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HomeMy WebLinkAboutC13-126 CDPHE Task Order Contract (FLA14-55858) DEPARTMENT OR AGENCY NAME COLORADO DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT PSD - NHVP DEPARTMENT OR AGENCY NUMBER FLA CONTRACT ROUTING NUMBER 14 -55858 AMENDMENT FOR TASK ORDERS #1 This Amendment is made this 1st day of Mav 2013, 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, (a political subdivision of the state of Colorado), 500 Broadway, Eagle, Colorado 81631 -0850, for the use and benefit of the EAGLE COUNTY PUBLIC HEALTH AGENCY, 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 17, 2012, with contract routing number 13 FAA 00016. Pursuant to the terms and conditions of the Master Contract, the parties entered into a Task Order Contract, dated May 11, 2012, with contract encumbrance number PO FLA PPG1343980, and contract routing number 13 FLA 43980, as amended by Grant Funding Change Letter #1, Contract Routing Number 13 FLA 53017, collectively referred to herein as the "Original Task Order Contract, whereby the Contractor was to provide to the State the following: Services for the project Nurse Home Visitor Program. In the event of the passage of House Bill (HB) 13 -1117 specific to the Nurse Home Visitor Program, Colorado Revised Statute (C.R.S.) 26 -6.4 -103, et al. (formerly C.R.S. 25 -31 -103 et al.), or an executed executive order from the Colorado State Governor specific to the Maternal, Infant, Early Childhood Visitation Program, the responsibilities, including but not limited to, the financial administration and contractual compliance of this contract shall be transferred from the Colorado Department of Public Health and Environment (CDPHE) to the Colorado Department of Human Services (CDHS) in accordance with and on the effective date as described in HB 13 -1117 or the executive order, respectively. The State promises to replace the Additional Provisions and to pay the Contractor the sum of Two Hundred Ninety -Four Thousand, Six Hundred Eighty -Seven Dollars, ($294,687.00) 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 twelve months, ending on June 30, 2014. NOW THEREFORE, in consideration of their mutual promises to each other, stated below, the parties hereto agree as follows: 1. . 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. 2. It is expressly agreed to by the parties that this Amendment is supplemental to the Original Task Order Contract, contract routing number 13 FLA 43980 as amended by Grant Funding Change Letter #1, Contract Routing Number 13 FLA 53017, collectively referred to herein as the Original Contract, which is by this reference incorporated herein. All terms, conditions, and provisions thereof, unless specifically Page 1 of 5 Rev 3/16/2010 modified herein, are to apply to this Amendment as though they were expressly rewritten, incorporated, and included herein. 3. 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 13 FLA 43980. This Amendment replaces the Additional Provisions of the Original Task Order Contract. The revised Additional Provisions are incorporated by this reference and identified as "Exhibit D." B. This Amendment is issued pursuant to paragraph 5 of the Original Task Order Contract identified by contract routing number 13 FLA 43980. This Amendment is for the renewal term of July 1, 2013, through and including June 30, 2014. The maximum amount payable by the State for the work to be performed by the Contractor during this renewal term is Two Hundred Ninety -Four Thousand, Six Hundred Eighty -Seven Dollars, ($294,687.00) for an amended total financial obligation of the State of FIVE HUNDRED SEVENTY -THREE THOUSAND, EIGHT HUNDRED FIFTY -EIGHT DOLLARS, ($573,858.00). This is an increase of Two Hundred Ninety -Four Thousand, Six Hundred Eighty -Seven Dollars, ($294.687.002 of the amount payable from the previous term. The revised Statement of Work is incorporated herein by this reference and identified as "Exhibit E ". The revised Budget is incorporated herein by this reference and identified as "Exhibit F". 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 July 1, 2013, or upon approval of the State Controller, or an authorized delegate thereof, whichever is later. 5. 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 conceming 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 5 Rev 3/16/2010 This page left intentionally blank. Page 3 of 5 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: STATE: Board of County Commissioners of Eagle County STATE OF COLORADO (a political subdivision of the state • Colorado) John W. Hickenlooper, Governor for the u > . benefit of the Eagle ' ounty P ; blic Health Ag By: Sign + tur ; of Author' 'd Officer For the Executive Director DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT 1 1 Print Name of Aut i orized I fficer NM OA MA Print Title of Authorized Officer 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 4 of 5 Rev 3/16/2010 This page left intentionally blank. Page 5 of 5 Rev 3/16/2010 EXHIBIT D ADDITIONAL PROVISIONS To Amendment for Task Orders Dated 05/01/2013 - Contract Routing Number 14 FLA 55858 These provisions are to be read and interpreted in conjunction with the provisions of the Amendment specified above. These Additional Provisions are effective 7/1/2013. 1. The list of acronyms attached hereto as Attachment D -1 may be referenced to in Exhibit D, Exhibit E, and all and any attachments thereof in this Task Order Contract. 2. This Task Order Contract contains state funds. 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. Unless otherwise provided for in this Contract, "Other Funding Sources," if any, shall be included on all Contract Reimbursement Statements as required. The Contract Reimbursement Statement must be submitted within sixty (60) calendar days of the end of the billing period for which services were rendered. Expenditures shall be in accordance with the Statement of Work attached hereto as Exhibit E and incorporated herein and the associated Budget attached hereto as Exhibit F and incorporated herein. 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. The Contractor shall not use state funds to satisfy federal cost sharing and matching requirements unless approved in writing by the State. 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. b. Notice of Defect. If the 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: 1) 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 ten (10) calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies within ten (10) 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. To be attached to CDPHE Page 1 of 3 Revised: 12/19/06 Task Order v1.0 (3/12) contract template EXHIBIT D The State has determined that this Task Order Contract does not constitute a Business Associate relationship under HIPAA. 6. Contractor shall request prior approval in writing from the State for all modifications to the Statement of Work/Work Plan or for any modification to direct costs in excess of twenty -five percent (25 %) of the total budget for direct costs. Contractor shall submit a Budget Revision Request Form to request prior approval for all budget modifications in excess of twenty-five percent (25 %) of the total budget for direct costs. The Budget Revision Request Form is incorporated herein by reference and is located at http: / /www.colorado.gov /cs/ Satellite /CDPHE- PSD/CBON/1251617515048 under the Fiscal Resources for Contractors tab. Any request for a modification to the Budget in excess of twenty-five percent (25 %) of the total budget for direct costs shall be submitted to the State at least 90 days prior to the end of the contract period and may require an amendment in accordance with Section 5 of this Original Task Order Contract. 7. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in Data, Documents and Computer Software or Other Intellectual Property, unless otherwise provided for, all data collected or produced or derived exclusively from the Contractor's or subcontractor's work under this Task Order Contract shall remain the sole property of the State, whether in individual, aggregate, identified or de- identified form or any other form required by the State. To facilitate follow -up, research, surveillance and evaluation, any such data collected, used or acquired shall be made available in any form required by the State, to the State and any other entity designated by the State. Any such data collected, used or acquired shall be used solely for the purposes of this Task Order Contract. The Contractor and its subcontractors agree not to release, divulge, publish, transfer, sell, or otherwise make known any such data to unauthorized persons without the express prior written consent of the State or as otherwise required by law. This includes a prior written request by the Contractor to the State for submission of abstracts or reports to conferences, which utilize data collected under this Task Order Contract. Notwithstanding the foregoing, the Contractor shall be entitled to retain a set of any such data collected or work papers necessary to perform its duties under this Task Order Contract and in accordance with professional standards. 8. Notwithstanding the terms contained in General Provisions of the Master Contract, Section 9, Rights in Data, Documents and Computer Software or Other Intellectual Property, or Section 23.i, General Provisions, Media or Public Announcements, the State of Colorado shall be the owner of all printed materials, graphic representations, educational materials, audio - visual products, or any other media, in whatever form, created under this Task Order Contract. This requirement applies, but is not limited to, any brochure, flyer, presentation, billboard, radio spot, website, banner advertisement. The State reserves the right to require logos, or other wording on any material, representation, product or other media form created under this Task Order Contract. Any material, representation, product or other media form that will use the State's or logo or information must be approved by the State prior to production and distribution. A minimum of ten (10) business days is required for the review and approval process. 9. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 25, Conformance with Law, the Contractor shall comply with the provisions of Section 601 of Title VI of the Civil Rights Act of 1964, as amended, which states that "no person in the United States shall on the grounds of race, color or national origin, be excluded from participation in, be denied the benefits of, or be subjected to discrimination under any program actively receiving Federal financial assistance." The Office for Civil Rights has established that it is the responsibility of any program that is a recipient of federal funds to ensure that any Limited English Proficient (LEP) person or beneficiary have meaningful access to programs, services and information. The Contractor and contract personnel shall adopt and implement policies and procedures in which reasonable steps are taken to provide language assistance in order to To be attached to CDPHE Page 2 of 3 Revised: 12/19/06 Task Order v1.0 (3/12) contract template EXHIBIT D ensure equal access to LEP persons or beneficiaries. The Contractor and contract personnel shall advise LEP individuals that language assistance will be provided at no cost to the LEP person or beneficiary. 10. 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 defmed by the Act. Contractor agrees that it shall require the language of the Act be included in any subcontracts which contain provisions for children's services and that all subcontractors shall sign and agree accordingly. 11. Notwithstanding the terms contained in the General Provisions of the Master Contract, Section 10, Confidential or Proprietary Information, 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. Contractor shall have written policies governing access, duplication, and dissemination of all such information. Contractor shall advise its employees, agents, servants, and any subcontractors that they are subject to these confidentiality requirements. 12. The State shall be the owner of all equipment as defmed by Federal Accounting Standards Advisory Board (FASAB) Generally Accepted Accounting Principles (GAAP) purchased under this Task Order Contract. At the end of the term of this Task Order Contract, the State shall approve the disposition of all equipment. 13. The Contractor shall not use funds provided under this Task Order Contract for the purpose of lobbying as defmed in Colorado Revised Statutes (C.R. S.) 24- 6- 301(3.5)(a). 14. The State may increase or decrease funds available under this Task Order Contract using a Grant Funding Letter substantially equivalent to Attachment D-2. The Grant Funding Change Letter is not valid until it has been approved by the State Controller or designee. To be attached to CDPHE Page 3 of 3 Revised: 12/19/06 Task Order v1.0 (3/12) contract template Attachment D -1 Commonly Used Acronyms and Abbreviations That May Be Referenced In the Scope of Work: ACS American Cancer Society ACNS Alamosa County Nursing Service ACF Administration for Children and Families ADA Americans with Disabilities Act ADAD Alcohol and Drug Abuse Division AHA American Heart Association AIDS Acquired Immune Deficiency Syndrome ALA American Lung Association ALA(C) American Lung Association (of Colorado) AMCHP Association of Matemal Child Health Programs ANR Americans for Non - Smokers' Rights ARC Addiction Recovery Centers ARRA American Recovery and Reinvestment Act ASC Adams State College ASSIST American Stop Smoking Intervention Study ASTHO Association of State and Territorial Health Office B &G Boys & Girls BACCHUS BACCHUS Peer Education Network BAG Build a Generation BBLHC Boulder Broomfield Latino Health Coalition BC Boulder County BCCP Breast and Cervical Cancer Program BCHD Bent County Health Dept BCPH Boulder County Public Health BCPHA Baca County Public Health Agency BCDSS Baca County Dept Social Services BCTEPP Bent County Tobacco Education Prevention Partnership BGC Boys & Girls Club BGCMD Boys & Girls of Metro Denver BHS Broomfield High School BMTF Baby & Me Tobacco Free BOCES Board of Cooperative Educational Services BOH Board of Health BRFSS Behavioral Risk Factor Surveillance System BVBAG Buena Vista Build a Generation BVSD Boulder Valley School District Bx Biopsy C Choice CAD Coronary Artery Disease CASB Colorado Association of School Board CB Community-based System CBE Clinical Breast Exam CBO Conununity-based Organization CC Clear Creek CC Custer County CC Community Coordination/Coordinator CCAP • Larimer County Child Care Assistance Program CCC Colorado Cancer Coalition CCCHE Colorado Community Coalition for health Equity CCGC Colorado Clinical Guidelines Collaborative CCIAA Colorado Clean Indoor Air Act CCMC Colorado Clinical Managed Care Network CCMC Commission for Case Manager Certification CCPD Cancer, Cardiovascular, and Pulmonary Disease Page 1 of 6 Attachment D -1 CCTCI Colorado Chew Tobacco Collaborative Initiative CCTEPP Custer County Tobacco Education Prevention Partnership CDC Centers for Disease Control and Prevention CDE Colorado Department of Education CDPHE Colorado Department of Public Health and Environment CDU Chronic Disease Unit CEC Career Education Center CEO Chief Executive Officer CFDA Catalog of Federal Domestic Assistance CFFC Colorado Foundation for Families and Children CFPI Colorado Family Planning Initiative CHIN Community Health Information Network CICP Colorado Indigent Care Program CJD Colorado Judicial Department CM Case Management CMC Colorado Mountain College CMS Contract Management System CMS Creative Media Solutions CNCC Colorado Northwestern Community College CNS County Nursing Service CO Colorado COD Colorado Donated Dental Services Program COPAN Colorado Physical Activity and Nutrition Program COV Colorado Van Program CPCF Colorado Parent and Child Foundation CPHA Colorado Public Health Association CPT Current Procedural Technology CRC Colorectal Cancer CRCCP Colorectal Cancer Screening Program CRUE Culturally Responsive Urban Education CSAP Colorado Student Assessment Program CSH Coordinated School Health CSU Colorado State University CSU -P Colorado State University- Pueblo's CTC Connect to Care CTEPA Colorado Tobacco Education and Prevention Alliance CTFK Campaign for Tobacco -Free Kids CTRP Colorado Tobacco Research Program CTP Crossroads Turning Point CU University of Colorado, Boulder CWCCI Colorado Women's Cancer Control Initiative CY Contract Year DAISI Denver At -home Intervention Service Initiative DASH Division of Adolescent & School Health (CDC) DCMH Delta County Memorial Hospital DH Denver Health DHHA Denver Health and Hospital Authority DHS Department of Human Services DHHS Unites States Department of Health and Human Services DOR Department of Revenue DOS Delta Opportunity School DSS Department of Social Services E&I Education and Information EAP Employee Assistance Program EBHV Evidence -Based Home Visiting to Prevent Child Maltreatment Grant Program ECC Early childhood council ECC Electrocardiogram ECCLC Early Childhood Council of Larimer County Page2of Attachment D -1 ECLC Early Childhood Leadership Council/Commission E.D. Executive Director EHR Electronic Health Record EHS Early Head Start EMR Electronic Medical Record EMT Emergency Medical Technicians EPA Environmental Protection Agency EPE Epidemiology Planning and Evaluation ESL English as a Second Language ETS Environmental Tobacco Smoke (a.k.a. secondhand smoke) FIRC Family and Intercultural Resource Center FICA The Federal Insurance Contribution Act FDA Food and Drug Administration FIT/FOBT Fecal Immunochemical Test/Fecal Occult Blood Test FNA Final Needle Aspiration FPP Family Planning Program FPL Federal Poverty Level FRCC Front Range Community College FTE Full Time Equivalent FTP File Transfer Protocol FY Fiscal Year FYI Family Youth Initiatives GASO Great American Smoke -out GED General Education Development GASP CO Group to Alleviate Smoking Pollution of Colorado Get R!EAL (GR) Resist! Expose Advertising Lies (Youth Empowerment Program) GLBT Gay, Lesbian, Bisexual, and Transgender GYN Gynecological HCP Health Care Program For Children with Special Needs HCYS Huerfano County Youth Services HHS Health and Human Services HIPPA Health Insurance Portability and Accountability Act of 19% HIPPY Home Instruction for Parents of Preschool Youngster HIT Health Improvement Team HIV Human Immunodeficiency Virus HPV Human Papillomamavirus HR Human Resources hr hour HRSA Health Resources and Services Administration HSL High School Leadership ID Identification IIK Invest in Kids ISHT Interagency School Health Team IT Information Technology JAC Juvenile Assessment Center KIS Keeping in STEPP KMH Keefe Memorial Hospital KPC Kevin Patrick Caleum LAHCDHD Las Animas Huerfano Counties District Health Department LBW Low Birth Weight LC Learning Community ty LGBT Lesbian, Gay, Bisexual, Transgender LEM Latinas en Movimiento LHA Local Health Agency LHD Local Health Department LLC Limited Liability Company LRCC Latino Regional Community Coalition LRPC Latino a Research and Policy Center Page 3 of 6 Attachment D- 1 LST Life Skills Training LSTPEN Latino Statewide Tobacco Prevention and Education Netw LWB Live Well Broomfield MCHA Montezuma Housing Authority MCHD Montezuma County Health Department MCHS Montezuma- Cortez High School MCPN Metro Community Provider Network MCRC Media Campaign Resource Center — CDC MD Medical Doctor MHCBBC Mental Health Center Serving Boulder and Broomfield Counties MIECHV Maternal, Infant and Early Childhood Home Visiting Program MO Month MOB Medical Office Building MOU Memorandum of Understanding MPA Master of Public Administration in Health and Human Services MPH Master of Public Health MRI Magnetic Resonance Imaging Scan MS Master of Science MSA Master Settlement Agreement MUH Multi -user Housing MYAT Multi - Disciplinary Youth Assessment Team N/A Not Applicable NACCHO National Association of County and City Health Officials NACR Native American Cancer Research NAQC North American Quitline Consortium NASBE National Association of State Board of Education NCCRT National Colorectal Cancer Round Table NCHD Northeast Colorado Health Department NCI National Cancer Institute NE North East NFP Nurse - Family Partnership NFPNSO Nurse - Family Partnership National Service Office NHVP Nurse Home Visitor Program NIDA National Institute on Drug Abuse NIH National Institute of Health NJH National Jewish Medical and Research Center N -O -T Not -on- Tobacco, (ALA's Youth Smoking Cessation Program) NP Nurse Practitioner NPP Nurturing Parenting Program NRT Nicotine Replacement Therapy NSBA National School Boards Association OSH Office on Smoking or Health (CDC) OTC Over the Counter PA Physician's Assistant PAC Prevention Awareness Crew PACT Partners Assessing Chew Tobacco PAT Parents as Teachers PCCHD Pueblo City-County Health Department PPC Personal Care Providers PE Presumptive Eligibility PEN Parent Engagement Network PVCHC Peak Vista Community Health Center PHN Public Health Nurse PIO Public Information Officer PM Peer Mentor PMC Parkview Medical Center PMR Planning Management Region PN Patient Navigator Page 4 of 6 Attachment D- 1 PO Purchase Order PPC Policy Partner Committee PPFC Pikes Peak Family Connections PPN Prevention Policy Network PRA Policy Resource Alliance PRAMS Pregnancy Risk Assessment and Monitoring Survey PRIDE Pure Respect Initiative Direct Education PSA Public Service Announcement PSD Prevention Service Division PTEPP Pueblo Tobacco Education and Prevention Partnership PVC Prairie View Clinic Q1 Quarter One Q2 Quarter Two Q3 Quarter Three Q4 Quarter Four QI Quality Improvement QOL Quality of Life RDAC Regional Disparities Advisory Council RFA Request for Applications RFP Request For Proposals RIE Reach, Implementation and Effectiveness RIHEL Regional Institute for Health and Environment RMC Rocky Mountain Center for Health Promotion & Education RMRH Rocky Mountain Rural Health RMYC Rocky Mountain Youth Corps RN Registered Nurse Rx Prescription RY Reconnecting Youth SafeCare SAMHSA Substance Abuse Mental Health Services Administration SB School -based System SBAG Salida Build A Generation SBHC School -Based Health Centers SCYC School Community Youth Coalition SCRHC Southern Colorado Regional Health Collaborative SD Service Delivery SECH Southeast Colorado Hospital SEMHS Southeast Mental Health Services SES Socio - Economic Status SEW School Employee Wellness SGR Surgeon General's Report SHAC Smoke -free Housing Action Committee SHI School Health Index SHS Secondhand Smoke SIDS Sudden Infant Death Syndrome SLV San Luis Valley SMART Staying Motivated at Reducing Temptations SMART OUTCOME OBJECTIVE Specific, Measurable, Achievable, Realistic, Time -Bound SMSU Self Management Service Unit SRO School Resource Officer STD . Sexually Transmitted Disease STEPP State Tobacco Education and Prevention Partnership STW Straight - to-Work SVVSD St. Vrain Valley School District SWOT Strengths, Weaknesses, Opportunities, Threats SYNAR Synar Regulation TA Technical Assistance TABS Tobacco Attitudes and Behavior Survey Page 5 of 6 Attachment D -1 TAG Technical Advisory Group (for evaluation & TPEG) TANF Temporary Aid to Needy Families TARP Tobacco Advocacy and Resource Partnership TBD To Be Determine TCP Tobacco Control Partners TDAC Tobacco Disparities Advisory Council TDG Tobacco Disparities Grant TDS Tobacco Disparities Subcommittee TEACH Teaching Equity to Advance Community Health TEFAP The Emergency Food Assistance Program TEPCGP Tobacco Education Prevention and Cessation Grant Program TEPP Tobacco Education Prevention Partnership TFCCI Tobacco-Free Colorado Communities Initiative TFLC Tobacco Free Larimer County TFS Tobacco-Free Schools TFS Law Tobacco-Free Schools Law TGYS Tony Grampsas Youth Services Title V Title V of the Social Security Act TND Project Toward No Drug Abuse TPEG Tobacco Program Evaluation Group TPI Tobacco Prevention Initiative TRC Tobacco Education and Prevention and Cessation Program Review Committee TRI Tobacco Rapid Improvement Activity TRIA Tobacco Rapid Improvement Assessment TTI Tony Grampsas Tobacco Initiative UCD University of Colorado — Denver UCDHSC Health Sciences Center at UCD (sometimes abr. UCHSC) UCDHSC University of Colorado at Denver and Health Sciences Center URL Uniform Resource Locator US United States of America USSTC US Smokeless Tobacco Company VP Vice President Well COA Wellness Councils of America WHU Women's Health Unit WIC Women, Infants, Children WWC Women's Wellness Connection Y @C Youth at Crossroads YE Youth Empowerment YPH Youth Partnership for Health Yr Year YRBS Youth Risk Behavior Survey YSAP Youth Substance Abuse Prevention Coalition YTS Youth Tobacco Survey YVMC Yampa Valley Medical Center 5 A's Ask, Advise, Assess, Assist, Arrange 2A's R Ask, Advise, Refer Page 6of6 • Attachment D -2 GRANT FUNDING CHANGE LETTER Date: 1 State Fiscal Year: 1 Grant Funding Change Letter # 1 CMS Routing # TO: Insert Grantee's name In accordance with Section of the Original Contract 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 <insert start date of original contract> and ending on Insert ending date <insert ending date of current contract amendment >, the undersigned commits the following funds to the Grant: The amount of grant funds available and specified in Section of < insert contract amendment number and routing number> is ❑ increased or ❑ decreased by $amount of change to a new total funds available of $ < insert new cumulative total> for the following reason: . Section 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 Ellis, Purchasing & Contracts Unit Director By: Date: ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER CRS §24 -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 provided hereunder. STATE CONTROLLER David J. McDermott, CPA By: Date: • Page 1 of 1 Effective Date: 1/6/09 -Rev 8/25/09 EXHIBIT E STATEMENT OF WORK To Amendment for Task Order Dated 05/01/2013- Contract Routing Number 14 FLA 55858 These provisions are to be read and interpreted in conjunction with the provisions of the Amendment specified above. Project Description: In order to implement the Nurse Home Visitor Program (NHVP) efficiently and effectively and to promote the successful partnerships between state public entities and the private sector, responsibility for the program is divided between the Colorado Department of Public Health and Environment, which is responsible for financial administration of the program, and the Regents of University of Colorado, a body corporate, for and on behalf of the University of Colorado Denver (UCD) located at the Anschutz Medical Campus which is responsible for programmatic, clinical and technical support, monitoring and evaluation, including data collection, for the program. II. Performance Requirements/Deliverables: 1. 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 fiscal management of the Colorado Nurse Home Visitor Program. The fiscal management provided by the contractor for the program must be deemed by the State to be acceptable and in good faith. For fiscal management 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.colorado.gov /cs /Satellite /CDPHE- PSD /CBON/ 1251617515048 • Colorado Nurse Home Visitor Program Act, as described in § 25 -31 -101, C.R.S. • Colorado Nurse Home Visitor Program Fiscal Compliance Requirements • Rules Concerning the Nurse Home Visitor Program • Nurse Home Visitor Program Targeted Case Management Medicaid Billing Manual • NFP Model Elements 2. The Contractor shall submit the following reports, when requested and by the indicated due dates, incorporated by reference. These documents are located at: http://www.cdphe.state.co.us/ps/nursehome/index.html • Year -to -Date Expenditure/Mid - Year Projections Report 3. The Contractor shall complete in a satisfactory manner and by the indicated date, all activities stated in the Areas Requiring Performance Improvement Plan or Funding Conditions in the NHVP Application Review Summary/Award Summary which is incorporated and made part hereof by reference. 4. The Contractor shall participate in meetings or trainings as requested by the State, including attendance by the Contractor's Nurse Supervisor and NHVP fiscal staff at the NHVP grantee workshop; and the Contractor must cover all costs as applicable. 5. The Contractor shall provide the nurse home visitor services in accordance with the grantee application and the FY2014 Budget, Exhibit F. 6. Funding adjustments may be executed during the term of this Task Order Contract in accordance with Additional Provisions, Exhibit D. Grant awards are made using NHVP funding and Medicaid reimbursement Page 1 of 2 Exhibit B- Statement of Work V l/MAR2012 EXHIBIT E estimates. The total amount of funding for the term of this Task Order Contract may not exceed the Total Amount Requested from the CDPHE as provided in the attached Budget, Exhibit F. 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 may increase the NHVP funding, if funding is available, during the Mid -Year Budget Projections process. Medicaid income generated from Nurse Home Visitor Program services is required to be spent on the Nurse Home Visitor Program. 7. Contractor shall submit Medicaid reimbursement requests for all eligible clients. Department of Health Care Policy and Financing (HCPF) oversees the submission of Medicaid reimbursement requests for compliance with HCPF procedures and the Medicaid Billing Manual. The Medicaid Billing Manual can be accessed at http: / /www_colorado. gov /cs /Satellite /CDPHE- PSD /CBON/ 1251617515048 8. Contractor shall refer families participating in any and all programs in its agency such as the Special Supplemental Program for Women, Infants and Children (WIC), Early and Periodic Screening, Diagnosis and Treatment (EPSDT), Immunization Clinics, Health Care Program for Children with Special Health Care Needs (HCP), Prenatal Plus (PNP), etc. to appropriate enabling and direct care service programs in the community. Contractor shall provide all pregnant women in need of resources for prenatal medical care information about programs such as WIC, PNP, etc. as needed; provide all individuals seeking reproductive health services with information about pregnancy planning, preconception health, the consequences of unintended pregnancies, and referrals to comprehensive family planning services; and shall ensure that all children ages birth through two years who may be eligible for early intervention services are referred to Early Intervention Colorado. 9. Contractor shall notify the State within thirty (30) days of a change of the NHVP Nurse Coordinator /Supervisor or fiscal staff and shall require any new NHVP Nurse Coordinator /Supervisor and fiscal staff working on NHVP services to participate in Fiscal Orientation within forty -five (45) days of employment. III. Monitoring: The monitoring of this contract for compliance with fiscal performance requirements is based in part on a fiscal risk assessment conducted prior to contracting, contractor fiscal and programmatic performance during the contract period and contractor compliance with contractual terms and conditions during the contract period. Monitoring will be conducted by the Program Manager and methods used will include review of documentation reflective of performance, including progress reports and other 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. IV. 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 Program 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 Remedies section of the General Provisions of this contract. Page 2 of 2 Exhibit B- Statement of Work V 1/MAR2012 Exhibit F Amendment for Task Order#1, NHVP FY2013 -14 Proposed Budget Contract Routing Number 14 FLA 55858 APPLICANT: Eagle County Public Health PROGRAM NAME: Eagle County Public Health FOR THE PERIOD: July 1, 2013 - June 30, 2014 NUMBER OF CLIENTS TO BE SERVED: 50 COUNTIES TO BE SERVED: One - Eagle County Enter whole amounts only /Do not create new formulas TOTAL CDPHE FY13-14 TOTAL AGENCY July 1, 2013 to June 30, 2014 14 NHVP BUDGET CONTRACT BUDGET (B+C) (A +B+C) Annual Salary/ No. of FTE Wages months (for all funding sources) A. Other B. Medicaid C. CDPHE (8 +C) Medicaid Sources of Estimate Funding Estimate & CDPHE (A +8 +0) Funding (NHVP) Funding (NHVP) PERSONNEL COSTS (Detail Expenses) Nurse Supervisor - Jennie Wahrer 87560 12 0.50 $14,715 529,065 $43,780 $43,780 Nurse Home Visitor 1- Luz Avila 63908 12 1.00 563,908 $63,908 $63,908 Nurse Home Visitor 2 - LaVina Beveridge 63608 12 1.00 563,608 563,608 $63,608 Program Support Technician - Kelly Matias 47476 12 0.25 511,869 $11,869 511,869 $0 $0 Fringe Benefits: Rate = Approximately 43.99% 574,055 $74,055 $74,055 1. TOTAL PERSONNEL COSTS $0 $14,715 $242,505 5257,220 5257,220 CONTRACTS Rate Hours Total Contractor Budget 50 50 Contractual /Fee for Service 5 50 Intrepreter - Pauline Araujo Agoitia 20 294 5880 55,880 55,880 55,880 Mental Health Consultant - Julia Kozusko 75 48 3600 53,600 53,600 $3,600 2. TOTAL CONTRACTS 50 $0 59,480 59,480 5 9 , 480 OPERATING (Detail Expenses) Office Operating Expenses (i.e. supplies, pens, etc.; 51,134 51,134 51,134 Client Support Materials Bright Beginning Literacy Bags = 51,250 51,250 $1,625 51,625 $2,875 Printing & Publications 51,100 51,100 $1,100 Postal & Shipping Services 50 50 $0 Communications (long distance, cellular and network s, Landline telephone Sery 52,000 $1,608 $1,608 $3,608 Medical Supplies $0 50 Outside Services IT Cost = $7,359 $7,359 $0 57,359 3. TOTAL OPERATING 510,609 $0 $5,467 $5,467 516,076 EQUIPMENT (Detail Expenses) Computers w/ Software 50 50 Cellular Phones 50 50 4. TOTAL EQUIPMENT 50_ $0 $D $0 $0 TRAVEL (Detail Expenses) Visit Outreach Mileage $8,470 58,470 58,470 NFP Training Travel 5558 $558 5558 Dyadic Assessment Tool (3 days in either Denver or Grand Junction) 51,508 51,508 $1,508 Annual Supervisor Training (2 -3 days in Denver - budget travel, hotel & meals) • $863 5863 $863 Program Meetings (nurses, supervisor, other) $1,233 51,233 51,233 Other Travel $0 $0 $0 $0 5. TOTAL TRAVEL $0 $0 $12,632 $12,632 $12,632 NFP TRAINING & TECH ASSISTANCE (Detail Expenses) i Program Support Fee ($7,046 per supervisor) 57,046 57,046 57,046 Nurse Consultation (52,534 for first supervisor) 52,534 $2,534 52,534 Professional Development (5600 cap per nurse home visitor or nurse supervisor) $1 $1,800 $1,800 _.. _... $0 $0 6. TOTAL TRAINING & TECH ASSISTANCE $0 $0 $11,380 $11,380 $11,380 DYADIC ASSESSMENT TOOL COSTS (Detail Dyadic Assessment Tool Training & Materials) Dyadic Assessment Tool Registration $1,098 51,098 $1,098 Dyadic Assessment Tool Materials 50 $O 7. TOTAL DYADIC ASSESSMENT TOOL COSTS 50 $0 $1,098 $1,098 51,098 OTHER COSTS (Detail Other Program Costs) 1 50 $0 8. TOTAL OTHER COSTS $0 50 $0 $0 $0 TOTAL DIRECT PROGRAM COSTS (Add budget categories 1 -8) 510,609 $14,715 , 5282,562 $297,277 5307,886 Indirect Indirect Public Health Director - 0.1 FTE = $8,000 58,000 $74 $12,125 512,199 520,199 Administrative Supplies (not program supplies) 50 50 Accounting (audit, bank expenses, liability) $0 50 Supporting Costs (mileage, recruitment) 50 50 Board of Health 50 SO Other Administrative Costs (Postage,Occupancy, Computer) 50 50 50 $O TOTAL ADMINISTRATIVE COSTS 58,000 $74 $12,125 512,199 520,199 TOTAL PROGRAM COSTS (Direct Program + Administrative Costs) 518,609 514,789 5294,687 5309,476 5328,085 Specify "OTHER SOURCES" (cash or in -kind) from the column A. above. Youth Foundation /Bright Beginnings 51,250.00 Eagle County Government $17,359.00 Total Other Sources $18,609.00 Page 1 of 5 Exhibit F Amendment for Task Order#1, Contract Routing Number 14 FLA 55858 NHVP FY13 -14 Budget Narrative (for column C. CDPHE Funding only, DO NOT include columns A. Other Sources of Funding or B. Medicaid Estimate) Agency Name Eagle County Public Health PERSONNNEL SERVICES Abu ,. ntributing Individual -Name of staff Description of the Individual's Ro nn FTE sition -rson (if known) in the NHVP and Calculation of I (CDP Cost how He /She is Funded by CDPH Fundi CDPHE e :z. ending Jennie Wahrer Nurse Supervisor &Fiscal $87,560 0.33194 $29,065 Calculation: Annual salary column /12 x 12 months x FTE CDPHE $87,560 /12 months x 12 months x .33194 FTE CDPHE funding only = $29,065 Luz Avila Nurse Home Visitor $63,908 1 $63,908 Calculation: Annual salary column /12 x 12 months x FTE CDPHE $63,908 /12 months x 12 months x 1 FTE CDPHE funding only = $63,908 LaVina Beveridge Nurse Home Visitor $63,608 1 $63,608 Calculation: Annual salary column /12 x 12 months x FTE CDPHE $63,608 /12 months x 12 months x 1 FTE CDPHE funding only = $63,608 Kelly Matias Program Support Technician $47,476 0.25 $11,869 Calculation: Annual salary column /12 x 12 months x FTE CDPHE $47,476 /12 months x 12 months x 0.25 FTE CDPHE funding only = 547,476 Fringe Benefits Fringe benefits are actual percentage rate of 74 g $ , 055 agency calculated against all salaries. Includes workers' comp insurance, unemployment insurance, long -term disability, FICA, retirement, health and dental and vision insurance. They are calculated on actual salaries and vary for each employee Total Personnel Services: 242 505 'Corti me f £ " De of Contracted Calculation of Total Cost Contract Cost Service (CDPHE Funding Only) Pa uline Araujo Agoitia Int Services $20 per hour x 294 hours = $5,880 $5,880 Julia Kozusko Mental Health Consultation $3,600 $75 per hour x 48 hours = $3,600 o a ontrac Page 2 of 5 Exhibit F Amendment for Task Order#1, Contract Routing Number 14 FLA 55858 NHVP FY13 -14 Budget Narrative (for column C. CDPHE Funding only, DO NOT include columns A. Other Sources of Funding or B. Medicaid Estimate) Agency Name Eagle County Public Health Calculation of Total Cost Item Cost (CDPHE Funding Only) Based on 2012 -13 cost $1,134 Includes pens, pencils, paper, markers, folders, toner for copier, photo copy paper, envelopes, stapling materials, paper and binder Office Operating Expenses (i.e. supplies, clips, tape, name badges, pens, etc.) labels, and batteries. Client support materials $32.50 per client x 50 clients $1,625 cost $32.50 per family per program cycle and are used to purchase support materials for families and for the Nurse Home Visitors to assist in the work they are doing with families beyond NHVP and PIPE handouts. Client Support Materials Includes all printing for Based on 2012 -13 cost $1,100 client printed materials (facilitators), staff supervision forms, home visit forms, reference publications, Professional Journals, brochures as deemed necessary by staff Printing & Publications Postal & Shipping Services NA $ Communications (long distance, cellular The monthly service cost $67 monthly service x 2 nurses x 12 81.608 and network service) for 2 Smart Phones mo. Medical Supplies NA $0 Outside Services NA SO Total Operating: $5.467 ' . scription Calculation of Computers w/ Software NA SO Cellular Phones NA ota • ill I ment: Page 3 of 5 Exhibit F Amendment for Task Order#1, Contract Routing Number 14 FLA 55858 NHVP FY13 - 14 Budget Narrative (for column C. CDPHE Funding only, DO NOT include columns A. Other Sources of Funding or B. Medicaid Estimate) Agency Name Eagle County Public Health TRAVEL Event Description Calculation of Total Cost Travel Cost , - (CDPHE Funding County and personal Based on 2012 -13 cost: $8,470 vehicles used when driving 2 county vehicles, 1 vehicle is to and from home visits, to designated solely for NFP use, and 1 community meetings to vehicle is shared with other HHS staff share information about = $6,500 NFP, and for recruitment. Personal vehide - 3,487 miles x $.565 County vehicles includes = $1,970 replacement cost, fuel, and maintenance Visit Outreach Mileage Travel costs for 3 nurses Hotel 3 nights $150 x 2 rooms =$900 $1,508 RT Mile 280mi x $.565 = $158 Dyadic Assessment Tool (3 days in either Meals (3 staff) x $50 /day x 3 days = Denver or Grand Junction) $450 Mandatory continuation Hotel 1 night $150 x 2 rooms = $300 $558 grant training RT Mile 280 mi x $.565 = $158 Meals (2 staff) x $50 /day x 1 day = $100 NFP Training Travel Hotel 3 nights $150 4450 $863 Hotel Parking 3 nights x $35 = $105 RT Mile 280mi x $.565 = $158 Annual Supervisor Training (2 -3 days in Meals @ $50 x 3 days = $150 Denver - budget travel, hotel & meals) Quarterly supervisor Hotel 1 night $120 x 4 mtg =$480 $1,233 meetings RT Mile 280mi x $.565 x 4 mtg = $633 Program Meetings (nurses, supervisor, Dinner @ $30 x 4 mtg = $120 other) Total Travel: $12,632 4 41 WIPP Training Cost (CDPHE Funding Only) Program Support Fee ($7,046 per Mandatory NSO Fee Preset annual fee $7,046 supervisor) Nurse Consultation ($2,534 for first Mandatory NSO Fee Preset annual fee $2,534 supervisor) It is estimated to cost $600 per nurse $1,800 Includes additional per year x 3 nurses. specialized professional development that individual nurses have identified after a thorough assessment of their needs beyond NHVP core education. The Nursing Practice Assessment/ Nurse Supervisor Assessment Professional Development ($600 cap per may guide use of additional nurse home visitor or nurse supervisor) training needs. 'eta! NFP Trammg & Tech Assistance: $11.380 Page4of5 Exhibit F Amendment for Task Order#1, Contract Routing Number 14 FLA 55858 NHVP FY13 -14 Budget Narrative (for column C. CDPHE Funding only, DO NOT include columns A. Other Sources of Funding or B. Medicaid Estimate) Agency Name Eagle County Public Health !WIC ASSESSMENT ;{ Description . Calculation of Total Cost Item Cost i iiiiii ( CDPHE Funding Only) Dyadic Assessment Tool Registration & Registration fee & materials $366 /nurse 3 nurses $1.098 Materials for3 nurses Total Dyadic Assessment Tool Costs: $1,098 NA 50 Total Other Costs:I SO TOTAL CDPHE FUNDING DIRECT 1 15282,562 yet . Indirect 5% of salary & fringe Indirect costs - Eagle $12,125 County Public Health does not have an approved indirect rate with CDPHE, however, the program is allowed to charge 10% of indirect on total salaries and fringe - Due to major decreases in Eagle County Government's revenue, and the high cost of fiscal operation staff and overhead the program would like to ask permission to charge 5% I indirect on total salaries and fringe. Total Administrative Costs: $12,125 TOTAL CDPHE FUNDING COSTS $294,687 Page 5 of 5