HomeMy WebLinkAboutC10-155 Nurse Home Visitor ProgramDEPARTMENT OR AGENCY NAME
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
PSD-N H~~'P
DEPARTMENT OR AGENCY NUMBER
FLA
CONTRACT ROUTING NUMBER
I1-15817
AMENDMENT FOR TASK ORDERS #2
This Amendment is made this 15 day of March, 2010, by and between the State of Colorado, acting by and through
the DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT, whose address or principal place of
business is 4300 Cherry Creek Drive South, Denver, Colorado 80246, hereinafter referred to as the "State"; and,
BOARD OF COUNTY COMMISSIONERS OF EAGLE COUNTY for the use and benefit of EAGLE
COUNTY PUBLIC HEALTH AGENCY, (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
The parties entered into a Master Contract, dated January 23, 2007, with contract routing number 08 FLA 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-FLA-
00003, as amended by Grant Funding Change Letter #1, contract routing number 09-FLA-00935, Contract
Amendment #1, contract routing number 10-FLA-00003 and Grant Funding Letter #2 ,contract routing number 10-
FLA-13531 collectively referred to herein as the "Original Task Order Contract, 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 State promises to pay the Contractor the sum of Three Hundred Five Thousand Fifty-Eight Dollars,
($305,058.001 in exchange for the promise of the Contractor to continue to perform the work identified in the
Original Task Order Contract for the renewal term of 12 months, ending on Julyl, 2010.
NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree
as follows:
Consideration for this Amendment to the Original Task Order Contract consists of the payments and
services that shall be made pursuant to this Amendment, and promises and agreements herein set forth.
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 # 1,
contract routing number 09-FLA-00935, Contract Amendment #l, contract routing number 10-FLA-00003
and Grant Funding Letter #2, contract routing number 10-FLA-13531 collectively referred to herein as the
Original 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.
It is expressly agreed to by the parties that the Original Task Order Contract is and shall be modified,
altered, and changed in the following respects only:
A. 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 July 1,
Page 1 of 1
Rev 3/]6/2010
,.
2010, through and including June30, 2011. The maximum amount payable by the State for the
work to be performed by the Contractor during this renewal term is Three Hundred Five
Thousand, Fifty-Eight Dollars, ($305,058.00) for an amended total financial obligation of the
State of EIGHT HUNDRED FIFTY-ONE THOUSAND, FIVE HUNDRED FORTY-SEVEN
DOLLARS, ($851,547.00). This is an increase of Three Hundred Five Thousand, Fifty-Eight
Dollars, ($305,058.00) of the amount payable from the previous term. The revised Statement of
Work is incorporated herein by this reference and identified as "Exhibit H". The revised Budget
is incorporated herein by this reference and identified as "Attachment H-1".
The Original Task Order Contract is modified accordingly. All other terms and conditions of the Original
Task Order Contract are reaffirmed.
The effective date of this Amendment is July 1, 2010 or upon approval of the State Controller, or an
authorized delegate thereof, whichever is later.
Except for the Special Provisions and other terms and conditions of the Master Contract and the General
Provisions of the Original Task Order Contract, in the event of any conflict, inconsistency, variance, or
contradiction between the terms and provisions of this Amendment and any of the terms and provisions of
the Original Task Order Contract, the terms and provisions of this Amendment shall in all respects
supersede, govern, and control. The Special Provisions and other terms and conditions of the Master
Contract shall always control over other provisions of the Original Task Order Contract or any subsequent
amendments thereto. The representations in the Special Provisions to the Master Contract concerning the
absence of personal interest of state of Colorado employees and the certifications in the Special Provisions
relating to illegal aliens are presently reaffirmed.
6. FINANCIAL OBLIGATIONS OF THE STATE PAYABLE AFTER THE CURRENT FISCAL YEAR
ARE CONTINGENT UPON FUNDS FOR THAT PURPOSE BEING APPROPRIATED, BUDGETED,
AND OTHERWISE MADE AVAILABLE.
Page 2 of 2 Rev 3/16/2010
IN WITNESS WHEREOF, the parties hereto have executed this Amendment on the day first above written.
* Persons signing for Contractor hereby swear and affirm that they are authorized to act on Contractor's
behalf and acknowledge that the State is relying on their representations to that effect.
CONTRACTOR:
BOARD OF COUNTY COMMISSIONERS OF
EAGLE COUNTY for the use and benefit of
EAGLE COUNTY PUBLIC HEALTH AGENCY
(a political subdivision of the state of Colorado)
Signatur of Authorized Officer
Print Name of Authorized Officer
STATE:
STATE OF COLORADO
Bill Ritter, Jr. Governor
By:
Print Title of Authorized Officer
For the Executive Director
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
PROGRAM APPROVAL:
By:
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
David J. McDermott, CPA
By:
Date:
Page 3 of 3 Rev 3/16/2010
EaHIBI'1' li
STATEMENT OF WORK
To Task Order Contract Dated 03/15/2010 -Contract Routing Number 11 FLA 15817
'Chose provisions are to be read and interpreted in conjunction with the provisions of the 'Cask Order Contract specified above.
The revised Statement of work is effective July 1, 20]0.
1. 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).
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:
http://www.cd~~h~ ,t~~tccu.us ~s;nun~h~~mcinci~x.i~tml
• 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.
These documents with corresponding due dates are located at:
http://www.cdphe.state.co.us/ps/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 atmual progress report included in the NHVP continuation grant application which is incorporated
and made part hereof by reference. This document is located at:
http://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:
http://www.cdphe.state.co.us/ps/nursehome/iudex.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 H
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
http://www. cdphe. 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. At minimum, the
contractor must ensure that the supervisor and nurse home visitors receive the Nursing Child
Assessment Satellite Training (NCAST) materials. The Contractor is responsible for scheduling and
payment of these trainings.
10. The Contractor shall collect data for evaluation purposes, using forn~s 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 FY 1011 Final
Approved Budget, attached as Attachment H-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 terns of
this contract may not exceed the Total Project Cost Request from the State as provided in the FY1011
Final Approved Budget, attached as Attachment H-I. 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 or decrease funds available under this Contract using a Grant Funding Letter
substantially equivalent to Exhibit E of Original Task Order Contract. The Grant Funding Letter is
not valid until it has been approved by the State Controller or designee.
16. 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:
http://www.cdphe.state.co.us/ps/nursehome/index.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
E?~HIBIT H
18. 1f 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, conrective action shall be
addressed through a Perforn~ance 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.
Page 3 of 3
~d~r~
Agency: Eagle County Health & Human Services
Project Name: Nurse Home Visitation Program
Annual
No. of SOURCE OF FUNDS
Salary
months
TOTAL _
A. Other '. B. Ivtedicaid C. REQUESTED
AMOUNT Sources '~, Estimate `3 j From
Rate Bud et FTE REOUIRED'1 of Fundin '2 ~~ ! CDPHE (NHYP)'4
PERSONAL SERVICES Detail Ex enses
Personal Services (Title and Name) 0
Nurse Supervisor, Rebecca McCaulley $78,122 12 0.5 $39,061 $0 $2,148 $36,913
Nurse Home Visitor, LeVina Beveridge _ $62,331 12 1 $62,331 $0 $3,428 $58,903
Nurse Home Visitor, Luz Avila $62,331 12 1 562,331 _ _ $0 $3,428 $58,903
Data Entry Person, Evelyn Vasquez _ $36,712 12 0.25 $9,178 $0 5505 _ $8,673
Contractual Interpreter, Pauline Agoista _ _ _ __ $41,600 12 0.3 $12,173 $0 _. ,~_ $670 _ __ _$11,503
Contractual Mental Health Consultant $1,800 12 $1,800 $99 $1,701
Asst. Director Childhren & Family Services, Jennie Wahrer $88,200 12 0.1 $8,820 _ _ __ $485 ~ __ $8,33E
Fringe Benefits: Rate = 46 % $150,740 12 583,592 SO $4,527 579.06°
0
1. TOTAL PERSONAL SERVICES- $279,286 50 $15,290 $263 995
OPERATING Detail Ex enses
Office Operating Expenses (i.e. suppiles, pens, etc) 1134 0 0 ~ 134
Office Expenses (rent, maim. & utilities) 15300 _ 15300 0 C
Postal & Shipping Services _ _ 315 _ _ _ _ 0 _ _ _ __ __ _ 0 __ _ _ 31'.
Printing & Publications 2100 _ _0 _ 0 _ _ 210C
Telephone Services (long distance and cellular service) 3200 2000 _ 0 120C
Outside Services Network fees 378 378 0 C
Program Expendables (client materials not printing) 5525 2500 0 302
2. TOTAL OPERATING 527,952.00 $20,178.00 50.00 $7 774.00
EQUIPMENT Maximum of 52,000. Detail Ex enses
Computers w/Software 0 0 0 C
Cellular Phones 0 0 0 C
3. TOTAL EQUIPMENT 50.00 50.00 50.00 $0.00
TRAVEL Detail Ex enses
_
Visit Outreach Mileage 19823 0 0 1982[
NCCFC/UCHSC Training Travel 525 0 0 52F
_ __ _ _
PIPE Travel 0 0 0 C
Program Meetings (nurses, supervis
o
r, other) 1100 0 __ _
0 110(
_
_
_ _ _ _ _ __ ___ __
Other Travel 0 0 0 [
4. TOTAL TRAVEL $21 448.00 50.00 50.00 $21 448.00
NFP TRAINING & TECH ASSISTANCE (Detail Expenses)
Technical Assistance required 8559 0 0 BS5E
On-going Nurse Education requfired 1482 0 0 148
Initial Nurse Education 0 0 _ _ 0 C
Initial Supervisor Education 0 _ 0 0 C
Education Materials NHV Manuals required 0 0 0 C
Professional Development (Limited to $600/nurse) 1800 0 0 180[
5. TOTAL TRAINING & TECH ASSISTANCE 511 841.00 $0.00 $0.00 S71,841.00
NCAST COSTS (Detail NCAST Training & Materials) _
NCAST Materials 0 0 0 C
PIPE Training Materials 0 0 0 C
o u o c
_ __
6. TOTAL NCAST COSTS. $0.00 $0.00 S0.00 $0.00
_
OTHER COSTS (Detail Other Pro ram Costs
_ _ _
7. TOTAL OTHER COSTS $0.00 $0.00 50.00 $0.00
TOTAL DIRECT PROGRAM COSTS (Add budget categories 1-7) $340,527 $20,178 $15,290 $305,058
ADMINSTRATIVE COSTS Detail Adminstrative Costs
Administrative Services (i. e.accting, admin) 4675 4675 0 <
Administrative Supplies (not program supplies) 0 0 0 C
Accounting (audit, bank expenses) 0 0 ~ 0 C
Other Administrative Costs 0 0 0
TOTAL ADMINISTRATIVE COSTS $4,675 $4,675 $0
TOTAL PROJECT COSTS (Direct Program « Administrative Costs) $345,202 $24,853 $15,290 $305,058
S eci "OTHER SOURCES" cash or in-kind from the column A. above.
Eagle County Government $22,353.00
Colorado Bright Beginnings $1,250
The Literacy Program $1,250
Total Other Sources $24,853.00
STATE OF COLORADO
Bill Ritter, Jr., Governor
James B. Martin, Executive Director
Dedicated to protecting and improving the health and environment of the people of Colorado
4300 Cherry Creek Dr. S. Laboratory Services Division
Denver, Colorado 80246-1530 8100 Lowry Blvd.
Phone (303) 692-2000 Denver, Colorado 80230-6928
TDD Line (303) 691-7700 (303) 692-3090
Lddafed in Glendale, Colorado
http://www.cdphe. state.co. us
WORK STATUS CONFIRMATION LETTER
Vendor Name:
pF COO
NT~. "1~~S~t':~90
,~ ~ ~,
•* ~~ ~ **
'~ Ig~6 ~
Colorado. Department_
of Public Health
and Environment
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 until you are notifted 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 and/or 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.
Signature of Authorized Officer
Print Name of Authorized Officer
Print Title of Authorized Officer
Date Signed
RETURN THIS LETTER TO:
Natalie El-Deiry, Contracts Manager
Colorado Department of Public Health &
Enviromnent
Center for Healthy Families and Communities
4300 Cherry Creek Dr So
PSD-CHFC-A4
Denver CO 80246-1530
