadline Date If this is a renewal enter previous Contract ID 2784 If this is part of a MSA enter MSA Contract ID Requester Date* 10/3012019 da Due Date 10126/2019 Will a work session with BDCC be required?* NO Does Contract require Purchasing Dept. to be included? NO Note: the Previous Contract Number and Master Services Agreement Number should be left blank if those contracts are not in On Rase Contract Dates Effective Date 10/31/2019 Review Date* 04/01/2020 Renewal Date Termination Notice Period Committed Delivery Date Expiration Date 06126/2020 Contact Information Contact Info Contact Name Purchasing Purchasing Approver Approval Process Department Head TANYA GEISER OH Approved Date 10/28/2019 Filial Approval BOCC Approved BOCC Signed Date 60CC Agenda Date Originator TGEPSER Contact Type Contact Email Finance Approver BARB CONNOLLY Contact Phone Z Purchasing Approved Date Finance Approved Date 10/29/2019 Tyler Ref # Legal Counsel Contact Phone 2 Legal Counsel Approved Date Hello