HomeMy WebLinkAbout20182937.tiffRESOLUTION
RE: APPROVE TASK ORDER AMENDMENT #1 FOR MATERNAL AND CHILD HEALTH
(MCH) 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 Task Order Amendment #1 for the
Maternal and Child Health (MCH) 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 October 1, 2018, and ending September 30, 2019, 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 Task Order Amendment #1 for the Maternal and Child Health (MCH)
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.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 17th day of September, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD f OUNTY, COLORADO
ATTEST: d.,,,ititod ..'lus:ok
Weld County Clerk to the Board
ounty orney
Date of signature: I O ((8'
ie A. Cozad
Mike Freeman
co. HLCTC,)
1134l►ct
2018-2937
H L0050
&--/dCdet /DI °aW6
Memorandum
TO: Steve Moreno, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: August 29, 2018
SUBJECT: Continuation Task Order Contract for the
FY18-19 Maternal and Child Health (MCH)
Program
For the Board's approval is a Task Order Amendment between Colorado Department of Public Health and
Environment ("CDPHE") 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 Maternal and Child Health (MCH) Program.
The task order represents total funding for a one-year renewal period and will not exceed $319,054 for the
period October 1, 2018, through September 30, 2019. The MCH program encompasses two separate and
distinct programs as described below.
Child-Adolescent/Early Childhood Obesity Prevention
The Weld County Community Health Improvement Plan identified obesity prevention as a top priority area
to be addressed. The strategies in the Early Childhood Obesity Prevention Action Plan are to focus closely
upon the maternal and child population and be a voice for maternal and early childhood health in existing
partnerships and efforts. Evidenced based strategies to reduce early childhood obesity include working
with childcare centers to increase structured physical activity and breastfeeding support, working with
employers to accommodate breastfeeding employees, and promoting community wide consistent
messaging for preventing obesity. While childhood obesity rates among low income children age 2-4 in
Colorado have been slowly declining since 2012, they have remained high in Weld County. In 2015, 7.3
percent of children age 2-4 were obese compared to 10.7 % in Weld County. Childhood obesity increases
the risk of developing a variety of health problems in adolescence, and later in life.
Health Care Program for Children with Special Needs (HCP): Care Coordination
The HCP program provides services to Weld County children and youth with special health care needs
from birth to age 21, who have, or are at risk for, physical, developmental, behavioral or emotional
conditions. There are no financial or diagnostic criteria; services are provided at no cost to the family. The
HCP program provides information and resources, individual care coordination/case management, access
to primary and specialty care, and referral to community resources. This program also facilitates the
development and enhancement of community -based systems of care for children and youth with special
health care needs. Services provided will include interagency collaboration, consultation, and community
involvement.
This Agreement has been reviewed by Assistant County Attorney, Bob Choate, and it meets with his
approval.
This contract was approved for placement on the Board's agenda via pass -around dated August 13, 2018.
I recommend approval for the renewal of this contract with CDPHE.
2018-2937
}at ca0
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PtPUBLIC HEALTH AND ENVIRONMENT
FHLA - CYF/MCH
DEPARTMENT OR AGENCY NUMBER
FAAA
TASK ORDER AMENDMENT ROUTING NUMBER
19 FHLA 112297
To Original Task Order Routing Number
17 FHLA 92905
TASK ORDER AMENDMENT #1
This Task Order Amendment is made this 16th day of July, 2018, by and between the State of Colorado, acting by and
through the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place of
business is 4300 Cherry Creek Drive South, Denver, Colorado 80246, hereinafter referred to as the "State"; and,
Board of County Commissioners of Weld County (a political subdivision of the state of Colorado), whose address
or principal place of business is 1150 "O" Street, Greeley Colorado 80631 for the use and benefit of Weld County
Department of Public Health and Environment whose address or principal place of business is 1555 North 17th
avenue, Greeley, Colorado 80631 hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract dated Ja n ua r} 17, 2012, with contract routing number 13 FAA 000051.
Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract dated July
21, 2016, with encumbrance number CT FAAA FHLA 201900002292 formerly known as CT FAAA FHLA
201700001309, and task order contract routing number 17 FHLA 92905, hereafter referred to as the "Original Task
Order Contract", whereby the Contractor was to provide to the State the following:
Implement population health strategies and provide services that will measurably impact the health and well being of the
MCH population.
The State promises to increase the amount of funds to be paid to the Contractor by Three Hundred Nineteen
Thousand Fifty Four Dollars. (S319,054.00) for the period of October 1, 2018 through and including September 30,
2019 and renew the term of tno (2) years, ending on September 30, 2020 in exchange for the promise of the
Contractor to perform the increased specifications to the work described herein. Additional funds may be included for
the period of October 1, 2019 through and including September 30, 2020 through the use of a contract modification,
pending funding availability.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree as
follows:
1. Consideration for this Contract Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Contract Amendment, and promises and agreements herein set
forth.
2. It is expressly agreed to by the parties that this Contract Amendment is supplemental to the Original Task
Order Contract, contract routing number 17 FHLA 92905, as amended by Grant Funding Change Letter 1,
contract routing number 18 FHLA 103799, collectively referred to herein as the Original Task Order Contract,
which is by this reference incorporated herein. All terms, conditions, and provisions thereof, unless specifically
modified herein, are to apply to this Contract Amendment as though they were expressly rewritten,
incorporated, and included herein.
Page 1 of 4
19 FHLA 112297 A M D I ver 09.8.18
ao/d= a 737(i)
3 It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified, altered,
and changed in the following respects only
A The period of performance of the current term is hereby extended for two (2) years, changing the
current ending date from September 30, 2018 to September 30, 2020 The revised period of
performance is October 1, 2016 through and including September 30, 2020
B This Contract Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract This
Contract Amendment is for the renewal term of October 1, 2018, through and including September 30,
2020 The maximum amount payable by the State for the work to be performed by the Contractor during
Fiscal Year 2019 term of October 1, 2018 through and including September 30, 2019 is Three Hundred
Nineteen Thousand Fifty Four Dollars ($319,054 00) for an amended total contract financial
obligation of the State of Nine Hundred Fifty Seven Thousand One Hundred Sixty Two Dollars,
($957,162 00)
1 For the fiscal year 2019 renewal term the maximum amount payable attributable to a State of
Colorado funding source is One Hundred Thirty Four Thousand Dollars, ($134,000 00), and the
amended total contract financial obligation attributable to a State of Colorado funding source is
Four Hundred Ninety Five Thousand Dollars, ($495,000 00)
2 For the fiscal year 2019 renewal term the maximum amount payable attributable to United States
Government funding source (see Catalog of Federal Domestic Assistance (CFDA) number 93 994) is
One Hundred Eighty Five Thousand Fifty Four Dollars, ($185,054 00), and the amended total
contract financial obligation attributable to United States Government funding source (see Catalog
of Federal Domestic Assistance (CFDA) number 93 994) is Four Hundred Sixty Two Thousand
One Hundred Sixty Two Dollars, ($462,162 00)
The modified specifications to the original Statement of Work and Budget are incorporated herein by
this reference and identified as "Exhibit D and Exhibit E"
4 The Effective Date of this Contract Amendment is October 1, 2018, or upon approval of the State Controller,
or an authorized delegate thereof, whichever is later
5 Except for the General Provisions and Special Provisions of the Original Task Order Contract, in the event of
any conflict, inconsistency, variance, or contradiction between the terms and provisions of this Contract
Amendment and any of the terms and provisions of the Original Task Order Contract, the terms and provisions
of this Contract Amendment shall in all respects supersede, govern, and control The Special Provisions shall
always control over other provisions of the Original Task Order Contract or any subsequent amendments
thereto The representations in the Special Provisions to the Original Task Order Contract concerning the
absence of personal interest of state of Colorado employees are presently reaffirmed
6 FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR ARE
CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED, AND
OTHERWISE MADE AVAILABLE
Page 2 of 4
19 FHLA 112297 AMD I ver 09 8 18
SIGNATURE PAGE
Contract Routing Number 19 FEIT..i 112297
THE PARTIES HERETO HAVE EXECUTED THIS TASK ORDER AMENDMENT
Each person signing this Task Order Amendment represents and warrants that he or she is duly authorized to execute this Task Order Amendment and to
bind the party authorizing his or her signature.
CONTRACTOR
Board of County Commissioners of Weld County for the
use and benefit of the Weld County Department of Public
Health and Environment
(a political subdivision of the state of Colorado)
Steve Moreno
By:
Print Name of Authorized Individual
BOCC Chair
Print Title of Authorized Individual
Signature of Authorized Individual
SEP 17 2018
Date
PROGRAM APPROVAL
Colorado Department of P nd Environment
re of
Date
d CDPHE Program Approver
By:
By:
STATE OF COLORADO
John W. Hickenlooper, Governor
Colorado Department of Public Health and
Environment
Larry Wolk, MD, MSPH, Executive Director and
Chief Medical Officer
crest
Lisa McGovern
Purchasing and Contracting Section Director, CDPHE
q DIA(
Date
LEGAL REVIEW
Cynthia H. Coffman, Attorney General
'
Signature — Senior Assistant Attorney General
Date
In accordance with §24-30-202 C.R.S., this Task Order Amendment is not valid until signed and dated below by the State
Controller or an authorized delegate.
By:
Effective Date:
19 FHLA 1 12297 AMDI
Page 3 of 4
ao/f- 4293?`--)
This page left intentionally blank
Page 4 of 4
19 FFILA 112297 AMDI
EXHIBIT D
STATEMENT OF WORK
To Original Contract Routing Number 17 FHLA 92905
Contract Amendment # 1 Routing Number 19 FHLA 112297
These provisions arc to be read and interpreted in conjunction with the provisions of the contract specified above
1 Entity Name Weld County Department of Public Health and Environment
Term October 1, 2018 - September 30, 2020
II Project Description This project serves to develop, implement and evaluate evidence -based MCH Action Plans
and HCP Care Coordination services that contribute to the improvement of MCH performance measures and
outcomes
III Definitions
1 CDPHE - Colorado Department of Public Health and Environment
2 CDS - the state HCP-developed data system for documentation of clinic coordination, care coordination and
information only services for children and yOuth with special health care needs
3 CYSHCN - children and youth with special health care needs
4 HCP — a program for children and youth with special health care needs
5 HCP Care Coordination — the state HCP developed intervention model for providing care coordination for
families of children and youth with special health care needs
6 HCP Consultants — the program staff for HCP who provide technical assistance, consultation and training on
HCP program components
7 LPHAs — local public health agencies
8 MCH — Maternal and child health
9 MCH Action Plans — action plans are work plans that Contractors select or develop to describe the goals,
objectives, key activities, persons responsible, and timelines of the MCH effort Action plans may be state -
developed and related to MCH priorities or may be developed by the Contractor
10 MCH Generalist Consultants - the primary MCH program staff who monitor MCH contracts and who
provide technical assistance and consultation to contractors on program development and implementation
IV
Work Plan
Goal #1 Optimize the health and well-being of mothers and children by employing primary prevention and early intervention
public health strategies
Objective #1 No later than the expiration of the contract, identify and address maternal and child health needs within their
countyjurisdiction to improve the health and well-being of mothers and children
Primary
Activity #1
The Contractor shall implement evidence -based strategies to improve maternal and child health
Sub -Activities
#1
1 The Contractor shall implement each activity specified within the agency's CDPHE-approved,
customized action plan(s)
2 The Contractor shall engage in a minimum of one (1) training or technical assistance opportunity to
support community engagement strategies specific to MCH initiatives
3 The Contractor shall participate in a minimum of three (3) check -in calls with their MCH Generalist
Consultant
Primary
Activity #2
The Contractor shall implement the HCP Model of Care Coordination for CYSHCN residing within the
Contractor's jurisdiction
Sub -Activities
#2
I The Contractor shall provide information and resources for community stakeholders and families of
children and/or youth with special health care needs
2 The Contractor shall participate in HCP statewide meetings via webinar every other month as
scheduled
3 The Contractor shall complete HCP Planning forms and budgets for care coordination
Page I of3
EXHIBIT D
Standards
Requirements
and
I.
2.
3.
4.
5.
6.
7.
8.
9.
10.
1 1.
I 2.
13.
14.
15.
16.
17.
incorporated
the
The
contained
The
The
selected
The
MCH
The
HCP
The
The
wwvv.
MCH
content
contractor
Contractor
Contractor
Contractor
staff
Contractor
Contractor
website
mchcolorado.org.
priorities.
on
on
website,
of
and
CDPHE
electronic
shall
shall
shall
www.mchcolorado.org
made
This
and
monitor
be
comply
information
part
guided
documents
non-CDPHE
documents
of this
with
by
the
contract
MCH
located
is
services,
with
MCH
located
and
by
population
websites
and
policies
approach
the
incorporated
part
CYSHCN
by
on
website
priority
on
reference.
including
Medical
online
CDPHE
technical
hereof
may
the
and
by
for
local
referencing
be
content
MCH
guidelines.
Home
by
and
on
CYSHCN.
and
HCP
the
and
updated
reference,
community
Guidelines
for
action
assistance,
HCP
made
Policy
tool.
the
non-CDPHE
for
website
made
Priority
HCP
therein.
local
made
Plan
term
documentation.
in
scheduled
and
next
stated,
updates
the
Policy
part
periodically
plans
This
services,
&
and
until
part
website,
CDS,
HCP
Budgets
part
as
www.mchcolorado.org
that
and
websites
during
comply
correspond
and
the
with
information
contract
all
with
their
and
by
in
on
Medical
made
web
the
Consultant
updates.
consumer
the
state
follow
by
website
term.
part
site
data
HCP
and
on
is
at
and
Reducing
Also
are
of
Guidelines
contract
to
information
oversight
Resource
family
a
of
made
of
approved
the
non
located
&
located
this
the
staff
this
included
HCP
this
incorporated
Guidelines
for
located
-reimbursable
state
part
MCH
contract
leaders
Contract
to
period.
Barriers
HCP
statewide
Contract
and
Document
at
on
are
of
promote
HCP-developed
by
is
located
Generalist
training
in
the
services
this
on
located
to
and
this
by
CDPHE.
by
the
solicit
to
and
HCP
contract
by
reference.
learning
reference.
shall
meetings,
available
a
document
on
MCH
reference.
deliverable.
shall
HCP care
shall
shall
incorporated
participate
use
be
the
coordination.
coordination
a
guided
document
located
and
These
of
Policy
medical
CYSHCN
families
program
Care
work
by
forms
all
in
and
at
&
forms
consultation,
the
home
made
available
www.hcpcolorado.org.
/tome
the
the
The
feedback
hereof
The
www.mchcolorado.org.
policies,
HCP
Contractor
Approach
by
Contractor
when
reference,
model
procedures,
shall
serving
shall
of
resource
care
engage
and
perform
in
required
Coordination
These
CDPHE
Electronic
MCH
Guidelines.
scheduled
reports
The
are
plans
accordance
expectations
are
incorporated
in
priority
HCP
data
forms
personnel
incorporated
the
progress
HCP
and
after
Planning
unless
Policy
documentation
The
activities
Local
budgets
and
are
Program.
readiness
the
with
set
reports.
otherwise
Information
HCP
incorporated
contract
and
to
Action
the
forth
&
Forms
attend
and
for
system
accordance
reference.
increase
at
The
The
via
The
The
web
The
HCP
I'he
The
the
The
Contractor
site
Contractor
annual
Contractor
www.mchcolorado.org.
for
at
skills,
documentation
with
www.hcpcolorado.org.
shall
the
complete
HCP
meetings,
shall
as
shall
organized
designate
and
use the
quarterly
These
by
HCP
all
all
appropriate
activities
MCH-HCP
the
action
the
deliverables,
final
Contractor
Contractor
Contractor
Contractor
Contractor
email.
Contractor
shall
shall
shall
shall
shall
shall
not
complete
complete
complete
submit
submit
begin
Expected
Results
Activity(s)
of
jurisdiction.
Increase or maintain the health
status and
needs of the
maternal and child
population
within
the
Contractor's
Measurementtheir
of
Expected
Results
1.
2. The
3. The
annual
4.
Quantitative
Data
Contractor
annual
Contractor
contained
HCP
analysis
HCP
Electronic
in
meets
meets
Electronic
CDS
of
a
a
all
m
minimum
Planning
provides
i
n
progress
i
m
Planning
um
documentation
of
of
Form.
reports.
ninety
ninety
Form.
percent
percent
of
the
(90%) of their
(90%) of their
care coordination
information
care
coordination
services
and
resource
target
provided.
target
in their
in
Page 2 of 3
EXHIBIT D
Completion Date
Deliverables
1 The Contractor shall submit MCH-HCP progress reports using a CDPHE-
approved template
No later than the
15th of the month for
Jan , April, July for
the duration of the
contract The final
quarterly report due
no later October 31,
2019 and 2020
2 Early Childhood Obesity Prevention Priority The Contractor shall submit a
program sustainability plan showing next steps for the breastfeeding and
healthy child care environments in the communities targeted, for each objective
selected from the ECOP local action plan
No later than
September 30, 2020
3 Early Childhood Obesity Prevention Priority The Contractor shall submit
quarterly via email post intervention assessment tools completed to assess
physical activity knowledge, skills, practices and integration in early care and
education centers
No later than the
15th of the month
for Jan , April, July
and October for the
duration of the
contract
4 Early Childhood Obesity Prevention Priority The Contractor shall submit an
email stating they have populated the ECOP local data collection tracking tool
reflecting the previous quarter's data for each selected objective in their action
plan This tool is a CDPHE approved google spreadsheet and must be
completed in the tab labeled with the agency's name
No later than the
15th of the month
for Jan , April, July
and October for the
duration of the
contract
5 The Contractor shall submit CDPHE approved readiness tools to assess ability
to begin or continue work within individual MCH priorities
No later than April
1, annually
6 The Contractor shall submit updated MCH action plans and budgets for the next
contract period
No later than June
13, annually
7 The Contractor shall submit via email to the MCH Generalist and the HCP
Consultant the electronic HCP Planning Form and Budget for care coordination
for the upcoming federal fiscal year
No later than
June 13, annually
V Monitoring
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the Program's MCH and HCP Consultants Methods used will include a
review of documentation determined by CDPHE to be reflective of performance to include progress meetings,
invoices and data reports The Contractor's performance will be evaluated at set intervals and communicated to
the contractor A Final Contractor Performance Evaluation will be conducted at the end of the life of the contract
VI Resolution of Non -Compliance
The Contractor will be notified in writing within 15 calendar days of discovery of a compliance issue Within 30
calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to determine the
action(s) necessary to rectify the compliance issue and determine when the action(s) must be completed The
action(s) and timeline for completion will be documented in writing and agreed to by both parties If extenuating
circumstances arise that requires an extension to the timeline, the Contractor must email a request to the MCH
Section Manager and receive approval for a new due date The State will oversee the completion/implementation
of the action(s) to ensure timelines are met and the issue(s) is resolved If the Contractor demonstrates inaction or
disregard for the agreed upon compliance resolution plan, the State may exercise its rights under the provisions of
this contract
Page 3 of 3
Exhibit E
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 112297
Agency Name
Weld County Dept of Public Health & Environment
Budget Period
October 1, 2018 - September 30, 2019
Identify the population
for this budget
Child/Adolescent (CA)
Identify all action plans
related to this budget
Early Childhood Obesity Prevention
Program Contact Name, Title,
Phone and Email
Kelly Martinez, Health
Communications Supervisor
970.400.2325
kmartinez@co.weld.co.us
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser
Director, Administrative Services
(970) 400-2122
tgeiser@co.weld.co.us
Expenditure
Categories
Personal
Services - Salaried
Employees
Position Title
Description of Work
Budget item
supports SOW
(Yes/No)
Gross or
Annual Salary
Fringe
Percent of Time
on Project
Total Amount
Requested
from CDPHE
HC Supervisor
Supervises day-to-day activities of the ECOP grant
and workplan
Yes
$74,854.80
$29,140.97
5.0%
$5,199.79
Health Communication
Specialist
Plans, Coordinates, and Implements Weld ECOP
Action Plan
Yes
$65,488.17
$25,494.54
66.0%
$60,048.59
Data Analyst
Coordinates ECOP workplan grant evaluation and
related data analysis
Yes
$98,449.09
$38,326.23
4.0%
$5,471.01
$0.00
Personal
Services - Hourly
Employees
Position Title
Description of Work
Budget
supports
item
SOW
(Yes/No)
Hourly Wage
Hourly Fringe
Total # of Hours
on Project
Total Amount
Requested
from CDPHE
$0.00
Total
Personal
Services (including
fringe benefits)
$70,719.39
,
Supplies
& Operating
Expenses
Item
Description of Item
Budget
supports
item
SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested
from CDPHE
Supplies & Materials
Miscellaneous office and other operating supplies and health
promotional materials
Yes
$5.00
12
$60.00
Refreshments
Light refreshments for ECOP trainings. An estimated average of $10
will be spent for refreshments for six trainings. The refreshments
will be offered to childcare professionals and employers attending
the ECOP trainings.
Yes
$10.00
$60.00
$0.00
Total
Supplies
& Operating Expenses $120.00
Travel
Item
Description of Item
Budget
supports
item
SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested
from CDPHE
Mileage
Travel to meetings and outreach opportunities such as early
childhood council meetings, childcare centers and worksites
engaged in ECOP work. Mileage is reimbursed at $0.525/mile.
Yes
$0.525
123.5
$64.84
$0.00
Total
Travel
$64.84
Contractual
Page 1 of 4
Exhibit E
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 112297
Agency Name
Weld County Dept of Public Health & Environment
Program Contact Name, Title,
Phone and Email
Kelly Martinez, Health
Communications Supervisor
970.400.2325
kmartinez@co.weld.co.us
Budget Period
October 1, 2018 - September 30, 2019
Identify the population
for this budget
Child/Adolescent (CA)
Fiscal Contact Name, Title,
Phone and Email
Tanya Geiser
Director, Administrative Services
(970) 400-2122
tgeiser@co.weld.co.us
Identify all action plans
related to this budget
Early Childhood Obesity Prevention
Subcontractor Name
Description of Item _
Budget
supports
item
SOW
(Yes/No)
Rate
Total Amount
Requested
Quantity from CDPHE
$0.00
Total
Contractual
$0.00
SUB -TOTAL BEFORE INDIRECT
$70,904.23
Indirect
Item
Description of Item
Total
Requested
from
Amount
CDPHE
Federally -negotiated
indirect cost rate
CDPHE-approved indirect
cost rate agreement
Weld's negotiated indirect rate with CDPHE is 19.88% for 2018; we will use our 2019 indirect rate once that is
determined.
$14,095.77
De minimis indirect cost
Total
Indirect
$14,095.77
TOTAL
AMOUNT
REQUESTED
FROM
CDPHE
$85,000.00
Page 2 of 4
Exhibit E
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FH LA 112297
Agency Name
Weld County Department of Public Health &
Environment
Budget Period
10/1/18 - 9/30/19
Identify the population for
this budget
CYSHCN - HCP Care Coordination (CC)
Identify all action plans
related to this budget
Care Coordination
Amy Antuna, RN, BSN,
Program Contact Name, Title,
Phone and Email
CHS Supervisor,
970-400-2322,
aantuna@co.weld.co.us
Fiscal Contact Name, Title, Phone
and Email
Tanya Geiser,
Director of Administrative Services,
970-400-2122,
tgeiser@co.weld.co.us
Expenditure
Categories
Personal
Services - Salaried
Employees
Position Title
Description of Work
Budget
supports
item
SOW
(Yes/No)
Gross or
Annual Salary
Fringe
Percent of Time
on Project
Total Amount
Requested from
CDPHE
CHS Nurse Supervisor
Provides direct oversight and supervision
care coodination program and staff,
coordination activities, oversees HCP
activities, participates in HCP program
represents HCP on several community
groups/coalitions, responsible for
evaluation of HCP program. WCDPHE
Actual HCP program FTE is 0.95 with
time budgeted to MCH contract and
county funds.
of HCP
directs care
support group
outreach and
reporting and
FTE is 1.0.
40% of this
55% paid for by
yes
$78,612.57
S- 30,603 3'
40.00%
1
$43,686.58
c:i� Nurse
Provides care coordination services to HCP clients,
assists with HCP program outreach and attends HCP
community meetings. WCDPHE FTE is 1.0. Actual
HCP program FTE is 1.0 with 70% of this time
budgeted to MCH contract and 30% paid for by
county funds.
Yes$58,476.74
$60,129.71
S 23,408.50
70.00%
Social Worker
Provides psychosocial care coordination
HCP clients, coordinates and facilitates
HCP support group, HCP program outreach
represents HCP on several community
services to
monthly
and
1.0. Actual HCP
budgeted to
for by county
Yes
$68,453.37
5 26,648.90
30.00%
$28,530.68
groups/coalitions. WCDPHE FTE is
program FTE is 0.8 with 30% of time
MCH contract and 50% of time paid
funds_
CHS Nurse
Provides care coordination services to HCP clients,
assists with HCP program outreach and attends HCP
community meetings. WCDPHE FTE is 1.0. Actual
HCP program FTE is 0.5 with 43% of time budgeted
to MCH contract and 7% of time paid for by county
funds.
Yes
$58,606.34
$ 22,815.45
43.00%
$35,011.37
CHS Director
Provides oversight of HCP program
participates in reporting and evaluation
and HCP staff,
of HCP
HCP program
to MCH
county funds.
Yes
$104,068.80
$ 40,513 98
1.00%
51,445.8 3
program. WCDPHE FTE is 1.0. Actual
FTE is 0.10 with 1% of time budgeted
contract and 9% of time paid for by
50.00
Personal
Services - Hourly
Employees
Position Title
Description of Work
Budget
supports
(Yes/No)
item
SOW
Hourly Wage ,
Hourly Fringe
Total # of Hours
on Project
Total Amount
Requested from
CDPHE
Page 3 of 4
Exhibit E
PREVENTION SERVICES DIVISION- BUDGET WITH JUSTIFICATION FORM
Contract Routing # 19 FHLA 112297
Agency Name
Weld County Department of Public Health &
Environment
Program Contact Name, Title,
Phone and Email
Amy Antuna, RN, BSN,
CHS Supervisor,
970-400-2322,
aantuna@co.weld.co.us
Budget Period
10/1/18 - 9/30/19
Identify the population for
this budget
CYSHCN - HCP Care Coordination (CC)
Fiscal Contact Name,
and Email
Title, Phone
Tanya Geiser,
Director of Administrative Services,
970-400-2122,
t user@co.weld.co.us
g
Identify all action plans
related to this budget
Care Coordination
Office Technician
Administrative support to HCP team.
Responsibilities include interpretation and
translation, CDS data entry, EMR data entry,
materials preparation, assists HCP staff with care
coordination activities,etc. WCDPHE FTE is 1.0.
Actual HCP program FTE is .5.
Yes
S19 13
5 T
1040
511.640 40
5O0
Total Personal Services (including fringe benefits)
$194,791.60
Supplies
& Operating
Expenses
Item
Description of Item
Budget
supports
item
SOW
(Yes/No)
Rate
Quantity
Total Amount
Requested from
CDPHE
Supplies & Operating
Expenses
HCP program outreach and promotional materials for systems
building activities. May include allocations for printing and office
supplies (i.e. brochures, handouts, etc).
Y.,)5
520. O
12
$240.00
$0.00
Total Supplies & Operating Expenses
$240.00
Travel
Item
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total
Requested
CDPHE
Amount
from
Mileage
MCH - HCP staff will travel to MCH/HCP
and participate in various outreach
visits related to the HCP program. Annual
reimbursed at $.525/mile.
meetings at various sites,
opportunities and client home
HCP team travel is
YRi5
$0.525
398
$208.95
50.00
Total Travel
$208.95
Contractual
Subcontractor Name
Description of Item
Budget item
supports SOW
(Yes/No)
Rate
Quantity
Total
Requested
CDPHE
Amount
from
50.00
50.00
Total Contractual
$0.00
SUB -TOTAL BEFORE INDIRECT
$195,240.55
Indirect
`
Item
Description of Item
Total
Requested
CDPHE
Amount
from
Federally -negotiated
indirect cost rate
CDPHE-approved indirect
cost rate agreement
Weld's negotiated indirect rate with
g
CDPHE is 19.88% for 2018; we will use our 2019 indirect rate once that is determined.
$38,813.45
De minimis indirect cost
Total
Indirect
$38,813.45
TOTAL
AMOUNT
REQUESTED
FROM
CDPHE
$234,054.00
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