HomeMy WebLinkAbout20150639.tiff RESOLUTION
RE: APPROVE TASK ORDER CONTRACT FOR WISEWOMAN PROGRAM UNDER THE
WOMEN'S WELLNESS CONNECTION 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
WISEWOMAN (Well-Integrated Screening and Evaluation for WOMan Across the Nation)
Program under the Women's Wellness Connection 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 upon execution of signature, and ending August 31,
2017, 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 WISEWOMAN (Well-Integrated Screening
and Evaluation for WOMan Across the Nation) Program under the Women's Wellness
Connection 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 9th day of March, A.D., 2015.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COL RADO
ATTEST: Ly(y/ !.C ;okárkmeebt
Weld County Clerk to the Board
re,E17_, —
1 Mike Freeman, Pro-Tem
BY: i. — _.
Deputy CI;'rk to the -.•t% i t. /j� C> -
r �'- , Sean P. Conway /, }
.. y •--4--, - /
APPROVEDR 6i v0
r�� ,
A Julie A. Cozad
County Attorney • • �/ .
• Steve Moreno
Date of signature: ‘,/d-105-
at;1 16t) 'Ws 2015-0639
HL0047
Memorandum
TO: Barbara Kirkmeyer, Chair
l N T Board of County Commissioners
G_O u z
FROM: Mark E. Wallace, MD, MPH, Executive Director
Department of Public Health & Environment
DATE: March 5, 2015
SUBJECT: New WISEWOMAN Task Order Contract with
CDPHE
Enclosed for Board review and approval is a contract between the Colorado Department of
Public Health and Environment and the Board of County Commissioners of Weld County on
behalf of the Weld County Department of Public Health and Environment.
The WISEWOMAN program is a new program falling under our Women's Wellness Connection
(WWC) program. The purpose and mission of the Well-Integrated Screening and Evaluation for
WOMen Across the Nation (WISEWOMAN) program is to provide WWC participants with
access to additional preventive health services including cardiovascular health screenings,
health risk assessments, risk reduction counseling, diabetes prevention case management
services, referrals for women with abnormal screening values to health care providers for
medical evaluation and management of condition(s), follow-up for uncontrolled hypertension,
linking participants to free or low-cost medication resources, and referrals to health coaching,
approved lifestyle programs and other healthy behavior support options to improve control of
hypertension and other cardiovascular disease risk factors. Direct beneficiaries of the
WISEWOMAN program are women residing in Colorado who are uninsured or underinsured
and are enrolled in the WWC program and who meet the age, income and lawful presence
requirements of both programs. Target populations include women of diverse ethnic
backgrounds, women living in geographically isolated and medically underserved areas and
women who have a high burden of cardiovascular disease.
The entire term of this Task Order Contract is from March 1, 2015, through August 31, 2017.
The initial period for clinical service delivery is March 1, 2015, through June 30, 2015. This
contract may be renewed upon mutual agreement of the parties for two more consecutive one-
year terms beginning July 1, 2015. The amount of the task order contract for the first fiscal
period is $9,145, all of which is federal funds.
Assistant Weld County Attorney, Frank Haug, has reviewed this contract and determined that
its terms are acceptable.
This contract was approved for placement on the agenda by the Board via pass-around dated
February 26, 2015.
2015-0639 0)
I recommend approval of this New WISEWOMAN Task Order Contract with CDPHE.
DEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 15 Fl ILA 77061
APPROVED TASK ORDER CONTRACT - WAIVER #154
This task order contract is issued pursuant to master contract made on 01/17/2012,with routing number 13 FAA 00051.
STATE: CONTRACTOR:
State of Colorado for the use&benefit of the Board of County Commissioners of Weld County for the use
Department of Public Health and Environment and benefit of the Weld County Department of Public Health
Women's Wellness Connection and Environment
4300 Cherry Creek Drive South 1555 North 17th Avenue
Denver,CO 80246 Greeley,CO 80631
CONTRACTOR DUNS. 075757955
CONTRACTOR ENTITY TYPE:
Political Subdivision Colorado
TASK ORDER MADE DATE:2/12/2015
BILLING STATEMENTS RECEIVED.
CORE ENCUMBRANCE NUMBER. Monthly eCaST
CT FHLA2015000000000757
TERM: STATUTORY AUTHORITY:Not Applicable
This Task Order shall be effective upon approval by
the State Controller,or designee,or on 03/01/2015, CLASSIFICATION-Contractor
whichever is later.The contract shall end on 08/31/2017. N
CONTRACT PRICE NOT TO EXCEED$9,145.00
PROCUREMENT METHOD.
Sole Source FEDERAL FUNDING DOLLARS. $9,145.00
RID/RFPJUIST PRICE AGREEMENT NUMBER. STATE FUNDING DOLLARS. $0.00
N/A MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR.
LAW SPECIFIED VENDOR STATUTE FY15: $9,145.00
N/A
ST:A I'E RLPRESFNTA❑VR.
Emily Kinsella, MSPH Section Manager
Colorado Department of Public Health and
Environment, WWC, WiWo PRICESTRLCn:RL Cost Reimbursement
4300 Cherry Creek Drive South CONTRACTOR REPRESENTATIVE:
Denver, CO 80246 Tanya Geiser-Administrative Services Director
Weld County Department of Public Health
1555 North 17th Avenue
Greeley, CO 80631
PROJECT DESCRIPTION:
Provide cardiovascular screenings,risk reduction counseling,referrals,lifestyle programs and other healthy behavior support options to
improve control of hypertension and other cardiovascular disease risk factors to women residing in Colorado who are uninsured or underinsured
and are enrolled in the Women's Wellness Connection program who meet the share age,income and lawful presence requirements
Contract lemplate_task Order 012215.doc Page 1 of 6
020/5- 0639 (�)
EXHIBITS.
The following exhibits are hereby incorporated:
Exhibit A - Additional Provisions(and any of its Attachments; e.g., A-1, A-2, etc.)
Exhibit B - Statement of Work (and any of its Attachments; e.g., B-l. B-2, etc.)
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.
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(51 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(I),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-[ask 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
Contract reinplate Task Order 012215 doe Page 2 of 6
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
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/•ffectire
Date is on or afier Judy 1. 2009 and the maximum amount payable to Contractor hereunder is S100,000 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
Contract_Template_Task Order 012215 doe Page 3 of 6
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-I05-102(6)),or(ii) under CRS §24-I05-102(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.
Contract_Template_Task_Order_012215.doe Page 4 of 6
THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
*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: STATE OF COLORADO:
JOHN W.HICKENLOOPER,GOVERNOR
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 of Colorado)
I egal Name of Contracting Entity
Barbara Kirkmeyer For I.xecutive Director
Print Name of Apthorized Officer Department of Public Health and Environment
Signature of ofAuthori
zed( leer
MAR 0 9 2015
Date
Department Program Approval:
Chair By: ( _�
Print Tide of Authori/ed Officer
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.
STATE CONTROLLER:
Robert Jaros 'PA,MBA,JD
By: A
Date 3/2(0l I 6
Contract_Template_task Order 012215.doc Page 5 of 6
ozo�5 ,o6—39s(?)1(a)
WISEWOMAN Program
ATTEST: O4 v 0(A BOARD OF COUNTY COMMISSIONERS
Weld u t Clerk to th Boar WELD COUNTY, COLORADO
BY:
Deputy CI k to the B - .6 Barbara Kirkmeyer, Chair MAR o 9 2015
t861
APPROVED AS TO FU • APPROVED AS TO SUBSTANCE:
y�
Contro er Elected Official or Department Head
APPROV ! AS TO FORM:
Director of General Services
Coup
a2.o/5- 06,3c!C�/
This page left intentionally blank.
Contract l emplate_I ask_Order U 122 I5 doe Page 6 of 6
EXHIBIT A
ADDITIONAL PROVISIONS
To Task Order Contract Dated 02/12/2015
CMS Task Order Routing Number 15 FHLA 77061
These provisions arc to be read and interpreted in conjunction with the provisions of the'task Order Contract specified
above.
This Task Order Contract contains federal funds(see Catalog of Federal Domestic Assistance(CFDA)
number 93.094).
2. The United States Department of Health and Human Services("US HHS"),through the Centers for Disease
Control and Prevention("CDC") has awarded as of 12/15/2014 anticipated federal funds of 5955,158.00
under Notice of Cooperative Agreement Award, hereinafter"NCAA", number 5L58DP004850-02
Revised,to perform the following Well Integrated Screening and Evaluation for Women across the
Nation(WISEWOMAN).
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 this Purchase Order,the Contractor shall provide Well Integrated Screening
and Evaluation for Women Across the Nation(WISEWOMAN)cardiovascular screening services to
women enrolled in Women's Wellness Connection (WWC)at its agency during the term of this Purchase
Order.The Contractor shall also provide WISEWOMAN approved follow-up and referral services to
women who meet the criteria in accordance with the Statement of Work.The Contractor shall be paid in
accordance with rates as outlined in this Purchase Order.
In order to be considered for payment, all WISEWOMAN services must be entered into the eCaST data
system within thirty(30)days of service being performed. Contractors shall only be paid for cases that
meet eligibility, performance and data requirements. Reimbursement is determined by specific outcomes of
each case. Reimbursement will occur according to the WISEWOMAN Bundled Payment System. This
document is incorporated and made part of this Purchase Order by reference and is available on the
following WWC website under"Screening and Diagnostic Services"
http://www.colorado.gov/cs/Satellite/CDPHE-PSD/CBON/1251617581963. Rates may be revised or
updated during the period this statement of work is in effect. Cases are not reimbursable if the data is not
entered completely or accurately into the eCaST data system. Cases closed in eCaST as"Lost to Follow-
Up"or"Refused"will be paid at the highest level achieved as long as evidence of contact attempts is
documented in the case management module of eCaST. The WISEWOMAN program will only pay one
Contractor for services provided for each woman,each fiscal year. If two Contractors provide
WISEWOMAN services to a client, the Contractor with which the client initiates her services will receive
reimbursement. The WISEWOMAN program will provide reimbursement for a client's completed
cardiovascular screening, laboratory test and risk reduction counseling as specified by the WISEWOMAN
program.Additional reimbursement will be provided as each client completes additional healthy behavior
support options classes,as outlined in the Bundled Payment System. The completion of health coaching.
Diabetes Prevention Program(DPP)and other approved Lifestyle Program(LSP)classes determines
Page 1 of4
Contraa_b:xhibit-.A Additlonall'rnv,sions I ask( rdcr_01?Oli
EXHIBIT A
additional payments to be made,once the data entered in eCaST meets the benchmark requirements for
each subsequent level.
Within the Bundled Payment System,Contractors are reimbursed for patient navigation/case management
services depending on the outcome or complexity of the case. In order to receive reimbursement for case
management services,Contractors must do the following:
a. Assess and refer eligible women who indicate a readiness to change,to health coaching,the
Diabetes Prevention Program(DPP)or another approved Lifestyle Program;
b. Use WISEWOMAN approved algorithms to determine next steps;
c. Assess clients for barriers to completing recommended health coaching sessions or Diabetes
Prevention Program classes;
d. Ensure intensive follow-up and reinforcement of goals for women that participate in DPP or other
LSPs:and
e. Follow-up with women within four weeks after program completion(this may be completed
directly by the Contractor or by the subcontractor). The Contractor shall comply with the"Lost to
Follow Up/Refused Service Policy"for clients who discontinue services.This policy is included
in the WISEWOMAN Manual.This document is incorporated and made part of this Purchase
Order by reference and is available on the following WISEWOMAN website
https://www.colorado.gov/pacific/cdphe/wisewoman-provider-resources
It is expected that reimbursement will cover:
a. Costs associated with enrollment of women into the WISEWOMAN Program and cardiovascular
screening services,as outlined in the WISEWOMAN Manual.This document is incorporated and
made part of this Purchase Order by reference and is available on the WISEWOMAN website at
https://www.colorado.gov/pacific/cdphe/wisewoman-provider-resources
f. Patient navigation and case management services;
g. Entry of all information into eCaST:and
h. Administrative procedures to ensure access to affordable medication for women who require it.
Data entered into eCaST are the basis for calculating reimbursement for each client screened.One
reimbursement check for all completed screenings and health coaching,Diabetes Prevention Program or
other Lifestyle Program sessions that have met data and quality standards will be sent to the Contractor
each month. WISEWOMAN will generate Contractor grant activity statements based on data entered into
eCaST each month on the I5' or next business day thereafter,except the first month of the fiscal year.
WISEWOMAN will only provide reimbursement for cases that are complete and correctly entered into
eCaST between June 30 and June 29 each year. Contractors are given a data entry grace period from June
30 through July 30,annually, in order to enter data for the previous service year.. WWC will generate a
final grant activity statement for the previous fiscal year the first business day in August and will
implement grant funding change letters in August to ensure all WWC funding is spent by August 31,
annually.
Unless otherwise provided for in the Purchase Order,"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 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.
Page 2 of 4
Contracr_I izhibir-.A_.lddinun.ilPnn i:ions_I ask()rder_01 2015
EXHIBIT A
b. Notice of Defect. lithe 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: 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 Task Order Contract does not constitute a Business Associate
relationship under HIPAA.
6. Notwithstanding the terms contained in General Provisions,Section 8,Insurance-Contractor,of this
Task Order Contract,the parties agree to add the following language to the end of Paragraph 8:
j. The Contractor agrees to maintain in full force and effect a Professional Liability Insurance Policy in
the minimum amount of$1,000,000 per occurrence and$1,000,000 in the aggregate, written on an
occurrence form that provides coverage for its work undertaken pursuant to this Task Order Contract.
If a policy written on an occurrence form is not commercially available,the claims-made policy shall
remain in effect for the duration of this Task Order Contract and for at least two(2)years beyond the
completion and acceptance of the work under this Task Order Contract,or,alternatively,a two(2)year
extended reporting period must be purchased.
7. 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 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. The law also applies to children's services that are provided in
indoor facilities that are constructed,operated,or maintained with such Federal funds. The law does not
apply to children's services provided in private residences: portions of facilities used for inpatient drug or
alcohol treatment; service providers whose sole source of applicable Federal funds is Medicare or
Medicaid: or facilities where Women, Infants and Children(WIC)coupons are redeemed. Failure to
comply with the provision of Public Law 103-227 may result in the imposition of a civil monetary penalty
of up to$1.000 for each violation and/or the imposition of an administrative compliance order on the
responsible entity. By signing this Task Order Contract,Contractor certifies that Contractor shall comply
with the requirements of the Act and shall not allow smoking within any portion of any indoor facility used
for the provision of services for children as defined by the Act.
8. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding
Letter substantially equivalent to Attachment.-1. 'Ike Grant Funding Change Letter is not valid until it
has been approved by the State Controller or designee.
9. Option to Extend Term
Page 3 of 4
Contract lixhibir-.A_Additiomil Provisions I ask()rdcr_01 2013
EXHIBIT A
The State may require continued performance for a period of up to four(4)years at the same rates and
same terms specified in the Task Order Contract.If the State exercises the option, it will provide written
notice to Contractor at least thirty(30)days prior to the end or the current Task Order Contract term in a
form substantially equivalent to Attachment A-2. If exercised,the provisions of the Option Letter shall
become part of and be incorporated into the original Task Order Contract.The total duration of this Task
Order Contract, including the exercise of any options under this clause, shall not exceed 5 years. (Note: 5
years is maximum allowable).
Page 4 of 4
(inttract_Iixl,ibit-.A_Addinona]Provisions_I,iskOrdrr_01 2015
Attachment A-I
GRANT FUNDING CHANGE LETTER
Date: State Fiscal Year: Grant Funding Change Letter# CMS Routing #
TO: >Insert Grantee's name< [including entity type: not-for-profit, political subdivision, etc. The name and entity type
should exactly duplicate the original contract or modification that changed the name.]
In accordance with Section of Exhibit A, Additional Provisions >Choose an item<, 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 word here if previous
amendment(s), renewal(s) have been processed] between the State of Colorado, Department of Public Health
and Environment and <Contractor's Name> beginning <Insert start date of original contract> and ending
on <Insert ending date>, the undersigned commits the following funds to the Grant:
The amount of [state/federalifoundation/tax rebate] grant funds available and specified in >Choose an
item< of <insert contract amendment number and routing number> is by $<amount of change for
this source>[insert semi-colon and repeat the previous text{starting from "the"}for each type of funds being modified;
ensure that the correct fund type(federal, state,etc.)is inserted each time.] to new total funds for the period
through of$<total new amount for the period> for the following reason:
The change results in a new cumulative grant total of funds available under this agreement of$
[include contract life-time total amount].
The revised budget is incorporated herein by reference and identified as [for example, insert as
'Revised Exhibit C"].
>Choose an item< is hereby modified accordingly.
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 , whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR
Department of Public Health and Environment PROGRAM APPROVAL:
By: Lisa McGovern, Purchasing & Contracts Unit By:
Director
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS§2J-30-202 requires the State Controller to approve all State Grants.This Grant is not valid until signed and dated below by
the State Controller or delegate.Grantee is not authorized to begin performance until such time. If Grantee begins performing prior
thereto,the State of'Colorado is not obligated to pay Grantee for such performance or for any goods and/or services prosided
hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
0 Grant_Funding_Change_Letter_OSC_082509 Page 1 )f 1
Attachment A-2
OPTION LETTER
Date: State Fiscal Year: Option Letter No. CMS Routing#
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 PROGRAM APPROVAL:
Department of Public Health and Environment
By:
By: Lisa McGovern, Purchasing & Contracts Unit Director
Date:
ALL CONTRACTS REQUIRE APPROVAL 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
sen ices provided hereunder.
STATE CONTROLLER
Robert Jaros, CPA, MBA, JD
By:
Date:
[option_Letter_O5O_082509 Page 1 f 1
EXHIBIT B
STATEMENT OF WORK
To Task Order Contract Dated 02/12/2015
CMS Task Order Routing Number 15 FHLA 77061
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
Entity Name: Weld County Department of Public Health and Environment
Term: March I,2015-August 31,2017
Period for Clinical Service Delivery: March 1,2015 through June 30,2015 the first year,then July I,
2015 through June 30,annually through June 30,2017.
II. Project Description:
This project serves to provide Women's Wellness Connection(WWC)participants with access to
additional preventive health services through the Well-Integrated Screening and Evaluation for WOMen
Across the Nation(WISEWOMAN) program.These medical services include cardiovascular health
screening; health risk assessments; risk reduction counseling; referrals for women with abnormal screening
values to health care providers for medical evaluation and management of condition(s): follow-up for
uncontrolled hypertension; linking participants to free or low-cost medication resources; and referrals to
health coaching,approved lifestyle programs and other healthy behavior support options.
Program Purpose and Mission:
The purpose and mission of the WISEWOMAN program is to provide cardiovascular screenings, risk
reduction counseling,referrals, health coaching, lifestyle programs and other healthy behavior support
options to improve control of hypertension and other cardiovascular disease risk factors.
Beneficiaries:
Direct beneficiaries are women residing in Colorado who are uninsured or underinsured;and are enrolled in
the WWC program and who meet the age, income and lawful presence requirements of both programs.
Target populations include women of diverse ethnic backgrounds, women living in geographically isolated
and medically underserved areas and women who have a high burden of cardiovascular disease.
III. Definitions:
I. Case Management-Case management services are provided to WISEWOMAN clients who have
initial abnormal or"alert"screening values for blood pressure or glucose or who have uncontrolled
hypertension. All women with alert values must receive these services to ensure access to the
indicated medical care.
2. CDC: Centers for Disease Control and Prevention
3. DPP: Diabetes Prevention Program
4. eCaST: Colorado Department of Public Health and Environment's (CDPI IF) Electronic Cancer
Surveillance"[racking data system
5. WISEWOMAN: Well-Integrated Screening and Evaluation for WOMen Across the Nation
6. WISEWOMAN Program: Ran by the Colorado Department of Public Ilealth and Environment.
Prevention Services Division, WWC.
7. WWC: Women's Wellness Connection. The local name in Colorado for the National Breast and
Cervical Cancer Early Detection Program
Page I of 6
Cuntrnet_I:ehibir 15_111-2015
EXHIBIT B
IV. Performance(Work Plan and Requirements):
Goal#1: Reduce the rate of cardiovascular disease risk in program eligible women in Colorado
Objective#1: No later than the expiration date of the Contract.women that meet WISE WOMAN eligibility
criteria are provided with cardiovascular screening services.
Primary Activity#1 The Contractor shall perform cardiovascular screening services onsite at the
Contractor's place of business.
1. The Contractor shall provide medical evaluation and treatment to
WISEWOMAN clients with alert lab values.
Sub-Activities#1 2. The Contractor shall provide case management to WISEWOMAN clients with
abnormal screening values.
3. The Contractor shall provide referrals to medical care for WISEWOMAN
clients with abnormal screening values.
The Contractor shall provide face-to face risk reduction counseling onsite, at the
Primary Activity#2 Contractor's place of business,at the time of their screening visit.
Objective#2: No later than the expiration date of the Contract, women that meet WISE WOMAN eligibility
criteria are offered healthy behavior support options.
The Contractor shall offer WISEWOMAN clients paid-for referrals to the Diabetes
Primary Activity#1 Prevention Program(DPP)or to another comparable CDPHE approved lifestyle
program,either onsite or at another DPP site.
The Contractor shall offer WISEWOMAN clients paid-for referrals to health
Primary Activity#2
coaching services either onsite or to a CDPHE approved subcontracted entity that
provides health coaching.
The Contractor shall offer WISEWOMAN clients not-paid-for other referrals to other
Primary Activity#3 healthy behavior support options such as other community based resources that
support the woman's health goals
Objective#3: No later than July 30,annually, WISEWOMAN data is entered into the eCaST data system.
Primary Activity#1 The Contractor shall record WISEWOMAN qualifying procedures into the eCaST
data system on a monthly basis.
Objective#4: No later than the expiration date of the Contract, participate in the Baseline Screening Assessment
and Clinic Quality Improvement project.
The Contractor shall participate in the Baseline Screening Assessment and Clinic
Primary Activity#1
Quality Improvement project by CDPHE related to breast, cervical. colorectal cancer
and cardiovascular screening rates.
The Contractor shall participate in collection of baseline cardiovascular and cancer
Sub-Activities#1 screening data from Contractor's electronic health record.
Standards and I. The content of electronic documents located on CDPIIE and non-CDPHE
Requirements websites and information contained on CDPHE and non-CDPI IF websites may
be updated periodically during the Contract term. The Contractor shall monitor
documents and website content for updates and comply with all updates.
2. The Contractor shall comply with the Id7SEH Oil..IS Program Eligibility Criteria
in the WISEWOMAN Colorado Program Manual, found in the WISEWOMAN
Provider Resources page on the WISEWOMAN website. This document is
incorporated and made part of the Contract by reference and is available on the
following website:
https://www.colorado.gov/pacific/sites/defaultifiles/HPFW W_WISEWOMAN-
Manual.pdf.
Page 2 of 6
Contract':xhibir-B_UI 21115
EXHIBIT B
3. The Contractor shall comply with the lawful presence requirements for W'W'C.
a. Comply with /.awful Presence Requirements according to Colorado
Department of Revenue guidelines.This information is incorporated and
made part of this Contract by reference as is available at the following
Department of Revenue website:
https://www.colorado.gov/pacific/dmv/identification-requirement-charts
b. 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 incorporated and made part of this Contract by reference and is
available at the W WC website on the Women's Wellness Connection
Provider Resources page:
https://www.colorado.gov/pacific/cdphe/wwc-provider-resources; and
c. Attest by checking the Verified Legal Presence box in the electronic record in
eCaST.
4. The Contractor shall complete the WW(' W SEll'OSbI X Combined Consent.
Patient Information and Risk Reduction Counseling and Referral forms.These
forms are incorporated and made part of this Statement of Work by reference and
are available in the WISEWOMAN Provider Resources page on the
WISEWOMAN website.
Standards and
Requirements 5. The Contractor shall perform cardiovascular screening services in accordance
with the W/SEII"O.N.IX Service Delivery flow Diagram and clinical and program
guidelines in the WISEWOMAN Colorado Program Manual.
6. The Contractor shall use as a guideline the published alert values, disease values,
flow chart, clinical guidelines and risk reduction counseling as described in the
WISEWOMAN Colorado Program Manual.
7. The Contractor shall provide face-to-face risk reduction counseling in
accordance with the Il'/SEIf'OM X Service Delivery Flow Diagram and the
WISEWOMAN Colorado Program Manual.
8. The Contractor shall provide all women, with alert lab values, medical
evaluation and treatment immediately or within seven(7)days of the alert
measurement, in accordance with national standards of care and the judgment of
the Contractor's Medical Director.
9. The Contractor shall provide all women, with alert level blood pressure or
laboratory alert values, referrals for medical evaluation and management of
condition(s) if not currently being treated.
10. The Contractor shall provide all women, with uncontrolled hypertension, case
management and other appropriate follow-up.
I I. The Contractor shall follow the guidelines and comply with the requirements for
case management of WISEWOMAN clients stated in the WISEWOMAN
Colorado Program Manual.
a. Clinical aspects of case management shall be overseen by a Registered Nurse,
Physician Assistant or Physician licensed and in good standing to provide
healthcare in the state of Colorado.
b. Case management shall begin from the first abnormal result through referral to
additional medical follow-up or evaluation.
Page 3 ot6
G nrract_I:xhibir tio I 2013
EXHIBIT B
12. The Contractor shall have a Medical Director to develop and implement medical
protocols to cover situations not addressed by WISEWOMAN national
guidelines.
13. The Contractor shall refer all women to free or low-cost medication resources, if
needed.
14. The Contractor shall have an established referral process for abnormal findings.
15. The Contractor shall provide services referenced on the Current Procedural
Technology(Cl'!) Code List directly or through a subcontractor agreement and is
available in the WISEWOMAN Provider Resources page on the WISEWOMAN
website.
16. If the Contractor is a CDC recognized Diabetes Prevention Program(DPP)site,
or pending recognition.then DPP services may be provided by the Contractor.
17. For services that may not be provided onsite, including the DPP services,the
Contractor shall maintain a network of subcontractors. Contractor shall forward a
copy of the fully executed Memorandum of Understanding or other binding
contractual agreement to the WISEWOMAN Program within fifteen (15)
calendar days of execution.
a. Subcontracts shall be secured with local providers to the extent possible.
b. Services performed by subcontractors shall be agreed upon in writing through
Standards and the use of a binding contract which includes the period ofservice.
c. This agreement shall cover referral of eligible clients for services in
Requirements
accordance with WISEWOMAN guidelines in the WISEWOMAN Colorado
Program Manual; utilize approved reimbursement rates; obtain written
monthly feedback on client participation: access and barriers to participation;
and date and length of DPP classes/sessions.
18. The Contractor shall comply with requirements stated in the most current
national clinical,diet and lifestyle guidelines as outlined in the WISEWOMAN
Colorado Program Manual.
19. At least one(I) representative from the Contractor and/or its network provider
sites shall attend all required meetings,conference calls or training hosted by the
WISEWOMAN Program.This attendance can be achieved by participating at the
time of the event or by reviewing meeting minutes or a recorded version at a later
time.
20. It is expected that if a Contractor enrolls a client in WISEWOMAN and provides
initial cardiovascular 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 and healthy behavior
support options.
21. When corresponding with the WISEWOMAN Program, Contractor shall use all
privacy and security measures to protect the client's personal health information.
Accepted forms of communication include:
a. Unencrypted email conversations using the eCaST identification number;
b. Mail or fax clearly marked"Confidential"and using the eCaST identification
Page 4 of 6
(om-nu:r_I IxhibiPl3_(II-2015
EXHIBIT B
number:
c. HIPAA compliant files transmitted via secure File Transfer Protocol (FTP)
sites;and
d. Secure encrypted email.
22. Contractor shall enter the most recent WISEWOMAN client data into the eCaST
system by the 15 of each month in preparation for the monthly billing run.
23. The Contractor's new data entry staff shall participate in WISEWOMAN eCaST
training within thirty(30)calendar days of hire,unless otherwise approved by the
WISEWOMAN Program.
24.The Contractor shall identify and support key personnel assigned these roles: a
WISEWOMAN Coordinator,Clinical Liaison,eCaST Coordinator,eCaST data
entry staff, Agency Director.Contract Administrator, Signature Authority. Fiscal
Payment Coordinator,Fiscal Manager, Health Coach,and Case Manager(s).
25. The Contractor shall comply with the requirements stated in the Contacts
Descriptions document,which is available in the WISEWOMAN Provider
Resources page of the WISEWOMAN website.
26. The Contractor shall report all staff changes during the contract period to
WISEWOMAN Program within fifteen (15)calendar days. The Contractor shall
use the Agency and Site Contacts Form or another form provided by
WISEWOMAN Program via email to WISE WOMAN Program Coordinator.
27. The Contractor shall report all subcontractor changes during the contract period
to the WISEWOMAN Program within fifteen(15)calendar days of occurrence,
via email to WISEWOMAN Program Coordinator.
Expected Results of Clients'complete cardiovascular screenings.risk reduction counseling and referrals,
Activity(s) and get the treatment they need.
WISEWOMAN Program will analyze data from eCaST to include the number of
Measurement of women receiving cardiovascular screenings, risk reduction counseling,and referrals
Expected Results for DPP.
Completion Date
((then is the
deliverable due)
Pagc 5of6
(i mtract_l ixhibii-R_01 2015
EXHIBIT B
Deliverables I. The Contractor shall identify(an)eCaST user(s)responsible No later than
for WISEWOMAN data entry in eCaST and submit a list of March 16,2015
eCaST user(s)via email to WISEWOMAN Program the first year of
Coordinator. the Contract and
July 15th each
successive year
2. Contractor shall submit key personnel contact information
to WISEWOMAN Program within fifteen(15)calendar No later than
days of the start of the fully executed contract or start of fifteen(15)
term date,whichever is later,via email to WISEWOMAN calendar days of
Program Coordinator. change
V. Monitoring:
CDPHE's monitoring of this contract for compliance with performance requirements will be conducted
throughout the contract period by the WISEWOMAN Program Coordinator. Methods used will include a
review of documentation determined by CDPHE to be reflective of performance to include monthly check-
in calls, All Agencies Calls,eCaST data, site visits,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 30 calendar days of discovery of a compliance issue.
Within 45 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 Woman's Wellness Connection (W WC) and WISEWOMAN 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
provisions of this contract.
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Contracr_I:xhibi t-R_0 12203
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