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HomeMy WebLinkAboutC10-272 CO Dept of Public Health and Environment State of Work Adult Services Children & Family Services HEALTH & HUMAN SERVICES Economic Services (970) 328 -8840 � Public Health FAX: (970) 328 -8829 Volunteer Services www.eaglecounty.us EAGLE CO11N; convoc Youth & Family Services Statement of Work October 1, 2010 — September 30, 2011 Between Colorado Department of Public Health and Environment Prevention Services Division Children with Special Health Care Needs Unit And Eagle County Public Health Agency L Purpose This Memorandum of Understanding (MOU) is entered by and between the Colorado Department of Public Health and Environment (CDPHE) Health Care Program for Children with Special Needs (HCP) Program, herein after referred to as CDPHE HCP or Lead Agency and Eagle County Public Health Agency, herein after referred to Partner Agency for the purpose of providing HCP services for families with children with special health care needs that reside in Eagle County. This MOU establishes the terms, conditions and responsibilities between the parties for county (ies) who provide HCP services. HCP Services are defined and described in the HCP Policy and Guidelines available on the CSHCN website at www.hcpcolorado.org. II. Parties The Administrator for the Lead Agency will be: Shirley Babler, HCP Director Health Care Program for Children with Special Needs (HCP) Children with Special Health Care Needs Unit Tel: 303 - 692 -2455 Email: shirley.babler@state.co.us The Administrator for the Partner Agency will be: Jennie Wahrer, MCH Manager 970 - 328 -2604 Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631 -0660 V 172- III. Effective Date, Modification, and Termination This MOU shall become effective upon the signature of both parties for a 12 month period commencing on October 1, 2010, and terminating September 30, 2011. This MOU may be amended if mutually agreed upon, to change scope and terms of the MOU. Such changes shall be incorporated in writing to this MOU. This MOU may be terminated by either party at any time; however, the terminating party shall provide written notice to the other party at least thirty (30) days in advance of the effective date of termination unless there is a critical failure to perform. IV. Lead Agency Responsibilities CDPHE HCP Program agrees to fulfill the terms and conditions executed between the Partner Agency and CDPHE HCP Program in the Memorandum of Understanding as follows: Administration 1. Provide administrative support for the HCP Program 2. Provide HCP Policy and Guidelines posted on web site, www.hcpcolorado.org 3. Notify contractors when HCP Policy and Guidelines and reporting and fiscal forms Y Y p g are revised. 4. Protect the confidentiality of all records containing personal health information 5. Monitor partner agency performance 6. Approve and process HCP invoices for payment 7. Contract with specialty providers for HCP Specialty Clinics Training 1. Plan and implement HCP Training 2. Provide information on continuing HCP education opportunities 3. Provide two required HCP Conference Calls per year to inform and update HCP Contractors on program and administrative changes. 4. Update resources, contract information and revisions to the HCP Policy and Guidelines on the CSHCN web site, www.hcpcolorado.org. Documentation, Evaluation and Quality Improvement 1. Provide CHIRP Data for MCH Table I Reporting 2. Provide HCP Annual Data Report as a resource for planning and evaluation V. Partner Agency Responsibilities The Partner Agency agrees to fulfill the terms and conditions executed between CDPHE HCP Program and Partner Agency in the Memorandum of Understanding as follows: The Partner Agency agrees to: Care Coordination 1. Assign and orient staff to provide HCP Services. 2. Provide HCP Care Coordination services for Level I, II and III in accordance with • the HCP Care Coordination Policy and Guidelines located in the HCP Policy and Guidelines at www.hcpcolorado.org. HCP Care Coordination shall be provided for children with special health care needs who reside in the partner agency's county (ies) are referred or are identified as needing HCP Care Coordination during the period covered by this MOU within the agency's reasonable capacity to deliver the services. 3. Document follow -up for CRCSN notifications in CHIRP in accordance with the CRCSN Policy and Guidelines located in the HCP Policy and Guidelines on the CSHCN web site, www.hcpcolorado.org. 4. Provide HCP Care Coordination as part of a "medical home team approach" including the child's primary care provider (PCP), specialists, school nurses, teachers, community providers and others who the family indicates as members of their medical home team. 5. Notify the state HCP Director of circumstances or staff vacancies preventing agency from providing HCP Services. 6. Utilize HCP Regional Office staff for consultation and technical assistance when providing HCP Services and documenting in CHIRP database. 7. Local Collaboration and Systems Development a) Participate in community collaboration for services that are easy to use for families with CHSNC. b) Collaborate with community partners to identify barriers and duplications that prevent families with CSHCN to use health systems and community services and find ways to improve access to services. c) Collaborate with community partner agencies to identify and refer children with special health care needs to community resources and family supports including WIC, EPSDT, Immunization clinics, Family Planning, Public Health Nursing, Early Intervention and to other local direct care service programs including public insurance programs i.e. Medicaid and CHP +. d) Collaborate with community partners and programs to plan for the development and maintenance of resources that assure access to direct care and services for all CSHCN. These efforts need to include those who are from ethnic or culturally diverse communities and who may experience language or cultural barriers that may increase their difficulty using services. HCP Specialty Clinics (for those agencies who facilitate and coordinate HCP Specialty Clinics) 1. Follow HCP Specialty Clinic Policy and Guidance when facilitating HCP Specialty Clinics. This document is part of HCP Policy and Guidelines and located on the CSHCN web site: www.hcpcolorado.org. 2. Provide HCP Specialty Clinics as indicated in the State document titled HCP Specialty Clinic Benchmarks located on the CSHCN web site: www.hcpcolorado.org. • CHIRP Database 1. Follow the HCP /CHIRP security policy and procedures outlined by the lead agency in the HCP Policy and Guidelines on CSHCN web site, www.hcpcolorado.org and assure that a "Data Security Use and Confidentiality Agreement" is signed by each user. 2. Document care coordination in CHIRP for Intake, Assessment and Interventions in accordance to the HCP CHIRP User Manual and the HCP Care Coordination Policy and Guidelines. 3. Document level of care coordination provided in CHIRP by September 30 each year indicating if child will continue with care coordination or will be closed. 4. Document community systems work in CHIRP as Community Encounters. Training 1. Assure HCP Care Coordinators complete the new web -based HCP CHIRP (Colorado Health Information Record of Patients) Database training. 2. Agency Nursing Director and agency Fiscal Administrator shall attend two required HCP Conference Calls per year to inform and update HCP Contractors on program and administrative changes. Documentation, Evaluation and Quality Improvement 1. The Contractor shall submit, but not limited to, the following reports, incorporated by reference. These documents, including instructions for completion and submission are available in the MCH Guidelines located on the MCH web site: www.mchcolorado.org. a) MCH Core Services Final Report for FY10 & FY11 b) Numbers Served by Title V Report for FY10 & FY11 Tables I & II 2. Make available to the State, or other duly authorized agent or government agency, for audits and inspection, client records, at any reasonable time during the term of this MOU and for a period of three years following the termination of this MOU to assure compliance with its terms, and /or to evaluate the partner agency's performance. VI. Financial Considerations To receive compensation under this SOW, for the period of October 1, 2010 through September 30, 2011, the partner agency shall submit a signed quarterly Invoice /Cost Reimbursement Statement providing a description of work completed on each reimbursement form. Quarterly payments will be processed when the format of the reimbursement form is acceptable to the state. The CDPHE reimbursement form is located on the CSHCN web site at www.hcpcolorado.org. A Reimbursement Request Statement: 1. Must be submitted within thirty (30) calendar days following each quarter. 2. Must be accompanied by a detailed cost ledger to reflect all expenditures being invoiced under this MOU and should include date of payment, payee name and amount, and check or voucher number, when available. 3. Shall reference the Purchase Order Number. 4. Expenditures shall be in accordance with the SOW in Paragraph V and the budget. These items may include, but are not limited to, the Partner Agencies salaries, fringe benefits, supplies, travel, operating, allowable indirect costs, and other allocable expenses related to its performance under this SOW and the approved budget. 5. Shall include the applicable service dates and the total requested payment, not to exceed a total of $13,622.00 for the period 10/01/2010 through 09/30/2011 6. Shall be sent to: Laura Zuniga Colorado Department of Public Health & Environment Children with Special Health Care Needs Unit (CSHCN) 4300 Cherry Creek Dr. South Denver CO 80246 -1530 (303) 692 -2409 Fax: (303) 753 -9249 laura.zuniga @state.co.us Final billings under this SOW must be received by the State within a reasonable time after the expiration or termination of this SOW; but in no event no later than sixty (60) calendar days from the effective expiration or termination date of this SOW. Partner Agencies may not receive payment for billings that exceed sixty (60) the calendar day period. Colorado Department of Public Health and Environment (CDPHE) Prevention Services Division Children with Special Health Care Needs (CSHCN) Unit Health Care Program for Children with Special Needs (HCP) BY: Lisa Ellis, Director of Purchasing and Contracts DATE: Eagle County Public Health Agency BY: TITLE: Witkr DATE: hfI CO Department of Public Health & Environment Feb 2009 Prevention Services Division, Center for Healthy Families & Communities Fiscal Services Unit . I ( 7 fF , Agency: Eagle County Public Health/H Date C om HS pleted: August 26, 2010 Name: Jennie Wahrer Name: R Woods Title: Maternal & Child Health Mana•er Title: De u t Director HHS Phone: 970 - 328 -2604 Phone: 970 - 328 -8817 Email: jennie.wahrer @eaglecounty.us E rita.woods @eaglecounty.us Due Date: Septemkier 14 (f the period of Oct. 1, 2010. through. Sept 30, 2011 Instructions: Refer to instructions for c ompletion of this form in the MCH Guidelines. Enter numbers in yellow highlighted areas below Total col umns will calculate automatically. PERSONN SERV Na & Titles Theresa Care $51,001.60 0. Staci Bruce $52,000.00 0`.01' Jennie Wahrer $84,988.80 0.01 ~ �` SUBTOTAL - -- - -- $9,020.13 Fringe Benefits: Rate = 46.00% N/A N /A , _ , OPE EXPENSES which a not part of indirect TRAVEL EXPENSES $453.00 INDIRECT COST: Rate = a Updated 05/10/2010 MCH Planning Budget FY11.xls • • Health Care Program for Children with Special Health Care Needs HCP 9 P (HCP) Budget Narrative FY11 Agency: Eagle County Public Health /HHS Date Completed: August 26, 2010 Program Contact °;.Person , Fis Contact:Person Name: Jennie Wahrer Name: Rita Woods Title: Maternal & Child Health Manager Title: Deputy Director HHS Phone: 970 - 328 -2604 Phone: 970 - 328 -8817 Email: jennie.wahrer @eaglecounty.us Email: rita.woods @eaglecounty.us Due Date: September 14, 2010 General Instructions: The purpose of the Budget Narrative is: > To describe how each line item in your budget relates to your agency's HCP MOU Scope of Work • To explain how you arrived at each cost. The Budget Narrative should provide a clear and reasonable rationale for the costs associated with implementing the HCP MOU Scope of Work. The HCP MOU Scope of Work, budget, and budget narrative should all be aligned. Be sure to describe how you arrived at each line item amount by providing detailed and specific information for EACH line item. The Budget Narrative should reflect the HCP MOU period from October 1, 2010 through September 30, 2011. Please provide narrative for each cost category in the spaces below. Examples are included for each category. •Personnel Servicies: List the.name and titleof each mem ber: (employed by your agency), annual salary and Fuil` Time ;Equivalent (ETE)that the staff member u+ill cormtit to the HCP MOU Briefly describe the rote of the staff' member end identify-the componernts of the MOU tha this person wtll be respons for corn ... ng� Example Susan Johnson,, Registered Nurse, salaryat $36,000 year,;.5 FTE;'(50 %)'to provide HCP Care�Coordination for children witt special health care :needs ( CSHCN) and document in HCP, CHIRP database,.:: , . Theresa Carey, Registered Nurse, annual salary $51,001 /year, .15 FTE (15 %) for $7,650.24 to provide to provide HCP Care Coordination for children with special health care needs (CSHCN) and document in HCP CHIRP database, coordinates the neurology clinic 3 -4 times /year and the cardiology clinic 3 -4 times /year, and maintains HCP CHIRP database. Staci Bruce, Registered Nurse, annual salary $52,000 /year, .01 FTE (1 %) for $520 to provide care coordination with a limited number of families, coordinates the Shriner's Clinic for children with special health care needs 2 times /year. Jennie Wahrer, RN, MCH Manager, annual salary $84,988, .01 FTE (1 %) for $849.89 to provide oversight and supervision of HCP staff and budget allocation and works with the state and HCP Regional Office to ensure HCP Policy and Guidelines are followed. Operating Expenses: Include expenses that are n ©t included in the indirect rate for your agency Examples: office supplies, copies, postage, telephone,. computer,' network fees project supplies and materials, professional development and /or training registration With limited funding, these expense should,le balanced with personnel *sts:to provide`, HCP services. Provide a brief explanation to Justify the need for each line item for fulfilling the HCP MOU Exariaple $100 wih provide copies and postage for mailing letters to families receiving care coordination and primary care,rzviders _ ` None. Travel Expenses: Travel costs to be incurred while implementing the HCP MOU and /or travel to attend trainings ; Example Travel costs are reimbursed at'32 cents /mile per agency policy Costs of $250.00 are - estimated to provide transportation when provi ng HCP Care Coordination and /or= doing'local. ys'tems Awork Travel costs are estimated at 0.50 cents /mile. Mileage for travel from Eagle to Glenwood Springs for neurology and cardiology clinics is estimated at 88 miles /round trip x 7 clinics x .50 /mile = $308. Travel to one regional meeting from Eagle to Grand Junction /year is estimated at 290 miles/ round trip x Revised 8/19/10/2010 Maternal and Child Health (MCH) • Planning Budget Narrative .50 /mile = $145 7. r Indirect Cysts ,,, Provide "your indirect,rate,. -An indirect rate cap will be applied :The caps ire as foli ws per' CC PHE agreement 25 %0 of total direct c osts, 27% of total d"trect sa[arle and /ter fringe, 30% of =total direct salaries aid fringe where no ether direct costs are charged, �f your rate exce the indirect rate caps identif thos indi rect casts above , the allowed rate as mach or in Find contributions Example Your indirect rates 34 93 %0 of total -direct SalariesfFringe 27 %a can be recognized in rout request and 7 93%- musfbe re cognized a match or in kind Example Your indirect rate is 19°fo Of-,fOtat dire costs4The:rate is within!the 25°l° cap, 19 %can be recognized in you None. Page 2 of 2 Revised 08/04/2010 i STATEMENT OF WORK BETWEEN COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PREVENTION SERVICES DIVISION CHILDREN WITH SPECIAL HEALTH CARE NEEDS UNtir AND EAGLE COUNTY PUBLIC HEALTH AGENCY 1) Requested hearing date: Septe ber 7 or 4, 2910 RECEIVED Contract due to state by Septe b 14 10 it 2) For County Manager signature: No AUG 2010 EAGLE COUNTY ATTORNEY 3) Requesting department: Public Health, HHS 4) Title: Statement of Work between Colorado Department of Public Health and Environment Prevention Services Division Children with Special Health Care Needs Unit and Eagle County Public Health Agency 5) Convening as another board or authority? State name NA 6) Check one: Consent: X On the Record: 7) Staff submitting: Jennie Wahrer RN, Maternal & Child Health Manager, x 2604 8) Purpose: The purpose is to provide Care Coordination for children with special health care needs, to document the care coordination in the state database, and to coordinate the Shriner's Clinic two times per year. The benefits include children with special health care needs will receive coordinated services within a Medical Home and community based services will be organized so families can use them easily. This program coordinates services for approximately 40 children each year. 9) Schedule: October 1, 2010 — September 30, 2011 10) Financial considerations: Contract amount is $13,622. The revenue line item number for the 2010 is 1209 - 505 -70- 4342.16 and for 2011 will be 1209 - 505 -72- 4342.16. The agreement amount is fully budgeted. None of the budgeted fun - s wi main a ter execution of this contract. 9) Other: None .V: ► A- � PR • OR �l x.11 � vt / � i C � �. •• ' Att. mey's Offi Eagle � j (� By • ' .. gi - Coun ' �' B y' Cammissioners' Office 1 ie CauntY