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HomeMy WebLinkAboutC23-111 Statement of Work_Tuberculosis Prevention and ControlDocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A C40 EAGLE COUNTY STATEMENT OF WORK I. Entity Name: Eagle County Public Health Agency Public Health & Environment 970-328-8840 www.eaglecounty.us II. Project Description: This project serves to implement a Tuberculosis (TB) preventive health service program to decrease widespread incidence of TB disease via pass -through funds to the Local Public Health Agencies (LPHAs) experiencing an elevated burden of TB infection and TB disease. TB remains the primary infectious disease killer in the world. The Colorado Department of Public Health and Environment (CDPHE) is funded by state general fund dollars and the Centers for Disease Control and Prevention (CDC) to address the potentially life -threatening TB illness, which is spread through the air from one person to another, impacts the lungs and any other part of the body, and can cause serious sickness and even death in humans. The Division of Disease Control and Public Health Response (DCPHR) supports TB health service activities as a part of the mandatory Class A and B medical testing process for Refugees entering the United States. The project seeks to screen, test, and treat TB infection (LTBI) and prevent onward transmission of the TB bacterial infection by offering appropriate treatment to all at elevated risk for TB infection and onward progression to TB disease as well as those presumptive for or with confirmed TB disease. The project also seeks to offer guidance and resources to help confirmed TB disease patients through to completion of appropriate TB disease treatment. The funds exist to reduce rates of illness, and increase use of the Tuberculosis Data Base (TBdb) among LPHAs caring for patients statewide. The project will collect vital statistics, and enable the technological capability needed to track and evaluate patient cases. The program seeks to identify latent TB illness in at -risk patients including close contacts to pulmonary TB patients through active surveillance, provide free TB medications, and reimburse LPHAs managing or ruling -out patients for Medicaid rate diagnostic testing recommended by the TB program. The project will improve the ability to evaluate TB cases, and bolster access to data for the medical community. A key program goal is to connect at -risk individuals including Refugees born in endemic areas to appropriate medical care, control epidemiologic outbreaks, and protect the health of the residents of Colorado. III. Definitions: 1. Active surveillance: Active disease surveillance is the process of actively searching for information through clinical testing and data management. For the purposes of this contract, active surveillance means the monitoring of testing class B 1 and B2 Refugee patients, and entering relevant data to the TBdb system. 2. AFB smear: Acid -Fast Bacilli; a rapid test used to detect infectious mycobacteria 3. Asylee: Individuals who, on their own, travel to the United States and subsequently apply for and receive a grant of asylum. 4. CDPHE: Colorado Department of Public Health and Environment 5. Chest X-ray: a type of high-energy radiation that can go through the body and onto film, making pictures of areas inside the chest, which can be used to diagnose disease. 6. Class A: defines Refugee applicants who have medical conditions that render a person inadmissible and ineligible for a visa or adjustment of status. 7. Class B 1: Immigrant with an abnormal chest X-Ray with evidence of TB, and/or the individual has a history of treatment for active TB disease. DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A 8. Class B2: The individual was diagnosed with latent TB infection (LTBI). These are typically children whose Tuberculin Skin Test result was positive and Chest X-ray was normal. 9. DOT: Directly Observed Therapy is a process where a trained health care worker or other designated individual (excluding a family member) provides the prescribed TB drugs and watches the patient swallow every dose. 10. HIV: Human Immunodeficiency Virus - Human immunodeficiency virus is a virus that attacks the body's immune system. If HIV is not treated, it can lead to AIDS (acquired immunodeficiency syndrome). Learning the basics about HIV can keep you healthy and prevent HIV transmission. TB is the primary killer of people with AIDS globally. 11. IGRA: Interferon gamma (y) release assay is a whole blood TB test. 12. LEP: Limited English proficiency (Over -the -Phone Interpretation (OPI) - lets you communicate with Limited -English Proficient (LEP) individuals using a phone interpreter. People use phone interpreters when they don't have an onsite interpreter, and to make phone calls to people who speak limited English. 13. LTBI: Latent Tuberculosis Infection commonly referred to as TB infection 14. OPI: Over -the -phone interpretation 15. Refugee: Any person who is outside his or her country of nationality or habitual residence and is unable or unwilling to return to or seek protection of that country due to a well- founded fear of persecution based on race, religion, nationality, membership in a particular social group, or political opinion 16. Pulmonary disease: A type of disease that affects the lungs and other parts of the respiratory system. Pulmonary sites of TB disease is the primary public health concerns as TB is spread through the inhalation of airborne bacilli. 17. RVCT: Report of Verified Case of Tuberculosis; a CDC surveillance report 18. Screening: the act of performing a test on a patient or patient's sputum, blood, urine, etc., to look for evidence of a disease. For the purposes of this contract, screening involves the testing and identification of at -risk persons including class B 1 and B2 Refugees with LTBI, HIV, pulmonary disease, and those without health insurance. 19. Service area: The jurisdiction (typically one or more counties) for with the LPHA is responsible. 20. Spirometry: A test that can help show how well lungs are working. 21. Tuberculosis (TB): An infectious bacterial disease characterized by the growth of nodules (tubercles) in the tissues, especially the lungs. 22. TB-18: CDPHE Tuberculosis Surveillance and Case Management Report 23. TBdb system: CDPHE Tuberculosis Data Base IV. Work Plan: Goal #1: Support public health disease control and intervention through the provision of public health monitoring. 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, improve tuberculosis prevention and control through the provision of TB health services and active surveillance. Primary Activity #1 The Contractor shall locate all patients with suspected or confirmed TB. 1. The Contractor shall provide TB health screening for the following patient groups: a. Refugee Class B 1 b. Refugee Class B2 c. All other persons found to be at elevated risk for TB infection or TB disease 2. The Contactor shall provide the following medical screening services to each patient: Sub -Activities #1 a. Medical evaluation b. Tuberculin skin test or IGRA (IGRA is preferred) c. Chest X-ray d. Three spontaneous sputum specimens for AFB smear to determine the biological culture of cells on consecutive days 3. The Contractor shall administer TB disease testing to all patients to identify individuals with LTBI. DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A a. The Contractor shall administer LTBI testing to 95% of patients identified with elevated risk. b. The Contractor shall document 95% of confirmed LTBI cases. c. The Contractor shall administer the following LTBI evaluation methods to all patients: i. Chest x-rays ii. Chest x-ray interpretations 4. The Contractor shall test patients for HIV. a. The Contractor shall administer HIV antibody tests to 95% of B 1 and B2 Refugee patients. b. The Contractor shall administer HIV antibody tests to 95% of all patients presumptive for or with confirmed TB infection or TB disease. c. The Contractor shall identify patients with HIV. d. The Contractor shall inform those individuals whom refuse HIV testing of the risks associated with HIV/TB co -infection. e. The Contractor shall document HIV testing results for all patients in TBdb. 5. The Contractor shall monitor patients for adverse reactions from TB drugs. 6. The Contractor shall monitor patients for other clinical concerns. 7. The Contractor shall offer limited English proficiency services to patients who do not speak English. a. The Contractor shall provide translation services in the patient's preferred language. i. The Contractor shall offer in -person, certified translation services. ii. The Contractor shall offer Over -the -Phone Interpretation (OPI) services. The Contractor shall ensure that all contacts to newly identified infectious TB cases are Primary Activity #2 identified, investigated, and receive appropriate evaluation. 1. The Contractor shall provide, or arrange for the following for individuals with newly identified suspected or confirmed TB, as well as patients with LTBI: a. Chest x-rays b. Chest x-ray interpretations 2. The Contractor shall provide, or arrange for, the treatment of patients, including DOT, and ensure the completion of therapy for all TB patients. 3. The Contractor shall provide, or arrange for, an HIV antibody test for all persons with LTBI with HIV risk factors including those who originate from an HIV -endemic area. Sub -Activities #2 4. The Contractor shall inform all individuals whom refuse HIV testing of the risks associated with HIV/TB co -infection. 5. A minimum of once a month, the Contractor shall evaluate patients face-to-face who are on LTBI treatment. 6. Throughout LTBI treatment, the Contractor shall monitor patients for adverse reactions or other clinical concerns. 7. The Contractor shall ask all TB clients about current health insurance enrollment and offered materials on how to become insured if not currently insured. 8. The Contractor shall complete a preliminary Tuberculosis Contact Investigation Record for all pulmonary TB patients. The Contractor shall participate in an electronic TB surveillance process (TBdb or other Primary Activity #3 designated TB database) 1. The Contractor shall enter data for each patient tested, treated, and cared for into the TBdb. a. The Contractor shall report each data element specified in the "Report of Sub -Activities #3 Verified Case of Tuberculosis (RVCT) for all patients who test positive for LTBI. b. The Contractor shall enter laboratory results for each patient tested for LTBI. c. The Contractor shall enter laboratory results for each patient tested for HIV. d. The Contractor shall enter laboratory results for each patient tested for DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A pulmonary TB disease. e. The Contractor shall enter into TBdb other clinical concerns identified during testing. f. The Contractor shall enter current medical insurance enrollment status information. 2. The Contractor shall complete a preliminary Tuberculosis Contact Investigation Record (TB-18) for all presumptive or confirmed TB disease and LTBI patients. a. The Contractor shall complete a Class B tuberculosis Follow Up worksheet for: i. Class B 1 patients ii. Class B2 patients 3. The Contractor shall complete the Semi-annual Progress Report that includes the following information: a. Number of patients screened, tested and treated with LTBI. i. All report info should be de -identified. The Contractor shall identify patients by TBdb number only. ii. The Contractor shall include medical insurance information for insured patients. iii. The Contractor shall identify patients without medical insurance. b. Number of Class B 1 Refugees with confirmed LTBI c. Number of Class B2 Refugees with confirmed LTBI d. Number of Class B 1 patients confirmed with HIV e. Number of Class B2 patients confirmed with HIV e. Number of Class B 1 patients with TB disease f. Number of Class B2 patients with TB disease g. Number of patients with adverse reactions h. Other clinical concerns identified per patient i. Number of uninsured patients guided to medical insurance resources j. Number of patients that used the OPI interpretation services The Contractor shall offer printed resource and referral materials to clients that direct them to the nearest community Medicaid and Connect for Health Colorado enrollment Primary Activity #4 location(s), including online enrollment options. 1. The Contractor shall discuss current health insurance enrollment status with each client for the purposes of becoming insured if not currently insured. a. The Contractor shall ask all TB patients about current health insurance Sub -Activities #4 enrollment status, including Medicaid and offer resource materials no later than the last business day of each month. b. The Contractor shall document that all TB patients were asked about current health insurance enrollment and offered materials no later than the last business day of each month. 1. 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 purchase order term. The Contractor shall monitor documents and website content for updates and comply with all updates. Standards and 2. CDPHE will provide access to the CDPHE TBdb system to the Contractor. Requirements a. CDPHE will register the Contractor. i. CDPHE will provide user log -in to the Contractor. 3. CDPHE will provide written notification to the Contractor a minimum of 30 calendar days of the arrival of: a. Class B 1 Refugees b. Class B2 Refugees DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A 4. The Contractor shall initiate treatment with patients in accordance with CDC guidance found at the following links, incorporated and made part of this Contract by reference: https://www.cdc.gov/tb/topic/treatment/Itbi.htm and https://www.cdc.gov/tb/toj2ic/treatment/tbdisease.htm 5. The Contractor shall complete the appropriate treatment as stated in the CDPHE TB Manual. The CDPHE TB Manual once updates and revisions are completed will be available on the CDPHE TB Program website and will be incorporated and made part of this Contract by reference. 6. The Contractor shall complete a Tuberculosis Contact Investigation Record at the following link, https://drive.gooale.com/file/d/OBOtmPO67k3NVRUtPRF8tcUZaV lE/view?resourcekey=0- KS5U1gQR g4yyouD4cgIXA incorporated and made part of this contract by reference. 7. The Contractor shall complete 100% of all RVCT fields no later than the end date of this Contract. 8. The Contractor shall include all data elements identified in the "Report of Verified Case of Tuberculosis (RVCT)", found at: https://drive.google.com/file/d/OBOtniPQ67k3NVekO I Q3JxZGdzYUE/view?resourcekey=0- sf_bObPR Zg rxhQRhTOU8Lg incorporated and made part of this contract by reference. a. The Contractor shall complete 100% of all RVCT fields. 9. The Contractor shall guide each patient to following insurance resource websites: a. https://www.colorado.aov/pacific/hcpf/how-to-apply, and b. http://connectforhealthco.com/resources/person-help/, incorporated and made part of this Contract by reference. 10. The Contractor shall provide CDPHE with the medical insurance information for those patients who have medical insurance. 11. The Contractor shall contact CDPHE for assistance with patients that need isolation services. a. The Contractor shall contact CDPHE to request reimbursement from CDPHE for costs incurred by the Contractor for isolating a patient. 12. The Contractor shall complete the Semi-annual Progress Report using the following website: https://drive.google.com/file/d/OBOtmPQ67k3NVbk8xemFPN3FpWU0/view, incorporated and made part of this Contract by reference. 13. The Contractor shall arrange for the placement of patients who require isolation. a. The Contractor shall contact CDPHE TB Program for assistance. b. The Contractor shall contact CDPHE to request reimbursement from CDPHE for those costs incurred by the Contractor in isolating a patient. 14. The Contractor shall administer LTBI testing to 95% of patients identified with elevated risk using the https://drive.google.com/file/d/lwp,tRX8lC3EBgZLE08z3WL15bkwu2ic6 /g view This link is incorporated and made part of this Contract by reference. 15. The Contractor shall complete a preliminary Tuberculosis Contact Investigation Record for all pulmonary TB patients after initiation of each contact investigation: a. https://drive. gooale.com/file/d/OBOtmPO67k3NVRUtPRF8tcUZaV 1 E/view?resourcekey=0- KS5U1gQR g4yyouD4cgIXA to the CDPHE TB Program after initiation of each contact investigation. This link is incorporated and made part of this Contract by reference. 1. Sustained TB disease testing for all at -risk persons identified in Colorado. 2. Sustained identification of at -risk persons with LTBI. 3. Increased identification of presumptive or confirmed TB patients with HIV. Expected Results of the Activity 4. Increased identification of Refugees with pulmonary TB disease. 5. Increased identification of persons at -risk for TB with other medical concerns. 6. Sustained and correct use of the TBdb case management database. 7. Improved adherence to national standards that govern health services for Refugees and others with TB disease. DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A 8. Increased medical insurance information provided to Refugees and other uninsured persons. 1. Increase HIV antibody tests to 95% of all patients. 2. Document 95% of confirmed LTBI cases. Measurement of Expected Results 3. Data contained in the CDPHE TBdb. 4. Data contained in the Tuberculosis Surveillance and Case Management Report. 5. Data contained in the Semi-annual Progress Reports. Completion Date Deliverables No later than ten 1. The Contractor shall submit the TB health services point of contact (10) days after the to the CDPHE Contract Monitor via email. start date of the contract 2. The Contractor shall submit the Semi-annual Progress Reports to No later than one the CDPHE Contract Monitor via email. month after the July - Dec and Jan -June reporting eriods V. Budget: Description Funding Source Amount Tuberculosis Control and Prevention State $6,500.00 PO Total $6,500.00 1. 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.goy/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 the following method. 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: the CDPHE Contract monitor, cdphe dcphrpayablesgstate.co.us. 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. The Contractor shall not use federal funds to satisfy federal cost sharing and matching requirements unless approved in writing by the appropriate federal agency. a. BENEFITS DISCLOSURE Vendor and its employees and agents are not entitled to unemployment insurance or workers compensation benefits through the State and the State shall not pay for or otherwise provide such coverage for Vendor or any of its agents or employees. Unemployment insurance benefits shall be available to Vendor and its employees DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A and agents only if such coverage is made available by Vendor or a third party. Vendor shall pay when due all applicable employment taxes and income taxes and local head taxes incurred pursuant to this Contract. Vendor shall (a) provide and keep in force workers' compensation and unemployment compensation insurance in the amounts required by law, (b) provide proof thereof when requested by the State, and (c) be solely responsible for its acts and those of its employees and agents. b. ENTIRE AGREEMENT These Provisions together with the Purchase Order constitute the entire agreement between the parties, and supersedes all prior proposals, agreements or other communications between the parties. VI. Monitoring: CDPHE's monitoring of the purchase order for compliance with performance requirements will be conducted throughout the purchase order period by the CDPHE Contract Monitor. Methods used will include a review of documentation determined by CDPHE to be reflective of performance to include monthly reports and invoices and other fiscal and programmatic 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. VII. Resolution of Non -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 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 CDPHE Contract Monitor and receive approval for a new due date. The State will oversee the completion/implementation of the action(s) to ensure time lines are met and the issue(s) is resolved. If the Contractor demonstrates inaction or disregard for the agreed upon compliance resolution plan, the State may exercise its rights under the Terms and Conditions of this Purchase Order. DocuSign Envelope ID: 7116E232-1 F14-4C8A-A74E-208ABC8E422A VIII. 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. Jeff Shroll, County Manager Contractor Name (Print) and Title [-Signed by: 3/31/2023 Datc