HomeMy WebLinkAbout20170723.tiffRESOLUTION
RE: APPROVE TASK ORDER AMENDMENT #1 FOR WOMEN'S WELLNESS
CONNECTION CLINICAL SERVICES 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 Women's
Wellness Connection Clinical Services 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 upon full execution of signatures and ending February 28, 2018,
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 Women's Wellness Connection Clinical
Services 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 amendment.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 13th day of March, A.D., 2017.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO,
ATTEST: datifet) jele.0•e4
Weld County Clerk to the Board
BY:
eputy Clerk to the Board
APP':►VED TO F
County Attorney
arbara Kirkmey
Oil 1mi
Date of signature: LA131.41
CC: HLCST/ (191W)
(4/(9/(7
Ju ie . Cozad, Chair
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Steve Moreno, Pro- em
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2017-0723
HL0049
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Memorandum
TO: Julie A. Cozad, Chair
Board of County Commissioners
FROM: Mark E. Wallace, MD, MPH
Executive Director
Department of Public Health & Environment
DATE: March 3, 2017
SUBJECT: Women's' Wellness Connection Clinical
Services Contract Extension & Additional
Funding
For the Board's approval is a Task Order Amendment #1 between 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) clinical services contract.
The WWC program provides low-income, uninsured and underserved women capable of
demonstrating lawful presence in Colorado access to timely, high quality screening and
diagnostic services to detect breast and/or cervical cancer at the earliest stages.
This amendment will extend the original term of the contract by six months, with the period of
clinical services delivery ending December 31, 2017, and administrative servicing of the contract
(aka the "project period") ending February 28, 2018. The purpose of this contract extension is to
provide CDPHE additional time between the end of the current multi -year federal funding period
(ending June 29, 2017) and December 31, 2017, to competitively re -apply for the multi -year CDC
federal funds that support the WWC program. No new FTE will be required to support the
contract extension period.
In addition, funding will increase under the current term of the contract by $17,000.00, all of
which is federal funding.
This contract amendment was approved from placement on the Board's agenda via pass -around
dated February 23, 2017. I recommend approval of this Task Order Amendment #1 with the
CDPHE.
2017-0723
+/Loo`/9
DEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
FHLA - HSCB
DEPARTMENT OR AGENCY NUMBER
FAAA
TASK ORDER AMENDMENT ROUTING NUMBER
17-96116
To Original Task Order Routing Number
13-54772
TASK ORDER AMENDMENT #1
This Task Order Amendment is made this 29th day of January, 2017, 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) 915 10`t' Street, Greeley, Colorado 80632-0758, for the use and benefit of the Weld County
Department of Public Health and Environment, whose address or principal place of business is 1555 North 171n
Avenue, Greeley, Colorado 80631, hereinafter referred to as the "Contractor".
FACTUAL RECITALS
The parties entered into a Master Contract dated January 17, 2012, with contract routing number 13 FAA 00051.
Pursuant to the terms and conditions of the Master Contract the parties entered into a Task Order Contract dated
March 29, 2013, with encumbrance number CT FHLA2015000000000562, and task order contract routing number
13 FLA 54772, hereafter referred to as the "Original Task Order Contract", whereby the Contractor was to
provide to the State the following:
Perform work for the Women's Wellness Connection (W WC) Program Service Delivery Initiative to
conduct breast and cervical cancer screenings for eligible women.
The State promises to increase the amount of funds to be paid to the Contractor by Seventeen Thousand Dollars
($17,000,00) during the current term of the Original Task Order Contract in exchange for the promise of the
Contractor to perform the increased work under the Original Task Order Contract.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree
as follows:
1. Consideration for this Task Order Amendment to the Original Task Order Contract consists of the
payments and services that shall be made pursuant to this Task Order Amendment, and promises and
agreements herein set forth.
2. It is expressly agreed to by the parties that this Task Order Amendment is supplemental to the Original
Task Order Contract, contract routing number 13 FLA 54772, as amended by Grant Funding Change
Letter 1 routing number 14 FLA 66091, Grant Funding Change Letter 2 routing number 15 FHLA 72419,
Grant Funding Change Letter 3 routing number 15 FHLA 75724, Grant Funding Change Letter 4 routing
number 15 FHLA 79647, Grant Funding Change Letter 5 routing umber 16 FHLA 87416, Grant Funding
Change Letter 6 routing number 16 FHLA 90767, and Grant Funding Change Letter 7 routing number 16
FHLA 91631, 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 Task Order Amendment as though they were expressly rewritten, incorporated, and
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17F1 -11,A96 116_AM D I. docx
020/ 7.-• .0 7O2 36)
included herein.
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 Contractor Representative in the Original Contract, contract routing number 13 FLA 54772,
dated March 29, 2013, is hereby changed from Dave Rademacher to Tanya Geiser.
B. The period of performance of the current term is hereby extended by six (6) months, changing
the current ending date from August 31, 2017 to February 28, 2018. The revised period of
performance is June 30, 2013 through and including February 28, 2018.
a. The following information shall be added as a supplement to page 1 of the Task Order
Contract:
i. Contractor DUNS: 075757955
C. This Task Order Amendment is issued pursuant to paragraph 5 of the Original Task Order
Contract. This Task Order Amendment is for the current term of June 30, 2013, through and
including February 28, 2018. This Task Order Amendment modifies the Additional Provisions
in Exhibit A, the specifications of the original Statement of Work in Exhibit B and the period
of performance on Page One of the Original Task Order Contract.
The revised Additional Provisions, and specifications to the original Statement of Work, are
incorporated herein by this reference and identified as "Revised Exhibit A" and "Revised
Exhibit B."
D. This Task Order Amendment is issued pursuant to paragraph 5 of the Original Task Order
Contract. This Task Order Amendment is for the current term of June 30, 2013, through and
including February 28, 2018. The maximum amount payable by the State for the work to be
performed by the Contractor during this current term is increased by Seventeen Thousand
Dollars ($17,000,00) for an amended financial obligation of the State for the current term of
Sixty Three Thousand Dollars ($63,000.00) and for an amended total contract financial
obligation of the State of One Hundred Ninety Five Thousand Eight Hundred Thirty Five
Dollars ($195,835.00).
Of the increased amount for the current term Seventeen Thousand Dollars ($17,000.00) are
attributable to a funding source of the State of Colorado and Zero Dollars, ($0.00) are attributable
to a funding source of the United States Government.
Of the amended total financial obligation of the State referenced above Seventy Eight
Thousand Four Hundred Fifty Nine Dollars and Fifty Four Cents ($78,459.54) are
attributable to a funding source of the State of Colorado and One Hundred Seventeen Thousand
Three Hundred Seventy Five Dollars and Forty Six Cents ($117,375.46) are attributable to a
funding source of the United States Government. (see Catalog of Federal Domestic Assistance
(CFDA) number 93.752).
The revised specifications to the original Budget, if any, are incorporated herein by this reference
and identified as "Exhibit C".
F Changes were required to modify Exhibit A, Additional Provisions and Exhibit B, Statement of
Work in the Original Task Order Contract, add Exhibit C, Budget, and to extend the period of
performance within the current term of the Original Task Order Contract.
1. Due to the extent of the revisions the Additional Provisions, Exhibit A, and Statement of
Work, Exhibit B, are hereby replaced in their entirety with Additional Provisions, Revised
Exhibit A and Statement of Work, Revised Exhibit B.
Page 2of5
17FHLA96116_AMD I .docx
2. The following exhibits are hereby added:
a. Exhibit C, Budget.
b. Exhibit D, Option Letter.
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
4. The Effective Date of this Task Order Amendment is February 19, 2017, 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 Task
Order Amendment and any of the terms and provisions of the Original Task Order Contract, the terms and
provisions of this Task Order 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 Task Order 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 3 of 5
17FHLA961 I6_AMD 1.docx
IN WITNESS WHEREOF, the parties hereto have executed this Task Order Amendment on the day first above
written.
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
BOARD OF COUNTY COMMISSIONERS
OF WELD COUNTY
(a political subdivision of the state of Colorado)
for the use and benefit of the
Weld County Department of Public Health and
Environment
;di; 0 •./
Signature of Authori i 0 cer
MAR 13.'
Date
Julie A. Cozad
Print Name of Authorized Officer
Chair
Print Title of Authorized Officer
By:
By:
STATE:
STATE OF COLORADO
John W. Hickenlooper, Governor
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
PROGRAM APPROVAL:
ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER
CRS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and
dated below by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If
Contractor begins performing prior thereto, the State of Colorado is not obligated to pay Contractor for such
performance or for any goods and/or services provided hereunder.
By:
Date:
17 FHLA96116_AMD 1. docx
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
C�ZC
z312S/r .7 --
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Page 5 of 5
I7FI ILA96l 16_AMDl .docx
REVISED EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 03/29/2013 CMS Task Order Routing Number 17 FHLA 96116
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 state and federal funds (see Catalog of Federal Domestic Assistance
(CFDA) number 93.752).
2. The United States Department of Health and Human Services ("USDHHS"), through the Centers for
Disease Control and Prevention ("CDC") has awarded as of 06/06/2016 anticipated federal funds of
$3,428,415.00 under Notice of Cooperative Agreement Award, hereinafter "NCAA", number
5 NU58DP003868-05-00, to perform the following — CANCER PREVENTION & CONTROL
PROGRAM FOR THE COLORADO DEPT OF HEALTH & ENVIRONMENT
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 for screening services under this Task Order Contract, the Contractor shall
provide Women's Wellness Connection Clinical Services approved breast and cervical cancer screening
services to eligible women during the term of this Task Order Contract. The Contractor shall also provide
approved diagnostic services to women who meet the criteria in accordance with this Statement of Work.
The Contractor shall be paid for approved screening and diagnostic services in accordance with rates as
outlined in the WWC Clinical Services Bundled Payment System.
Data entered into eCaST is the basis for calculating reimbursement for each client screened. To be
considered for payment, all Women's Wellness Connection services must be entered into eCaST within
thirty (30) days of service being performed. Breast and cervical cancer screening cases that exceed sixty
(60) calendar days in screening length and negatively affect the program's Core Performance Indicators
may or may not be reimbursed at the discretion of the State. Contractors shall only be paid for cases that
meet eligibility, performance and data requirements. Reimbursement is determined by the outcome of the
case; therefore, cases must be clinically complete or administratively closed before reimbursement occurs.
The Contractor shall be paid in accordance with rates as outlined in the WWC Clinical Services Bundled
Payment System. This document is incorporated and made part of this Task Order Contract by reference
and is available on the following WWC website under "Billing and Reimbursement" at
https://www.colorado.gov/cdphe/wwc-provider-resources. Rates may be revised or updated during the
period this statement of work is in effect. Detailed reimbursement policies can be found in the WWC
Toolkit in the "Agency Reimbursement" section on the following WWC website:
https://www.colorado.gov/cdphe/wwc-toolkit, incorporated and made part of the Task Order Contract by
reference.
The Contractor may be reimbursed for the purchase of allowable supplies/operating, and travel listed in the
Women's Wellness Connection Clinical Services Allowable Purchases document. To receive
Page 1 of 3
(:ontract_Reviscd I,:xhibit-A_;kdditionalProvisjons—'1'ask()rdcr_040715
REVISED EXHIBIT A
compensation for non-eCaST purchases under the Task Order 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 Task Order 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 the WWC Section
Manager via email at cdphe_wwc@state.co.us.
Final billings under the Task Order Contract must be received by the State within a reasonable time after
the expiration or termination of the Task Order Contract; but in any event no later than forty-five (45)
calendar days from the effective expiration or termination date of the Task Order Contract.
Unless otherwise provided for in the Task Order 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.
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: I ) 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 Contractor shall request prior approval in writing from the Women's Wellness Connection Section
Manager for any modifications to the eCaST budget line item.
Page 2 of 3
Contract_ Revised I xhibit-A_j dditionalProvisions_'1'ask()rde_040715
REVISED EXHIBIT A
9. The 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 of supplies/operating and travel 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 5, Contract Modifications, of this Task Order Contract.
10. Contractor agrees to provide services to all Program participants and employees in a smoke -free
environment in accordance with Public Law 103-227, also known as "the Pro -Children Act of 1994", (Act).
Public Law 103-227 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 eighteen
(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.
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.
12. 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.
13. Contractor shall not use State funds provided under this Task Order Contract for the purpose of lobbying as
defined in Colorado Revised Statutes (C.R. S.) 24-6-301(3.5)(a).
14. Option to Increase or Decrease Quantities and Total Price
The State may increase or decrease the quantity of goods/services described in Revised Exhibit B based
upon the rates established in the Task Order Contract. If the State exercises the option, it will provide
written notice to Contractor as least 1 day prior to the end of the current Task Order Contract term in a form
substantially equivalent to Exhibit D. Delivery/performance of the goods/service shall continue at the same
rates and terms. If exercised, the provisions of the Option Letter shall become part of and be incorporated
into the original Contract.
Page 3 of 3
Contract_Itevised I.:xhibit-:\_AdditionalProvisjons_'I'ask()rder 040715
REVISED EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 13 FLA 54772
Contract Amendment #1 Routing Number 17 FHLA 96116
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified
above.
I. Project Description:
Program Overview: Women's Wellness Connection (WWC) provides breast and cervical cancer
screening (clinical breast exams, mammograms, pelvic examinations, and Pap tests) to eligible women
through multiple statewide providers.
Program Purpose and Mission: The purpose and mission of the Women's Wellness Connection (WWC)
is to provide, promote and ensure quality breast and cervical cancer screenings for underserved women in
Colorado and to connect them to resources.
Beneficiaries: Direct beneficiaries are women residing in Colorado who are uninsured or underinsured;
and who meet age, income and lawful presence requirements of the program. Target populations include
women of diverse ethnic backgrounds, women living in geographically isolated and medically underserved
areas, those who are rarely or never screened for breast and/or cervical cancer.
Project Period: Date of fully executed contract — June 30, 2013 through February 28, 2018.
Period for Clinical Service Delivery: Date of fully executed contract — June 30, 2013 through June 29,
annually through 2017. For the final year, June 30, 2017 through December 31, 2017. For
each annual Period for Clinical Service Delivery, cases not clinically complete by June 29 shall not be paid.
For the final year, cases not clinically complete by December 31, 2017 shall not be paid.
Budget: The budget amount for the Clinical Service Delivery shall be determined on an annual basis and
this contract shall be increased or decreased in accordance with the Additional Provisions.
For non-eCaST purchases, the Contractor shall comply with allowable purchases of supplies/operating and
travel listed in the Women's Wellness Connection Clinical Services Allowable Purchases document. This
information is located on the website https://www.colorado.gov/cdphe/wwc-provider-resources and is
incorporated and made part of this Contract by reference.
Should the Contractor purchase gift cards or vouchers, the Contractor shall provide to CDPHE upon
request the Contractor's written procedures related to gift card and voucher purchase and handling. At a
minimum, the procedures must include the following:
a) How the gift card or voucher inventory is tracked and maintained.
b) Gift card or voucher storage and safeguards against theft.
c) The primary person responsible for securing and distribution of gift cards or vouchers.
d) A gift card or voucher distribution log that records each gift card or voucher number, dollar
amount, and the printed name and signature of each gift card or voucher recipient.
e) Gift cards shall be distributed before the end of the contract term.
II. Work Plan:
1. Performance Requirements/Deliverables:
The content of electronic documents located on CDPHE and non-CDPHE websites and
information contained on CDPHE and non-CDPHE websites may be updated periodically during
the contract term. The Contractor shall monitor documents and website content for updates and
comply with all updates.
version: Contract Statement of Work — Exhibit R
December 2015
Page 1 of 5
REVISED EXHIBIT B
A. Administration:
a. Contractor contact information shall be provided to WWC within fifteen (15) calendar
days of the start of the fully executed contract. The Contractor shall use the "WWC
Contacts Update Form" located under the "Other" heading on the website
https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated and made
part of this Contract by reference.
1. The Contractor must identify and support a WWC Coordinator, Clinical Liaison,
eCaST Coordinator, Agency Director, Contract Administrator, Signature Authority,
Fiscal Payment Coordinator, Fiscal Manager, and Case Manager(s). The Contractor
shall comply with the requirements stated in the "WWC Contacts Descriptions"
document, which is located under the "Other" heading on the website
https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated and
made part of this Contract by reference.
2. The Contractor shall complete the "New Contractor Checklist" form which will be
provided by WWC within fifteen (15) calendar days of the start of the fully
executed contract.
b. All staff changes during the contract period shall be reported to WWC within fifteen (15)
calendar days. The Contractor shall use the "WWC Contacts Update Form" or another
form provided by WWC.
c. Contractor shall enter data into the eCaST data system.
1. CDPHE will provide training on the eCaST system to the Contractor, unless
otherwise approved by the program.
i. New data entry staff must be trained by WWC on eCaST within thirty (30)
calendar days of hire, unless otherwise approved by the program.
2. Any changes to Contractor staff responsible for WWC data entry must be reported
to the WWC program within fifteen (15) calendar days.
3. The Contractor shall renew eCaST users annually. The Contractor shall use the
"WWC Contacts Update Form" or another form provided by WWC, and shall be
submitted to WWC staff.
4. It is expected that if a Contractor enrolls a client in WWC and provides initial
cancer screening services, the same Contractor shall be responsible for entering all
data in eCaST and assuring that clinically appropriate follow-up care is completed
through case management services.
5. Clients eligible for WWC may be enrolled in the program at any point in their
screening or diagnostic cancer screening care prior to biopsy. Clients should be
enrolled and noted as "referred in for diagnostics" in eCaST if they are enrolled in
the WWC program for diagnostic services only.
d. When corresponding with the WWC Staff, Contractors must use all privacy and security
measures to protect the client's personal health information.
1. Accepted forms of communication include:
i. WWC identification number used in unencrypted email conversations;
ii. Mail or fax clearly marked "Confidential";
iii. H1PAA compliant files transmitted via secure File Transfer Protocol (FTP)
sites; and
iv. Secure encrypted email.
2. l f a Contractor intends to use data from eCaST for publications, conference
presentations, and/or research projects, the Contractor must notify and receive prior
approval from the WWC Program.
e. At least one representative from the Contractor and/or its network provider sites shall
attend meetings or conference calls hosted by WWC staff Contractors can make up
attendance by reviewing meeting minutes or a recorded version at a later time.
version: Contract Statement of Work — Exhibit B
December 2015
Page 2of5
REVISED EXHIBIT B
1. The Contractor will attend WWC sponsored conference calls, meetings and
trainings, including:
i. 50% of WWC monthly Health Improvement Team (HIT) calls;
ii. 50% of bimonthly eCaST Users Group Conference Calls;
iii. 100% of WWC clinical webinars; and
iv. Other meetings and trainings as needed.
f. The Contractor receives a contracted funding amount that they can use to provide
services under the WWC program for the annual Period for Clinical Service Delivery.
Once this funding cap has been reached, the WWC program will not pay for any
additional expenses incurred by the Contractor.
1. Contractors are responsible for management of funds including:
i. Ensuring that all funds are fully spent by the end of the contract period;
ii. Reviewing eCaST reports monthly (after the 15th of the month) to determine
spending status;
iii. Ensuring enough funds remains at the end of the contract year to pay for a
woman in need of Health First Colorado BCCP.
iv. Making programmatic changes as needed to adjust spend rate.
g.
2. Contractors who are under spent in their budgets may have funds taken back and
reallocated to other Contractors at any time during the contract period.
Changes to basic eligibility requirements of the program may not be made by the
Contractor without WWC approval including:
I Age requirements;
2. Income requirements;
3. Insurance status; and
4. Legal presence requirements.
B. Provision of Clinical Services:
a. The Contractor shall perform basic breast and cervical cancer screening services on -site
at the contractor's place of business. Basic screening services include clinical breast
exams, pelvic exams and Pap tests.
b. The Contractor shall provide screening services to women and have entered qualifying
procedures into eCaST no later than July 29th, annually and for the final year, January
30th.
c. The Contractor shall provide all services referenced on the "Current Procedural
Technology (CPT) Code List" directly or through a subcontractor agreement. The
Contractor shall not charge WWC for services not listed on the CPT Code List. This form
is located under the "Screening and Diagnostic Services" heading of the WWC website,
located at https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated
and made part of this Contract by reference.
d. Contractors shall ensure all steps involved in the breast and cervical screening and
diagnostic process can be performed within 60 calendar days of the first abnormal
finding.
1. For services that cannot be provided on -site, the Contractor must maintain a
network of subcontractors. Contractors shall complete and forward a
"Subcontractor Form" within 15 calendar days of the fully executed contract to
WWC Data Specialist. This form is located at the following WWC website
https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated and
made part of this Contract by reference.
2. All subcontractor changes during the contract period shall be reported to WWC
within fifteen (15) calendar days of occurrence using the "Subcontractor Form"
version: Contract Statement of Work — Exhibit B
December 2015
Page3of5
REVISED EXHIBIT B
above or another form provided by WWC.
3. Subcontracts must be secured with local providers to the extent possible. Women
should not be required to travel more than 60 miles for any service unless a highly
specialized service (breast surgery, stereotactic biopsy, etc.) is required and is not
available at any facility in that radius. Any subcontracts for services beyond 60
miles must receive WWC staff approval.
4. Services performed by subcontractors shall:
i. Be performed in an outpatient setting to the extent possible.
ii. Not exceed the Medicare reimbursement rate as established in the annual
CPT Code List. Rates in the CPT Code List included as part of this scope
of work shall be the rates that Contractors use through the entire annual
Period for Clinical Service Delivery.
iii. Only perform and charge the Contractor for procedures in the CPT Code
List.
iv. Not be charged to WWC eligible women unless services are performed
that are not on the CPT Code List. Women may be charged for services
outside the CPT Code List, but should be notified before services are
performed and be told how much the services will cost.
v. If services outside of the CPT Code List are required, arrangements for
completing and paying for services should be specified in the
subcontractor agreement.
vi. Be agreed upon in writing through the use of a signed contract which
includes the period of service.
e. The Contractor shall comply with the requirements stated in the WWC Provider Toolkit.
This document is located on the following WWC website
https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated and made
part of this Contract by reference.
f. The Contractor shall comply with requirements stated in a) the most current American
Society for Colposcopy and Cervical Pathology (ASCCP) consensus guidelines for
cervical cancer screening services, b) the California Department of Health Services
Breast Cancer Diagnosis Algorithms for breast cancer screening services and c) the
WWC Tobacco Use Assessment Policy. All three documents are available on the
following WWC website https://www.colorado.gov/cdphe/wwc-provider-resources and
are incorporated and made part of this Contract by reference.
g.
The Contractor shall comply with the requirements of case management stated in the
WWC Provider Toolkit. Clinical aspects of case management shall be provided by a
Registered Nurse, Physician Assistant or Physician in good standing to provide
healthcare in the state of Colorado.
h. The Contractor shall comply with the requirements of enrollment of eligible women with
a Breast and Cervical Cancer Program (BCCP) eligible diagnosis into Breast and
Cervical Cancer Program Medicaid. The "BCCP Enrollment Step List" is available on
the following WWC website https://www.colorado.gov/cdphe/wwc-provider-resources
and is incorporated and made part of this Contract by reference.
C. Enrollment:
a. The Contractor shall comply with the WWC Program Eligibility Criteria in the WWC
Provider Toolkit.
1. The Contractor shall:
i. Comply with Lawful Presence Requirements according to Colorado
Department of Revenue guidelines. This information is located on the
following Department of Revenue website
https://www.colorado.gov/pacific/dmv/identification-requirement-charts and
version: Contract Statement of Work — Exhibit B
December 2015
Page 4 of 5
REVISED EXHIBIT B
is incorporated and made part of this Contract by reference.
ii. Shall annually obtain a signed lawful presence affidavit. The Contractor shall
keep a copy in the patient's medical record before services are rendered.
This form is located at the following WWC website
https://www.colorado.gov/cdphe/wwc-provider-resources and is incorporated
and made part of this Contract by reference, and
iii. Shall check the "Verified Legal Presence" box in the electronic record in
eCaST.
2. The Contractor shall complete the WWC Consent Form. This form is available at the
following website at: https://www.colorado.gov/cdphe/wwc-provider-resources and
is incorporated and made part of this Contract by reference.
3. CDPHE contractors shall 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.
4. Printed resource and referral materials for Medicaid and Connect for Health
Colorado enrollment shall be available for clients with Limited English Proficiency
(LEP). Contractors that routinely offer enrollment services on -site are exempt from
this requirement because the services provided go beyond this minimum
requirement.
5. Information on enrollment resources, referral locations, LEP and outreach and
promotional materials is available at https://www.colorado.gov/cdphe/wwc-provider-
resources and is incorporated and made a part of this contract by reference.
D. Clientele Data
a. 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.
III. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the WWC Section Manager. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include progress reports 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.
IV. Resolution of Non -Compliance:
The Contractor will be notified in writing within fifteen (15) calendar days of discovery of a compliance
issue. Within thirty (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 WWC Section Manager 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 Remedies section of the General Provisions of
this contract.
version: Contract Statement of Work — Exhibit R
December 2015
Page 5of5
Exhibit C Budget
COLORADO
Department of Public
Health & Environment
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
Contract Routing # 17 FHLA 96116
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
upon execution of amendment - 6/29/2017
Project Name
WWC Clinical Services
Program Contact Name, Title, Phone and Email
Keri Dennison, Program Coordinator, (970)400-2315,
kdennison@co.weld.co.us
Fiscal Contact Name, Title, Phone and Email
Tanya Geiser, Fiscal Manager, (970)304-6410 x2122,
tgeiser@co.weld.co.us
Contract/Encumbrance Number
CT-FHLA2015*562
Expenditure Categories
Budget Totals
Personal Services
Salaried Employees
Original Contract
Budget
Current Revised
Budget
Modification to
Budget in
AmendmentiGFCU
Option Letter
Total Amount
Requested from
CDPHE
Position Title
Description of Work and Justification for Revision
Personal Services
Hourly Employees
Original Contract
Budget
Current Revised
Budget
Modification to
Budget in
AmendmentIGFCL/
Option Letter
Total Amount
Requested from
CDPHE
Position Title
Description of Work and Justification for Revision
Total Personal Services
(including fringe benefits)
$0.00
$0.00
$0.00
$0.00
Supplies & Operating Expenses
Pp p g
Original Contract
Budget
Current Revised
Budget
Modification to
Budget In
Amendment/GFCU
Option Lotter
Total Amount
Requested from
CDPHE
Item
Description of Item and Justification for Revision
Clinical Services
Billed in eCaST
$46,000.00
$46,000.00
Operating/supplies
Allowable purchase of supplies/operating listed on the WWC Clinical Services allowable purchase
document on the WWC website: https://www.colorado.gov/cdphe/wwc-provider-resources
$14,500.00
$14,500.00
Total Supplies
& Operating Expenses
$46000.00
$0.00
$14,500.00
$60,500.00
Travel
Original Contract
Budget
Current Revised
Budget
Modification to
Budget in
Amendment/GFCU
Option Letter
Total Amount
Requested from
CDPHE
Item
Description of Item and Justification for Revision
Travel Costs
Allowable purchase of travel costs listed on the WWC Clinical Services allowable purchase
documert on the WWC website: https://www.colorado.gov/cdphe/wwc-provider-resources
$2,500.00
$2,500.00
Total Travel
$0.00
$0.00
$2,500.00
$2,500.00
Page 1 of 2
Revised -November 2013
Exhibit C Budget
PREVENTION SERVICES DIVISION- BUDGET JUSTIFICATION FORM
Contract Routing # 17 FHLA 96116
Contractor Name
Weld County Department of Public Health and
Environment
Budget Period
upon execution of amendment - 6/29/2017
Project Name
WWC Clinical Services
Program Contact Name, Title, Phone and Email
Keri Dennison, Program Coordinator, (970)400-2315,
kdennison@co.weld.co.us
Fiscal Contact Name, Title, Phone and Email
Tanya Geiser, Fiscal Manager, (970)304-6410 x2122,
tgeiser@co.weld.co.us
Contract/Encumbrance Number
CT-FHLA2015'562
!r
Contractual (payments to third parties or entities)
Original Contract
Budget
Current Revised
Budget
Modification toiilli
Budget In
AmendmentlGFCu
Option Letter
Total Amount
Requested from
CDPHE
Item
Subcontractor Entity Name and/or Description of Item
Total Contractual
$0.00
$0.00
So.00
$0.00
SUB -TOTAL BEFORE INDIRECT
$46,000.00
$0.00
$17,000.00
$63,000.00
Indirect
Original Contract
Budget
Current Revised
Budget
Modification to
Budget in
Arnendment/GFQJ
Option Letter
Total Amount
Requested from
CDPHE
Item
Description of Item
Federal Negotiated Indirect cost
rate
$0.00
CDPHE Negotiated Indirect Cost
Rate
50.00
De minimis Indirect Cost Rate
$0.00
Total Indirect
$0.00
So.0o
$0.0o
$0.00
TOTAL
$46,000.00
$0.00
$17,000.00
$63,000.00
_
Page 2 of 2
Revised -November 2013
EXHIBIT D
a
OPTION LETTER
Date:
State Fiscal Year:
Option Letter No.
CMS Routing #
CORE Encumbrance #
1) OPTIONS: Choose all applicable options listed in §1 and in §2 and delete the rest.
a. Option to renew only (for an additional term)
b. Change in the amount of goods within current term
c. Change in amount of goods in conjunction with renewal for additional term
d. Level of service change within current term
e. Level of service change in conjunction with renewal for additional term
f. Option to initiate next phase of a contract
2) REQUIRED PROVISIONS. All Option Letters shall contain the appropriate provisions set forth below:
a. For use with Options 1(a -e): In accordance with Section(s) of the Original Contract routing number
between the State of Colorado, Insert Name of Department or Higher Ed Institution , and Contractor's
Name, the State hereby exercises its option for an additional term beginning Insert start date and ending on
Insert ending date at a cost/price specified in Section , AND/OR an increase/decrease in the amount of
goods/services at the same rate(s) as specified in Identify the Section, Schedule, Attachment, Exhibit etc.
b. For use with Option 1(f), please use the following: In accordance with Section(s) of the Original
Contract routing number between the State of Colorado, Insert Name of Department or Higher Ed
Institution , and Contractor's Name, the State hereby exercises its option to initiate Phase indicate which
Phase: 2, 3, 4, etc for the term beginning Insert start date and ending on Insert ending date at the cost/price
specified in Section
c. For use with all Options 1(a -f): The amount of the current Fiscal Year contract value is
increased/decreased by $ amount of change to a new contract value of Insert New $ Amt to as consideration
for services/goods ordered under the contract for the current fiscal year indicate Fiscal Year. The first
sentence in Section is hereby modified accordingly. The total contract value including all previous
amendments, option letters, etc. is Insert New $ Amt.
3) Effective Date. The effective date of this Option Letter is upon approval of the State Controller or
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment
By: Lisa McGovern, Purchasing & Contracts Section
Director
Date:
PROGRAM APPROVAL:
By:
ALL CONTRACTS REQUIRE APPROVAL BY THE STATE CONTROLLER
('RS §24-30-202 requires the State Controller to approve all State Contracts. This Contract is not valid until signed and dated below
by the State Controller or delegate. Contractor is not authorized to begin performance until such time. If Contractor begins
performing prior thereto, the State of Colorado is not obligated to pay Contractor for such performance or for any goods and/or
services provided hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
Contract_OptionLetter_101915
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