HomeMy WebLinkAbout20181814.tiffRESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR TUBERCULOSIS PREVENTION AND
CONTROL 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 a Task Order Contract for the
Tuberculosis Prevention and Control Program 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
Department of Public Health and Environment, and the Colorado Department of Public Health
and Environment, commencing July 1, 2018, and ending June 30, 2019, with further terms and
conditions being as stated in said task order contract, and
WHEREAS, after review, the Board deems it advisable to approve said task order
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 Task Order Contract for the Tuberculosis Prevention and Control
Program 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 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 task order contract.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 11th day of June, A.D., 2018.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: ;P:e.'.1t)aC ,i,
Weld County Clerk to the Board
ounty Attorney
Date of signature: a7 -/d f8
Steve Moreno, Chair
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113o1t9
2018-1814
HL0050
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Memorandum
TO: Steve Moreno, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: June 6, 2018
SUBJECT: FY18-19 Tuberculosis Prevention and Control
Program Task Order Contract with CDPHE
For the Board's approval is a FY18-19 Tuberculosis Prevention and Control Program task order
contract between the 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").
This task order contract is for the continuation of the Tuberculosis (TB) Prevention and Control
Program to assist in preventing and controlling TB in Weld County. As many as 220,000
Coloradoans are latently infected with the bacteria that causes active TB disease. In 2017, eighty-
four (84) cases of active TB disease were identified in Colorado. With proper identification and
treatment, nine out of ten people infected with this bacteria will avoid getting TB.
The term for this task order contract is from July 1, 2018, through June 30, 2019, in the amount
of $52,500. Of this amount, $45,000 is State funding for prevention and control activities and
$7,500 Federal funding for TB outreach activities. Additional funding from the Directly Observed
Therapy and Diagnostic Blanket funds will be granted as necessary for the treatment of active TB
disease and for contract investigations.
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 May 7,
2018.
I recommend approval of this TB Prevention and Control Program task order contract with
CDPHE.
Uhl te,
2018-1814
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 19 FHHA 109285
APPROVED TASK ORDER CONTRACT - WAIVER #154
This task order contract is issued pursuant to master contract made on 11/23/2016, with routing number 18 FAA 00051.
STATE:
State of Colorado for the use & benefit of the
Department of Public Health and Environment
Disease Control and Enviornmental Epidemiology
Tuberculosis - Prevention and Control
4300 Cherry Creek South Drive
Denver, Colorado 80246
CONTRACT MADE DATE: 4/16/2018
CORE ENCUMBRANCE NUMBER:
************
TERM:
This contract shall be effective upon approval by
the State Controller, or designee, or on 07/01/2018,
whichever is later. The contract shall end on 06/30/2019.
PROCUREMENT METHOD:
Exempt
BID/RFP/LIST PRICE AGREEMENT NUMBER:
Not Applicable
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE:
Pete Dupree
4300 Cherry Creek South Drive
Denver, Colorado 80246
CONTRACTOR:
Board of County Commissioners of Weld County
1150 "O" Street
Greeley, Colorado 80631
for the use and benefit of the
Weld County Department of Public Health and Enviornment
1555 North 17th Avenue
Greeley, Colorado 80631
CONTRACTOR DUNS: 075757955
CONTRACTOR ENTITY TYPE:
Political Subdivision
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY: Not Applicable
CLASSIFICATION: Subrecipient
CONTRACT PRICE NOT TO EXCEED: $52,500.00
FEDERAL FUNDING DOLLARS: $7,500.00
STATE FUNDING DOLLARS: $45,000.00
OTHER FUNDING DOLLARS:
Specify "Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY19: $52,500.00
PRICE STRUCTURE:
Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Mark Wallace
1555 North 17th Avenue
Greeley, Colorado 80631
PROJECT DESCRIPTION:
This project serves to provide diagnostic, patient education and treatment services for individuals with suspected/known latent TB infection
(LTBI) and those classified with Class A and Class B TB status or who are suspected of having active TB. Also for individuals who are
identified as newly arrived refugees, asylees and other high risk persons with LTBI.
Page 1 of 6
19 FHHA 109285.docx ver 16.4.18
EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A -
Exhibit B -
Exhibit C -
Exhibit D -
Exhibit E -
Additional Provisions (and any of its Attachments; e.g., A-1, A-2, etc.)
Statement of Work (and any of its Attachments; e.g., B-1, B-2, etc.)
Budget (and any of its Attachments; e.g., C-1, C-2, etc.)
Option Letter
Grant Funding Change Letter
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or made
more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of this Task
Order Contract provide more specificity than these general clauses, the more specific provision shall control.
1. This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any
renewals or extensions, may not exceed five (5) years. The parties intend and agree that all work shall be
performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1), C.R.S., as amended, this Task Order Contract is not valid until it has
been approved by the State Controller, or an authorized delegee thereof. The Contractor is not authorized to,
and shall not; commence performance under this Task Order Contract until this Task Order Contract has been
approved by the State Controller or delegee. The State shall have no financial obligation to the Contractor
whatsoever for any work or services or, any costs or expenses, incurred by the Contractor prior to the effective
date of this Task Order Contract. If the State Controller approves this Task Order Contract on or before its
proposed effective date, then the Contractor shall commence performance under this Task Order Contract on
the proposed effective date. If the State Controller approves this Task Order Contract after its proposed
effective date, then the Contractor shall only commence performance under this Task Order Contract on that
later date. The initial term of this Task Order Contract shall continue through and including the date specified
on page one of this Task Order Contract, unless sooner terminated by the parties pursuant to the terms and
conditions of this Task Order Contract and/or the Master Contract. Contractor's commencement of
performance under this Task Order Contract shall be deemed acceptance of the terms and conditions of this
Task Order Contract.
3. The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made a
part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task Order
Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated, the terms of
this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event of conflicts or
inconsistencies between the Master Contract and this Task Order Contract (including its exhibits and/or
attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: 1) the
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
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19 FHHA 109285.docx ver 16.4.18
Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. The Contractor, in accordance with the terms and conditions of the Master Contract and this Task Order
Contract, shall perform and complete, in a timely and satisfactory manner, all work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit C".
5. The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend the
term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this Task
Order Contract's Statement of Work through a contract amendment. To be effective, the amendment must be
signed by the State and the Contractor, and be approved by the State Controller or an authorized delegate
thereof. This contract is subject to such modifications as may be required by changes in Federal or State law,
or their implementing regulations. Any such required modification shall automatically be incorporated into and
be part of this Task Order Contract on the effective date of such change as if fully set forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work - Exhibit
B, establishes or creates standards of performance greater than those set forth in the RFP, then the Contractor
shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective Date
is on or after July 1, 2009 and the maximum amount payable to Contractor hereunder is $100,000 or higher]
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the provisions of
CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning the monitoring of
vendor performance on state contracts and inclusion of contract performance information in a statewide
contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies and Guidance. Evaluation
of Contractor's performance shall be part of the normal contract administration process and Contractor's
performance will be systematically recorded in the statewide Contract Management System. Areas of review
shall include, but shall not be limited to quality, cost and timeliness. Collection of information relevant to the
performance of Contractor's obligations under this Task Order Contract shall be determined by the specific
requirements of such obligations and shall include factors tailored to match the requirements of the Statement
of Project of this Task Order Contract. Such performance information shall be entered into the statewide
Contract Management System at intervals established in the Statement of Project and a final review and rating
shall be rendered within 30 days of the end of the Task Order Contract term. Contractor shall be notified
following each performance and shall address or correct any identified problem in a timely manner and
maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado Department
of Public Health and Environment and showing of good cause, may debar Contractor and
Page 3 of 6
19 FHHA 109285.docx ver 16.4.18
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result by:
(i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24-105-
102(6)), or (ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights provided in
CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and reinstatement of
Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and its
agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws, state
laws, Executive Orders and implementing regulations as they currently exist and may hereafter be amended.
Without limitation, these federal laws and regulations include the Federal Funding Accountability and
Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law 110-252, including
without limitation all data reporting requirements required there under. This Act is also referred to as FFATA.
Page 4 of 6
19 FHHA 109285.docx ver 16.4.18
SIGNATURE PAGE
Contract Routing Number: 19 PHHA 109285
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
Each person signing this Contract represents and warrants that he or she is duly authorized to execute this Contract and to bind the party authorizing his or her
signature.
By:
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
Print Name of Authorized Individual
Chair
tint Title of Authorized Individual
Signature of Authorized Individual
JUN i i 2013
Date
PROGRAM APPROVAL
Colorado Department of Public Health and Environment
Si nature of Authorized CDPHE Pr gram Approver
if
ate
STATE OF COLORADO
John W. Hickenlooper, Governor
Colorado Department of Public Health and
Environment
Larry Wolk, MD, MSPH, Executive Director and
Chief Medical Officer
Lisa McGovern
Purchasing and Contracting Section Director, CDPHE
Date
In accordance with §24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or an
authorized delegate.
ST E CON
By:
Effective Date:
19 FHHA 109285.docx ver 16.4.18
LER
BA, JD
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Page 6 of 6
19 FHHA 109285.docx ver 16.4.18
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 4/16/2018 CMS Task Order Routing Number 19 FHHA 109285
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
1. This Task Order Contract contains federal and state funds (see Catalog of Federal Domestic Assistance
(CFDA) number 93.1 16).
2. The United States Department of Health and Human Services ("USH-IS"), through the Centers for Disease
Control and Prevention ("CDC") has awarded as of 12/18/2017 anticipated federal funds of $123,118.00
under Notice of Cooperative Agreement Award, hereinafter "NCAA", number 5 NU52PS004660-04-00, to
perform the following — This grant will assist our efforts to prevent, control, and ideally eliminate TB in
Colorado. The funds are intended to strengthen current local contributions to essential TB program
activities.
If the underlying Award authorizes the State to pay all allowable and allocable expenses of a Contractor as
of the Effective Date of that Award, 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 Task Order Contract. If the underlying Award does not authorize the State to pay all allowable
and allocable expenses of a Contractor as of the Effective Date of that Award, 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 Task Order Contract, with such effective date being the
later of the date specified in this Task Order Contract or the date the Task Order 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 this Statement of Work and Budget.
Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email
the scanned invoice with the Excel workbook containing the Expenditure Details page to: Pete Dupree, TB
Program Manager and Public Health Epidemiologist, peter.dupree@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.
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.
4. Time Limit For Acceptance Of Deliverables.
Page 1 of 3
Contract_F.xhibit-A_Additionallkovisions_'1'askOrdcr_l 8.1.4
EXHIBIT A
a. Evaluation Period. The State shall have thirty (30) 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 thirty (30) 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 thirty (30)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within thirty (30) calendar days, the Contractor shall be in default of its obligations under this
Task Order Contract and the State, at its option, may elect to terminate this Task Order Contract or
the Master Contract and all Task Order Contracts entered into pursuant to the Master Contract.
5. Health Insurance Portability and Accountability Act (HIPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship under
HIPAA.
6. This award does not include funds for Research and Development.
7. The State, at its discretion, shall have the option to extend the term under this Task Order 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 Task Order. In order to exercise this option, the State shall provide written notice to Contractor in a
form substantially equivalent to Exhibit D. If exercised, the provisions of the Option Letter shall become
part of and be incorporated in the original Task Order. The total duration of this Task Order shall not
exceed 5 years.
8. 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 Task Order and modify 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 Task Order.
9. The State, at its discretion, may unilaterally increase or decrease the total funds available under this Grant,
the funds available under the Grant during any State fiscal Year or the funds available for any specific line
items described in this Grant. In order to exercise this right, the State shall provide written notice to
Grantee in a form substantially equivalent to Exhibit E. The exercise of this right shall not be valid until it
has been approved by the State Controller or designee.
10. Transfer of funds within the Budget:
a. Transfer funds between budget lines if the total of all cumulative transfers is less than 25% of the
budgeted amount does not require Tuberculosis Section approval. However the Contractor shall
notify the Section of the changes in writing prior to the transfer of funds.
b. When the cumulative total of all transfers equals or exceeds twenty five percent (25%) of the total
budgeted amount, the Contractor must obtain written permission from the Tuberculosis Section to
move any funds between lines. The Contractor shall submit the Tuberculosis Section approved
budget modification form prior to making revised expenditures. The Tuberculosis Section staff
Page 2 of 3
Contract_Ixhibit-A_Additionallkovisions_ faskOrder 18.1.4
EXHIBIT A
will evaluate the request and inform the Contractor of a decision within 15 calendar days of
receiving the request.
Page 3 of 3
Contract_Exhibit-A_AdditionalProvisions_'I'askOrder_18.1.4
EXHIBIT B
STATEMENT OF WORK
To Original Contract Number: 19 FHHA 109285
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
I. Entity Name: Weld County Health Department
II. Project Description:
This project serves to provide diagnostic, patient education and treatment services for individuals with
suspected/known latent TB infection (LTBI) and those classified with Class A and Class B TB status or who are
suspected of having active TB. Also for individuals who are identified as newly arrived refugees, asylees and other
high risk persons with LTBI.
III. Definitions:
1. AFB smear — Acid -Fast Bacilli; a rapid test used to detect infectious mycobacteria
2. Asylee -- individuals who, on their own, travel to the United States and subsequently apply for and
receive a grant of asylum.
3. CDPHE — Colorado Department of Public Health and Environment
4. Class A — Pulmonary TB, the applicant has an abnormal chest radiograph suggestive of
active TB disease, and one or more sputum smears positive for acid -fast bacteria
5. Class B1 - Immigrant with an abnormal CXR with evidence of TB, and/or the individual has a history of
treatment for active TB disease.
6. Class B2 — The individual was diagnosed with latent TB infection (LTBI). These are typically children
whose TST result was positive and CXR was normal.
7. DOT — Directly Observed Therapy
8. HIV— Human Immunodeficiency Virus
9. IGRA — interferon gamma (y) release assay (whole blood TB test)
10. LEP — limited English proficiency (Over -the -Phone Interpretation (OPI) provider only)
11. LTBI — Latent Tuberculosis Infection
12. OPI — over -the -phone interpretation
13. PO — Purchase Order
14. Refugee -- any person who is outside his or her country of nationality or habitual residence and is unable
or unwilling to return to or seek protection of that country due to a well-founded fear of persecution based
on race, religion, nationality, membership in a particular social group, or political opinion
15. RVCT — Report of Verified Case of Tuberculosis
16. TB — Tuberculosis
17. TB -17— CDPHE's TB surveillance form
18. TBdb — CDPHE Tuberculosis Data Base
19. TST — Tuberculin Skin Test
IV. Work Plan:
Goal #1: Prevent and control tuberculosis infection and active TB disease throughout the Contractor's jurisdiction
Objective #1: No later than the expiration date of the Contract, the Contractor shall assist in supporting tuberculosis
prevention and control activities throughout the agency's jurisdiction.
Primary Activity #1
The Contractor shall locate all patients with suspected or confirmed TB.
Sub -Activities #1
1. The Contractor shall provide, or arrange for, chest x-rays and interpretations for
individuals with suspected or confirmed TB.
2. The Contractor shall provide interpretations for individuals with suspected or confirmed
TB, as necessary.
3. The Contractor shall collect specimens for mycobacteriology testing on all persons
suspected of having TB.
4. The Contractor shall arrange for the transportation of the specimens to the CDPHE
laboratory for testing.
version: Purchase Order Statement of Work
for Services or Services with Goods
December 2015
Page 1 of 6
EXHIBIT B
5. The Contractor shall arrange for the placement of patients who require isolation.
a. The Contractor shall contact CDPHE TB Program for assistance.
b. The Contractor shall contact CDPHE to request reimbursement from CDPHE for
those costs incurred by the Contractor in isolating a patient.
6. The Contractor shall provide, or arrange for, the treatment of patients with suspected or
confirmed active TB, including DOT.
7. The Contractor shall ensure patients' adherence to TB treatment.
8. The Contractor shall inform those individuals whom refuse testing of the risks associated
with HIV/TB co -infection.
9. A minimum of once a month, the Contractor shall monitor and evaluate those persons
with suspected or confirmed active TB disease by in -person assessment.
10. As needed, the Contractor shall offer limited English proficiency services via an
accredited Over -the -Phone Interpretation (OPI) provider to be reimbursed using TB
DOT/Diagnostic reimbursement invoice template by the CDPHE TB Program at a rate
not to exceed $0.75/minute. The instructions are incorporated and made part of this
Contract by reference and is available on the following website under the Over -the -phone
(OPI) section,Ftps://www.colorado.gov/pacific/cdphe/tb-lpha.
Primary Activity #2
The Contractor shall ensure that all contacts to newly identified infectious TB cases are
identified, investigated, and receive appropriate evaluation.
Sub -Activities #2
1. The Contractor shall provide, or arrange for, chest x-rays and interpretations for
individuals with newly identified infectious, suspected, confirmed, and LTBI TB cases.
2. The Contractor shall provide, or arrange for, the treatment of patients, including DOT,
and ensure the completion of therapy for infected patients.
3. The Contractor shall provide, or arrange for, an HIV antibody test for all persons with
LTBI with HIV risk factors or who originate from an HIV -endemic area.
4. The Contractor shall inform all individuals whom refuse testing of the risks associated
with HIV/TB co -infection.
5. A minimum of once a month, the Contractor shall monitor and evaluate persons with
LTBI during treatment.
6. The Contractor shall ask all TB clients about current health insurance enrollment and
offered materials to become insured if not currently insured.
7. The Contractor shall complete a preliminary Tuberculosis Contact Investigation Record.
The instructions are incorporated and made part of this contract by reference and is
available at the following link, Tuberculosis Contact Investigation Record to the CDPHE
TB Program after initiation of each contact investigation.
Primary Activity #3
The Contractor shall provide or arrange for newly arrived refugees, asylees and other eligible
individuals with Class B TB designation to complete a TB screening.
Sub -Activities #3
1. A minimum of thirty (30) calendar days of the Contractor's receipt of written notification
from CDPHE of the arrival of a Class B immigrant or refugee, the Contactor shall
provide, or arrange for a TB screening that includes the following:
a. medical evaluation
b. tuberculin skin test or IGRA
c. chest radiograph
d. three spontaneous sputum specimens for AFB smear and culture collected on
consecutive days
2. Upon completion of testing and examination, the Contractor shall complete, sign, and
date the CDC 75.17 form or Class B tuberculosis Follow Up worksheet, and return it
within ninety (90) days to:
Colorado Department of Public Health and Environment
Tuberculosis Program
Attn: Class B Coordinator
4300 Cherry Creek Drive South
Denver, CO 80246
version: Purchase Order Statement of Work
for Services or Services with Goods
December 2015
Page 2 of 6
EXHIBIT B
Primary Activity #4
The Contractor shall identify, investigate, and evaluate persons with a high risk of LTBI.
Sub -Activities #4
Primary Activity #5
1. The Contractor shall offer an HIV antibody test to 100% of persons with LTBI and
provide, or arrange for, HIV antibody test with a test result rate >80%.
a. The Contractor shall record 80% of all HIV antibody testing result rates for
LBT1 patients into the CDPHE TBdb.
b. The Contractor shall record 95% of all HIV testing result rates among suspect
and confirmed cases of active TB disease, and enter that information into the
CDPHE TBdb.
2. The Contractor shall offer an HIV antibody test to 100% of persons diagnosed with active
TB disease.
a. The Contractor shall provide an HIV antibody test for those clients with a test result
rate >95%, regardless of their age or the apparent absence of risk factors for HIV
infection.
3. A minimum of once a month, the Contractor shall monitor and evaluate persons with
LTBI during treatment for all such .atients.
The Contractor shall offer printed resource and referral materials to clients that direct them to
the nearest community Medicaid and Connect for Health Colorado enrollment location(s),
including online enrollment options.
Sub -Activities #5
1. The Contractor shall discuss current health insurance enrollment status with each client
for the purposes of becoming insured if not currently insured.
a. The Contractor shall guide each client to following websites:
https://www.colorado.gov/pacific/hcpf/how-to-apply and
http://connectforhealthco.com/resources/person-help/, incorporated and made part
of this contract by reference.
b. The Contractor shall ask all TB clients about current health insurance enrollment
status, including Medicaid and offer resource materials no later than the last
business day of each month.
c. The Contractor shall document that all TB clients were asked about current
health insurance enrollment and offered materials no later than the last
business day of each month.
Standards and
Requirements
1. The Contractor shall complete the appropriate treatment as stated in the CDPHE TB
Manual. The CDPHE TB Manual is available on the State of Colorado website
https://www.colorado.gov/pacific/cdphe/colorado-tb-manual and is incorporated and
made part of this Contract by reference.
2. CDPHE shall provide templates and instructions for any additional information requests.
Report forms are subject to revision and the Contractor agrees to use the most recent
version.
3. The Contractor shall increase the percentage of persons that complete LTBI treatment to
meet the state objective of 84% by June 30, 2019 and maintain or improve on that rate
thereafter.
4. The Contractor shall develop reports of suspected or confirmed active TB disease results,
and include the following information:
a. reason for initiating
b. patient name
c. date of birth
d. country of birth
e. date arrived in U.S.
f. demographic information
g. locating information
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December 2015
Page 3 of 6
EXHIBIT B
h. provider information
i. TB risk factors
j. results of diagnostic testing
k. results of mycobacteriology including susceptibility results
I. dates of infectious period
m. treatment information
n. changes in patients' status
o. diagnosis
p. any other information as appropriate.
5. For those persons identified with LTBI or active TB, the Contractor shall report to
CDPHE:
a. patient name
b. date of birth
c. country of birth
d. date arrived in the U.S.
e. demographic information
f. locating information
g. provider information
h. TB risk factors
i. results of diagnostic testing
j. treatment information
k. any other information deemed appropriate by the Contractor.
6. The Contractor shall complete tests including the following:
a. smears for acid -fast bacilli, (using concentrated fluorescent method)
b. isolation of mycobacteria (using rapid methods)
c. identification of Mycobacterium tuberculosis complex (MTB) (using rapid
methods)
d. susceptibility testing (isoniazid, rifampin, ethambutol, and pyrazinamide) on
isolates of MTB.
7. The CDPHE TB Program will notify the Contractor of all newly arrived Class B TB
immigrants/refugees via a CDC 75.17 form which is incorporated herein by this
reference, or Follow-up worksheet which is incorporated herein by this reference, made a
part of this Contract, and available on the following website:
https://www.colorado.gov/pacific/cdphe/tb-btb-arrivals
8. The Contractor shall record 95% of all HIV testing result rates among suspect and
confirmed cases of active TB disease, and enter that information into the CDPHE TBdb.
a. The Contractor shall record 95% of all HIV testing result rates among suspect and
confirmed cases of active TB disease into the CDPHE TBdb no later than the day
before TB treatment begins, and no later than the end date of this Contract.
9. The Contractor shall record 80% of all HIV antibody testing result rates for LBTI patients
into the CDPHE TBdb.
a. The Contractor shall record 80% of all HIV antibody testing result rates for LBTI
patients into the CDPHE TBdb no later than the end date of this Contract.
10. The Contractor shall provide culturally appropriate patient education and information
pertaining to TB treatment and the follow-up plan.
11. The Contractor shall provide services in patient's preferred language using medical
interpretation resource
12. The Contractor shall report to CDPHE via (CDPHE TBdb) or via Tuberculosis
Surveillance and Case Management Report (TB 17) when a TB patient completes
treatment, moves, or transfers out of the Contractor's service area.
a. The Contractor shall complete 100% of all TB -17 and RVCT CDPHE TBdb
fields no later than the last business day of each month, and by the end date of this
contract.
13. The Contractor shall discuss current health insurance enrollment and offered materials
with the client for the purposes of becoming insured if not currently insured.
a. The Contractor shall ask all TB clients about current health insurance enrollment
including Medicaid, and offer resource materials no later than the last business
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December 2015
Page 4 of 6
EXHIBIT B
day of each month.
14. The Contractor shall provide or arrange for treatment and ensure completion of therapy.
15. The Contractor shall provide a final report via email or CDPHE TBdb to the TB
Program's Data Coordinator when a contact investigation is completed.
16. The Contractor shall provide all other necessary laboratory testing and medical
evaluation services to identify TB.
17. The Contractor shall report all known HIV antibody test results to CDPHE.
18. The Contractor shall report information via web -based TB case/contact management
system (CDPHE TBdb) or via "Tuberculosis Surveillance and Case Management
Report" (TB 18), which is incorporated herein by this reference, made a part of this
Contract and is available at the following link: TB -18.
19. For confirmed cases of TB, the Contractor shall include all data elements identified in
the "Report of Verified Case of Tuberculosis (RVCT)", which is incorporated herein by
this reference, made a part of this Contract and is available at the following link:
RVCT and is incorporated and made
part of this contract by reference.
20. The Contractor shall use the CDPHE Laboratory for testing.
21. The CDPHE Laboratory will, at no charge to the Contractor, supply specimen containers
and perform the above testing for the Contractor.
22. The Contractor shall order TB medications through the CDPHE TB Program.
23. The Contractor shall provide CDPHE with the medical insurance information for those
patients who have medical insurance.
24. The Contractor shall provide consultation services, as needed, to providers in its
service area regarding TB reporting, screening, treatment, and follow-up.
25. The Contractor shall comply with TB specimen shipping guidelines. See TB Sputum
Collection Kit and Shipping Instructions
https://drive.google.com/file/d/0B0tmPO67k3NVRXRPLVIVY1ZScEE/view which is
incorporated and made part of this Contract by reference.
26. The Contractor shall provide printed resource, referral and Medicaid and Connect for
Health Colorado enrollment materials for clients with Limited English Proficiency
(LEP).
a. Contractors that routinely offer enrollment services on -site are exempt from this
requirement because the services provided go beyond this minimum requirement.
27. The Contractor shall use LEP, Over -the -Phone Interpretation (OPI) to communicate
with clients.
a. The Contractor shall provide a monthly reimbursement DOT/Diagnostic
invoice according to the following criteria:
i. The monthly DOT/Diagnostic invoice must be provided
with supporting documentation confirming use is TB -related.
ii. The Contractor shall request monthly DOT/Diagnostic reimbursement no
later than the last business day of each month.
28. The Contractor shall complete the Semi -Annual Progress Report per the following
criteria:
a. The Semi -Annual Progress Reports must cover July -December and January -
June.
b. The Contractor shall complete the Semi -Annual Progress Report using the
following website:
https://drive.google.com/file/d/0B0tmPO67k3NVbk8xemFPN3Fp WU0/view
which is incorporated and made part of this Contract by reference.
29. The Contractor shall use information on enrollment resources, referral locations, LEP and
outreach and promotional materials is available at
https://coloradopeak.secure.force.com/CPCLA which is incorporated and made a part of
this Contract by reference.
30. The content of electronic documents located on CDPI-IE and non-CDPHE websites and
information contained on CDPHE and non-CDPHE websites may be updated periodically
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for Services or Services with Goods
December 2015
Page 5 of 6
EXHIBIT B
during the Contract term. The Contractor shall monitor documents and website
content for updates and comply with all updates.
I. New TB cases shall be diagnosed, documented and treated.
2. Patients with existing or newly diagnosed TB or LTBI shall be treated, as appropriate.
3. Newly arrived refugees, asylees and other eligible individuals with Class B TB
designation receive treatment.
4. In order to facilitate and improve client access and enrollment in health insurance,
CDPHE is asking all state contractors and sub -recipients who contract with the
Expected Results of the
department for direct patient care clinical service programs to provide Colorado Medicaid
Activity
and Connect for Health Colorado information to clients presenting for services at their
agencies. At a minimum, CDPHE Contractors must offer clients printed resource and
referral materials that direct them to the nearest community Medicaid and Connect for
Health Colorado enrollment location(s), including online enrollment options. These
materials must be available for clients with limited English proficiency (LEP). To help
locate the nearest enrollment locations in the community, the following
available: https://www.colorado.gov/pacific/hcpf/how-to-apply
websites are
http://connectforhealthco.com/resources/person-help/, and are incorporated
and made part
of this Contract by reference.
Measurement of Expected
1. Data contained in the CDPHE TBdb.
Results
2. Data in Semi -Annual progress report.
3. Data in final progress report.
i4 e: x rI% ��'' :✓f'L_�,`ij y/Gf
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Completion Date
Deliverables
1. The Contractor shall submit the Semi -Annual Progress Report
No later than
covering July -December and January -June to the CDPHE Contract
1/31/2019 and
Monitor.
6/30/2019
V. Monitoring:
CDPHE's monitoring of the Contract for compliance with performance requirements will be conducted
throughout the Contract period by the CDPHE Contract Monitor. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include monthly reports and invoices
and other fiscal and programmatic documentation as applicable. 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 time line for completion will be documented in writing and agreed to by both parties. If extenuating
circumstances arise that requires an extension to the time line, the Contractor must email a request to the CDPHE
Contract Monitor and receive approval for a new due date. The State will oversee the
completion/implementation of the action(s) to ensure time lines 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 Terms and Conditions of this Contract.
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for Services or Services with Goods
December 2015
Page 6 of 6
EXHIBIT C
Budget
To Original Contract Routing Number: 19 FHHA 109285
Weld County Health Department
Description
Funding Source
Amount
Tuberculosis Control and
Prevention
State
Federal
(for TB Outreach Activities)
$ 45,000.00
$ 7,500.00
DOT & Diagnostic
Blanket Funds
As Administered
Total
$ 52,500.00
PAGE 1 OF I
Exhibit D
OPTION LETTER
Date:
: tatcc tikcaf 1 ear.
Option Letter No.
Original
Contract CMS#
Option Letter CMS
Routing #
CORE
Encumbrance
#
DELETE alI BLUE text, CUSTOMIZE Red text and CHANGE Red text to Black after customization.
1) OPTIONS: Choose all applicable options listed below
a. Option to extend for a renewal or additional term
b. Option to change amount of goods
c. Option to change amount of services
d. Option to change contract rates
e. Option to initiate next phase of contract
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options a: In accordance with Section(s) enter Section the Original Contract referenced above between the State of
Colorado, Colorado Department of Public Health and Environment, and enter Contractor's name the State hereby exercises its option
for an additional term beginning insert start date and ending on insert end date at the rates stated in the Original Contract, as
amended.
b. For use with Option b and c. In accordance with Section(s) enter Section of the Original Contract routing number referenced
above, between the State of Colorado, Colorado Department of Public Health and Environment, and enter Contractor's name die
State hereby exercises its option to Increase/Decrease the quantity of Goods/Services or both at the same cost/price as specified in
enter Exhibit/Attachment name.
c. For use with Option d. In accordance with Section(s) enter Section of the Original Contract routing number referenced above, the
State hereby exercise its option to modify the Contract rates specified in Exhibit/Section number. The Contract rates attached to this
Option letter in enter Exhibit/Attachment name replace the rates in the original Contract as of the Option Effective Date of this
Option Letter.
d. For use with Option e: In accordance with Section(s) enter Section of the Original Contract routing number referenced above, the
State hereby exercise its option to initiate Phase indicate which Phase: 2, 3, 4 etc. which shall begin on insert start date and ending on
insert end date at the cost/price specified in Section enter Section the Original Contract referenced above.
e. For use with Options a, b, c that modify the contract value: The amount of the current Fiscal Year contract value is
increased/decreased by $ enter amount of change to a new contract value of insert new $ amount as consideration for services/goods
ordered under the contract for the current fiscal year Indicate Fiscal Year. The Contract is hereby modified accordingly. The amended
total contract financial obligation including all previous amendments, option letters, etc. is insert new $ amount.
3) Effective Date: The effective date of this Option Letter is upon approval of the State Controller if exact date is required complete the
following enter date, and include the following: whichever is later.
Department
John
Hickenlooper,
OF
Health
COLORADO
GOVERNOR
and Environment
By:
PROGRAM
APPROVAL:
STATE
W.
of
Public
By:
Lisa
McGovern,
Date:
Purchasing
& Contracts
Section
Director
Date:
CRS §24-30-202
bs the
performing
requires
State Controller
prior thereto,
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
or
If
signed and dated
Contractor
for any goods
begins
and/or
below
the State Controller to approve all State
or delegate. Contractor is not authorized
the State of Colorado is not obligated
services provided
Contracts.
to begin
to pay Contractor
hereunder.
This Contract
performance
for
such
is not
until
performance
valid
such
until
time.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
Page 1 of 1
Exhibit E
GRANT
A FUNDING CHANGE LETTER
Date:1
► Change
CMS Routing •
TO: <Insert Grantee's name>
In accordance with Section of the Original Contract routing number , [insert the following language here if
previous amendment(s), renewal(s) have been processed] as amended by [include all previous amendment(s), renewal(s) and
their routing numbers], [insert the following words here if previous amendment(s), renewal(s) have been processed] between the State
of Colorado, DepartmentofPublicHealthand Environmentand <insert contractorbeginning
start date of original contract> and ending on <insert ending date of current contract amendment>, the undersigned commits
the ffil lowing funds to the Grant:
The amount of(federal,state, other) grant available and p' • Of<insertiflevious
1
contract modification number and routing number> is increased or decreased by
amount of change tonew total
funds for the period <date to date> Of $ <insert new period cumulative total> for the following reason:
Section - -bmodified accordingly. The revised Budget • p• . -• herein by this reference . •
identified as Revised Exhibit *. (if budget attached; delete sentence if no budget included.)
Complete the table below: insert/delete rows as needed.
The table below reflects the original budget Original
• .
SUMMARY
,
CHANGES
CMS
Routing
•
(federal,
Funding
Source
state, other)
Period
Dollar
Amount
Period
Document
I.
Original
C•
•
1 1
1
1
1
1
1
/
1
1
Contract
Cumulative
Grand
Total
This Grant Funding Change Letter does not constitute an order for services under this Grant.
The effective date of hereof is upon approval of the State Controller or <insert projected effective date>,
whichever is later.
STATE OF COLORADO
John W. Hickenlooper,• •
Department of Public Health and Environment
McGovern
Colorado Department of Public Health and
PROGRAM
• ,• APPROVAL
Environment
INSERT -Name of AuthorizedIndividual
Purchasing and ContractingSectionDirector, /PIIE INSERT -Official Titleof Authorized Individual
Date
Date
In acconclance with §24-30-202 C.R.S., this Contract is not valid until signed and dated below by the State Controller or an authorized
delegate.
-
STATE CONTROLLER
Robert Jaros, CPA,
: • JD
Name of Agency Delegate -Please delete if contract will be routed to OSC for approval.
Effective Date:
Exhibit E Grant Funding Change Lettet-iclocx ver 03.1.18 Page 1 al
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