HomeMy WebLinkAboutC16-219 Colorado Department of Public Health and Environment Tuberculosis ServicesIACLECOUNTY
DEPARTMENT OF PUBLIC HEALTH
AND ENVIRONMENT
970-328-8840
www.eaqlecountv. us
551 BROADWAY
EAGLE, COLORADO
81631
III.
STATEMENT OF WORK
I. Entity Name: Eagle County Public Health Agency
Term: July 1,2016-June 30,2017
IL Project Description:
This project serves to provide diagnostic, patient education and treatment services for individuals with
suspected,&nown tuberculosis (TB) infection and those classified with Class A and Class B TB status or who are
suspected of having active TB. Also for individuals who are identified as newly arrived refugees, asylees and
other high risk persons with Latent Tuberculosis Infection (LTBI).
1. AFB smear - Acid-Fast Bacilli; a rapid test used to detect infectious mycobacteria
2. CDPHE - Colorado Department of Public Health and Environment
3. Class A - Pulmonary TB, the applicant has an abnormal chest radiograph suggestive of
active TB disease, and one or more sputum smears positive for acid-fast bacteria
Class Bl - Immigrant with an abnormal CXR with evidence of TB, and/or the individual has a history of
treatment for active TB disease.
Class 82 - The individual was diagnosed with latent TB infection (LTBI). These are typically children
whose TST result was positive and CXR was normal.
6. CXR-ChestX-Ray
7. DOT - Directly Observed Therapy
8. HIV- Human Immunodeficiency Virus
9. IGRA - interferon gamma (y) release assay (whole blood TB test)
10. LEP - limited English proficiency (Over-the-Phone Interpretation (OPI) provider only)
I l. LTBI - Latent Tuberculosis Infection
12. OPI - over-the-phone interpretation
13. RVCT - Report of Verified Case of Tuberculosis
14. TB - Tuberculosis
15. TB-17- CDPHE's TB surveillance form
16. TBdb - Tuberculosis Data Base (CDPHE)
17. TST - Tuberculin Skin Test
IV. Work Plan:
A+.
Goal #l: Prevent and control tuberculosis infection and active TB disease throughout Colorado.
OUlective #1: No later than the expiration date of this purchase order, the Contractor shall support tuberculosis prevention and
control activities throughout the agency's jurisdiction.
Primary Activity #1 The Contractor shall locate all patients with suspected or confirmed TB.
Sub-Activities #1
l. The Contractor shall provide, or affange for, chest x-rays and interpretations for
individuals with suspected or confirmed TB.
2. The Contractor shall collect specimens for mycobacteriology testing on all persons
suspected of having TB.
3. The Contractor shall arrange for the transportation of the specimens to the CDPHE
laboratory for testing.
4. The Contractor shall affange for the placement of patients who require isolation.
a. The Contractor shall contact CDPHE TB Program for assistance, if needed, and to
request reimbursement from CDPHE for those costs incurred by the Contractor in
Eagle County Building, 500 Broadway, P.O. Box 850, Eagle, Colorado 81631-0850
C16-219
isolating a patient.
5. The Contractor shall provide, or arrange for, the treatment of patients with suspected or
confirmed active TB, including DOT, and ensure adherence to treatment.
6. The Contractor shall offer an HIV antibody test to 100% of persons diagnosed with active
TB disease and provide, or arrange for, the HIV antibody test with a test result rate>95o/o,
regardless oftheir age or the apparent absence ofrisk factors for HIV infection.
a. The Contractor shall inform those individuals whom refuse testing of the risks
associated with HIV/TB co-infection.
7. The Contractor shall monitor and evaluate those persons with suspected or confirmed
active TB disease by in-person assessment, a minimum of once per month.
8. The Contractor shall offer limited English proficiency services, as necessary, via an
accredited Over-the-Phone Interpretation (OPI) provider to be reimbursed using TB
DOT/Diagnostic reimbursement invoice template by the CDPHE TB Program at a rate not
to exceed $0.75lminute.
Primary Activity #2 The Contractor shall ensure that all contacts to newly identified infectious TB cases are
identified. investisated, and receive appropriate evaluation.
Sub-Activities #2
2.
The Contractor shall provide, or arrange for, chest x-rays and interpretations for
individuals with newly identified infectious, suspected, conf,rmed, and LTBI TB cases.
The Contractor shall provide, or arrange for, the treatment of patients, including DOT, and
ensure the completion oftherapy for infected patients.
The Contractor shall provide, or alrange for, an HIV antibody test for all persons with
LTBI with HIV risk factors or who originate from an HlV-endemic area.
a. The Contractor shall inform all individuals whom refuse testing of the risks
associated with HIV/TB co-infection.
The Contractor shall monitor and evaluate persons with LTBI during treatment, a
minimum of once per month.
The Contractor shall submit a preliminary Tuberculosis Contact Investigation Record, to
the CDPHE TB Program after initiation of each contact investigation. This document is
found here: https://www.colorado.gov/pacific/cdphe/tuberculosis-providers, and made
part ofthis purchase order by reference.
5.
:
Primarv Activitv #3 The Contractor shall provide or arrange for newly arrived refugees, asylees and other eligible
individuals with Class B TB designation TB screening.
Sub-Activities #3
l.A minimum of thirty (30) calendar days of the Contractor's receipt of written notification
from CDPHE of the arrival of a Class B immigrant or refugee, the Contactor shall provide,
or arrange for, a TB screening that includes medical evaluation, tuberculin skin test or
IGRA, chest radiograph, and three spontaneous sputum specimens for AFB smear and
culture collected on consecutive days.
Upon completion of testing and examination, the Contractor shall complete, sign, and date
the TB Follow-up worksheet and email or fax the form to the CDPHE TB Program.
2.
.
i.
;.5
Primary Activity #4
The Contractor shall ensure that all persons with a high risk of LTBI are identified,
investigated, and receive appropriate evaluation.
Sub-Activities #4
l. The Contractor shall offer an HIV antibody test tol00% of persons with LTBI and provide,
or arrange for, HIV antibody test with a test result rate>|IYo.
a. The Contractor shall inform all individuals whom refuse testing of the risks
associated with HIV/TB co-infection.
2. The Contractor shall monitor and evaluate persons with LTBI during treatment for all such
patients. a minimum of once per month.
Primarv Activitv #5
CDPHE contractors shall provide clients printed resource and referral materials that direct them
to the nearest community Medicaid and Connect for Health Colorado enrollment location(s),
includine online enrollment options.
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Sub-Activities #5
l. The Contractor shall indicate in client's case notes in TBdb, specific to provision of health
insurance enrollment materials.
Expected Results of the
Activity
I
2
J
New TB cases shall be diagnosed, documented and treated.
Patients with existing or newly diagnosed TB or LTBI shall be treated, as appropriate.
Newly arrived refugees, asylees and other eligible individuals with Class B TB designation
will receive treatment.
Standards and
Requirements
l.
11.
The Contractor shall ensure the completion of the appropriate treatment as stated in the
CDPHE TB Manual. The CDPHE TB Manual is available on the State of Colorado
website htto://www.colorado. gov/cs/SatelliIe/CDPHE-DCEED/CBON/1 25 1 6077675 I 0
and is incorporated and made part ofthis purchase order by reference.
CDPHE will provide templates and instructions for any additional information requests.
Report forms are subject to revision and the Contractor agrees to use the most recent
version.
The Contractor shall increase the percentage of persons that complete LTBI treatment to
meet the state objective of 83Yo by end of 2017 and maintain or improve on that rate
thereafter.
All reports of suspected or confirmed active TB disease shall include: reason for initiating,
patient name, date of birth, country of birth, date arrived in U.S., demographic information,
locating information, provider information, TB risk factors, results of diagnostic testing,
results of mycobacteriology including susceptibility results, dates of infectious period,
treatment information, changes in patients'status, diagnosis, and any other information as
appropriate.
For those persons identified with LTBI or active TB, the Contractor shall report to CDPHE
patient name, date of birth, country of birth, date arrived in the U.S., demographic
information, locating information, provider information, TB risk factors, results of
diagnostic testing, heatmi:nt information, and any other information deemed appropriate
by the Contractor.
The Contractor shall ensure appropriate testing is performed, e.9., smears for acid-fast
bacilli, (using concentrated fluorescent method), isolation of mycobacteria (using rapid
methods), identification of Mycobacterium tuberculosls complex (MTB) (using rapid
methods), and susceptibility testing (isoniazid, rifampin, ethambutol, andpyrazinamide) on
isolates of MTB.
The Contractor shall submit via email or fax, TB Follow-up worksheet, within ninety days
upon completion of consultation and examination of Class B immigrant or refugee. This
document is found here: https:/iwww.colorado.gov/pacific/cdohe/tuberculosis-providers,
and made part of this purchase order by reference.
The Contractor shall provide culturally appropriate patient education and information
pertaining to TB treatment and,/or follow-up plan. The Contractor shall provide services in
patient's preferred language using medical interpretation resource The Contractor shall
report to CDPHE via (TBdb) or via Tuberculosis Surveillqnce and Case Management
Report (fB I 7) when a TB patient completes treatment, moves, or transfers out of the
Contractor's service area. This document is found here:
https://www.colorado.gov/pacific/cdohe/tuberculosis-providers, and made part of this
purchase order by reference.
The Contractor shall provide, or arange for, treatment and ensure completion of therapy.
The Contractor shall submit a final report via TBdb or email to the TB Program's Data
Coordinator when a contact investigation is completed.
The Contractor shall provide all other necessary laboratory testing and medical evaluation
services to identiff TB.
3.
4.
10.
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12. The Contractor shall report all known HIV antibody test results to CDPHE.
13. The Contractor shall report information via web-based TBdb, email or fax "Tuberculosis
Surtteillance and Case Management Report", This document is found here:
https://www.colorado.gov/pacific/cdphe/tuberculosis-providers, and made part of this
purchase order by reference.
14.In order to facilitate and improve client access and enrollment in health insurance, the
Contractor shall provide Colorado Medicaid and Connect for Health Colorado information
to clients presenting for services at their agencies. At a minimum, CDPHE contractors
shall offer clients printed resource and referral materials that direct them to the nearest
community Medicaid and Connect for Health Colorado enrollment location(s), including
online enrollment options. These materials must be available for clients with limited
English proficiency (LEP). To help you locate the nearest enrollment locations in your
community, see resources below.
https ://www.colorado. gov/pacifi c/hcpf/how-to-apply,
http://connectforhealthco.com/resources/person-help/ . This information is incorporated
and made part ofthis purchase order by reference.
For conf,rrmed cases of TB. the Contractor shall include all data elements identified in the
"Report of Verified Case of Tuberculosis (RVCT)". This document is found here
https://www.colorado.gov/pacific/cdphe/tuberculosis-providers, and made part of this
purchase order by reference.
The Contractor shall use the CDPHE Laboratory for testing.
a. The CDPHE Laboratory will, at no charge to the Contractor, supply specimen
containers and perform the above testing for the Contractor.
The Contractor shall comply with TB specimen shipping guidelines, TB Sputum Collection
Kit and Shipping Instructio,ras. This document is found here:
https://www.colorado.gov/oacific/cdphe/tuberculosis-providers, and made part of this
purchase order by reference.
The Contractor will order TB medications through the CDPHE TB Program.
The Contractor will provide CDPHE with the medical insurance information for those
patients who have medical insurance.
The Contractor will provide consultation services, as needed, to providers in its service
area regarding TB reporting, screening, treatment, and follow-up.
Printed resource and referral materials for Medicaid and Connect for Health Colorado
enrollment shall be available for clients with Limited English Proficiency (LEP).
Contractors that routinely offer enrollment services on-site are exempt from this
requirement because the services provided go beyond this minimum requirement.
Information on enrollment resources, referral locations, LEP and outreach and promotional
materials is available at https://coloradopeak.secure.force.com/CPClA and is incorporated
15.
t6.
t7.
18.
19.
20.
2t.
22.
and made oart of this order by reference.
l. Data contained in the CDPHE TB Data Base.Measurement of Expected
Results
Page 4 of 6
95%HlV testing rates among suspect and confirmed cases of active
TB disease.
No later than
the end date of
this contract
2. 80% HIV antibody testing result rates for LBTI patients
3. 100% completion of all TB-17 and RVCT report fields.No later than
the last day of
each month
No later than
the last day of
each month
LEP Over-the-Phone lnterpretation (OPI) provider use will be
documented and billed for monthlv and reimbursement
DOT/Diagnostic invoice sent monthly along with supporting
documentation confirming use was TB-related.
No later than
the last of
each month
Documentation that all TB clients were asked about current health
insurance enrollment and offered materials to become insured if not
currently insured.
No later than
the last of
each month
V.Budget:
VI.
FY 2017 Budget
Counfv Health
Description Fundine Source Amount
Tuberculosis Control and Prevention State $ s,000
DOT, Diagnostics, and LEP
Blanket Funds
As Administered
Total $ 5,000
Additional Provisions:
To receive compensation under the Purchase Order, the Contractor shall submit a signed monthly CDPHE
Reimbursement Invoice Form. This form is accessible from the CDPHE internet website
http://www.colorado.gov/pacific/cdphe/standardized-invoice-form-and-links and is incorporated and made part
of this purchase order by reference. CDPHE will provide technical assistance in accessing and completing the
form. The CDPHE Reimbursement Invoice Form and Expenditure Details page must be submitted no later
than forty-five (45) calendar days after the end of the billing period for which services were rendered.
Expenditures shall be in accordance with this Statement of Work and Budget. The Contractor shall submit the
invoice using one of the following three methods.
Mail to:
Pete Dupree, TB Program Manager
DCEED - Tuberculosis
Colorado Department of Public Health and Environment
A-3
4300 Cherry Creek Drive South
Denver, Colorado 80246
Scan the completed and signed CDPHE Reimbursement Invoice Form into an electronic document. Email the
scanned invoice with the Excel workbook containing the Expenditure Details page to: Pete Dupree' TB
Program Manager, peter.dupree@state.co.us
Pase 5 of6
Fax the completed and signed CDPHE Reimbursement Invoice Form and Expenditure Details page to:
Attention: Pete Dupree, TB Program Manager, (303) 759-5538
Final billings under the Purchase Order must be received by the State within a reasonable time after the
expiration or termination of the Purchase Order; but in any event no later than forty-five (45) calendar days
from the effective expiration or termination date of the Purchase Order.
Unless otherwise provided for in the Purchase Order, "Local Match", if any, shall be included on all invoices
as required by funding source.
Tuberculin skin testing, chest x-rays and chest x-ray interpretations are not eligible for reimbursement under this
Purchase Order for the followins:
correctional facility inmates;
ii. Persons other than Class A or B TB immigrants undergoing medical examinations;
iii. Paid or volunteer employees of health care facilities, long-term care facilities, drug treatment
centers, correctional facilities, shelters, schools, or child care facilities that undergo skin testing
as part of a routine employment skin testing program.
The Contractor shall not use federal funds to satisSr federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
Monitoring:
CDPHE's monitoring of the purchase order for compliance with performance requirements will be conducted
throughout the purchase order period by the TB Program Manager. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include progress reports HIV testing rates
for active and latent TB patients, monthly Prevention and Control as well as DOT/Diagnostic invoice and other
fiscal and programmatic documentation as applicable. The Contractor's performance will be evaluated at set
intervals and communicated to the contractor.
V[I. ResolutionofNon-Compliance:
The Contractor will be notified in writing within 15 calendar days of discovery of a compliance issue. Within 30
calendar days of discovery, the Contractor and the State will collaborate, when appropriate, to determine the
action(s) necessary to recti$, 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 TB Program Manager and receive approval for a new due date. The State will oversee the
completior/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 provisions ofthis contract.
IX. Attestation:
The Vendor agrees to perform services in accordance with the terms and conditions of the Purchase Order to
include Statement of Work and Budget.
COUNTY OF EAGLE, STATE OF COLORADO, By and Through
Date: c/ r/ r
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