HomeMy WebLinkAboutC17-162 Colorado Department of Public Health and EnvironmentDEPARTMENT OF PUBLIC HEALTH AND
ENVIRONMENT
CMS ROUTING NO. 18 FHHA 98973
APPROVED TASK ORDER CONTRACT — WAIVER #154
This task order contract is issued pursuant to master contract made on 11/23/2016, with routing number 18 FAA 00016.
STATE: CONTRACTOR:
State of Colorado for the use & benefit of the Eagle County Public Health Agency
Department of Public Health and Environment PO Box 660
Disease Control and Enviromnent Eagle, CO 81631
Epidemiology Division
Tuberculosis
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACT MADE DATE: 4/7/2017
CORE ENCUMBRANCE NUMBER:
201800000943
TERM:
This contract shall be effective upon approval by
the State Controller, or designee, or on 07/01/217,
whichever is later. The contract shall end on 06/30/2018.
PROCUREMENT METHOD:
Exempt
BID/RFP/LIST PRICE AGREEMENT NUMBER:
Not Applicable
LAW SPECIFIED VENDOR STATUTE:
Not Applicable
STATE REPRESENTATIVE:
Pete Dupree
Department of Public Health and Environment
DCEED
Tuberculosis
4300 Cherry Creek Drive South
Denver, CO 80246
CONTRACTOR DUNS: 084024447
CONTRACTOR ENTITY TYPE:
Political Subdivision Colorado
BILLING STATEMENTS RECEIVED:
Monthly
STATUTORY AUTHORITY: Not Applicable
CLASSIFICATION: Subrecipient
CONTRACT PRICE NOT TO EXCEED: $4,500.00
FEDERAL FUNDING DOLLARS: $0.00
STATE FUNDING DOLLARS: $4,500.00
C�7�liiti[i���i�]P►[�l�Z�]illls\�.�I
Specify "Other":
MAXIMUM AMOUNT AVAILABLE PER FISCAL YEAR:
FY 18: $4,500.00
PRICE STRUCTURE: Cost Reimbursement
CONTRACTOR REPRESENTATIVE:
Rebecca Larson
PO Box 660
Eagle,CO 81631
PROJECT DESCRIPTION:
Provide or coordinate the Tuberculosis (T13) prevention and control activities for individuals within its service area.
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EXHIBITS:
The following exhibits are hereby incorporated:
Exhibit A - Additional Provisions (and any of its Attachments; e.g., A-1, A-2, etc.)
Exhibit B - Statement of Work (and any of its Attachments; e.g., B-1, B-2, etc.)
Exhibit C - Budget (and any of its Attachments; e.g., C-1, C-2, etc.)
Exhibit D- Grant Funding Letter
GENERAL PROVISIONS
The following clauses apply to this Task Order Contract. These general clauses may have been expanded upon or
made more specific in some instances in exhibits to this Task Order Contract. To the extent that other provisions of
this Task Order Contract provide more specificity than these general clauses, the more specific provision shall
control.
This Task Order Contract is being entered into pursuant to the terms and conditions of the Master Contract
including, but not limited to, Exhibit One thereto. The total term of this Task Order Contract, including any
renewals or extensions, may not exceed five (5) years. The parties intend and agree that all work shall be
performed according to the standards, terms and conditions set forth in the Master Contract.
2. In accordance with section 24-30-202(1), C.R.S., as amended, this Task Order Contract is not valid until it
has been approved by the State Controller, or an authorized delegee thereof. The Contractor is not
authorized to, and shall not; commence performance under this Task Order Contract until this Task Order
Contract has been approved by the State Controller or delegee. The State shall have no financial obligation
to the Contractor whatsoever for any work or services or, any costs or expenses, incurred by the Contractor
prior to the effective date of this Task Order Contract. If the State Controller approves this Task Order
Contract on or before its proposed effective date, then the Contractor shall commence performance under
this Task Order Contract on the proposed effective date. If the State Controller approves this Task Order
Contract after its proposed effective date, then the Contractor shall only commence performance under this
Task Order Contract on that later date. The initial term of this Task Order Contract shall continue through
and including the date specified on page one of this Task Order Contract, unless sooner terminated by the
parties pursuant to the terms and conditions of this Task Order Contract and/or the Master Contract.
Contractor's commencement of performance under this Task Order Contract shall be deemed acceptance of
the terms and conditions of this Task Order Contract.
The Master Contract and its exhibits and/or attachments are incorporated herein by this reference and made
a part hereof as if fully set forth herein. Unless otherwise stated, all exhibits and/or attachments to this Task
Order Contract are incorporated herein and made a part of this Task Order Contract. Unless otherwise stated,
the terms of this Task Order Contract shall control over any conflicting terms in any of its exhibits. In the event
of conflicts or inconsistencies between the Master Contract and this Task Order Contract (including its exhibits
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and/or attachments), or between this Task Order Contract and its exhibits and/or attachments, such conflicts or
inconsistencies shall be resolved by reference to the documents in the following order of priority: 1) the
Special Provisions of the Master Contract; 2) the Master Contract (other than the Special Provisions) and its
exhibits and attachments in the order specified in the Master Contract; 3) this Task Order Contract; 4) the
Additional Provisions - Exhibit A, and its attachments if included, to this Task Order Contract; 5) the
Scope/Statement of Work - Exhibit B, and its attachments if included, to this Task Order Contract; 6) other
exhibits/attachments to this Task Order Contract in their order of appearance.
4. 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 work items described in the
Statement of Work and Budget, which are incorporated herein by this reference, made a part hereof and
attached hereto as "Exhibit B" and "Exhibit U.
The State, with the concurrence of the Contractor, may, among other things, prospectively renew or extend
the term of this Task Order Contract, subject to the limitations set forth in the Master Contract, increase or
decrease the amount payable under this Task Order Contract, or add to, delete from, and/or modify this
Task Order Contract's Statement of Work through a contract amendment. To be effective, the amendment
must be signed by the State and the Contractor, and be approved by the State Controller or an authorized
delegate thereof. This contract is subject to such modifications as may be required by changes in Federal or
State law, or their implementing regulations. Any such required modification shall automatically be
incorporated into and be part of this Task Order Contract on the effective date of such change as if fully set
forth herein.
6. The conditions, provisions, and terms of any RFP attached hereto, if applicable, establish the minimum
standards of performance that the Contractor must meet under this Task Order Contract. If the Contractor's
Proposal, if attached hereto, or any attachments or exhibits thereto, or the Scope/Statement of Work -
Exhibit B, establishes or creates standards of performance greater than those set forth in the RFP, then the
Contractor shall also meet those standards of performance under this Task Order Contract.
7. STATEWIDE CONTRACT MANAGEMENT SYSTEM [This section shall apply when the Effective
Date is on or after July 1, 2009 and the maximum amount payable to Contractor hereunder is $100, 000 or
higher]
By entering into this Task Order Contract, Contractor agrees to be governed, and to abide, by the
provisions of CRS §24-102-205, §24-102-206, §24-103-601, §24-103.5-101 and §24-105-102 concerning
the monitoring of vendor performance on state contracts and inclusion of contract performance information
in a statewide contract management system.
Contractor's performance shall be evaluated in accordance with the terms and conditions of this Task Order
Contract, State law, including CRS §24-103.5-101, and State Fiscal Rules, Policies and Guidance.
Evaluation of Contractor's performance shall be part of the normal contract administration process and
Contractor's performance will be systematically recorded in the statewide Contract Management System.
Areas of review shall include, but shall not be limited to quality, cost and timeliness. Collection of
information relevant to the performance of Contractor's obligations under this Task Order Contract shall be
determined by the specific requirements of such obligations and shall include factors tailored to match the
requirements of the Statement of Project of this Task Order Contract. Such performance information shall
be entered into the statewide Contract Management System at intervals established in the Statement of
Project and a final review and rating shall be rendered within 30 days of the end of the Task Order Contract
term. Contractor shall be notified following each performance and shall address or correct any identified
problem in a timely manner and maintain work progress.
Should the final performance evaluation determine that Contractor demonstrated a gross failure to meet the
performance measures established under the Statement of Project, the Executive Director of the Colorado
Department of Personnel and Administration (Executive Director), upon request by the Colorado
Department of Public Health and Environment and showing of good cause, may debar Contractor and
OC 18 98973.docx Page 3 of 6
prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result
by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS
§24-105-102(6)), or (ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights
provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and
reinstatement of Contractor, by the Executive Director, upon showing of good cause.
If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and
its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws,
state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be
amended. Without limitation, these federal laws and regulations include the Federal Funding
Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law
110-252, including without limitation all data reporting requirements required there under. This Act is also
referred to as FFATA.
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THE PARTIES HERETO HAVE EXECUTED THIS CONTRACT
* 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:
Eagle County Public Health Agency
Legal Name of Contracting Entity
Jillian H. Ryan
Y4nt Name of Authoriz cer
ZZ Signature of Auth zed Officer
Date
Chair, Eagle County Board of County Commissioners
Print Title of Authorized Officer
STATE OF COLORADO:
JOHN W. HICKENLOOPER, GOVERNOR
By.�'ryl
For Executive Director
Department of Public Health and Environment
Department Program Ap roval:
By:
�E, � 'I'
1 44
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:
Robert JarosfqA, MBA, JD
By: JA alvm(J4
Date 42A I-
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prohibit Contractor from bidding on future contracts. Contractor may contest the final evaluation and result
by: (i) filing rebuttal statements, which may result in either removal or correction of the evaluation (CRS
§24-105-102(6)), or (ii) under CRS §24-105-102(6), exercising the debarment protest and appeal rights
provided in CRS §§24-109-106, 107, 201 or 202, which may result in the reversal of the debarment and
reinstatement of Contractor, by the Executive Director, upon showing of good cause.
8. If this Contract involves federal funds or compliance is otherwise federally mandated, the Contractor and
its agent(s) shall at all times during the term of this contract strictly adhere to all applicable federal laws,
state laws, Executive Orders and implementing regulations as they currently exist and may hereafter be
amended. Without limitation, these federal laws and regulations include the Federal Funding
Accountability and Transparency Act of 2006 (Public Law 109-282), as amended by §6062 of Public Law
110-252, including without limitation all data reporting requirements required there under. This Act is also
referred to as FFATA.
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EXHIBIT A
ADDITIONAL PROVISIONS
CMS Task Order Routing Number 18 FHHA 98973
These provisions are to be read and interpreted in conjunction with the provisions of the Task Order Contract specified
above.
To receive compensation under the Contract, the Contractor shall submit a signed Monthly CDPHE
Reimbursement Invoice Form. This form is accessible from the CDPHE internet website
https://www.colorado.gov/pacific/cdphe/standardized-invoice-form-and-links and is incorporated and made
part of this Contract 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
DCEED-Tuberculosis Program
Colorado Department of Public Health and Environment
A3-TB-DCEED
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, pete.dupree c@7i state.co.us
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 Contract must be received by the State within a reasonable time after the expiration
or termination of the Contract; but in any event no later than forty-five (45) calendar days from the
effective expiration or termination date of the Contract.
Unless otherwise provided for in the Contract, "Local Match", if any, shall be included on all invoices as
required by funding source.
The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless
approved in writing by the appropriate federal agency.
Time Limit For Acceptance Of Deliverables.
a. Evaluation Period. The State shall have forty-five (45) 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.
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
Page 1 of 2
Contract Zxhibit-A AdditionatProvisions TaskOrder 040'15
EXHIBIT A
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.
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 thirty (30)
calendar days, to correct the noted deficiencies. If the Contractor fails to correct such deficiencies
within thirty (30) 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.
Health Insurance Portability and Accountability Act (fflPAA) Business Associate Determination.
The State has determined that this Contract does not constitute a Business Associate relationship Linder
HIPAA.
This award does not include funds for Research and Development.
Tuberculin skin testing, chest x-rays, and chest x-ray interpretations are not eligible for reimbursement
under this Contact for the following:
a. Correctional facility inmates
b. Persons other than Class A or B TB immigrants undergoing medical examinations;
C. 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.
Pursuant to 25-4-501, 8 C.R.S., as amended, the General Assembly has declared that tuberculosis is an
infectious and communicable disease, that it endangers the population of this state, and that the treatment
and control of said disease is a state responsibility and further, pursuant to 25-4-511, 8 C.R.S., assistance
under section 25-4-501, shall be given to any applicant who is suffering from tuberculosis in any form
requiring treatment and is without sufficient means to obtain such treatment. The State, through the
Tuberculosis Program has a mandate to provide care coordination services for the residents of the State of
Colorado.
The State Promises to make available to the Contractor a portion of the Statewide funds for the
Tuberculosis Direct Observed Therapy and Statewide funds for the Tuberculosis Quantiferon (QFT)
Diagnostic Testing for the term of this contract, in exchange for the promise of the Contractor to perform
the work described herein. Of the total financial obligation of the Stated referenced above, one hundred
percent is derived from the State General Fund. The liability of the State, at any time, for such payments
shall be limited to the unencumbered remaining balance of such funds. If there is a reduction in the total
funds appropriated for the purposes of this Contract, then the State, in its sole discretion, may
proportionately reduce the funding for this Contract or terminate this Contract in its entirety.
8. The State, at its discretion, may unilaterally increase or decrease the total funds available under this Grant,
the funds available under the Grant during any State fiscal Year or the funds available for any specific line
items described in this Grant. In order to exercise this right, the State shall provide ,vritten notice to Grantee
in a form substantially equivalent to Exhibit D. The exercise of this right shall not be valid until it has been
approved by the contractor.
Page 2 of 2
Contract —Exliibit-A—,,-\dcfitionaU'rovisions--I'askOrder-040715
EXHIBIT B
STATEMENT OF WORK
To Original Contract Routing Number 18 FHHA 98973
These provisions are to be read and interpreted in conjunction with the provisions of the contract specified above.
L Entity Name: Eagle County Public Health Agency
Term: July 1, 2017 -June 30, 2018
II. Project Description:
This project serves to provide diagnostic, patient education and treatment services for individuals with
suspected/known 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).
III. Definitions:
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
4. Class B 1 — Immigrant with an abnonnal CXR with evidence of TB, and/or the individual has a
history of treatment for active TB disease.
5. Class B2 — The individual was diagnosed with latent TB infection (LTBI). These are typically
children whose TST result was positive and CXR was normal.
6. DOT — Directly Observed Therapy
7. HIV— Human Immunodeficiency Virus
S. IGRA — interferon gamma (y) release assay (whole blood TB test)
9. LEP — limited English proficiency (Over -the -Phone Interpretation (OPI) provider only)
10. LTBI — Latent Tuberculosis Infection
11. OPI — over -the -phone interpretation
12. RVCT — Report of Verified Case of Tuberculosis
13. TB — Tuberculosis
14. TB -17— CDPHE's TB surveillance fonn
15. TBdb — Tuberculosis Data Base (CDPHE)
16. TST — Tuberculin Skin Test
IV. Work Plan:
Goal #1: Prevent and control tuberculosis infection and active TB disease throughout the Contractor's Jurisdiction
Objective #1: No later than the expiration date of the Contract, the Contractor shall assist in supporting
tuberculosis prevention and control activities throughout the agency's jurisdiction.
Primary Activity #1
The Contractor shall locate all patients with suspected or confirmed TB.
1. The Contractor shall provide, or arrange for, chest x-rays and interpretations for
individuals with suspected or confirmed TB.
2. The Contractor shall provide interpretations for individuals with suspected or
confirmed TB, as necessary.
Sub -Activities #1
3. The Contractor shall collect specimens for mycobacteriology testing on all
persons suspected of having TB.
4. The Contractor shall arrange for the transportation of the specimens to the
CDPHE laboratory for testing.
5. The Contractor shall arrange for the placement of patients who require isolation.
a. The Contractor shall contact CDPHE TB Program for assistance, if
version. Contract Statement of Work— ExhibitIt
December 2015
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Contract SOW TB approved.doc
EXHIBIT B
version: Contract Statement of Work -- Exhibit B
December 2015
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Contract SOW TB approved.doc
needed, and to request reimbursement from CDPHE for those costs
incurred by the Contractor in isolatiri9 a patient.
6. The Contractor shall provide, or arrange for, the treatment of patients with
suspected or confirmed active TB, including DOT.
7. The Contractor shall ensure patients' adherence to TB treatment.
8. 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 >95%, regardless of their age or the apparent absence of risk
factors for HIV infection.
9. The Contractor shall inform those individuals whom refuse testing of the risks
associated with HIV/TB co -infection.
10. A minimum of once a month, the Contractor shall monitor and evaluate those
persons with suspected or confirmed active TB disease by in-person assessment.
11. As needed, the Contractor will offer limited English proficiency services 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 $0.75/minute. The instructions are incorporated and made
part of this contract by reference and is available on the following website,
htt2s://www.colorado.gov/i)acific/cdi)he/tb-lpha
Primary Activity #2
The Contractor shall ensure that all contacts to newly identified infectious TB cases
are identified, investigated, and receive appropriate evaluation.
1. The Contractor shall provide, or arrange for, chest x-rays and interpretations for
individuals with newly identified infectious, suspected, confirmed, and LTBI TB
cases.
2. The Contractor shall provide, or arrange for, the treatment of patients, including
DOT, and ensure the completion of therapy for infected patients.
3. The Contractor shall provide, or arrange for, an HIV antibody test for all persons
with LTBI with HIV risk factors or who originate from an HIV -endemic area.
Sub -Activities #2
4. The Contractor shall inform all individuals whom refuse testing of the risks
associated with HIV/TB co -infection.
5. A minimum of once a month, the Contractor shall monitor and evaluate persons
with LTBI during treatment.
6. The Contractor shall submit a preliminary Tuberculosis Contact Investigation
Record. The instructions are incorporated and made part of this contract by
reference and is available on the following website,
https://www.colorado.gov/pacific/cdphe/tb-fonns-lpha to the CDPHE TB
Program after initiation of each contact investigation.
Primary Activity #3
The Contractor shall provide or arrange for newly arrived refugees, asylees and other
eligible individuals with Class B TB designation TB screening.
1. 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
Sub -Activities #3
sputum specimens for AFB smear and culture collected on consecutive days.
2. Upon completion of testing and examination, the Contractor shall complete, sign,
and date the CDC 75.17 form or Class B tuberculosis Follow Up worksheet, and
return it within ninety (90) days to:
Colorado Department of Public Health and Environment
Tuberculosis Program
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December 2015
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Contract SOW TB approved.doc
EXHIBIT B
version: Contract Statement of Work - Exhibit B
December 2015
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Contract SOW TB appmved.doc
Attn: Class B Coordinator
4300 Cherry Creek Drive South
Denver, CO 80246
The Contractor shall ensure that all persons with a high risk of LTBI are identified,
Primary Activity #4
investigated, and receive appropriate evaluation.
1. The Contractor shall offer an HIV antibody test to100% of persons with LTBI
Sub -Activities #4
and provide, or arrange for, HIV antibody test with a test result rate >80%.
2. A minimum of once a month, the Contractor shall monitor and evaluate persons
with LTBI during treatment for all such patients.
CDPHE contractors shall offer clients printed resource and referral materials that
Primary Activity #5
direct them to the nearest community Medicaid and Connect for Health Colorado
enrollment location(s), including online enrollment options.
1. A note will be included in TBdb specific to provision of health insurance
Sub -Activities #5_
enrollment materials. These resources are incorporated and made part of this
contract by reference and is available on the following website:
hM2s://www.colorado.gov,/pacific/hcpf/how-to-aggly
1. 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 https://www.colorado.gov/pacific/edphe/colorado-tb-manual
and is incorporated and made part of this Contract by reference.
2. CDPHE shall 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.
3. The content of electronic documents located on CDPHE and non-CDPHE
websites and information contained on CDPHE and non-CDPHE websites may
be updated periodically during the contract term. The contractor shall monitor
documents and website content for updates and comply with all updates.
4. The Contractor shall increase the percentage of persons that complete LTBI
treatment to meet the state objective of 80% by 2016 and maintain or improve on
Standards and
that rate thereafter.
Requirements
5. All reports of suspected or confirmed active TB disease shall include:
a. reason for initiating
b. patient name
c. date of birth
d. country of birth
e. date arrived in U.S.
f. demographic information
g. locating information
h. provider information
i. TB risk factors
j. results of diagnostic testing
k. results of mycobacteriology including susceptibility results
1. dates of infectious period
m. treatment information
n. changes in patients' status
o. diagnosis
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December 2015
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Contract SOW TB appmved.doc
EXHIBIT B
p. any other information as appropriate.
6. For those persons identified with LTBI or active TB, the Contractor shall report
to CDPHE:
a. patient name
b. date of birth
c. country of birth
d. date arrived in the U.S.
e. demographic information
£ locating information
g. provider information
h. TB risk factors
i� results of diagnostic testing
j. treatment information
k. any other information deemed appropriate by the Contractor.
7. The Contractor shall ensure appropriate testing is perforned:
a. smears for acid-fast bacilli, (using concentrated fluorescent
method)
b. isolation of mycobacteria (using rapid methods)
c. identification of Mycobacterium tuberculosis complex (MTB)
(using rapid methods)
d. susceptibility testing (isoniazid, rifampin, ethambutol, and
pyrazinamide) on isolates of MTB.
8. The CDPHE TB Program will notify the Contractor of all newly arrived Class B
TB immigrants/refugees via a CDC 75.17 form which is incorporated herein by
this reference, or Follow-up worksheet which is incorporated herein by this
reference, made a part of this contract and is available on the following website:
https://Nvww.colorado. gov/pacific/cdphe/tb-btb-arrivals.
9. 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
Surveillance and Case Management Report (TB 17) when a TB patient completes
treatment, moves, or transfers out of the Contractor's service area.
10. The Contractor shall provide, or arrange for, treatment and ensure completion of
therapy.
11. The Contractor shall submit a final report via email or TBdb to the TB Program's
Data Coordinator when a contact investigation is completed.
12. The Contractor shall provide all other necessary laboratory testing and medical
evaluation services to identify TB.
13. The Contractor shall report all known HIV antibody test results to CDPHE.
14. The Contractor shall report information via web -based TB case/contact
management system (TBdb) or via "Tuberculosis Surveillance and Case
Management Report" (TB 17), which is incorporated herein by this reference,
made a part of this contract and is available on the following website:
https://www.colorado.c�ov/pacific/cdphe/tb-forms-lpha and is incorporated and
made part of this Contract by reference.
15. For confirmed cases of TB, the Contractor shall include all data elements
identified in the "Report of Verified Case of Tuberculosis (RVOT)", which is
incorporated herein by this reference, made a part of this contract and is available
version: Contract Statement of Work- Exhibit B
December 2015
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Contract SOW TB approved.doc
EXHIBIT B
version' Contract Statement of Work — Exhibit B - -
December 2015 - -
Page 5 of 6
Contract SOW TB approved.doc
on the following website: https://www.colorado.,izov/pacific/cdphe/tb-forms-lpha
and is incorporated and made part of this Contract by reference.
16. The Contractor shall use the CDPHE Laboratory for testing.
17. The CDPHE Laboratory will, at no charge to the Contractor, supply specimen
containers and perform the above testing for the Contractor.
18. The Contractor will order TB medications through the CDPHE TB Program.
19. The Contractor will provide CDPHE with the medical insurance information for
those patients who have medical insurance.
20. The Contractor will provide consultation services, as needed, to providers in its
service area regarding TB reporting, screening, treatment, and follow-up.
21. The Contractor shall comply with TB specimen shipping guidelines. See TB
Sputum Collection Kit and Shipping Instructions
https://drive.google.com/file/d/OBOtmPQ67k3NVRY,RPLVIVYIZScEE/view _--
which is incorporated and made part of this Contract by reference.
22. 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.
23. Information on enrollment resources, referral locations, LEP and outreach and
promotional materials is available at
https://coloradopeak.secure.force.com/CPCLA which is incorporated and made a
part of this contract by reference.
1. New TB cases shall be diagnosed, documented and treated.
2. Patients with existing or newly diagnosed TB or LTBI shall be treated, as
appropriate.
3. Newly arrived refugees, asylees and other eligible individuals with Class B TB
designation receive treatment.
4. In order to facilitate and improve client access and enrollment in health insurance,
CDPHE is asking all state contractors and sub -recipients who contract with the
department for direct patient care clinical service programs to provide Colorado
Expected Results of the
Medicaid and Connect for Health Colorado information to clients presenting for
Activity
services at their agencies. At a"minimum, CDPHE contractors must 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, the following is incorporated and made part of this
contract by reference and is available on the following websites:
https://www.colorado.gov/l)acific/hcl)f/how-to-apply
http://connectforhealthco.com/resources/t)erson-help/
Measurement of
1. Data contained in the CDPHE TB Data Base.
Expected Results
2. Data in semi-annual progress report.
3. Data in final progress report.
Completion Date
Deliverables 1. 95% HIV testing rates among suspect and confirmed
No later than the
version' Contract Statement of Work — Exhibit B - -
December 2015 - -
Page 5 of 6
Contract SOW TB approved.doc
EXHIBIT B
V. Monitoring:
CDPHE's monitoring of the Contract for compliance with performance requirements will be conducted
throughout the Contract period by the TB Program Manager. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include review of electronic
data, HIV testing compliance, and completeness of RVCTs and TB -17s.
VI. Resolution of Non -Compliance:
The Contractor will be notified in writing within fourteen (14) calendar days of discovery of a
compliance issue. Within thirty (30) 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 TB 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
Terms and Conditions of this Contract.
version: Contract Statement of Work -- Exhibit B
December 2015
Page 6 of 6
Contract SOW TB approved.doc
cases of active TB disease are entered.
day before TB
treatment begins
2. 80% HIV antibody testing result rates for LBTI patients
No later than the
are entered.
end date of this
contract
3. 100% of all TB -17 and RVCT fields are completed.
No later than the
last business day
of each month
4. LEP Over -the -Phone Interpretation (OPI) provider use
No later than the
will be documented and billed for monthly and
last business day
reimbursement DOT/Diagnostic invoice sent monthly
of each month
along with supporting documentation confinning use is
TB -related
5. Documentation that all TB clients were asked about
No later than the
current health insurance enrollment and offered
last business day
materials to become insured if not currently insured.
of each month
6. Semi -Annual Progress Report, which is incorporated
No later than the
herein by this reference, made a part of this contract
last day of this
and is available on the following website:
contract.
(htlps:Hdrive.google.com/file/d/OBOtmPQ67k3NV
bk8xemFPN3FpWUO/view) covering January -June
and July -December sent to TB Program Manager.
V. Monitoring:
CDPHE's monitoring of the Contract for compliance with performance requirements will be conducted
throughout the Contract period by the TB Program Manager. Methods used will include a review of
documentation determined by CDPHE to be reflective of performance to include review of electronic
data, HIV testing compliance, and completeness of RVCTs and TB -17s.
VI. Resolution of Non -Compliance:
The Contractor will be notified in writing within fourteen (14) calendar days of discovery of a
compliance issue. Within thirty (30) 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 TB 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
Terms and Conditions of this Contract.
version: Contract Statement of Work -- Exhibit B
December 2015
Page 6 of 6
Contract SOW TB approved.doc
SIC
FY 2018 Budget
Eagle County Health Department
Description
Funding Source
Amount
Tuberculosis Control and
Prevention
State
$ 4,500
DOT, Diagnostics, and LEP
Blanket Funds
As Administered
Total
$ 4,500
K:\Accounting_and_Purchasing\_Procurement & Contracting\Contracts\Tuberculosis\Eagle 2018 -\Original Tenn (OC)\OC 18 FHHA
98973\Backup Docs\Exhibit C Budget.docx
Last printed 6/19/2017 10:17:00 AM
Created on 3/29/2017 8:07:00 AM
ONmeI10.10a
GRANT FUNDING CHANGE LETTER
Date:
State Fiscal Year:
Grant Funding Change
Letter (GFCL) #
CMS Routing #
I CORE Encumbrance #
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 words here if previous amendment(s), renewal(s) have been processed] between the State
of Colorado, Department of Public Health and Environment and <insert contractor name> beginning <insert
start date of original contract> and ending on <insert ending date of current contract amendment>, the undersigned commits
the following funds to the Grant:
The amount of (federal, state, other) grant funds available and specified in Section of <insertprevious
contract modification number and routing number> is ❑ increased or ❑ decreased by $ amount of change to new total
funds for the period <date to date> of $ <insert new period cumulative total> for the following reason:
Section is hereby modified accordingly. The revised Budget is incorporated herein by this reference and
identified as Revised Exhibit *. (if budget attached; delete sentence if no budget included.)
Complete the table below; insert/delete rows as needed.
The table below reflects the original budget and all modifications to the total since the effective date of the Original
Contract.
SUMMARY OF CHANGES
Document Type CMS Routing Funding Source Period
# (federal, state, other)
Dollar Amount
Period
Total
Original Contract
$
$
$
$
$
$
Contract Cumulative Grand Total
$
10
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 <insert projected effective date>,
whichever is later.
STATE OF COLORADO
John W. Hickenlooper, GOVERNOR PROGRAM APPROVAL:
Department of Public Health and Environment
By:
By: Lisa McGovern, Purchasing & Contracts Section Director
Date:
ALL GRANTS REQUIRE APPROVAL BY THE STATE CONTROLLER
CRS §2430-202 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
Robert Jaros, CPA, MBA, JD
Date:
Exhibit D GFCL.docx Page 1 of 1
