HomeMy WebLinkAboutC09-161 09 FLA 00003~~-~~ 6 DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PSD - NHVP DEPARTMENT OR AGENCY NUMBER FLA CONTRACT ROUTING NUMBER 10-00003 CONTRACT AMENDMENT #1 THIS AMENDMENT, made this 17th day of April, 2, 009, by and between the State of Colorado for the use and benefit of 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 EAGLE COUNTY, whose address or principal place of business is 500 Broadway, Eagle, Colorado 81631, for the use and benefit of the EAGLE COUNTY PUBLIC HEALTH AGENCY formerly known as, EAGLE COUNTY HEALTH & HUMAN SERVICES, a political subdivision of the state of Colorado, whose address or principal place of business is 551 Broadway, Eagle, Colorado 81631, hereinafter referred to as "the Contractor". FACTUAL RECITALS Authority exists in the Law and Funds have been budgeted, appropriated, and otherwise made available and a sufficient unencumbered balance thereof remains available for payment; and Required approval, clearance, and coordination has been accomplished from and with all appropriate agencies; and The parties entered into a Master Contract, dated January 23, 2007, with contract routing number 08 FAA 00016. Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated April 21, 2008, with contract encumbrance number PO FLA FHS0900003, and contract routing number 09 00~, whereby the Contractor was to provide to the State the following: Contractor is to provide nurse home visitor services to low-income, first-time mothers in the state of Colorado. The purpose for this amendment is described below. To renew the contract for one year, to modify the Additional Provisions and the Statement of Work and to incorporate a new provision to the General Provisions of the Task Order Contract, concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract management system. NOW THEREFORE, it is hereby agreed that 1. Consideration for this amendment to the original task order contract, dated April 21, 2008 with contract routing number 09 FLA 00003 and contract encumbrance PO FLA FHS0900003, consists of the payments which shall be made pursuant to this amendment and the promises and agreements herein set forth. 2. It is expressly agreed to by the parties that this Amendment is supplemental to the original task order contract, contract routing number 09 FLA 00003, as amended by Grant Funding Change Letter # 2, Contract Routing Number 09 FLA 00935, collectively referred to herein as the Original Task Order Page 1 of 4 rev 4/3/09 -'Contract, which is by this reference incorporated herein. All terms, conditions, and provisions thereof, unless specifically modified herein, are to apply to this Amendment as though they were expressly rewritten, incorporated, and included herein. 3. !fit is agreed the original task order contract is and shall be modified, altered, and changed in the following ~~espects only: IA. This Amendment is issued pursuant to paragraph 1- of the Original Contract identified by contract routing number 08 FAA 00016, dated January 23, 2007. The Contractor's legal name in the original contract is hereby changed form EAGLE COUNTY HEALTH & HUMAN SERVICES to the Contractor's new legal name of EAGLE COUNTY PUBLIC HEALTH AGENCY. The Contractor's FEIN remains the same as it was under the original contract. The State desires to continue working with the Contractor under the new name and EAGLE COUNTY PUBLIC HEALTH AGENCY desires to continue working with the State. ',B. This Amendment is issued pursuant to paragraph 5. of the Original Task Order Contract identified by contract routing number 09 FLA 00003. This Amendment is for the renewal term of Jules 2_, through and including June 30, 2010. Exhibit A, Additional Provisions, of the Original Task Order Contract is hereby revised for the renewal term and incorporated herein by this reference and identifi ed as Exhibit F. C. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is Two Hundred Seventy-Eight Thousand, Eighty-Nine Dollars, $278 089.00 for an amended total financial obligation of the State of FIVE HUNDRED EIGHTEEN THOUSAND, ONE HUNDRED EIGHTY-ONE DOLLARS, ($518,181.00). This is an increase of Two Hundred Seventy-Eight Thousand, Eighty-Nine Dollars, $278 089.00 of the amount payable from the previous term. The revised specification to the original Statement of Work for this renewal term is incorporated herein by this reference and identified as Exhibit G. The revised Budget for this renewal term is incorporated herein by this reference and identified as Attachment G-1. The Original Task Order Contract is modified accordingly. D. The General Provisions of the Contract are hereby modified to incorporate the following language: ~' 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 Ruies, 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 b the s ecific re uirements of Y p q 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 addressor 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 !,i 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 Page 2 of 4 rev 4/3/09 debar Contractor and prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result by: (i) flung rebuttal statements, which may result in either removal or correction of the evaluation (CRS §24-105-102(6)), or (ii) under CRS §24-1 OS-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. 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 amendment is upon approval of the State Controller or July 1, 2009 whichever is later. 5. Except for the "Special Provisions", in the event of any conflict, inconsistency, variance, or contradiction between the provisions of this amendment and any of the provisions of the original contract, the provisions of this amendment shall in all respects supersede, govern, and control. The "Special Provisions" shall always be controlling over other provisions in the contract or amendments.. The representations in the Special Provisions concerning the absence of bribery or corrupt influences and personal interest of State 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 4 rev 413109 IN WITNESS WHEREOF, the arties hereto have executed this amendment on the da first above written. p Y * Perst~ns 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: BOAR>~ OF COUNTY COMMISSIONERS OF EAGL 'COUNTY for the use of benefit of EAGLE COUN Y PUBLIC HEALTH AGENCY (a politi, al subdivision of the state of Colorado) r ~ ; -w ''Signature of Authorized Officer )` A Print Name of Authorized Officer Print tle of Aut~or~z d Officer / i k/ ~ ~ ~~ STATE: STATE OF COLORADO Bill Ritter, Jr. Governor By: For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT Signatory avers to the State Controller or that Contractor has not begun performance or that a Statutory Violation waiver has been requested under Fiscal Rules PROGRAM APPROVAL: By: ALL CONTRACTS MUST BE APPROVED BY THE STATE CONTROLLER CRS §~4-30-202 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 perf rmance until such time. If Contractor begins performing prior thereto, the State of Colorado is not oblig ted to pay Contractor for such performance or for any goods and/or services provided hereunder. STATE CONTROLLER ~~I David J. McDermott, CPA B• y• ^Kevin Edwards ^Yvonne Anderson ^Robert Jaros ^Donald Rieck ~, Date: Page 4 of 4 rev 4/3/09 EXHIBIT F ADDITIONAL PROVISIONS To Task Order Contract Dated 04/17/09 -Contract Routing Number '10 FLA 00003 These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above. The revised Additional Provisions is effective July 1, .2009. 1. 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. 2. This Task Order Contract is governed by those rules that were adopted by the state of Colorado's Board of Health pursuant to section 25-31-104, C.R.S., as amended, incorporated herein by reference. 3. To receive compensation under this Task Order Contract, the Contractor shall submit a signed Monthly Contract Reimbursement Statement in a format acceptable to the State. A sample Contract Reimbursement Statement is attached hereto as Attachment F-1 and incorporated herein by this reference. A Contract Reimbursement Statement must be submitted within sixty (60) calendar days of the end of the billing period for which services were rendered.. Contract Reimbursement Statements must be accompanied by detailed cost ledger to reflect all purchases being invoiced under that contract and should include date of payment, payee name and amount,. and check or voucher number, when available. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit F. These items may include, but are not limited to, the Contractor's salaries, fringe benefits, supplies, travel, operating, indirect costs which are allowable, and other allocable expenses related to its performance under this Task Order Contract. Contract Reimbursement Statements shall: /)reference this Task Order Contract by its contract routing number, which number is located on page one of this Task Order Contract; 2) state the applicable performance dates; 3) state the names of payees; 4) include a brief description of the services performed during the relevant performance dates; and, 5) show the total requested payment. Payment during the initial, and any renewal or extension, term of this Task Order Contract shall be conditioned upon affirmation by the State that all services were rendered by the Contractor in accordance with the terms of this Task Order Contract. Contract Reimbursement Statements shall be sent to: Fiscal Offtcer Nurse Home Visiting Program (NHVP) Prevention Services Division Colorado Department of Public Health and Environment PSD - A4 4300 Cherry Creek Drive South Denver, CO 80246 To be considered for payment,, billings for payments pursuant to this Task Order Contract must be received within a reasonable time after the period for which payment is requested, but in no event no later than sixty (60) calendar days after the relevant performance period has passed. Final billings under this Task Order Contract must be received by the State within a reasonable time after the expiration or termination of this Task Order Contract; but in no event no later than sixty (60) calendar days from the effective expiration or termination date of this Task Order Contract. To be attached to CDPHE Page l of 3 Revised:l2/19/06 Task Order vl .0 (11105) contract template EXHIBIT F Unless otherwise provided for in this Task Order Contract, "Other Funding Sources", if any, shall be included on all billing statements as required by the 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. The Contractor is authorized to make limited transfers of funds from one line item in its Budget to another line item in its Budget but must notify the Nurse Home Visitor Program Director by email prior to the ,transfer. A transfer from one line item to another line item may not exceed ten percent (10%) or one 'thousand dollars ($1000), whichever is less, of the total amount of the line item from which the transfer is made unless prior written approval is received from the Nurse Home Visitor Program Director. If the Contractor desires to transfer more than ten percent (10%) from one line item in its budget to another line item in its budget then the Contractor shall request and receive prior written approval from the Nurse Home 'Visitor Program Director by completing and submitting a NHVP Budget Revision Reguest Form, attached hereto as Attachment F-2, before the transfer can be made. 5. The 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, the Contractor certifies that the 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. The Contractor agrees that it shall require that the language of the Act be included in any subcontracts which contain provisions for .children's services and that all contractors shall sign and agree accordingly. 6. 7. To be Task ~ 'The Contractor certifies, to the best of its knowledge and belief, that no federally appropriated funds have '~~ been paid or shall be paid by or on behalf of the Contractor, to any person for influencing or attempting to influence an officer or employee of any agency, a Member of Congress, an officer or employee of ~'~ Congress, or an employee of a Member of Congress in connection with the awarding of this Task Order 'Contract, and the extension, continuation, renewal, amendment, or modification of this Task Order Contract, or any grant, loan, or other cooperative agreement that utilizes Federal funds. If any funds other than federally appropriated funds have been paid or shall be paid to any person for influencing or ~~, attempting to influence an officer or employee of any agency, Member of Congress, an officer or employee !~ of Congress in, connection with this Task Order Contract, or any other grant, loan, or other cooperative ', agreement, then the Contractor shall complete and submit Standard Form - LLL, "Disclosure Form to ', Report Lobbying" in accordance with its instructions. The Contractor shall require that the language of this ~~ certification be included in the award documents for subawards at all tiers (including subcontracts, subgrants, and contracts under grants, loans, and cooperative agreements) and that all subrecipients shall ~I certify .and disclose accordingly. This certification is a material representation of fact upon which reliance was placed when this transaction was made or entered into. This certification is a prerequisite for making or entering into this transaction imposed by section 1352, title 31, U.S. Code. Any person who fails to file ;the required certification shall be subject to a civil penalty of not less than $10,000 and not more than ~'i $100,000 for each such failure. Notwithstanding anything herein to the contrary, the parties understand and agree that all terms and conditions of this Task Order Contract and the exhibits and attachments hereto which may require led to CDPHE Page 2 of 3 Revised:l2/19/06 v1.0 (11/OS) contract template EXHIBIT F continued performance, compliance or effect beyond the termination date of this Task Order Contract shall survive such termination date and shall be enforceable by the State as provided herein in the event of such failure to perform or comply by the Contractor. 8. The Contractor shall protect the confidentiality of all applicant or recipient records and other materials that are maintained in accordance with this Task Order Contract. Except for purposes directly connected with the administration of this Task Order 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. The Contractor shall have written policies governing the access to, and duplication and dissemination of, all such information. The Contractor shall advise its employees, agents, servants, and subcontractors, if any, that they are subject to these confidentiality requirements. 9. Under this Task Order Contract, the Contractor shall refer families participating in any and all programs in its agency such as WIC, Early. and Periodic Screening, Diagnosis and Treatment (EPSDT), Immunization Clinics, Family Planning, HCP, Prenatal Plus (PNP), etc, to appropriate enabling and direct care service programs in the community. All pregnant women in need of resources for prenatal medical care are provided with information about programs such as WIC, PNP, etc. as needed; provide all individuals seeking reproductive health services with information about pregnancy planning, the consequences of unintended pregnancies, and, referrals to comprehensive family planning services; and all children ages birth through two years who maybe eligible for early intervention services are referred to Early Intervention Colorado. 10. Contractor shall ensure that the provisions of Section 601 of Title VI of the Civil Rights Act of 1964 are carried out. That Act states that "no person in the United States shall on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program or actively receiving Federal financial assistance." The Office of Civil Rights has concluded that it is the responsibility of any program which is a recipient of funds from the Department of Health and Human Services to ensure that clients who do not speak or understand English well, be provided interpretation services to ensure that the service provider and the client can communicate effectively. The Contractor shall have policies and procedures to ensure that interpretation services are available for clients with Limited English Proficiency and shall advise such clients that an interpreter shall be provided for them. If a client has their own interpreter, they shall be advised that the Contractor shall provide an interpreter if the client so chooses. 1 1. The services or activities under this Contract may be carried out by the Contractor, or through subcontracts with other providers or, through collaborative partnerships with other community partners. The State authorizes the Contractor to subcontract some, or all, or the services that are to be performed under this Contract. However, a subcontractor is subject to all of the terms and conditions of this Contract. Additionally, the contractor remains ultimately responsible for the timely and satisfactory completion of all work performed by any subcontractor(s) under this Contract. If the Contractor desires to subcontract some, or all, of the services that are to be performed under this Contract, the Contractor shall obtain the prior, express, written consent of the State before entering into any subcontract. The Contractor shall maintain, at a minimum a Memorandum of Understanding or other binding contractual agreement, and provide a copy to the Nurse Home Visitor Program Director fifteen (15) calendar days from the date the agreement is executed. The Contractor shall maintain records of any subcontractors for a minimum of three years. To be attached to CDPHE Page 3 of 3 Revised:l2/19/06 Task Order vl .0 (11/OS) contract template i C V Q Z W H Z W W m WN LEI. H V Z 0 V V 0 0 W 0 W Z W m ~ H Z D W W 0 0 Z Z .. oWC H D W a W LL 0 W Q D i ~ I ~~ ~ 0 0 j u. UZ ~ c L ~~~ ~ Q ~U .~ ~ ~ ~ ~ ~ U D. V ~ N 0 ~~ _ ~ co a ~ U . N N 00 u. .> > a~ ~o~ U .~ ~ ~ ~ c~~` o ~V~ ~ ~ i ~ ~ ~' 0 N .~ oLU ~ U ~ ~ r c~ ~. ~ o > ~ °~~ o ac J ~ M 0', X Z X w ~- ; ~ u. ~,,, ~`"` ~;;,.: y!;~e ~~ ,,~,., ,, v,;,,,,~ h- ~ ~ ,;<; w ~,,,. 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LL E ~- LL~~ c~ _ °' a V ~ a Z N ca0 0 C ~ N ~~ ~ o ~ ~ ~~ = N V a ~ ~, G~~ ~ ~ c ~ ~ m W ~~ ~ Zr ~ _ ~ ~ NL~ Q W ~' ~ Z m~o C~ (n ~ ~ U w a 0 0 Attachment F-2 NHVP BUDGET REVISION REQUEST APPLICANT: FOR THE PERIOD: PROJECT: CONTACT: PHONE NUMBER: AnnuallHourty SalarylRate # of Months Bud et Time FTE Original Budget Revised Request Variance 1. PERSONNEL: __ __ _ __ _ __ Fringe Benefits Rate = 2. OPERATING __ 3. EQUIPMENT ____ _ _ __ "/i l ~ `~~ ~,./ / y/x ~ /; d/ ~~~~/~ / i~,'f a ~,;iiiy y~ (~' Vii/ ~r';p ~ 4. TRAVEL (In state/out-state) .,// i ~ / A ~PK -~Y. a„, ti, , , 5. TRAINING !y...i.;. N ~ /y .,'' ~/ ~ ~/il Y.. ' ~I'/ ~. %~. 71r/ ~ , ,, , , . ,~ ;~~~ ~` `~ ~ /i l . ;,,, „ ,.. .. ~~~G~~/i~q ,.dr., 1 ~ ~/~~~i d~// ..fir,, ... ~~/.~'~i/~< ' ', '~/,,i. ~`l%~i~~~~ /, ~ € u. .. , . .. .. e~/~/p'. ~ ~v. ~, 6. 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Signature of Authorized Representative Date BUDGETAPPLFORM.XLS Rev:4l24f2009 Page 1 of 1 Llippman EXHIBIT G STATEMENT OF WORK To Task Order Contract Dated .04117/09 -Contract Routing Number 10 FLA 00003 These ovisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified above, The revised Statement of work is effective July 1, 2009. !l . The Contractor shall coordinate its efforts with the state's NHVP Director, Colorado Department of Health Care Policy and Financing (HCPF), and the University of Colorado at Denver and Health Sciences Center (UCDHSC), National Center for Children, Families and Communities (National Center), and/or subcontractors of the National Center including but not limited to the Nurse-Family Partnership National Service Office (NFPNSO) and Invest in Kids (IIK). 2. 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 activities and services related to the Colorado Nurse Home Visitor Program (NHVP). The services provided by the contractor must be deemed by the state to be acceptable and in good faith. For a service to be "acceptable" it must comply with all, but not limited to, the items listed below, which are incorporated and made part hereof by reference. These documents are located at: htt~a/www.cdphe.state.co.us/ps/nursehome/index.html • Colorado Nurse Home Visitor Program Act, as described in § 25-31-101, C.R.S. • NHVP Grantee Administrative/Fiscal Requirements • Rules Concerning the Nurse Home Visitor Program • NHVP Client Eligibility Verification and Documentation Guidance Document • NHVP Continuation Grant Application (Progress Report) • NHVP Client Application • Medicaid Reimbursement Guidelines • Federal Poverty Guidelines • NHVP Audit Recommendations (as applicable) • NHVP Grantee Caseload Guidelines • Nurse-Family Partnership. Implementation Agreement 3 . The Contractor shall submit, but not limited to, the following reports, incorporated by reference. j These documents with corresponding due dates are located at: '~, httpa/www.cdphe.state.co.uslps/nursehome/index.html • Expenditure Year-to-Date & Mid-Year Budget Projections Report • Final Expenditure Report • Annual Progress Report (included in the NHVP Continuation Grant Application) 4. The Contractor shall perform and complete in a satisfactory manner all activities and services stated in the annual progress report included in the NHVP continuation grant application which is incorporated '~ and made part hereof by reference. This document is located at: httPa/www.cdphe.state.co.us/ps/nursehome/index.html 5. The Contractor shall complete in a satisfactory manner and by the date listed, all activities stated in the "Areas Requiring Performance Improvement Plan or Funding Conditions" in the NHVP Award Summary letter which is incorporated and made part hereof by reference. This document is located at: htt~a/www.cdphe.state.co.us/ps/nursehome/index.html 6. The Contractor shall ensure that program eligibility is based on the client's income and is not restricted by age or length of gestation and that all program brochures and referral materials are stated as such. Page 1 of 3 EXHIBIT G 7. The Contractor shall utilize a State provided, linguistically appropriate NHVP Client Application in which clients document their income or attest that they receive no income as a means of verifying program eligibility. Client income verification and documentation must be collected and maintained in accordance with the NHVP Client Eligibility Verification and Documentation Guidance Document. These documents are incorporated and made part hereof by reference and are located at httpa/www.cd~he.state.co.us/ps/nursehome/index.html 8. The Contractor shall ensure that clients enrolled in Medicaid and the NHVP are not participating in the Prenatal Plus Program (PNP) or any other Medicaid prenatal program. 9. The Contractor shall ensure that all nurse home visitors, supervisors and data entry staff complete all required NFPNSO prerequisites and trainings within the required time frame. The contractor must ensure that the supervisor and nurse home visitors receive the Nursing Child Assessment Satellite Training (NCAST). The Contractor is responsible for scheduling and payment of these trainings. 10. The Contractor shall collect data for evaluation purposes, using forms developed by the National Center and/or its subcontractors. Enter the data collected into the Clinical Information System (CIS) program, on a monthly basis; taking all appropriate steps to maintain client confidentiality and obtain any necessary written permissions or agreements for data analysis or disclosure of protected health information, in accordance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) regulations, including, but not limited to, authorizations, data use agreements, business associate agreements, as necessary. The Contractor's failure to comply with any applicable provision of HIPAA will constitute a breach of this agreement. 11. The Contractor shall participate in meetings or trainings as requested by the State and the UCDHSC. The Contractor must cover all training costs as applicable. 12. The Contractor shall provide the equipment and supplies needed for program implementation. 13. The Contractor shall provide the nurse home visitor services in accordance with the FY0910 Final Approved Budget, attached as Attachment G-1. 14. Funding adjustments may be made during the term of this contract. Grant awards are made using NHVP funding and Medicaid reimbursement estimates. The total amount of funding for the term of this contract may not exceed the Total Project Cost Request from the State as provided in the FY0910 Final Approved Budget, attached as Attachment G-1. If the contractor draws more Medicaid funding, the state will reduce the NHVP funding. Unless otherwise approved, overages of Medicaid funding in one fiscal year are reconciled in the subsequent fiscal year. If the contractor draws less Medicaid funding the state will increase the NHVP funding, if funding is available, during the Mid-Year Budget Projections process. 15. The State may increase of decrease funds available under this Contract using a Grant Funding Letter substantially equivalent to Exhibit E. The Grant Funding Letter is not valid until it has been approved by the State Controller or designee. 1 b. The Contractor shall submit Medicaid reimbursement requests for all eligible clients in accordance with HCPF procedures and the Medicaid Reimbursement Guidelines, which is incorporated and made part hereof by reference. This document is located at: httpa/www.cdphe.state.co.us/ps/nursehomelindex.html 17. The. Contractor shall provide the state's NHVP administrators and program consultants with reasonable access to its operations to perform: periodic site reviews, data reviews, fiscal reviews or other evaluations of the contractor's NHVP program. The contractor shall cooperate during all periodic site visits, data reviews, fiscal reviews and other evaluations or audits conducted by the State. Page 2 of 3 EXHIBIT G ',18. If the State believes in good faith that an activity or service fails to meet the standard for that particular ', activity or service, or is otherwise deficient, then the State shall notify the Contractor of the failure or deficiencies in writing, If the failure or deficiency is programmatic in nature, corrective action shall be addressed through a Performance Improvement Plan (PIP) or some other method defined by the State. If the failure is administrative or fiscal in nature, corrective action shall be addressed through an Action Plan or some other method defined by the State. Due dates for completion of activities listed in a PIP or Action Plan will be negotiated on a case by case basis. 19. It is anticipated that during the State Fiscal Year 2010, the State, in association with HCPF and Center for Medicare and Medicaid Services (CMS), will be undertaking a study in order to set new rates for Medicaid reimbursement claims under the NHVP's Targeted Case Management. Upon completion of said study, historical reimbursement rates will be retroactively adjusted to conform to the approved rates. Should the approved rate result in a decreased eligible billing, NHVP providers maybe .subject to a recoupment process with HCPF. It is the State's intent, based on funding availability, to mitigate the potential financial impact of recoupment for NHVP providers, from the period of July 16, 2008 to such time as the revised rate's effective date. 20. NHVP providers shall retain the right to contest the application of any potential recoupment under this agreement to HCPF and/or CMS. Page 3 of 3 Attachment G-1 [V'lAA0..4 M1 d.~,.,n~o.~ RiirlnaF^ Iglu 1 9MU . Jima '30. 7010 Agency: Eagle County Health & Human Services Project Name: Nurse Home Visitation Annual Salary Rate No, of months Bud et TE ,,, ~~~ t~)NDS TOTAL A, Other... 8, Medicaid C, RE4U~TEt1 AMOUNT Sources Estimate *9 From REpUii3ED *1 of Funding'2 6DPHE NH1i~! `d PERSONAL SERVICES Detail Ex enses Personal Services (Title and Name) Rebecca McCaulley Nurse Supervisor $ 76,122 12.00 0.50 $ 39,061 $ -_ - $ _-- - _ 4,492 $ 34,569 , - - - __ Nurse Home Visitor, Kimberely Wallach Nurse Home Visitor, Luz Avila $ 69,626 $ 62,331 12.00 12.00 1.00 1.00 $ $ 69,626 $ 62,331 $ - - $ $ 8,007 7,168 $ - $ 61,619 55,163 Data En Person, Eve Vas uez $ 36,712 12.00 0.25 $ 9,178 $ - $ 1,055 $ 8,123 _ - - -- - - Con6ractualiFeefor Service (translators $ 34,965 12.00 0.50 $_- 17,482 $ - $ _ _ 2,010 $ 15,472_ -- -- -- - - -__ Asst. Director Childhren & Family Services, Jennie Wahrer -- $ 88,200 12.00 - 0.05 $ _ 4,410 $ 4,410 $ - - - - - - - _ Fringe Benefits. Rate = 49°!° +,,, ;..;.,,. „-- )rrrrr~.tirl.r/•i ~ 1, 1~I + , ~ l%4` rfr/fir/firrr~~/lrt y OPERATING Detail Ex enses $- - 164,146 12.00 ;, 0.55 ~~ $ $ 90,280 $ ~% ' ~~ M~ ~' 2,161 ,,., `~ ~~ $ ~ r:~ rlltrr ~ %, ,~ }~ ~/ ~~ ~ 76,653 11,466 $ r~m;~rfr?,fi;`i~3r di~ir;,n.. 1 ~ /~ ~ `lf~~'~ & utilities)network comp fees maint enses (rent Off ce E $ 9,378 $ 9,378 $ - $ - . , i xp etc) pens suppiles enses (i e Ex eratin Office O $ 1,134 $ - - $ 130 - $ _ 1,004 - , , . . p g p Services in Postal & Shi _ -_ $ - _ -- 315 $ - _ $ 36 $ 27 pp g & Publications Pri kin _ -- -- $ - 2,100 $ - $ 242 $ 1,859 n g distance and cellular service) hone Services (lon Tele $ 4,200 $ 1,500 $ 311 $ 2,390 g p Outside Services $ - $ -- $ $ _ -- - endables (dient materials not printing) am Ex Pro $ -- - - - $ -- -- - $ - $ -- p gr medical 8 program supplies ort materials clientsu _-_ - __ $ _- 5,525 $ 2,500 $ 348 $ 2,617 , pp ~.T ~~ ~ ~~ „-, ~ ~;~;~rrr,~,r~y , , , EQUIPMENT Detail Ex enses ~j;~ ,. ;1 ~ ~, s~~l~r`;~,~ ; 'w ,, r, ;;li,^~r;;rf 13 ~f'~e `~ ' r r, r ,%Fi i 9' ` ,,,, ~r n ,l rr;r r;rr; >%~„ rrrrirr rrr~r~r Computers wl Software - - Cellular Phones - - - - $ - $ - $ - $ - ... / . ... v ! .r/ ~~ rv/'i~. ~~ , ~i ~w ;, TRAVEL Detail Ex enses ,r rr,rrr„rr; rr ~,~~rr%ri~r%%~tl,., ~ !%ri r /r%~r ~,~rh ~ ~~ $ trrrry „ ~ reir~rlr.. '~/t1 - $ ; a~,,r;l~,~r,.rr,/r; ~ ~ trlrr rin ~ rrUrrFrrd, rr ~il - ''!4%r y%//~Ql~ ' r. ~~h /, , rr r~'~ `"~"```~ Visit Outreach Mile e $ 14,854 $ 6,000 $ 796 $ 8,058 NCCFCNCHSC Trainin~Travel -- -- -- - $ _ _- - $ "---- $ --- - $- - - - NCAST Travel -- PIPE Travel - $ $ --- $ $ - - $ $ $ - $ _ Pro ram Meetings (nurses supervisor, other) _ _ $ 315 $ -- - - - - $ 36 $ -- 279 Other Travel s +o r/ r ~., 4. TO ~ i ~' / ll! ~ NFP TRAINING 8 TECH ASSISTANCE Detail Ex enses Technical Assistance r r r r .','~.. r r~ . ^/. 1 ~/tf/')Y~ r l/ ! r,' $ $ r liiiiriii, r% f ~~ ~ ,~„ rr,~r'r1%rrrr~i lr! ~. "`~ l!`rr ~N r~! l/~; ~rr'ldrr/rdrr,f .,rl "~ ~lrGr~ ~ rr rr~r 8,310 $ - $ frrr~ r r~ ~ rA/~/f ry~~~1i, f ,r ~ r r, /' $ M t. ~~/~!'/ `~ r ~ r ~'p~~ 956_ $ - l is Wr f~ ullr 7,354 On oin Nurse Education $ _ 1,439 $ - $ 165 $ 1,274 Initial Nurse Education Initial Supervisor Education _ - $ $ - - $ -- - - $ - ~-- - $---- $ -- - - - - $ - $ - Education Materials $ $ - $ $ Professional Develo ment set at $500 er Nurse ~' . /,,/ / f/ ~ ; ~ .. ~ /~/rr,,~/,/r~%rj~~j~ ~ ~ NCAST COSTS Detail NCAST Trainin & Materials NCAST Re istration " -/f / ~ .rjir/~j~j~~ $ ~lt~~rv _ /r~ $ 1 ~ ~ $ ... - / / /l Ana '.r..vn 1~ ~ 5%r~ r/ /!rr/fir' rir` ,'!~ - $ - - $ ~ j~rrrll~ : ,fit r ^° $ 161 1Nr. ..y •F( F rr!!i ifr $ .... l1 ' $ 1949. ^A~4 'A rr lrlr!!!Q~ ' ' ` rr NCAST Materials -- PIPE Training Materials - $ -- $ - "- $ - - - $- - -- ~'°~UT ;;;rrrrrr;, OTHER COSTS Detail Other Pro ram Costs r, ;~-, $ ~ -- - $ rte;, - $ ~rr~r ;;f;; ` ;'~ ~ $ $ - $ - $ - $ - -- - - - -- ;,,,,,. , ,. „ n,~, ~„ n , r rrirri/{~` -7. T f,~frr` trrr, (, rrrr r /r/'' r , rrr, , . ~ , tr,,r~rr rr r l~~r~~lVr{r~p~.ttl!r, ... ,. 'vrf r /1~fl r~rl r r rrrrrrrrrrr ~t,~~~ r~/Nrr r'n.. r r.r, ,' ^ ~.,~, ~ v G; rt TOTAL DIRECT PROGRAM COSTS Add bud et cafe ones 1=7 $ 341,438 $ 25,949 $ 37,400 $ 278,089 Administrative Services i.e,acctin , admin $ 3,200 $ 3,200 $ - $ - Administrative Supplies (not program supplies)_ -- - -- $ ___ - $ "- $ - - $ - - - - bank expenses) Accoun8ng (audit $ $ - $ - - - __ _ , OtherAdministrative Costs _ -__ _ -- $ - $ TOTAL ADMINISTRATIVE COSTS $ 3,200 $ 3,200 $ - $ - TOTALPROJECT COSTS (Direct Program+AdministrativeCosts) $ 344,638 $ 29,149 $ 37,400 $ 278,089 Colorado Department of Public Health and Environment INSTRUCTIONS FOR PROCESSING: TASK ORDERS & AMENDMENTS Local Health Department, State Agencies, and Intergovernmental ^ Print FOUR (4) copies of the Task Order Contract including Exhibit and Attachment documents. DO NOT print the Task Order double sided. Each Task Order document may contain the following: o Contract o Exhibit A -Additional Provisions and its Attachments if any o Exhibit B -Statement of Work and its Attachments if any o Exhibit C -Limited Amendment Template ^ Each of the FOUR (4) copies of the Task Order signature page is to be signed by the signature authority for your organization. Although not required, blue ink is preferred. FOUR (4) original signatures are required. Do not have this document notarized. The following are authorize signatures for local health departments, state agencies and intergovernmental contract. o City signatories are either the mayor or city manager; o County signatory is always the county commission chairperson; o School district signatory is usually the superintendent. o Health department signatory is the Board of Health President If the contract is signed by any other official of the intergovernmentaientlty then you will need to obtain documentation that supports the signature authority of the individual signing the contract (i.e., bylaws, a board resolution, or signature authority letter). The documentation should clearly state the names and titles of those who do have signature authority. Please see attached example. C~ Work Status Confirmation -please complete the work status confirmation letter and return with your contract. Q Return all FOUR (4) copies of the signed Task Order and all Exhibit(s) andlor Attachment(s) to the address below no later than May 22, 2009. Colorado Department of Public Health & Environment PSD-CHFC-A4 4300 Cherry Creek Drive South Denver, CO 80246-1530 Attn: Natalie Ordonez-Campbell ^ We strongly encourage returning contracts before the deadline so as not to delay contract processing. We recommend using an overnight service to return your Task Order documents. The use of an overnight service allows for tracking and delivery confirmation. !! j(~ ~ii r~~~ iii ~ !4 ~~r ~ r VY ~(( yy//i ~ ~~ ~ ~i ~~/YMq //!~ it XYZ Center for Youth Development Signature Authority Letter XYZ Center for Youth Developments exists as anon-profit corporate entity and as such does not have a President orVice-President, but instead is governed by a Board of Directors. In addition, XYZ Center for Youth Development operates under the leadership of Jane Smith our Executive Director OR the Chief Executive Officer. Jane Smith has the authority to sign contracts on behalf of Sally Johnson, Board President that are legally binding. Signature Print Name Board President Title Date CO. Dept, of Public Health & Environment, Prevention Services Division, Center for Healthy Families & Communities •~ t STATE OF COLORADO Bill Ritter, Jr., Governor James B. Martin, Executive Director of ~~lo w .. -- Dedicated to protecting and improving the health and environment of the people of Colorado tip' -rte d 4300 Cherry Creek Dr. S. Laboratory Services Division * `. ` ~~,~~~~ ~b ~ Inver, oor o ~- -Lowry v . -- _ ,~ r87s Phone (303) 2-2000 Denver, Colorado 80230-6928 TDD Line (30) 691-7700 ,(303) 692-3090 _. -T __ -_ -_ C4 oca e m n a e, o ora o of Public Health http:llwww.cd he.state.co.us and Environment WORK STATUS CONFIRMATION LETTER Vendor Name: Contract Routing Number: CRS §24-30-202 requires the State Controller to approve all State Contracts. The above referenced Amendment is not valid until it is signed and dated below by the State Controller or delegate. Therefore, your agency is not authorized to begin performance uuntil you are notified that it's signed. If your agency begins performing Contract tasks prior to that date, the State of Colorado is not obligated to pay your agency for such performance or for any goods andlor services provided prior to the date signed. By signing below, your confirm that (Signature MUST be that of the person signing the Contract) a) No work has been performed under this contract b) No work will begin under this contract until the contract is signed by the State Controller or on the effective date; whichever is later. •..I" Signature of A thorized Officer ~~ ~ ~~ . Print Name of Authorized Officer ,~ ~ //r ~J p ~ y Print Title of Authorized_ fficer ~~{ ~ , ,`~ ,~ ~~~ *` ~ ~.,l~-~ G ~~~ ,~ a~ Dat~ Signed RETURN THIS LETTER T0: ..Natalie Ordonez-Campbell, Contracts Manager Colorado Department of Public Health & Environment Center for Healthy Families & Communities, Fiscal Services Unit 4300 Cherry Creek Drive South PSD-CHFC-A4 Denver, CO 80246-1530 ~ ~ TERM SHEET Approved Amendment to Task Order Contract between Eagle County and the Colorado Department of Public Health & Environment (CDPHE) for Nurse Family Partnership Services 1) Re uested hearin date: Ma 12 2009 Ma 19 2009 Time sensitive contract, due May 22, 2009. 2) For County Manager signature: No 3) Requesting department: HHS, Children and Family Services 4) T=: Approved Amendment to Task Order Contract between Eagle County and the Colorado Department of Public Health & Environment (CDPHE) for Nurse Family Partnership Services 5) Check one: Consent: X On the Record: 6) Staff submitting: Jennie Wahrer, Asst. Director Children & Family Services X2604 7) Pur ose: To renew the contract to provide nurse home visitor services to low- income, first time mothers for one year, to modify the Additional Provisions and the Statement of Work and to incorporate a new provision to the General Provisions of the Task Order Contract, concerning the monitoring of vendor performance on state contracts and inclusion of contract performance information in a statewide contract management system. 8) Schedule: July 1, 2009 to June 30, 2010. 9} Financial considerations: is $278,089. 10) 0=: . ~~ ~ ~ ~~ ~r ,.- : ~ ~ ~ ~~ ~ ~z ~~ .u Suhm~tted bv~ Je~~ni~ Wa}~rer S/GE'09 The contract amount under this renewal agreement AP TO FORM , gy~ Eagie County Attpmey's ~ v By; ~~- Eagle County Commissioners' Office " ~