1999-102-PUBLIC HEALTH SERVICES, TDH 7560022067 00
RESOLUTION NO. 99-102
WHEREAS, the State of Texas is a funding partner with the County of Lamar and the
City of Paris for the Paris-Lamar Counly Health Department; and,
WHEREAS, the Contract for Public Health Services, TDH Document No. 7560022067
00, is the conduit through which the state funds are received; and,
WHEREAS, it is appropriate that the form of said Contract, attached hereto as Exhibit
A, be approved, and that the City Manager. Michael E. Malone, be authorized to execute the
same on behalf of the City of Paris, which is the authorized contracting entity for the performing
agency. the Paris-Lamar County Health Department; NOW, THEREFORE,
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF PARIS, that the
form of the Contract for Public Health Services, TDH Document No. 756002206700, attached
hereto as Exhibit A, be, and the same is hereby, approved; and.
BE IT FURTHER RESOLVED, that the City Manager, Michael E. Malone, be, and he
is hereby, authorized and directed to execute, on behalf of the City of Paris, which is the
authorized contracting entity for the performing agency, the Paris-Lamar County Health
Department. the Contract for Public Health Services, under the terms and conditions and in the
form shown in Exhibit A. attached hereto.
PASSED AND ADOPTED this 9th day of August, 1999.
~j,;/
harles H. Neeley, Mayor
ATTEST:
Mattie Cunningham, City Clerk
APPROVED AS TO FORM:
~le~~
Acting City Attorney
CONTRACT FOR PUBLIC HEALTH SERVICES
~
Contract Issued by: TEXAS DEPARTMENT OF HEALTH DM
(RECEIVING AGENCY) 1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
Legal Authority to Contract: Chapters 12 and 121, Health and Safety Code.
Venne: The provisions of this Contract shall be interpreted in accordance with Texas law. Venue for any court disputes shall be in
Travis County, Texas.
PERFORMING AGENCY NAME: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
MAILING ADDRESS: P. O. BOX 938 PARIS TX 75460-0938
(City, State, Zip)
STREET ADDRESS: 740 SOUTHWEST 6TH. PARIS TX 75460-0000
ICilY, State, Zip)
NAME OF AUTHORIZED
CONTRACTING ENTITY:
or differem from PERFORMING AGENCY)
PAYEE DATA (If not the same as PERFORMING AGENCY or AUTHORIZED CONTRACTING ENTITY: must be on file with the Texas State
Comptroller's Office.):
NAME:
ADDRESS:
Slate of Texas Vendor Identification No. (14 digits) PAYEE AGENCY Fiscal
17560022067001 Year Ending Month: Sentember
PAYEE BUSINESS INFORMATION FOR STATISTICAL REPORTING: Please check the categories that apply to your business.
- Small Business ~ A corporation, sole proprietorship, or other legal entity formed for the purpose of making a profit which is independently
owned and operated and has fewer than 100 employees or has less than $1,000,000 in annual gross receipts.
- Historically Underutilized Business (HUB) - A corporation, sole proprietorship, or joint venture formed for the purpose of making a profit
in which at least 5 I % of all classes of the shares of stock or other equitable securities are owned by one or more persons who have been
historically underutilized (socially disadvantaged) because of their identification as members of certain groups: Black American, Hispanic
American, Asian Pacific American, Native American, and Women. The HUB must be certified by General Services Commission or
another entity.
For Profit Ore:anization
SUMMARY OF CONTRACT DOCUMENTATION:
COVER PAGE 1 - Receiving and Performing Agency Data GENERAL PROVISIONS
COVER PAGE 2 - Details of Attachment(s) ATTACHMENT(S)
COVER PAGE 3 - Authorized Si.natures EXHIBITS, IF APPLICABLE
TDH DOCUMENT NO. 756002206700
Cover Page 1
EXHIBIT
A
DErAILS OF ATTACHMENTS
AttI TDH Term Financial Assistance Direct Total Amount
Amd Program/ Assistance (TDH Share)
No. 10 Begin End Source of Amount
Funds.
01 COPH/PR1MARY 09/01/99 08/31/00 State 211,415.00 0.00 211,415.00
02 BRLHO/V AC 09/01/99 08/31/00 State 93.991 121,404.00 0.00 121,404.00
TDH Document No.7560022067 2000 Totals $332,819.00 $0.00 $332,819.00
.Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
t
Cover Page 2
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
.
PERFORMING AGENCY NAME:
RECEIVING AGENCY NAME:
PARIS-LAMAR COUNTY HEALTH
DEPARTMENT
TEXAS DEPARTMENT OF HEALTH
(Signature of person aulhorized to sign contracts)
By:
(Signature of
/~
By:
rson authorized to sign contracts)
MICHAEL E. MALONE, CITY MANAGER
(Name and Title)
Sidney P. Shelton, Chief
Bureau of Financial Services
(Name and Title)
Date:
'I/1/QQ
Date:
07-21-99
RECOMMENDED:
By:
AGENCY Director, if different
thorized to sign contract)
TDH Document No: 756002206700
Cover Page 3
"
"
GENERAL PROVISIONS FOR
TEXAS DEPARTMENT OF HEALTH GRANT CONTRACTS
TABLE OFGONTEN'fS
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. .. " '" ',... - -. , "
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.. - . --." ........... .
· ARTICLE 1 . PREAMBLE
.2 -TERM
. 3 - FUNDiNG
4 - AMENDMENTS
.5 ~ APPLICABLE LAWS AND STANDARDS
6 - DEBARMENT AND SUSPENSION
7 . ASSURANCES
8 - INTELLECTUAL PROPERTY
. . .9 - HISTORICALLY UNDERUTILlZED BUSINESSES
10 . CERTIFICATION REGARDING LICENSE. CERTIFICATE, OR PERMIT
. 11 . - CONFLICT OF INTEREST
12 - YEAR-2ooo CERTIFICATION
13 . STANDARDS FOR FINANCIAL AND PROGRAMMATIC MANAGEMENT
. 14 - BONDING
.. .... .15. - FUNDING PARTICIPATION REQUIREMENT
.. ..16 - ALLOWABLE COSTS AND AUDiT REQUIREMENTS
. 17 . TERMS AND CONDITIONS OF PAYMENT
. 18 -ADVANCEPAYMENTS
19 . PROGRAM INCOME
20 . OVERTIME COMPENSATION
. 21 . EQUIPMENT AND SUPPLIES
22 - CONTRACTS WITH SUBRECIPIENTS
23 - CONTRACTS FOR PROCUREMENT
24 . REPORTS
25 - INSPECTIONS
. 26 - RECORDS RETENTION
27 - CLIENT RECORDS
28 . CONFIDENTIALITY
29 - SANCTIONS
30 - SANCTION REVIEW
31 . BREACH OF CONTRACT
32 TERMINATION
.33 . VOID CONTRACT
34 . SEVERABILITY
35 . LOCAL HEALTH DEPARTMENT PERSONNEL
36 - SURVIVAL OF TERMS
37 . NO-WAIVER OF SOVEREIGN IMMUNITY
38 - CERTIFICATIONS
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2000 GENERAL PROVISIONS
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Any alterotion to this document constitutes a counler.offer and must be approved in writing by the Tells Department of Health.
GENERAL PROVISIONS FOR
TEXAS DEPARTMENT OF HEALTH GRANT CONTRACTS
ARTICLE 1. Preamble
PERFORMING AGENCY and RECEIVING AGENCY (the parties) hereby agree to make and enter into this grant
contract (contract), to faithfully perform the duties prescribed by this contract and to uphold and abide by its terms
and provisions. This contract consists of RECEIVING and PERFORMING AGENCY identifying data, Details of
Attachment(s), authorized signatures, General Provisions, and Attachment(s) with detailed Scope(s) of Work,
Special Provisions, budget(s), and exhibit(s) as applicable. This contract represents the complete and entire
understanding and agreement of the parties. No prior agreement or understanding, oral or otherwise, of the parties
or their agents will be valid or enforceable unless. embodied in this contract.
The person or persons signing and executing this contract on behalf of PERFORMING AGENCY, or representing
themselves as signing and executing this contract on behalf of PERFORMING AGENCY, warrant and guarantee
that he, she, or they have been duly authorized by PERFORMING AGENCY to execute this contract on behalf of
PERFORMING AGENCY and to validly and legally bind PERFORMING AGENCY to all of its terms,
performances, and provisions.
PERFORMING AGENCY assures compliance with this contract, including these General Provisions unless
otherwise specified in any Special Provisions ofthe Attachment(s) to this document. If these General Provisions
are revised or replaced during the term ofthis contract, and PERFORMING AGENCY does not consent to comply
with the modified General Provisions, PERFORMING AGENCY may exercise its termination options in
accordance with the General Provisions, Termination Article.
ARTICLE 2. :Imn
The time period of this contract shall be governed by the term(s) ofthe Attachment(s). No commitment of contract
funds is permitted prior to the first day or subsequent to the last day of the term. The term may be extended or
shortened byamendment(s).
ARTICLE 3. Fundine-
This contract is contingent upon the availability offunding for each Attachment for the term of the Attachment.
PERFORMING AGENCY will have no right of action against the State of Texas or RECEIVING AGENCY in the
event that RECEIVING AGENCY is unable to fulfill its obligations under this contract as a result of lack of
sufficient funding of RECEIVING AGENCY for any Attachment(s) to this contract. If funds become unavailable,
provisions of the Termination Article will apply.
ARTICLE 4. Amendments
This contract may be amended only if the amendment is in writing and signed by individuals with authority to bind
all parties.
PERFORMING AGENCY shall not perform and RECEIVING AGENCY shall not pay for the performance of
different or additional services, work, or products except pursuant to an amendment of this contract that is executed
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2000 GENERAL PROVISIONS Page 1
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.'
ARTICLE 6. Debarment and Suspension
PERFORMING AGENCY certifies by execution ofthis contract to the following:
· it is not ineligible for participation in federal or state assistance programs under Executive Order
12549, Debannent and Suspension;
. neither it nor its principals are presently debarred, suspended, proposed for debannent, declared
ineligible, or voluntarily excluded from participation in this transaction by any federal department
or agency;
. it has not knowingly failed to pay a single substantial debt or a number of outstanding debts to a
federal or state agency; and
· it is not subject to an outstanding judgment in a suit against PERFORMING AGENCY for
collection of the balance of a debt.
Where PERFORMING AGENCY is unable to certifY to any of the statements in this Article, PERFORMING
AGENCY shall attach an explanation.
PERFORMING AGENCY shall not contract with a subrecipient nor procure goods or services from a
subcontractor, at any tier, which is debarred or suspended or is otherwise excluded from or ineligible for
participation in federal assistance programs under Executive Order 12549.
ARTICLE 7. Assurances
PERFORMING AGENCY shall establish safeguards to prohibit employees from using their positions for a purpose
that constitutes or presents the appearance of personal or organizational conflict of interest or personal gain.
To the extent such provisions are applicable to PERFORMING AGENCY, PERFORMING AGENCY agrees to
fully comply with the following:
· Title VI of the Civil Rights Act of 1964, 42 USC ~~2000d el seq. (P.L. 88-352), which prohibits
discrimination on the hasis of race, color or national origin, and includes the provision for effective
communication and equal access to programs, services and activities to persons with Limited
English Proficiency (LEP);
· Title IX ofthe Education Amendments of 1972, as amended, 20 USC ~~] 68] -1683, and 1685- I 686,
which prohibits discrimination on the basis of sex;
. Section 504 of the Rehabilitation Act of 1973, 29 USC ~794(a), which prohibits discrimination on
the basis of disabilities and the Americans with Disabilities Act of 1990, 42 USC ~~]2]OI el seq.,
including the provision for effective communication and equal access to programs, services and
activities to persons with sensory and speech impainnents;
. The Age Discrimination Act of 1975, as amended, 42 USC ~~6101-6]07, which prohibits
discrimination on the basis of age;
· The Drug Abuse Office and Treatment Act of ]972 (P.L. 92-255), as amended, relating to
nondiscrimination on the basis of drug abuse;
. The Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment and Rehabilitation Act
of 1970 (P.L. 9]-616), as amended, relating to the nondiscrimination on the basis ofalcohol abuse
or alcoholism;
. Public Health Service Act of 1912, ~~523 and 527,42 USC ~290 dd-2, as amended, relating to
confidentiality of alcohol and drug abuse patient records;
(LGS)
2000 GENERAL PROVISIONS Page 3
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(7) Protection of underground sources of drinking water under the Safe Drinking Water Act of 1974,
as amended, 42 USC 99300f-300j (P.L. 93-523).
(8) Protection of endangered species under the Endangered Species Act of 1973, as amended (P.L. 93-
205).
K. The Hatch Political Activity Act, 5 USC ~~7321-29, which limits the political activity of employees
whose principal employment activities are funded in whole or in part with federal funds.
L. The Federal Fair Labor Standards Act and the Intergovernmental Personnel Act of 1970, as applicable,
concerning minimum wage and maximum hours.
M. General Appropriations Act, Regular Session, 75th Legislature, 1997, Article IX, 933 "Limitation on
Grants to Units of Local Government." For the purpose of 933, "unit of local government" shall mean
a council of governments, a regional planning commission, or a similar regional planning agency created
under Chapter 391, Local Government Code; a Local Workforce Development Board; or an MHMR
community center.
N. Texas Government Code, Chapter 573,Vernon's 1994, relating to nepotism.
O. Texas Government Code, Chapter 552, Vernon's 1994, relating to open records and public information.
P. Texas Government Code, Chapter 551, Vernon's 1994, relating to open meetings.
Q. Texas Government Code, Chapter 415, and all rules adopted by the Texas Commission on Law
Enforcement Officer Standards and Education pursuant to Chapter 415, Texas Government Code,
relating to regulated law enforcement agencies.
PERFORMING AGENCY shall ensure that the facilities under its ownership, lease or supervision which shall be
utilized in the accomplishment of the project are not listed on the Environmental Protection Agency's (EP A) list
of Violating Facilities and shall notify the Federal grantor agency of the receipt of any communication from the
Director of the EPA Office of Federal Activities indicating that a facility to be used in the project is under
consideration for listing by the EP A (Executive Order 11738).
PERFORMING AGENCY shall comply with the flood insurance purchase requirements of 102(a) of the Flood
Disaster Protection Act of 1973 (P.L. 93-234). Section 102 (a) requires the purchase of flood insurance in
communities where the insurance is available as a condition for the receipt of any Federal financial assistance for
construction or acquisition proposed for use in any area that has been identified by the Secretary of the U. S.
Department of Housing and Urban Development as an area having special flood hazards.
PERFORMING AGENCY shall comply with the requirements of the Texas Workers' Compensation Act, Labor
Code, Chapters 401-406, VTCA, and rules promulgated thereunder found at 28 Texas Administrative Code
(TAC), Chapter 41, et seq., which cover compensation for employees' injuries.
When incorporated into a contract, standard assurances contained in the application package, if any, become terms
or conditions for receipt of RECEIVING AGENCY funds. PERFORMING AGENCY and its subrecipients shall
maintain an appropriate contract administration system to ensure that all terms, conditions, and specifications are
met.
PERFORMING AGENCY shall comply with all federal tax laws and is solely responsible for filing all required
state and federal tax forms.
PERFORMING AGENCY shall comply with all applicable requirements of federal and state laws, executive
orders, regulations and policies governing the activity described in Attachment(s), and with the applicable standard
conditions or assurances prescribed by UGMS in "Part III-State Uniform Requirements for Grants and Cooperative
Agreement, Subpart B -Pre-Award Requirements, _' 14-State Assurances."
(LOS)
2000 GENERAL PROVISIONS Page 5
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shall ensure all rights, titles, and interest in and to the intellectual property are secured to RECEIVING AGENCY
from PERFORMING AGENCY and its subrecipients. PERFORMING AGENCY agrees to give RECEIVING
AGENCY and agrees to require its subrecipients to give RECEIVING AGENCY, or any person designated by
RECEIVING AGENCY, all assistance required to perfect the rights defined in this Article, without any charge or
expense beyond those amounts payable to PERFORMING AGENCY for the services fendered under the contract.
Iffederal funds are used to finance activities supported by the contract Attachment(s) that result in the production
of original books, manuals, films, or other original material, the federal awarding agency reserves a royalty-free,
nonexclusive, and irrevocable license to reproduce, publish or otherwise use, and to authorize others to use, for
federal government purposes (I) the copyright in any work developed under a grant, subgrant, or contract under
a grant or subgrant; and (2) any rights of copyright to which a PERFORMING AGENCY or its subrecipient
purchases ownership with grant support. PERFORMING AGENCY shall place an acknowledgment of federal
awarding agency grant support and a disclaimer, as appropriate, on any publication written or published with such
support and, if feasible, on any publication reporting the results of or describing a grant-supported activity. An
acknowledgment shall be to the effect that "This publication was made possible by grant number
from (federal awardinll allencv)" or "The project described was supported by grant number from
(federal awardini allencv)" and "Its contents are solely the responsibility of the authors and do not necessarily
represent the official views ofthe (federal awardinl1 allencv)."
In the event the tenns ofa federal grant award the copyright to PERFORMING AGENCY, RECEIVING AGENCY
reserves a royalty-free, nonexclusive, worldwide and irrevocable license to reproduce, publish or otherwise use,
and to authorize others to use, for RECEIVING AGENCY, public health, and state governmental noncommercial
purposes (I) the copyright, trade mark, service mark, and patent on an invention, discovery, or improvement to any
process, machine, manufacture, or composition of matter; products; technology; scientific infonnation; trade
secrets; and computer software, in any work developed under a grant, subgrant, or contract under a grant or
subgrant; and (2) any rights of copyright, service or trade marks or patents to which a grantee, subgrantee or a
contractor purchases ownership with grant support.
PERFORMING AGENCY may publish the results of the contract perfonnance if those results are subject to
copyright law at its expense with prior RECEIVING AGENCY review and approval. RECEIVING AGENCY will
not withhold the approval unreasonably. If RECEIVING AqENCY withholds approval, PERFORMING AGENCY
may still publish the results of the contract perfonnance but shall not reference the Texas Department of Health
in any manner. If RECEIVING AGENCY approves and owns the copyright, any publication should include"~
Texas Department of Health, 1100 West 49th Street, Austin, Texas, (the year of publication), All Rights Reserved."
If PERFORMING AGENCY is the copyright holder, any publication shall include acknowledgment of the support
received from RECEIVING AGENCY. At least six copies of any such publication must be provided to
RECEIVING AGENCY. RECEIVING AGENCY reserves the right to require additional copies before or after the
initial review.
PERFORMING AGENCY and any subrecipient, as appropriate, must comply with the standard patent rights
clauses in 37 Code of Federal Regulations g401.14 or Federal Acquisition Regulations 52.227.11.
ARTICLE 9. Historicallv Underutilized Businesses
RECEIVING AGENCY shall comply with Texas Government Code, Chapter 2161, VTCA, and 1 TAC gglll.I 1_
111.24 whereby state agencies are required to make a good faith effort to assist historically underutilized businesses
. (HUBs) in receiving contract awards issued by the state to purchase "goods," which are defined as "supplies,
materials, or equipment," services, or public works.
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2000 GENERAL PROVISIONS Page 7
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ARTICLE 12. Year-2000 Certification
PERFORMING AGENCY certifies that any supplied or supported software, hardware, firmware and micro code
products used individually or together as a system to comply with RECEIVING AGENCY contract requirements
will be yeaf-2000-compliant on or before the date such hardware, software, firmware and systems are to be
impacted. Year-2000-compliant means that such product operates "accurately" in the manner in which it was
intended as it relates to date related operations when given a "valid date" containing century, year, month, and
day.
For purposes of this Article, "supplied or supported software, hardware, firmware and micro code products" does
not include software supported by RECEIVING AGENCY or an agency of the federal govenunent.
PERFORMING AGENCY is responsible for installing and implementing year-2000-compliant versions of any
software provided by RECEIVING AGENCY.or an agency of the federal government which is used in
performance of this contract.
For purposes of this Article,
1) "accurately" is defined to include the following:
a) calculations must be correctly performed using four-digit year processing;
b) functionality-on-line, batch including entry, inquiry, maintenance and updates must support four-digit
year processing;
c) interfaces and reports must support four-digit year processing;
d) successful translation into year-2000 with the correct system date (e.g., 0110112000) must occur
without human intervention;
e) processing with a four-digit year after transition to any dale beyond the year 2000 must occur without
human intervention;
f) correct results in forward and backward date calculation spanning century boundaries must be
provided;
g) correct leap year calculations must be performed; and
h) processing correct results in forward and backward date calculation spanning century boundaries
must occur, including the conversion of previous years currently stored as two digits;
2) "date integrity" shall mean all manipulations of time-related data (dates, durations, days of week, etc.)
wilI produce desired results for all valid date values within the application domain;
3) "explicit century" shall mean date elements in interfaces and data storage permit specifying century to
eliminate date ambiguity;
4) "extraordinary actions" shall be defined to mean any action outside the normal documented processing
steps identified in the product's reference documentation;
5) "general integrity" shall mean no value for current date wilI cause interruptions in desired operation _
especially from the 20th to 21st centuries;
6) "implicit century" shall mean for any data element without century, the correct century is unambiguous
for all manipulations involving that document;
(LGS)
2000 GENERAL PROVISIONS Page 9
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AGENCY or its subrecipient must become a Medicaid provider if performing approved Texas Medicaid services
authorized by the Attachment(s).
PERFORMING AGENCY and its governing body shall bear full responsibility for the integrity of the fiscal and
programmatic management. Such responsibility shall include: accountability for all funds and materials received
from RECEIVING AGENCY; compliance with RECEIVING AGENCY rules, policies, procedures, and applicable
federal and state laws and regulations; and correction of fiscal and program deficiencies identified through self-
evaluation and RECEIVING AGENCY's monitoring processes. Ignorance of any contract provisions or other
requirements contained or referenced in this contract shall not constitute a defense or basis for waiving or appealing
such provisions or requirements.
ARTICLE 14. Bondinl!
PERFORMING AGENCY is required to carry a fidelity bond, insurance coverage or self-insurance equal to the
amount of funding provided under the contract Attachment(s) up to $100,000 that covers each employee of
PERFORMING AGENCY handling funds under this contract, including person(s) authorizing payment of such
funds. The fidelity bond, insurance, or self-insurance will provide for indemnification oflosses occasioned by: I)
any fraudulent or dishonest act or acts committed by any of PERFORMING AGENCY's employees, either
individually or in concert with others, and/or 2) failure of PERFORMING AGENCY or any of its employees to
perform faithfully hislher duties or to account properly for all monies and property received by virtue of hislher
position or employment.
ARTICLE 15. Fundine- Participation Requirement
PERFORMING AGENCY agrees funds provided through this contract will not be used for matching purposes in
securing other funding unless otherwise directed or approved by RECEIVING AGENCY.
ARTICLE 16. Allowable Costs and Audit Requirements
Only those costs allowable under UGMS and any revisions thereto plus any applicable federal cost principles are
eligible for reimbursement under this contract. Applicable cost principles, audit requirements, and administrative
requirements are as follows:
Applicable Cost Principles"
Audit Requirements"
Administrative
Requirements"
OMB Circular A-87, State &
Local Governments
OMB Circular A-133
UGMS
. OMS Circulars shall be applied with the modifications prescribed by UGMS.
PERFORMING AGENCY must have incurred a cost within the applicable Attachment term to be eligible for
reimbursement under this contract. PERFORMING AGENCY must incur cost(s) prior to requesting
reimbursement under this contract. No later than 90 days after the end of the applicable Attachment term,
RECEIVING AGENCY must receive vouchers from PERFORMING AGENCY for costs encumbered by the last
day of the applicable Attachment term. Reimbursement requests submitted and postmarked more than 90 days
following the end of the applicable Attachment term mayor may not be reimbursed, at the discretion of
RECEIVING AGENCY.
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2000 GENERAL PROVISIONS Page 11
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!
AGENCY. RECEIVING AGENCY may take repayment from funds available under any contract Attachment,
active or expired, in amounts necessary to fulfill PERFORMING AGENCY repayment obligations.
ARTICLE 18. Advance Pavments
PERFORMING AGENCY may request a one-time advance for each Attachment only to meet immediate need for
cash disbursement. PERFORMING AGENCY must make the request on a State of Texas Purchase Voucher,
accompanied by written justification and supporting documentation as specified in RECEIVING AGENCY's
Financial Administrative Procedufes Manual. The advance shall be requested at the beginning of the applicable
Attachment period or at a later time in the applicable Attachment period if circumslances so warrant. Approval
of the request for advance will be at the discretion of RECEIVING AGENCY. If the request is approved, the
voucher will be processed; if disapproved, RECEIVING AGENCY will provide written notification to
PERFORMING AGENCY.
RECEIVING AGENCY will determine the amount of the advance, ifany, by the amount and term of the applicable
Attachment(s). For each Attachment, the amount of the advance shall not exceed an amount equal to the amount
of the Attachment divided by the number of months covered by the Attachment multiplied by two (2). Advance
funds will be expended during the applicable Attachment term so that, after the final monthly billing,
PERFORMING AGENCY will not have advance funds on hand.
If the Attachment is amended to increase or decrease the total amount, RECEIVING AGENCY may make an
upward or downward adjustment to the allowable advance in accordance with the above formula. If
PERFORMING AGENCY is requesting an upward adjustment, PERFORMING AGENCY must submit a written
justification and Slate of Texas Purchase Voucher in the amount necessary to correct the ratio. If the adjustment
is downward, RECEIVING AGENCY will determine the amount of adjustment to the advance and the method of
repayment.
ARTICLE 19. Pro"ram Income
PERFORMING AGENCY may, but if a local health department shall, develop a fee-for-service system and a
schedule of fees for personal health services in accordance with the provisions of Chapter 12, Subchapter D, Health
and Safety Code, VTCA; the Texas Board of Health rules covering Fees for Clinical Health Services, 25 TAC
~1.91; and other applicable laws. No patient may be denied a service due to inability to pay.
All revenues directly generated by an Attachment(s) supported activity or earned only as a result of the
Attachment(s) during the term of the Attachment(s) are considered program income. PERFORMING AGENCY
shall identify and report this income utilizing the forms and time frames specified in the Reports Article of these
provisions.
PERFORMING AGENCY shall utilize one of the following methods for applying program income:
I. Additive method - add the program income to the funds already committed to the project by both
parties. Program income will be used by PERFORMING AGENCY to further the program
objectives of the slate/federal slatute under which the Attachment(s) was/were made, and it shall
be spent on the same project in which it was generated.
2. Deductive method - deduct the program income from the tolal allowable costs to determine the net
allowable costs.
(LGS)
2000 GENERAL PROVISIONS Page 13
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party designated by RECEIVING AGENCY. RECEIVING AGENCY may, at its option and to the extent allowed
by law, transfer the reversionary interest to such property to PERFORMING AGENCY.
ARTICLE 22. Contracts with Suhredoients
PERFORMING AGENCY may enter into contracts with subrecipients unless restricted or otherwise prohibited in
specific Attachment(s). PERFORMING AGENCY is responsible to RECEIVING AGENCY for the performance
of any subrecipient.
Contracts with subrecipients shall be in writing and must include the following:
. name and address of all parties;
. a detailed description of the services to be provided;
. measurable method and rate of payment and total amount of the contract;
. clearly defined and executable termination clause;
. beginning and ending dates which coincide with the dates of the applicable contract Attachment(s)
or cover a term within the beginning and ending dates of the applicable contract Attachment(s);
. access to inspect the work and the premises on which any of the work is performed, in accordance
with the Inspections Article contained in this contract; and
. all clauses required by state/federal statutes, executive orders, and their implementing regulations.
PERFORMING AGENCY agrees that all contracts with subrecipients containing a categorical budget shall include
audit requirements referenced in the Allowable Costs and Audit Requirements Article of this contract, as
appropriate.
Prior to entering into an agreement equaling $25,000 or 25% of an Attachment, whichever is greater,
PERFORMING AGENCY shall obtain written approval from RECEIVING AGENCY.
PERFORMING AGENCY shall ensure that:
. subrecipients are fully aware of the requirements imposed upon them by state/federal statutes and
regulations;
. subrecipients comply with all financial management requirements as defined by RECEIVING
AGENCY and the applicable OMB circulars;
. subrecipients complete required audits;
. an adequate tracking system is maintained to ensure timely receipt of any subrecipient's required
audit reports and the resolution of any findings and questioned costs cited by these reports.
ARTICLE 23. Contracts for Procurement
PERFORMING AGENCY may enter into contracts for procurement unless restricted or otherwise prohibited in
specific Attachment(s). PERFORMING AGENCY agrees that it shall be responsible to RECEIVING AGENCY
for the performance of any subcontracted activity.
Contracts for procurement shall be in writing and must contain the following provisions:
(LGS)
2000 GENERAL PROVISIONS Page 15
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objectives ofthis contract. If PERFORMING AGENCY is legally prohibited from providing such reports, it shall
immediately notify RECEIVfNG AGENCY.
ARTICLE 25. Insoections
RECEIVING AGENCY and, when federal funds are involved, any authorized representative(s) of the federal
government have the right, at all reasonable times, to inspect or otherwise evaluate the work (including reviews
of client or patient records and discussions with staff) performed by PERFORMING AGENCY and its
subrecipient(s), ifany, and the premises on which the work is being performed. PERFORMING AGENCY and
its subrecipient(s) shall participate in inspections and provide reasonable access, facilities, and assistance to the
representatives. All inspections and evaluations will be performed in such a manner as will not unduly interfere
with the work.
PERFORMING AGENCY and its subrecipient(s), if any, shall give RECEIVING AGENCY, the federal
government, and the Texas State Auditor, or any of their duly authorized representatives, access to any pertinent
books, documents, papers, and client or patient records, if any, for the purpose of making audit, examination,
excerpts, and transcripts of transactions related to contract Attachment(s). RECEIVING AGENCY will have the
right to audit billings both before and after payment. Payment under Attachment(s) will not foreclose the right of
RECEIVING AGENCY to recover excessive or illegal payments.
Any deficiencies identified by RECEIVING AGENCY upon examination of PERFORMING AGENCY's records
will be conveyed in writing to PERFORMING AGENCY. PERFORMING AGENCY's resolution of findings will
also be conveyed in writing to RECEIVING AGENCY within 30 days of receipt of RECEIVING AGENCY's
findings. A RECEIVING AGENCY determination of either an inadequate or inappropriate resolution of the
findings may result in sanctions which will remain in effect until RECEIVING AGENCY determines the
deficiencies are properly remedied.
ARTICLE 26. Records Retention
PERFORMING AGENCY shall retain, preserve and make available all required records for a period of three years
from the date of the last expenditure report submitted under contract Attachment(s) or until all audit questions are
resolved, or until any court orders requiring record retention are dissolved, whichever time period is longer.
Microfilm copies of records required to be kept under the Attachment(s) may be substituted for the originals in
accordance with guidelines and procedures approved by RECEIVING AGENCY, provided that the microfilm
procedures are reliable and are supported by an adequate retrieval system, unless otherwise ordered by a court of
general jurisdiction.
ARTICLE 27. Client Records
Notwithstanding any other provision herein, if requested by RECEIVING AGENCY, PERFORMING AGENCY
shall share all patient information with RECEIVING AGENCY when the contract involves patient care by the
PERFORMfNG AGENCY.
RECEIVING AGENCY may require PERFORMING AGENCY, or any subrecipient, to transfer a client or patient
record to another agency or to RECEIVING AGENCY if the transfer is necessary to protect either the
confidentiality of the record or the health and welfare of the client or patient.
(LGS)
2000 GENERAL PROVISIONS Page 17
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B. suspend all or part of the contract. Suspension is, depending on the context, either (I) the temporary
withdrawal of PERFORMING AGENCY's authority to obligate funds pending corrective action by
PERFORMING AGENCY or its subrecipient(s) or pending a decision to terminate or amend the contract,
or (2) an action taken by a suspending official in accordance with agency regulations implementing
Executive Order 12549 to immediately exclude a person from participating in contract transactions for
a period, pending completion of an investigation and such legal or debarment proceedings as may ensue.
PERFORMING AGENCY costs resulting from obligations incurred by PERFORMING AGENCY
during a suspension are not allowable unless expressly authorized by the notice of suspension;
C. disallow (deny both use of funds and matching credit for) all or part of the activities or action not in
compliance;
D. temporarily withhold cash payments. Temporarily withholding cash payments means the temporary
withholding of advances or reimbursements to PERFORMING AGENCY or its subrecipient(s), for
proper charges or obligations incurred; pending resolution of issues of noncompliance with contract
conditions or indebtedness to the United States or to the State of Texas;
E. permanently withhold cash payments. Permanently withholding of cash payment means that
RECEIVING AGENCY retains funds billed by PERFORMING AGENCY or its subrecipient(s) for a)
unallowable, undocumented, disputed, inaccurate, improper, or erroneous claims; b) failure to comply
with contract provisions; or c) indebtedness to the United States or to the State of Texas;
F. deny contract renewal or future contract awards to a PERFORMING AGENCY for a certain period of
time not to exceed five years;
G. delay contract execution with PERFORMING AGENCY while other imposed or proposed sanctions are
pending resolution;
H. place PERFORMING AGENCY on probation. Probation means that PERFORMING AGENCY will be
placed on accelerated monitoring for a period not to exceed six months at which time items of
noncompliance must be resolved or substantial improvement shown by PERFORMING AGENCY;
I. conduct accelerated monitoring of PERFORMING AGENCY. Accelerated monitoring means more
frequent or more extensive monitoring will be performed by RECEIVING AGENCY than would
routinely be accomplished;
J. require PERFORMING AGENCY to obtain technical or managerial assistance;
K. disallow requests for reimbursement by disapproving costs or fees submitted for payment or
reimbursement by PERFORMING AGENCY;
L. establish additional prior approvals for expenditure of funds by PERFORMING AGENCY;
M. require additional, more detailed, financial and/or programmatic reports to be submitted by
PERFORMING AGENCY;
N. demand repayment from PERFORMING AGENCY;
(LGS)
2000 GENERAL PROVISIONS Page 19
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PERFORMING AGENCY's notice shall contain the following: (I) a copy of the letter from RECEIVING ,i
AGENCY notifying PERFORMING AGENCY of the sanction; (2) a specific description of each act that is the
basis for the dispute; (3) the grounds upon which PERFORMING AGENCY bases the complaint; (4) an
identification of the issue or issues to be resolved; (5) a precise statement of the relevant facts; (6) any
documentation in support of PERFORMING AGENCY's position; and (7) a statement and authorities in support
of PERFORMING AGENCY's position.
Evidence that PERFORMING AGENCY properly notified RECEIVING AGENCY consists of any of the following
documents: (I) signature on delivery card; (2) confirmation ofa facsimile to the correct telephone number; or (3)
signed acknowledgment of delivery.
RECEIVING AGENCY's representative will schedule a meeting or a conference call to attempt to resolve the
issues in dispute. If the dispute is resolved, any resolution will be in writing and will be signed by all parties. If
the dispute is not resolved, RECEIVING AGENCY's representative will notify PERFORMING AGENCY in
writing. RECEIVING AGENCY will appoint a reviewer(s), who will review the information, who may permit or
require additional information and who may grant, deny, or modify all relief requested in the written notice of
dispute. The reviewer(s)'s decision will be in writing and will contain a discussion of the reason for the decision
and the remedial action, ifany. The reviewer(s) will send copies of the decision to all parties by any verifiable
means. The decision of the reviewer(s) is final and is the final action of RECEIVING AGENCY for purposes of
further proceedings.
A state statute or rule or a federal statute, regulation or guideline will prevail over the provisions of this Article
unless the statute, rule, regulation or guideline can be read together with the provision or provisions of this Article
to give effect to both.
ARTICLE 31. Breach of Contract
Any remedies set out in this contract are in addition to rights and remedies for breach of contract provided by law.
ARTICLE 32. Termination
Each Attachment shall terminate upon the expiration date of the Attachment unless extended by written amendment
in accordance with the Amendments Article. Prior to completion of the contract term, all or a part of this contract
may be terminated with or without cause as set out below.
A. Termination without cause.
(1) Either party may terminate this contract with at least 90 days prior written notice to the other
party.
(2) The parties may terminate this contract by mutual agreement.
(3) Either party may terminate this contract with at least 30 days prior written notice to the other party
in the event state and/or federal funding for this contract is terminated, limited, suspended, or
withdrawn.
(4) RECEIVING AGENCY may terminate this contract when, in the sole determination of
RECEIVING AGENCY, termination is in the best interest ofthe State of Texas.
(WS)
2000 GENERAL PROVISIONS Page 21
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thereof to be stayed during such appeal while providing such reserves therefore
as may be required under generally accepted accounting principles.
C. Emergency tennination. RECEIVING AGENCY may tenninate the contract immediately upon notice
to PERFORMING AGENCY in an emergency by any verifiable means. "Emergency" is defined in the
Sanctions Article.
Either party may deliver written notice of intent to tenninate by any verifiable method. If either party gives notice
of its intent to tenninate all or a part of this contract, RECEIVING AGENCY and PERFORMING AGENCY will
try to resolve any issues related to the anticipated tennination in good faith during the notice period. Upon
termination of all or part of this contract, RECEIVING AGENCY and PERFORMING AGENCY will be
discharged from any further obligation created under the applicable tenns of this contract except for the equitable
settlement of the respective accrued interests or obligations incurred prior to tennination. Tennination does not,
however, constitute a waiver of any remedies for breach of this contract. In addition, the obligations of
PERFORMING AGENCY to retain records and maintain confidentiality of infonnation shall survive this contract.
ARTICLE 33. Void Contract
RECEIVING AGENCY may hold a contract void upon its detennination that the contract award was obtained
fraudulently or was otherwise illegal or invalid from its inception.
ARTICLE 34. Severabilitv
If any provision of this contract is construed to be illegal or invalid, the illegal or invalid provision will be deemed
stricken and deleted to the same extent and effect as if never incorporated, but all other provisions will continue.
ARTICLE 35, Local Health Dellartment Personnel
All local health department personnel funded by Attachment(s) to this contract are employees of PERFORMING
AGENCY which will be responsible for their direction and control and liable for any of their acts or omissions.
PERFORMING AGENCY will have in place legally sufficient due process hearing procedures for all of its
employees filling state-budgeted positions.
PERFORMING AGENCY will have full authority to employ, promote, suspend, demote, discharge, and transfer
within its organization any and all state-budgeted personnel funded by Attachment(s) to this contract provided,
however, that any demotion, suspension, or discharge of such state-budgeted employees will be in accordance with
the due process hearing procedures as set out above. The only distinction between state-budgeted and local paid
employees is that employees on state budgeted positions receive state benefits and are subject to certain duties,
obligations, and restrictions as state employees as contained in state law. One such restriction, as contained in the
State Appropriations Act, is that no employee paid on a state-budgeted position may receive a salary supplement
from any source unless specifically authorized in the Appropriations Act or other state law. This prohibition
includes the payment to such employee of a so-called "flat rate" car allowance or travel allowance. Any travel or
per diem allowance to these employees must be on a reimbursement basis, supported by appropriate records, and
may not exceed the reimbursement for mileage and/or per diem allowed under the Appropriations Act and current
state travel regulations. This restriction will apply whether travel funds are provided in Attachment(s) under this
contract or from any other source.
(WS)
2000 GENERAL PROVISIONS Page 23
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,
"
DOCUMENT NO. 7560022067-00
ATTACHMENT NO. 01
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF COMMUNITY ORIENTED PUBLIC
HEALTH
TERM: September 01, 1999
THRU: August 31, 2000
SECTION I. SCOPE OF WORK
PERFORMING AGENCY shall deliver comprehensive health care services to eligible low-income
individuals as authorized under the Health and Safety Code, Chapter 31, Texas Primary Health
Care Services Act. PERFORMING AGENCY shall comply with all applicable federal and state
laws, rules, regulations, standards, and guidelines in effect on the beginning date of this contract
Attachment unless replaced with a subsequent amendment. The following documents are
incorporated by reference and made a part of this contract Attachment. These include:
. RECEIVING AGENCY'S FYOO Primary Health Care Program Request for Proposal
(RFP) issued March 31, 1999;
. PERFORMING AGENCY'S FYOO Continuation Application, and any revisions;
. RECEIVING AGENCY'S Primary Health Care Program Rules, 25 TAC, Chapter 39;
. RECEIVING AGENCY'S Primary Health Care (pHC) Handbook, and any revisions;
. Texas Primary Health Care Services Act, Health and Safety Code, Chapter 31;
. RECEIVING AGENCY'S Client Services Standards for Public Health and Community
Clinics, revised June 1997;
. Service-specific standards/guidelines set by RECEIVING AGENCY'S Programs for the
particular client services provided; and
. Changes in income guidelines as determined by RECEIVING AGENCY.
Any amended guidelines will become effective within thirty (30) days of receipt by
PERFORMING AGENCY. If PERFORMING AGENCY does not consent to comply with these
guidelines, PERFORMING AGENCY may exercise the termination option set out in the General
Provisions.
PERFORMANCE MEASURES
The following performance measures will be used to assess in part the PERFORMING
AGENCY'S effectiveness in providing the services described in this Attachment, without waiving
the enforceability of any of the other terms of the contract.
PERFORMING AGENCY shall report on:
ATTACHMENT - Page I
· screening, referral and PHC eligibility services (PHC-200)
· client intake - new and recertified clients (PHC-200)
· number of PHC eligible clients receiving medicat services (PHC-200)
· clients served by quarter (PHC-200)
· cost and type of sefvices provided (PI-IC-200)
· client demographic data (PHC-300) (annual)
PERFORMING AGENCY shall report quality measures on the:
· Clinical Process = Outcome Measures report (PHC-30I)
· Client Satisfaction Survey (PHC-302) (annual)
PERFORMING AGENCY shall use the required eligibility system as described in the PHC
Handbook and use TESS (Texas Eligibility Screening System) as the initial step.
PERFORMING AGENCY shall make reasonable efforts to investigate and apply for all other
sources of third party funding available to or identified by the patient before submitting claims for
allowable costs to RECEIVING AGENCY Program.
When each client is enrolled, the client shall be assigned to a specific primary care provider for
preventive, episodic and chronic care to foster continuity and efficiency of care.
PERFORMING AGENCY shall provide services to.l..2QO clients who live or who receive services
in the following county(ies)/area: Lamar.
SECTION II. SPECIAL PROVISIONS
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shall submit a Program Services Report on or before the
following dates: January I, April 1, July 1 and October 1. A final Program Services
Report shall be submitted on or before November 1. RECEIVING AGENCY Program
requires comprehensive reports which allow the Program to assess the volume and quality
of services being provided.
A IT ACHMENT - Page 2
SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$128,147.00
32,037.00
1,500.00
0.00 .
7,731.00
36,000.00
6,000.00
TOTAL
$211,415.00
Total reimbursements will not exceed $ 211,415.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th of
November.
DOCUMENT NO. 7560022067-00
ATTACHMENT NO. 02
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF REGIONAL/LOCAL HEALTH
OPERATIONS
.
TERM: September 01, 1999
THRU: August 31, 2000
SECTION I. SCOPE OF WORK:
ESSENTIAL PUBLIC HEALTH SERVICES
PERFORMING AGENCY shall use direct assistance and/or financial assistance, as specified in
SECTION m., BUDGET, from RECEIVING AGENCY to deliver one or more of the following
essential public health services as specified in PERFORMING AGENCY'S FY 2000 Service
Delivery Plan, which is adopted by reference:
. Monitor health status to identify community health problems;
. Diagnose and investigate health problems and health hazards in the community;
. Inform, educate, and empower clients about health status;
. Mobilize community partnerships to identify and solve health problems;
. Develop policies and plans that support individual and community health efforts;
. Enforce laws, rules, regulations, and ordinances, where applicable, that protect
health and ensure safety;
. Link clients to needed personal health services and assure the provision of health
care when otherwise unavailable;
. Assure a competent public health and personal health care work force;
. Evaluate effectiveness, accessibility, and quality of personal and population-based
health services; and
. Research for new insights and innovative solutions to health problems.
Two types of support are provided under this program: (1) direct assistance in the form of
state-paid positions and/or (2) financial, assistance from General Revenue funds and the Preventive
Health and Health Services Block Grant.
STATE-PAID POSITIONS
State-paid positions under this contract Attachment shall perform activities as specified in
PERFORMING AGENCY'S FY 00 Service Delivery Plan. Activities shall be specific to one of
the ten essential public health services or cardiovascular and cancer activities.
ATTACHMENT - Page 1
FINANCIAL ASSISTANCE
PERFORMING AGENCY shall direct 73.5 % of the General Revenue funds toward the delivery
of a bfoad range of essential public health services and 26.5 % of the Preventive Health and Health
Services Block Grant funds for activities designed to reduce the incidence of cancer and
cardiovascular disease.
PERFORMANCE MEASURES (Bureau of Regional/Local Health Operations)
,
The following performance measure(s) will be used to assess, in part, PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment, without
waiving the enforceability of any of the other terms of the contract.
PERFORMING AGENCY shall submit qUl\rlerly progress reports which describe
accomplishments, challenges, barriers, impact and progress toward achieving the work plan goals
and objectives contained in PERFORMING AGENCY'S FY 2000 Service Delivery Plan. These
reports shall include the progress and activities of the employees in state-paid positions under
the "000" budget.
IMMUNIZATION
PERFORMING AGENCY will implement the "Standards for Pediatric Immunization Practices,"
February 1996, recommended by the National Vaccine Advisory Committee, approved by the
United States Public Health Service, and endorsed by the American Academy of Pediatrics.
PERFORMING AGENCY shall formulate and implement a comprehensive immunization policy
for all employees according to the most current Advisory Committee on Immunization Practices
(ACIP) statement: "Immunization of Health-Care Workers."
PERFORMING AGENCY will attend and participate in at least one seminar or training session
addressing the immunization requirements for children and students emolled in Texas public and
private schools and licensed child-care facilities.
PERFORMING AGENCY shall investigate all suspected cases of invasive Haenwphilus influenzae
disease in children less than 5 years of age and all suspected cases of measles, rubella, pertussis,
paralytic poliomyelitis, diphtheria, and all suspected deaths due to varicella (chickenpox) within
24 hours of receipt of the initial case report. PERFORMING AGENCY shall investigate all
suspected cases of mumps; tetanus, and hepatitis B infection in pregnant women and in children
less than 7 years of age within 48 hours of receipt of the initial case report.
PERFORMING AGENCY shall complete all case investigation forms and provide complete
epidemiologic data on all reported cases of invasive Haemophilus influenzae disease in children
less than 5 years of age; hepatitis B infection in pregnant women and in children less than 7 years
ATTACHMENT - Page 2
of age; all deaths due to varicella (chickenpox); and all reported cases of measles, mumps, rubella,
congenital rubella syndrome, pertussis, diphtheria, and paralytic poliomyelitis to RECEIVING
AGENCY Immunization Division within 30 days of the initial case report. PERFORMING
AGENCY shall provide copies of completed investigation forms to RECEIVING AGENCY
Immunization Division.
.
PERFORMING AGENCY shall adhere to the Vaccine-Preventable Disease Surveillance
Guidelines provided by RECEIVING AGENCY Immunization Division and shall implement the
most current outbreak control procedures and measures as recommended in those guidelines.
PERFORMING AGENCY shall implement an immunization reminder and recall system to notify
parents or guardians of children when immunizations are due. The notifications may be automated
or manual and may include mailed or telephone contacts. Extra efforts shall be made to notify
parents or guardians of children at high-risk of failure to complete the vaccines on schedule (e.g.,
children who start their vaccines late).
PERFORMING AGENCY shall provide immunization services outside usual clinic hours (which
are 8:00 a.m. to 5:00 p.m., Monday through Friday) at least once each month or as needed to
insure barrier-free access to immunization clinics. PERFORMING AGENCY residency
requirements are not applicable under this contract Attaclunent. PERFORMING AGENCY shall
not deny vaccinations to recipients because they do not reside within PERFORMING AGENCY'S
jurisdiction.
PERFORMING AGENCY will maintain an accurate, up-to-date list of clinics and sites where
public sector (free or low cost) immunization services are offered in PERFORMING AGENCY'S
local area. PERFORMING AGENCY will update the clinic list monthiy and provide the updates
to local area Temporary Aid to Needy Families (TANF) offices and to the Immunization
Communication and Training Program of RECEIVING AGENCY.
No fee may be charged for vaccines provided by RECEIVING AGENCY Immunization Division.
All vaccines obtained from RECEIVING AGENCY Immunization Division shall be used solely
fOf purposes of this contract Attaclunent and shall not be sold to agencies or individuals.
PERFORMING AGENCY shall not collect vaccine administration fees from Medicaid recipients.
Vaccine administration fees collected from non-Medicaid patients shall be kept within guidelines
established by RECEIVING AGENCY. No one may be denied immunization services in public
clinics because of inability to pay the administration fee. Fee schedules shall not be based on
vaccine type, formulation, or dose in series. A copy of PERFORMING AGENCY'S fee schedule
shall be submitted to RECEIVING AGENCY Immunization Division by the first day of the fifth
month of this contract Attaclunent term.
All equipment and vaccine used by PERFORMING AGENCY which are provided by
RECEIVING AGENCY Immunization Division shall be accounted for the same as other public
A TT ACHMENT - Page 3
property. RECEIVING AGENCY Immunization Division may investigate equipment or vaccine
loss, destruction, spoilage, or other waste and may then require PERFORMING AGENCY to
replace or reimburse RECEIVING AGENCY Immunization Division for them.
PERFORMING AGENCY shall record vaccine lot numbers on all vaccine storage records and in
individual clinic immunization records to ensure a vaccine audit trail. PERFORMING AGENCY
shall provide RECEIVING AGENCY Immunization Division with a copy of any local agency
audit of immunization program funds and vaccines.
PERFORMING AGENCY shall submit a report to RECEIVING AGENCY Immunization
Division for the previous calendar year that details storage measures and methods used to control
vaccine loss, including methods to monitor and record daily vaccine storage temperatures. The
report shall be submitted by the first day of the fifth month of this contract Attachment term in a
format provided by RECEIVING AGENCY Immunization Division.
PERFORMING AGENCY will assist in distributing state-supplied vaccines to "Texas Health
Steps" providers, Medicaid providers, physicians, and other providers and organizations within
PERFORMING AGENCY'S local area.
PERFORMING AGENCY shall provide the parent, managing conservator, or guardian of each
patient with a form, developed by RECEIVING AGENCY Immunization Division in compliance
with 25 TAC, Chapter 100. This form will allow the parent, managing conservator, or guardian
to authorize participation in the Immunization Tracking System (ImmTrac). When this form is
signed and returned to PERFORMING AGENCY, PERFORMING AGENCY shall comply with
the requirements of 25 TAC, Chapter 100 and provide an immunization history to RECEIVING
AGENCY Immunization Division.
PERFORMING AGENCY shall provide RECEIVING AGENCY Immunization Division weekly
data transfers of all vaccines administered, detailed by client name, demographics, and dose
information. The data shall be submitted in a format provided by RECEIVING AGENCY
Immunization Division for inclusion in the state's immunization registry (lmmTrac).
PERFORMING AGENCY shall comply with all applicable federal, state, and local laws, rules
and regulations as these now appear or may be amended during the term of this contract
Attachment, and standards and guidelines in effect on the beginning date of this contract
Attachment. These include:
. Texas Human Resources Code ~42.043. VTCA;
. Texas Education Code ~~38.001-38.002, VTCA;
. Health and Safety Code ~~81.023 and 161.001-161.009, VTCA;
. 25 TAC ~~97.61-97.77 and 97.101-97.102;
. 25 TAC, Chapter 100;
. 42 USC ~~247b and 300 aa-25;
A TT ACHMENT - Page 4
. Omnibus Budget Reconciliation Act of 1993,26 USC ~4980B; and
. RECEIVING AGENCY Client Services Standards for Public Health and
Community Clinics, revised June 1997.
PERFORMANCE MEASURES (Immunization)
The following performance measure(s) will be used, in part, to assess PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment, without
waiving the enforceability of any of the terms of the contract.
PERFORMING AGENCY shall provide an estimated 2,215 doses of vaccine to clients
who live or receive services in the following county(ies)/area defined as: Lamar.
PERFORMING AGENCY shall provide RECEIVING AGENCY Immunization Division
monthly reports of doses administered by vaccines and age group and vaccine
utilization/loss. Reports shall be submitted by the fifteenth day of each month for the
previous calendar month, on forms provided by RECEIVING AGENCY Immunization
Division (forms C5, C33, C33A). If automated reports are used by PERFORMING
AGENCY, the report shall be similar to and include the same information as the C5, C33,
C33A forms. PERFORMING AGENCY shall provide copies of each Biological Transfer
Form (C-68) used to transfer vaccines to another agency or private provider. Vaccine lot
numbers shall be included on all Biological Transfer Forms used to transfer vaccines.
PERFORMING AGENCY shall endeavor to achieve and maintain the following vaccine
coverage levels:
. 90% for diphtheria and tetanus toxoids and pertussis vaccine (DTP), diphtheria and
tetanus toxoids and acellular pertussis vaccine (DTaP) , diphtheria and tetanus
toxoids (DT), polio, measles/mumps/rubella (MMR), and Haemophilus influenzae
type b conjugate (HibCV) vaccines in preschool age children (24-35 months of
age); and
. 80% for hepatitis B and varicella vaccine.
PERFORMING AGENCY will implement and participate in RECEIVING AGENCY'S
Perinatal Hepatitis B Prevention Program following program protocol and providing
program services when HBsAg-positive pregnant women are identified in their service
area.
PERFORMING AGENCY will assist licensed child care facilities and registered family
homes in achieving and maintaining 90% immunization levels.
A TT ACHMENT - Page 5
PERFORMING AGENCY will assist accredited public and private schools in achieving
and maintaining 95 % immunization levels.
,
PERFORMING AGENCY shall assess the clinical records of preschool-age children to
determine immunization levels. PERFORMING AGENCY shall use the Assessment
Feedback Initiative Exchange (AFIX) methodology to assess immunization records using
the Texas Windows version Clinic Assessment Software Application (TexWinCASA)
available from RECEIVING AGENCY Immunization Division. PERFORMING
AGENCY shall complete one annual on-site assessment of all its facilities and one (1)
assessment on at least twelve (12) Texas Vaccines for Children (TVFC) private providers
within their jurisdiction or, if less than 12 providers, all private providers, during the term
of this contract Attachment, using the criteria specified in the attached Exhibit" A." All
selected TVFC private providers must have prior approval from RECEIVING AGENCY
Immunization Division. Assessment results shall be reported to RECEIVING AGENCY
Immunization Division not more than two weeks after the assessments are completed.
SECTION II. SPECIAL PROVISIONS
General Provisions, Inspections Article, is amended to include the following paragraph:
PERFORMING AGENCY shall submit quarterly reports and an Annual Expenditures Report to
the appropriate Public Health Regional Director in the format specified by RECEIVING
AGENCY Program within thirty (30) days following the end of each quarter and sixty (60) days
following the end of PERFORMING AGENCY'S fiscal year.
For immunization activities performed under this contract Attachment, General Provisions,
Overtime Compensation Article, is not applicable, and PERFORMING AGENCY shall comply
with the following paragraphs:
PERFORMING AGENCY is authorized to pay employees who are not exempt under the
Fair Labor Standards Act (FLSA), 29 USC, Chapter 8, ~20I et seq., for overtime or
compensatory time at the rate of time and one-half per FLSA. '
PERFORMING AGENCY is authorized to pay employees who are exempt under FLSA
on a straight time basis for wor!c performed on a holiday or for regular compensatory time
hours when the taking of regular compensatory time off would be disruptive to normal
business operations.
PERFORMING AGENCY shall document proper authorization or approval for any work
performed by exempt or non-exempt employees in excess of 40 hours in a workweek.
ATTACHMENT - Page 6
SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$100,476.00
20,928.00
0.00
0.00
0.00
0.00
0.00
TOTAL
$121,404.00
Total reimbursements will not exceed $ 121,404.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th
of November.
A TT ACHMENT - Page 7
EXHIBIT A
IMMUNIZATION ASSESSMENT CRITERIA AND REPORTING REQUIREMENTS
Assessment Criteria:
Methodology used for an automated assessment must be approved by RECEIVING AGENCY as meeting
contractual requirements.
The assessment criteria below is to be used for conducting/reporting all immunization assessments.
CASA CliniclProvider Site Requirements
CASA Client Information
Date of Assessment
Common Review Date
Provider Type
Name of Clinic/Provider Site
Address
City, State, Zip Code, County Code
Reviewer Initials (XPR ifelectronicfile)
Estimated "Active" Client Population and Sample Size for
12-35 months of age
FULL Last and First Name
Date of Birth
Moved or Gone Elsewhere
VFC Status/Documentation
Shot Type
Shot Date
Reportin'l Requirements:
TexWin CASA clinic data files should be submitted to the Regional AFIX Coordinator and to the Texas
Department of Health Immunization Division-Central Office within two weeks of completion of the
assessment. Please contact the Immunization Division if you need the latest version of TexWin CASA or
assistance with data file transfer. Please include the following information with your electronic files for each
clinic assessment:
Name of assessment site and address (including County and TDH Region)
Mailing address (if different from above)
Site contact name, title, phone andfax number
Type ofsite(s) (e.g., LHD, TDH. WIC, etc.)
Date of assessment
Description offiles (e.g., cardfiles, medical records. ICES, TexWin, other electronic)
Exclusive criteria (must be approved by RECEIVING AGENCY)
Name, address, and phone number of individual that performed the assessment
Detailed explanation Q.f reminder/recall criteria:
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS. GRANTS. LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief that:
(I)
No federal appropriated funds have been paid or will be paid, by or on behalf of the
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of congress in connection with the awarding of any
federal contract, the making of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuation, renewal,
amendment, or modification of any federal contract, grant, loan, or cooperative
agreement.
.
(2) If any funds other than federal appropriated funds have been paid or will be paid to any
person for influencing or attempting to influence an officer or employee of any agency,
a member of congress, an officer or employee of congress, or an employee of a member
of congress in connection with this federal contract, grant, loan, or cooperative agreement,
the undersigned shall complete and submit Standard Form-III, "Disclosure Form to
Report Lobbying, " in accordance with its instructions.
(3) The undersigned shall require that the language of this certification be included in the
award documents for all subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans and cooperative agreements) and that all subrecipients shall
certify and disclose accordingly.
This certification is a material representation of fact upon which reliance was placed when this transaction
was made or entered into. Submission of this certification is a prerequisite for making or entering into this
transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the required
certification shall be subject to a civil penalty of not less than $10,000 and not more than $100,000 for each
such failure.
Signature
Date
Print Name of Authorized Individual
7560022067 2000-02
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name
P O. BOX 938
PARIS, TX 75460-0938