2005-117-RES AUTHORIZING THE EXECUTION OF CONTRACT CHANGE ORDER NOTICE NO 02 FOR PUBLIC HEALTH SERVICES DSHS DOCUMENT NO 7560022067-2006 (ATTACHMENT NO 03) CHS PRIMARY
RESOLUTION NO. 2005-117
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE ORDER NOTICE NO. 02 FOR PUBLIC HEALTH
SERVICES, DSHS DOCUMENT NO. 7560022067-2006 (ATTACHMENT NO.
03) CHS - PRIMARY HEALTH CARE; MAKING OTHER FINDINGS AND
PROVISIONS RELATED TO THE SUBJECT; AND PROVIDING AN
EFFECTIVE DATE.
WHEREAS, the State of Texas is a funding partner with the County of Lamar and the
City of Paris for the Paris-Lamar County Health Department; and,
WHEREAS, the Contract for Public Health Services, Contract Change Notice No. 02,
DSHS Document No. 7560022067-2006 (Attachment No. 03) ,CHS - Primary Health Care is
the conduit through which the state funds are received; and,
WHEREAS, it is appropriate that the form of said Contract Change Notice No. 02,
attached hereto as Exhibit A, be approved, and that the City Manager 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, PARIS,
TEXAS:
Section 1. That the findings set out in the preamble to this resolution are hereby in all
things approved.
Section 2. That the form of the Contract for Public Health Services, Contract Change
Notice No. 02 DSHS Document No. 7560022067-2006 (Attachment No. 03) CHS - Primary
Health Care, attached hereto as Exhibit A, be, and the same is hereby, approved.
Section 3. That the City Manager 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, Contract Change Notice No. 02, under the terms and conditions and in the form shown
in Exhibit A, attached hereto.
Section 4. That this resolution shall be effective from and after its date of passage.
PASSED AND APPROVED this 19th day of September, 2005.
ATTEST:
~~A' 0 f OO~
Ice EllIS, CIty Clerk
Larry . Schenk, City Attorney
~
DEPARTMENT OF STATE HEALTH SERVICES
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
DSHS Document No. 7560022067 2006
Contract Change Notice No. 02
The Department of State Health Services, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in
writing with PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The
arties thereto now desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
Art NO. 03 : CHS - PRIMARY HEALTH CARE
All terms and conditions not hereb amended remain in full force and elfect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF PARIS
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of;
PERFORMING AGENCY:
RECEIVING AGENCY:
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
DEPARTMENT OF STATE HEALTH SERVICES
By:
(Signature of person authorized to sign)
By:
(Signature of person authorized to sign)
(Name and Title)
Bob Burnette, Director
Client Services Contracting Unit
(N arne and Title)
Date:
Date:
By:
(PERF R I AGENC rector, if different
from per on authorized to sign contract
KR CSCU - Rev. 6/05
Cover Page 1
EXHIBIT A..
DETAILS OF ATTACHMENTS
Attl DSHS Program illl Term Financial Assistance Direct Total Amount
Amd DSHS Purchase Assistance (DSHS Share)
No. Order Number Begin End Source of Amount
Funds'
01 RLSS/LPHS 09/01105 02/28/06 60,259.50 0.00 60,259.50
02 IMM/LOCALS 09101105 . 08/31106 State 93.268 50,023.00 0.00 50,023.00
0000309169
03 CHSIPHC 09101/05 08/31/06 State 151,558.00 0.00 151,558.00
0000309477
DSHS Document No.7560022067 2006 Totals $261,840.50 $ 0.00 $261,840.50
I Change No. 02 .
'Federal funds are indicated by a number from the Catalcg of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 7560022067-2006
ATTACHMENT NO. 03
PURCHASE ORDER NO. 0000309477
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: COMMUNITY HEALTH SERVICES SECTION
TERM: September 01, 2005 THRU: August 31, 2006
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall deliver comprehensive health care services to eligible 10w-
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 amended, including but not limited to:
. RECEIVING AGENCY'S Primary Health Care (PHC) Program Rules, 25 TAC, Chapter
39;
. RECEIVING AGENCY'S PHC Handbook, and any revisions; and
. Texas PHC Services Act, Health and Safety Code, Chapter 31.
The following documents are incorporated by reference and made a part of this contract
Attachment. These include:
. RECEIVING AGENCY'S FY2006 Primary Health Care Renewal Application and
any reVISIOns;
. PERFORMING AGENCY'S FY2006 Application and any revisions;
. RECEIVING AGENCY'S Family & Community Health Services Grants FY2005
Competitive Request For Proposal (RFP);
. PERFORMING AGENCY'S FY2005 Component II, Attachment E application and
any revisions; and
. RECEIVING AGENCY'S Department of State Health Services Standards for
Public Health Clinic Services, revised August, 2004.
Within thirty (30) days of receipt of an amended standard(s) or guideline(s), PERFORMING
AGENCY shall inform RECEIVING AGENCY Program, in writing, if it will not continue
performance under this Attachment in compliance with the amended standard(s) or guide1ine(s).
RECEIVING AGENCY may terminate the Attachment immediately or within a reasonable
ATTACHMENT-Page 1
period oftime as determined by RECEIVING AGENCY.
RECEIVING AGENCY'S Health Service Regional Director or designee, as coordinator of
regional services, will assist RECEIVING AGENCY staff in providing direction to
PERFORMING AGENCY. RECEIVING AGENCY personnel may, from time to time, provide
technical assistance and training to PERFORMING AGENCY. PERFORMING AGENCY shall
cooperate with RECEIVING AGENCY staff to attain the goals of unified community health
assessment, policy development, coordinated services, and quality assurance and to prevent
unnecessary duplication of services.
PERFORMANCE MEASURES:
The following performance measures 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 report on:
. Screening, referral and PHC eligibility services (PHC-200) (monthly)
. Client intake - new and recertified clients (PHC-200) (monthly)
. Number ofPHC eligible clients receiving medical services (PHC-200) (monthly)
. Clients served by month (PHC-200) (monthly)
. Cost and type of services provided (PHC-200) (monthly)
. Contract objectives (PHC-301) (quarterly)
. Client demographic data (PHC-300) (annually)
ELIGIBILITY:
All individuals considered for PHC eligibility must be screened and determined eligible using a
DSHS or PHC program approved screening tool as updated in the spring of each year when
federal poverty levels and eligibility determination forms are revised.
CO-PAY:
PERFORMING AGENCY may assess co-pay from clients provided services by RECEIVING
AGENCY under this Attachment. A co-pay assessment may not exceed 25% of the amount
RECEIVING AGENCY pays PERFORMING AGENCY for the provision of a given service. A
client shall not be denied services due to inability to pay. Local Health Departments shall
comply with RECEIVING AGENCY fee collection policies detailed in 25 T AC S 1.91.
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.
ATTACHMENT - Page 2
PERFORMING AGENCY shall provide services to clients who live or who receive services in
the following county (ies)/area: Lamar.
SECTION II. SPECIAL PROVISIONS:
General Provisions, Child Abuse Reporting Requirements Article, first sentence, is replaced in
its entirety:
PERFORMING AGENCY is required to comply with this article only as related to
services provided under the following Attachments: Human Immunodeficiency Virus and
Sexually Transmitted Diseases (all direct client care services for HIV and other sexually
transmitted diseases funded under the Ryan White CARE Act Title 11 or general
revenue), Title V Family Planning (CHS/FEE-FP), Title X Family Planning (CHS/TITLE
X), Title XX Family Planning (CHS/TTLXX), Primary Health Care (CHSIPHC), Title V
Matemal and Child Health (CHSIFEE), Special Supplemental Nutrition Program for
Women, Infants, and Children (NSS/WIC-CARD), and the Services Delivery Integration
project (SDI/FFS).
General Provisions, Terms and Conditions of Payment Article, is revised to include:
PERFORMING AGENCY shall notify RECEIVING AGENCY immediately in the event
of any significant change affecting the PERFORMING AGENCY'S identity, ownership
or control, name change, goveming board membership, vendor identification, medical or
program director, changes in hours of operation, clinic site information regarding closure,
relocation, change of address, and openings of new clinic sites. Failure to disclose the
required information or inaccurate disclosure by the PERFORMING AGENCY may be
treated as a material breach of this contract and may be grounds for termination.
PERFORMING AGENCY shall coordinate their services with existing FQHCs located in
their county(ies) or examine seeking designation as an FQHC if no FQHC is currently
available within their county.
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shall submit the PHC 200 with the Monthly Reimbursement
Request (MRR) within 30 days following the end of the prior month. PERFORMING
AGENCY shall submit the PHC 301 within 30 days after the end of each quarter.
PERFORMING AGENCY shall submit the PHC 300 within 90 days of the end of the
Attachment term. Failure to submit reports in a timely manner may result in sanctions
according to provisions of the contract. RECEIVING AGENCY requires comprehensive
reports that allow the Contract Management Branch to assess the volume and quality of
services being provided.
ATTACHMENT - Page 3
SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$80,160.00
19,840.00
1,477.00
0.00
10,940.00
30,500.00
8,641.00
TOTAL DIRECT CHARGES
INDIRECT CHARGES
TOTAL
$151,558.00
$0.00
$151,558.00
Total reimbursements will not exceed $151,558.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th
of November.
A TT ACHMENT - Page 4
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:
(1) No federal appropriated funds have been paid or will be paid, by or on behalf ofthe
undersigned, to any person for influencing or attempting to influence an officer or an
employee of any agency, a member of Congress in co.nnection 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-HI, "Disclosure Form to Report Lobbying," in accordance with it's
instructions.
The undersigned shall require that the language of this certification be included in the
award documents for all sub awards at all tiers (including subcontracts, sub grants,
and contracts under grants, loans and cooperative agreements) and that all
sub recipients shall certify and disclose accordingly.
(3)
This certification is a material representation of fact upon which reliance was placed when
this transaction was made or entered into. Submission ofthis certification is a prerequisite
for making or entering into this transaction impos~d 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 2006-03
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 6TH ST SW
PARIS, TX 75460-8530