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www.eaglecounty.us
EAGLE COUNTY COLORADO
Colorado Department of Public Health and Environment
Colorado Immunization Program (CIP)
Amendment 35 Immunization Funds for Local Public Health Agency
Statement of Work
Agency: EAGLE COUNTY PUBLIC HEALTH AGENCY
Project name: Amendment 35 Core Services
Funding period: July 15, 2012 through June 30, 2013
Project description: Funding for local public health agencies (LPHA) to provide core services
and infrastructure building for local immunization access by promoting, educating, and
supporting reminder /recall activities, evaluating access to appropriate immunization services,
and supporting the Colorado supplemental nutrition program - Women, Infants, and Children
(WIC).
I. Provider Performance Requirement/Deliverables:
A. The local public health agency (LPHA) shall collaborate with community leaders to
work toward formulating policies designed to solve local immunization access issues
by:
1. Promoting, educating, and supporting providers regarding the value of active
participation in reminder and recall activities through:
a. community and provider trainings regarding implementation of clinic and
practice based reminder and recall systems.
b. collaboration with community providers to implement clinic and practice
based reminder and recall systems (i.e. Colorado Immunization
Information System — CIIS).
c. implementation of LPHA clinic based reminder and recall systems.
B. The LPHA shall follow the Standards for Child and Adolescent Immunization
Practices (CDC, 2006) to assure all populations have access to appropriate
immunization services and evaluate the effectiveness of that service in their
communities by:
Old Courthouse Building, 551 Broadway, P.O. Box 660, Eagle, Colorado 81631 -0660
1. Delivering optimal immunization clinical services including proper storage and
documentation of vaccinations including:
a. developing and following appropriate procedures for vaccine storage and
handling with appropriate clinic equipment and implementation of written
policies and procedures for vaccine storage, vaccine ordering, and
emergency response.
b. utilizing up -to -date written vaccination protocols and having them readily
accessible at all locations where vaccines are administered.
c. persons who administer vaccines and staff who manage or support vaccine
administration are knowledgeable and receive ongoing education.
2. Conducting onsite clinical services with optimal access such as:
a. non - traditional clinic access at a minimum of one (1) of the LPHA's clinics
to permit clients access to necessary vaccinations during evening or
weekend hours (e.g. expanded clinic hours).
b. providing "express lane" or drop -in appointments at the LPHA's clinic.
c. utilizing incentives to encourage completion of children's primary
immunization schedule.
3. Providing support for immunization initiatives through the Colorado
Supplemental Nutrition program — Woman, Infants and Children (WIC) by:
a. providing vaccinations on site, or
b. assessing immunization histories and referring children appropriately, or
c. distributing educational materials regarding immunization and locally
available services.
C. The LPHA shall perform an assessment of the available immunization services within
their jurisdiction and monitor the health of their communities and children at risk for
under- immunization by:
1. Collaborating with one or more agencies to:
a. determine the availability of immunization services within their
communities.
b. ensure immunization services are readily accessible at sites other than the
LPHA's site.
c. provide community education regarding vaccines and immunizations
through distribution of educational materials, provision of educational
workshops, and submission of press releases with relevant news and
updates.
d. provide technical advice and assistance for providers and other appropriate
activities.
D. OFFICE VISIT FEE: Contractors receiving these 2012 -13 Amendment 35
Immunization Funds for LPHA agree to abstain from charging an office visit fee in
addition to the allowable vaccine administration fee.
II. Payment:
A. In consideration of those services satisfactorily and timely performed by the LPHA
under this Purchase Order, the State shall cause to be paid to the LPHA a sum not to
exceed FORTY -FOUR THOUSAND ONE HUNDRED EIGHTY -EIGHT
DOLLARS ($44,188.00). Of the total financial obligation of the State referenced
above, $0.00 are identified as attributable to a funding source of the United States
government and, $44,188.00 are identified as attributable to a funding source of the
state of Colorado.
B. Reimbursement under this Purchase Order shall be made to the LPHA by the State on
a quarterly basis; accordingly, the LPHA shall be paid one fourth (1/4) of the State's
financial obligation under this Purchase Order each quarter. The LPHA shall be
reimbursed ELEVEN THOUSAND FORTY -SEVEN DOLLARS ($11,047.00) per
quarter. The final payment for this Purchase Order is contingent upon the State's
timely receipt of an annual statement from LPHA in the form attached hereto as
Attachment A, which is incorporated herein by this reference.
III. Monitoring:
CIP's monitoring of this contract for compliance with performance requirements will be
conducted throughout the purchase order period by the Program's Project Manager.
Methods used will include review of documentation reflective of performance to include
progress reports. The LPHA shall submit four (4) online progress reports to the State.
The link to the report form is:
http: / /fs9. formsite. com /ColoradolMMprogram/ IMMCoreServicesReport /index.html .
Each progress report is due within fifteen (15) calendar days of the end of each reporting
period. The progress reports shall document the LPHA's progress towards completion of
the activities described herein. The LPHA's payments shall not be reimbursed by the
State until the requisite progress report is submitted to the State by the LPHA. Reporting
period and progress report due dates are as follows:
Progress Period Due Date
July 15 — September 30, 2012 October 15, 2012
October 1 — December 31, 2012 January 15, 2013
January 1 — March 31, 2013 April 15, 2013
April 1 — June 30, 2013 July 15, 2013
IV. Resolution of Non - Compliance:
The Contractor will be notified by e -mail and/or telephone within thirty (30) calendar of
discovery of a compliance issue. Within (30) calendar 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 by e -mail and agreed to by
both parties. If extenuating circumstances arise that require an extension to the time line,
the Contractor must e-mail a request to the Project 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 Terms and Conditions of this Purchase Order.
Statement of Work Acceptance:
AMENDMENT 35 FUNDS
LOCAL COUNTY HEALTH AGENCY TOTAL FOR FY 2013 = $44,188.00
LOCAL PUBLIC HEALTH PARTNER ACCEPTANCE OF Colorado Department of
Public Health and Environment Immunization Program Amendment 35 Immunization Funds for
Local Public Health Agency Statement of Work REQUIREMENTS:
I, 2 - YCA 00\1 , on behalf of altiLe CI) Iflhi (IC1(tj,IWV1(i.fi
hereby acknowledge the requirements for the above -named Immunization Service Purchase
Order have been reviewed, and are accepted and agreed to. I further acknowledge that I have the
necessary authority to • In this :.u.' e on behalf of the entity mentioned above.
A't 414
Signature Title Date
Attachment A
COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT
IMMUNIZATION PROGRAM
2012 -2013 CONTRACT REIMBURSEMENT CERTIFICATION FORM
PLEASE RETURN BY July 15, 2013
RE: AMENDMENT 35 FUNDS
TO: Colorado Department of Public Health and Environment
DCEED- IMM -A3
4300 Cherry Creek Drive South
Denver, CO 80246 -1530
FROM: * *DO NOT SIGN SAMI'I.i: ()N1,A' *X
Tax ID #:
This is to certify that the con act se e'ces e been f + A
fy n pe er rchase Order Number
o the p- .'od aced above.
SIGNATURE
Contractor or A h►ri 1 De e Date
CDPHE:
I hereby certify that all contrac quirements have been met and final payment of $
for contract services for the period of July 15,
2012 through June 30, 2013 is authorized.
SIGNATURE
Program Director or Authorized Designee Date
