1997-144-RES WHEREAS, THE STATE OF TEXAS IS A FUNDING PARTNER WITH THE COUNTY OF LAMAR AND COP
.
.
.
RESOLUTION NO. 97-144
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 City Council of the City of Paris did heretofore, on the 9th day of
October, 1997, in Resolution No. 97-120, authorize the execution of a Contract for Public Health
Services, TDH Document No. 75600227067 98, which is the conduit through which the state
funds are received; and,
WHEREAS, the City Council of the City of Paris did heretofore, on the 13th day of
October, 1997, in Resolution No. 97-125, authorize the execution of Contract Change Notice 01
to said Contract; and,
WHEREAS, said contract is in need of additional amendments, and it is deemed
appropriate that the forms of Contract Change Notices Nos. 02, 03, and 04, attached hereto as
Exhibits A, B, and C, respectively, 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
forms of the Contract Change Notices Nos. 02, 03, and 04 to the Contract for Public Health
Services, TDH Document No. 75600022067 98, attached hereto as Exhibits A, B, and C,
respectively, be, and the same are 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 Change Notices Nos. 02, 03, and 04 under the terms and conditions and
in the forms shown in Exhibits A, B, and C, respectively, attached hereto.
PASSED AND ADOPTED this 8th day of December, 1997.
Eri'~~
ATTEST:
/
Mattie Cunningham, City Clerk
a
~
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560022067 98
CONTRACT CHANGE NOTICE NO. l!Z
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did heretofore enter into a contract in writing with
PARIS-LAMAR COlJNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 03: PHR 4/5 - EPSDT
All terms and conditions not hereby amended remain in full forec and effect.
,..
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:
RECEIVING AGENCY:
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
TEXAS DEPARTMENT OF HEALTH
By:
By:
of person authorized to sign contracts)
(Signature of person authorized to sign contracts)
MICHAEL E. MALONE, CITY MANAGER
(Name and Title)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date:
11-11-97
Date:
/CJ~f7
,
APPROVED AS TO FORM:
BY:xI~~
OCT 17 ml,
Office of General Counsel
DM GMD - Rev. t2l95
~ .'S/fA
Cover Page 1
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No.7560022067 98
CONTRACT CHANGE NOTICE NO. QZ
The Texas Department of Health, hereinafter referred 10 :IS RECEIVING AGENCY, did heretofore eoter into a contract in writing with
PARIS-LAMAR COUNTY HEAl.TH DEPARTMENT hereinafter referred to :IS PERFORMING AGENCY. The parties thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 03: PHR 4/5 - EPSDT
C.,
".:")
. '. ~',
All terms and conditions not hereby amended remain in full force and effect.
.A"
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:
RECEIVING AGENCY:
PAlUS-LAMAR COUNTY HEALTII DEPARTMENT
TEXAS DEPARTMENT OF HEALTIf
By:
By:
of person authorized to sign contracts)
(Signarure of person autllorized to sign contracts)
MICHAEL E. MALONE, CITY MANAGER
(Name and Title)
Linda Farrow. Chief
Bureau of Financial Services
(Name and Title)
Date:
11-11-97
Dale:
/(}~f7
,
RECOMMENDED:
APPROVED AS TO FORM:
BY:xI~~
OCT 11 flJ7.
AGENCY Di ector, if different
rom person authorized to sign contract)
Office of General Counsel
DM GMD ' Rev. 12/95
Cover Page 1
DETAILS OF ATTACHMENTS
Att/ TDH Term Financial Assistance Direct Total Amount
Amd Programl Begin End Source of Assistance (TDH Share)
No. lO Amount
Funds'
01 BCNS/CARDS 10/01/97 09/30/98 10.557 93.268 0.00 0.00 0.00
02 PRIMARY 09/01/97 08/31/98 State 211,415.00 0.00 211,415.00
03 PHR 4/5-EPSD 09/01/97 08/31/98 State 11,497.00 0.00 ,11,497.00
TDH Document No.7560022067 98 Totals $222,912.00 $0.00 $222,912.00
Change No. 02
"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 AITACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 7560022067-98
ATTACHMENT NO. 03
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALDI DEPARTMENT
RECEMNG AGENCY PROGRAM: PUBLIC HEALTH REGION 4/5
TERM: September 01, 1997
THRU: August 31, 1998
SECTION 1. SCOPE OF WORK:
PERFORMING AGENCY will conduct EPSDT Outreach Activities to assist RECEIVING
AGENCY in meeting the Federally-mandated 80% medical screening participation goal for
EPSDT/Medicaid eligibles. PERFORMING AGENCY will:
1. Conduct EPSDT Outreach Activities in order to increase the awareness of EPSDT
medicaIl dental screenings.
For the purposes of this Attachment, EPSDT Client Outreach is defmed as efforts,
strategies" plans, events, organized activities, and courses of action taken to advertise,
educate, or in some way increase participation in utilizing EPSDT preventive health care
services. Some of the activities approved in the past include health fairs, group
presentations in various locations (WIC clinics, DHS offices), home visits, telephone
outreach, and mail-outs.
Outreach will include offering client support services which will respond to requests from:
a client for assistance, a Health Care Provider on behalf of a client, and Texas Department
of Human Services (TDHS) or another agency on behalf of a client. Action on all requests
for EPSDT information or services by the client or on behalf of client must be completed
within ten (10) working days from the date of the request. These services would include
the following activities:
a. Assistance with scheduling of appointments for EPSDT medical and/or dental
check-ups in an area that is convenient and acceptable to the client;
b. Assistance with scheduling Medical Transportation when requested by the
EPSDT/Medicaid client;
ATTACHMENT - Page 1
c. Responding to client requests for EPSDT assistance/information;
d. Developing Outreach methods for informing EPSDT/Medicaid eligible clients
regarding the EPSDT Program through personal" contacts, mail-outs, group
meetings and other venues that involve innovative approaches in a variety of
settings;
e. Telephone coverage at a designated number in each sector, answered by an EPSDT
knowledgeable person who will assist clients in utilizing EPSDT services that will
facilitate medical and/or dental check-ups, diagnosis and treaunent;
f. Participation in education/information sessions that will describe and promote the
concept and services of EPSDT;
g. Provision of information to EPSDT/Medicaid clients about where EPSDT services,
support services and medical Transportation Services can be obtained;
h. Conducting intensive outreach with those targeted groups of clients identified by
the RECEIVING AGENCY.
2. PERFORMING AGENCY will operate and manage a centralized telephone answering
system that is toll free and will respond promptly to incoming EPSDT inquiries from the
Medicaid Eligible clients who reside in PERFORMING AGENCY'S service area
described below.
Activities must include the following:
a. Implementation and maintenance of a toll free phone system that is user-friendly,
community-based, accessible, culturally relevant, and provides information,
referral and assistance to EPSDT clients.
b. All calls must be toll free through a dedicated EPSDT 1-800 number or a dedicated
EPSDT local telephone number.
c. The dedicated telephone system must have adequate lines and staff to answer 90%
of all incoming calls promptly (within two [2] minutes), which is the same goal
that has been set for the Medical Transportation Program's toll free system. No
calls will be "answered" exclusively by a tape recorded message during normal
working hours, except in unusual circumstances. The Medical Transportation
ATTACHMENT - Page 2
number may not be given by a recorded message. The EPSDT Telephone
Outreach system must have the capability of directly linking the client requesting
services to the Medical Transportation Service, PERFORMING AGENCY, or
other Outreach Contractors via the call transfer or call forwarding system. This
will eliminate the need for a second client initiated call.
d. Telephone equipment will be adequate so that equipment failure will only be a
direct result of circumstances beyond the control of staff.
e. The regional toll free telephone system must have staff available to answer the
from 8:00 am until 5:00 pm during the regular Monday-Friday work week.
f. There must be an adequate number of bilingual staff as determined by the
population served.
g. The EPSDT centralized telephone system staff must have access to the EPSDT
Automated System. The staff will receive training in this system that will be
conducted by the staff of RECEIVING AGENCY.
h. The telephone staff must ask the calling client if they need assistance with
scheduling medical, dental or transportation appointments. If the answer is in the
affmnative, then the answering operator must be able to provide the client with the
assistance requested.
i. The EPSDT Telephone Outreach operators must forward all provider initiated
complaints to the designated RECENING AGENCY Regional staff. In addition,
a report of provider initiated requests for client assistance must be submitted to
RECEIVING AGENCY'S Provider Relation staff in a format provided by
RECEMNG AGENCY within 24 hours of each call.
3. PERFORMING AGENCY will provide to RECEMNG AGENCY both statistical and
narrative reports delineating the EPSDT telephone outreach activities. These reports will
be submitted no later than the 5th day of each month for the previous month's EPSDT
telephone outreach activities. Once the automated system designed by RECENING
AGENCY is fully functional, PERFORMING AGENCY will not be required to submit
statistical reports. However, specific reports, as designated by RECEMNG AGENCY
will be required.
ATTACHMENT - Page 3
4. RECEIVING AGENCY requires, at minimum, a monthly meeting with the relevant staff
of PERFORMING AGENCY for the purpose of monitoring adherence to this contract.
RECEIVING AGENCY will submit, in writing, a report of findings to the person(s)
identified by PERFORMING AGENCY.
PERFORMING AGENCY must utilize RECEIVING AGENCY'S automated system for tracing
EPSDT activities for eligible customers. PERFORMING AGENCY will also provide to
RECEIVING AGENCY both statistical and narrative reports delineating various EPSDT outreach
activities. PERFORMING AGENCY will provide RECEIVING AGENCY reports by the fifth
working day of each month for the previous month's EPSDT outreach activities in the format
provided by RECEMNG AGENCY.
RECEIVING AGENCY will provide to PERFORMING AGENCY the following:
1. Listing of the EPSDT IMedicaid eligible clients in the service area. This will include
updated lists of those clients Who are new or recertified Medicaid eligibles, those who
are overdue for their EPSDT medical check-ups and those who are due for a medical
check-up (screen).
2. Listing of active EPSDT/Medicaid medical and dental providers in each service area.
Listings of newly enrolled providers will be distributed periodically.
3. TDH/EPSDT program written materials for clients and staff.
4. Training for PERFORMING AGENCY staff involved in the EPSDT program, including
Medicaid information and other information as needed.
PERFORMING AGENCY agrees to comply with Medicaid law, Title XIX of the Social Security
Act, 42 USC 91396, et seq., as amended; 42 CFR 99441.50-441.62; 42 USC 91396. et seq.;
EPSDT program rules, 25 TAC Chapter 33; the Client Services Standards for Public Health and
Community Clinics, revised June 1997; and, the Texas State Plan for Medical Assistance. The
Texas State Plan for Medical Assistance is subject to revision during the Attachment term.
RECEIVING AGENCY will notify PERFORMING AGENCY of the revisions; PERFORMING
AGENCY will have thirty (30) days from receipt of the notice to concur or terminate this
Attachment.
PERFORMING AGENCY agrees that all activities will be performed in accordance with
RECEIVING AGENCY'S Request for Proposal and PERFORMING AGENCY'S application
ATTACHMENT - Page 4
plan, and revisions, if any, as agreed to and approved by RECEIVING AGENCY Program.
These documents are hereby adopted by reference as part of this Attachment.
PERFORMING AGENCY will provide outreach and/or 1-800 telephone services in or benefiting
the count(ies)/area defmed as: Lamar.
PERFORMANCE MEASURES
RECEMNG and PERFORMING AGENCIES agree that the following performance measure(s)
will be used to assess in part PERFORMING AGENCY'S effectiveness in providing the services
set forth in this contract Attachment, without waiving the enforceability of any of the other terms
of the contract.
PERFORMING AGENCY agrees to meet the Minimum Performance Standards, as applicable,
listed in Exhibit A. These are called Minimum Performance Standards because PERFORMING
AGENCY must comply with all applicable contractual standards, provisions, and requirements,
A PERFORMING AGENCY providing client outreach services agrees to comply with Minimum
Performance Standards numbers 1,2,3,5,6,7 and 8 (if entering CARES data on computer), or
9 (if only completing CARES form).
A PERFORMINO AGENCY providing 1-800 telephone service agrees to comply with Minimum
Performance Standards numbers 4, 5, 7, and 8 (if entering CARES data on computer), or 9 (if
only completing CARES form).
SECTION II. SPECIAL PROVISIONS:
PERFORMING AGENCY will maintain a permanent base of operations that will house the
outreach workers.
PERFORMING AGENCY will respect the client's choice of EPSDT service providers.
PERFORMING AGENCY must obtain prior written approval of all client-informing materials
from RECEMNG AGENCY before distributing these materials.
PERFORMING AGENCY will use EPSDT outreach funds included in this contract Attachment
for Outreach only. PERFORMING AGENCY will not use these funds for the provision of other
EPSDT services, nor divert these funds for usc in any other EPSDT Program in which
PERFORMING AGENCY is involved.
ATTACHMENT - Page 5
General Provisions, ASSURANCES Article, paragraph ten, is revised to read as follows:
PERFORMING AGENCY assures it will not transfer or assign its interest in this contract
Attachment.
General Provisions, REPORTS AND INSPECTIONS Article, paragraph three, is revised to read
as follows:
PERFORMING AGENCY agrees that RECEIVING AGENCY and the federal
government, or any of their duly authorized representatives, will have access to any
pertinent books, documents, papers, electronic data, and client or patient records of
PERFORMING AGENCY 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.
General Provisions, REPORTS AND INSPECTIONS Article, paragraph five, is replaced to read
as follows:
Due to pending litigation involving RECEMNG AGENCY'S EPSDT Program (Frew vs
McKinney), PERFORMING AGENCY is required to retain all records related to services
funded by this Attachment until RECEIVING AGENCY notifies PERFORMING
AGENCY that retention of these records is no longer required.
PERFORMING AGENCY will acquire and utilize at least the minimum requirements for the
EPSDT outreach software/hardware. The EPSDT Outreach software was developed by
RECEIVING AGENCY to comply with minimum requirements of the lawsuit referenced in
Section I above, and is an asset of RECEMNG AGENCY. RECEIVING AGENCY will not
provide source code to PERFORMING AGENCY. PERFORMING AGENCY may use the
software for its intended purpose upon the condition that the software may not be modified,
decompiled, transferred, assigned, sold, or distributed in any manner by PERFORMING
AGENCY.
PERFORMING AGENCY agrees to obtain RECEIVING AGENCY Central Office staff approval
prior to developing any software to be used with RECEMNG AGENCY software. The
copyright to any such software will belong to RECEMNG AGENCY.
ATTACHMENT - Page 6
In addition to the General Provisions CONFIDENTIALITY Article, PERFORMING AGENCY
will adhere to RECEIVING AGENCY requirements for confidentiality of EPSDT/Medicaid client
information. PERFORMING AGENCY will ensure compliance with all federal and state laws
and regulations related to access, safeguards, and disclosure of confidential client information
subject to any changes in law that may occur. State and federal law prohibits disclosure of any
information including, but not limited to, names and addresses concerning Medicaid applical1ts
or recipients for purposes not directly connected with administration of the Medicaid program.
PERFORMING AGENCY will adopt security procedures to protect the confidentiality of
information to assure that unauthorized persons cannot retrieve the information by means of
computer, remote terminal, or otherwise.
PERFORMING AGENCY will store any printed reports or other materials containing confidential
information in a physically secure location protected from access by unauthorized persons.
PERFORMING AGENCY will protect EPSDT outreach software against intrusion by
unauthorized users, including providing protective virus screening software.
PERFORMlNG AGENCY will notify RECEIVING AGENCY immediately upon detecting any
security violation of any provisions contained herein.
PERFORMING AGENCY agrees that as Medicaid Managed Care is implemented within its
service area, the Scope of Work described in Section I above is subject to renegotiation.
PERFORMING AGENCY agrees to coordinate outreach activities with Managed Care providers
within PERFORMING AGENCY'S service area described in Section I above.
ATTACHMENT - Page 7
SECTION m. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$7,678.00
1,920.00
720.00
0.00
540.00
0.00
639.00
TOTAL
$11,497.00
Total reimbursements will not exceed $ 11,497.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 15th
of October.
ATTACHMENT - Page 8
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TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560022067 98
CONTRACT CHANGE NOTICE NO. !U.
The Texas Depanment of Health, 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 panies thereto now
desire to amend such contract anachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 04: ORAS/VACCINE
All terms and conditions not hereby amended remain in full force and effect.
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:
(Signature of person authorized to sign contracts)
By:
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
By:
MICHAEL E. MALONE, CITY MANAGER
(Name and Tille)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date:
11-11-97
Date:
/{)-~7'7
RECOMMENDED:
Ii II
APPROVED AS TO FORM:
By:
xI~D~~Q
OCT 1 7 fl97
Office of General Counsel
OM GMD - Rev. 12195
J
.'
.,BIT B
Cover Page 1
DETAILS OF ATTACHMENTS
AttI TDH Term Financial Assistance Direct Total Amount
Amd Program! Begin End Source of Assistance (TDH Share)
No. m Amount
Funds.
01 BCNS/CARDS 10/01/97 09/30/98 10.557 93.268 0.00 0.00 0.00
02 PRIMARY 09/01/97 08/31/98 State 211,415.00 0.00 211,415.00
03 PHR 4/5-EPSD 09/01/97 08/31/98 State 11,497.00 0.00 ' 11,497.00
04 ORASN AC 09/01/97 08/31/98 State 93.991 120,006.00 79,080.00 199,086.00
TDH Document No.7560022067 98 Totals $342,918.00 $79,080.00 $421.998.00
Change No. 03
.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.
Cover Page 2
DOCUMENT NO. 7560022067-98
ATTACHMENT NO. 04
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: OFFICE OF REGIONAL ADMIN. SERVICES
TERM: September 01, 1997
THRU: August 31, 1998
SECTION I. SCOPE OF WORK:
ESSENTIAL PUBLIC HEALTH SERVICES
PERFORMING AGENCY will use direct assistance and/or fmancial assistance, as specified in
SECTION m., BUDGET, from RECEIVING AGENCY to deliver one or more of the following
ten (10) essential public health services as specified in PERFORMING AGENCY'S FY'98
Service Delivery Plan, which is herein adopted by reference:
1. Monitor health status to identify community health problems;
2. Diagnose and investigate health problems and health hazards in the community;
3. Inform, educate, and empower people about health status;
4. Mobilize community partnerships to identify and solve health problems;
5, Develop policies and plans that support individual and community health efforts;
6. Enforce laws and regulations that protect health and ensure safety;
7. Link people to needed personal health services and assure the provision of health
care when otherwise unavailable;
8. Assure a competent public health and personal health care workforce;
9. Evaluate effectiveness, accessibility, and quality of personal and population-based
health services; and
10. 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 vaccines and/or (2) financial assistance from General Revenue funds and the
Preventive Health and Health Services Block Grant.
STATE-PAID POSITIONS
These positions report to and are directly supervised by PERFORMING AGENCY administrative
staff. Supervision authorization includes, but is not limited to, overseeing daily work assignments
ATTACHMENT - Page 1
and duties, staff development, evaluations, daily supervision, leave approval, promotions, and
disciplinary actions including termination of the employee.
FINANCIAL ASSISTANCE
For FY 1998, while 73.5% (the General Revenue funds) will continue to be directed toward the
delivery of a broad range of essential public health services, 26.5 % (the Preventive Health and
Health Services Block Grant funds) will be designated for activities directed solely toward
environmental and/or policy change designed to reduce the incidence of cancer and heart disease.
PERFORMING AGENCY agrees to perform activities as stipulated in PERFORMING
AGENCY'S written plans for service delivery in FY '98. These plans include monitoring,
outcome objectives, and specific activities to be performed throughout the year.
IMMUNIZATION
PERFORMING AGENCY agrees to implement the "Standards for Pediatric Irmnunization
Practices," February 1996 edition, 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 agrees to formulate and implement a comprehensive immunization
policy for all employees according to the most current Advisory Committee on Irmnunization
Practices (ACIP) statement: "Irmnunization of Health-Care Workers."
PERFORMING AGENCY agrees to attend at least one seminar or training session addressing the
immunization requirements for children and students enrolled in Texas' public and private schools
and licensed child-care facilities.
PERFORMING AGENCY will investigate all reported and suspected cases of invasive
Haemophilus influenzae type b infections in children < 5 years of age and all reported cases and
suspected cases of measles, rubella, pertussis, paralytic poliomyelitis, and diphtheria within 24
hours of receipt of the initial case report. PERFORMING AGENCY will investigate all reported
suspected cases of mumps and tetanus within 48 hours of receipt of the initial case report.
PERFORMING AGENCY will complete all case investigation forms and provide complete
epidemiologic data on all reported cases of invasive Haemophilus influenzae type b infections in
children < 5 years of age, and all reported cases of measles, mumps, rubelIa, congenital rubelIa
syndrome, pertussis, diphtheria, and paralytic poliomyelitis to RECEIVING AGENCY within 30
A TT ACHMENT - Page 2
days of the initial case report. PERFORMING AGENCY will provide copies of investigation
forms to the RECEIVING AGENCY.
PERFORMING AGENCY will adhere to the Vaccine-Preventable Disease Surveillance Guidelines
provided by the RECEIVING AGENCY. PERFORMING AGENCY will implement the most
current outbreak control procedures and measures as recommended and provided by RECEIVING
AGENCY.
PERFORMING AGENCY will 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 agrees to provide immunization services outside usual clinic hours
(8:00 a.m. to 5:00 p.m.) 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 Attachment. PERFORMING AGENCY cannot deny vaccinations to recipients because they
do not reside within PERFORMING AGENCY's jurisdiction.
PERFORMING AGENCY agrees to 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 further agrees to update the clinic list monthly
and provide the updates to local area Aid to Families with Dependant Children (AFDC) offices
and to the Immunization Communication and Training Program of RECEIVING AGENCY.
PERFORMING AGENCY will provide immunization services in public clinics regardless of
ability to pay.
No fee may be charged for vaccines provided by RECEIVING AGENCY. All vaccines obtained
under this Attachment must be used solely for purposes of this Attachment and cannot 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 will be kept within guidelines
established by RECEIVING AGENCY and described in "Vaccines for Children", available at
immunization clinics. No one may be denied immunization services because of inability to pay the
administration fee. Fee schedules will not be based on vaccine type, formulation, or dose in
A TT ACHMENT - Page 3
series. A copy of PERFORMING AGENCY's fee schedule must be submitted to RECEIVING
AGENCY, Immunization Division, by January 1st of each year.
All vaccines provided to PERFORMING AGENCY are purchased with public funds and must be
accounted for the same as other public property. RECEIVING AGENCY may investigate vaccine
loss, destruction, spoilage, or other waste and may then require PERFORMING AGENCY to
replace or reimburse RECEIVING AGENCY for them.
PERFORMING AGENCY agrees to record vaccine lot numbers on all vaccine storage records
and in individual clinic immunization records to ensure a vaccine audit trail. PERFORMING
AGENCY agrees to provide RECEIVING AGENCY with a copy of any local agency audit of
immunization program funds and vaccines.
PERFORMING AGENCY agrees to submit a report to RECEIVING AGENCY 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 must be submitted
to RECEMNG AGENCY, Immunization Division, by January 1st of each year in a format
provided by RECEMNG AGENCY.
PERFORMING AGENCY agrees to 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 will provide the parent, managing conservator, or guardian of each
patient with a form, developed by RECEIVING AGENCY in compliance with Health and Safety
Code, g 161.007(a), VTCA. 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, PERFORMING AGENCY will comply with the requirements of gI61.007(d)
and provide an immunization history to RECEIVING AGENCY.
PERFORMING AGENCY agrees to provide RECEMNG AGENCY weekly data transfers of
all vaccines administered, detailed by client name, demographics, and dose information. The data
will be submitted in a format provided by RECEIVING AGENCY, Immunization Division, for
inclusion in the state's immunization registry (ImmTrac).
PERFORMING AGENCY agrees to comply with all applicable laws, regulations, standards, and
guidelines established at Federal, State and Local levels as these rules now appear or may be
amended during the period of this Attachment. These include, but are not limited, to the following
Texas Immunization laws, rules, and regulations: Texas Human Resources Code, ~ 42.043,
ATTACHMENT - Page 4
VTCA; Texas Education Code, ~~ 38.001-38.002, VTCA; Texas Health and Safety Code, ~~
81.023 and 161.001-161.008, VTCA ; 25 TAC ~~ 97.61-97.77 and 97.101-97.102; 42 USC ~
247b as amended, and the Omnibus Budget Reconciliation Act of 1993,26 USC ~ 4980 B.
PERFORMANCE MEASURES
RECEIVING and PERFORMING AGENCIES agree that the following performance measures
will be used to assess in part the PERFORMING AGENCY'S effectiveness in providing th~
services set forth in this contract Attachment, without waiving the enforceability of any of the
other terms of the contract.
PERFORMING AGENCY will provide an estimated 2..2.ll doses of vaccine to clients in or
benefiting the area dermed as: Lamar.
PERFORMING AGENCY agrees to provide RECEIVING AGENCY monthly reports of doses
administered by vaccines and age group and vaccine utilization/loss. Reports will be submitted
by the fifteenth of each month for the previous calendar month, on forms provided by
RECEIVING AGENCY (forms C5, C33, C33A). If automated reports are used by the
PERFORMING AGENCY, the report must be similar to and include the same information as the
C5, C33, C33A forms. PERFORMING AGENCY further agrees to provide copies of each
Biological Transfer Form (C-68) used to transfer vaccines to another agency or private provider.
Vaccine lot numbers must be included on all Biological Transfer Forms used to transfer vaccines.
The goal of PERFORMING AGENCY will be to endeavor to achieve and maintain 90% vaccine
coverage levels for diphtheria and tetanus toxoids and pertussis vaccine [DTP], diphtheria and
tetanus toxoids and acellular pertussis vaccine [DTaPJ, diphtheria and tetanus toxoids [DT], and
polio, measles/mumps/rubella [MMR], and Haemophilus influenzae type b conjugate [HibCV]
vaccines in preschool age children. During the term of this Attachment, the coverage level for
hepatitis B will be 80%.
PERFORMING AGENCY agrees to implement and participate in the TDH 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 agrees to assist licensed child care facilities and registered family
homes in achieving and maintaining 90% immunization levels.
PERFORMING AGENCY agrees to assist accredited public and private schools in achieving and
maintaining 95 % immunization levels.
ATTACHMENT - Page 5
PERFORMING AGENCY will assess the clinical records of preschool-age children to determine
immunization levels. PERFORMING AGENCY will randomly select and assess immunization
records using the Centers for Disease Control and Prevention (CDC) Clinic Assessment Software
Application (CASA) available from RECEMNG AGENCY. PERFORMING AGENCY shall
complete two assessments, using the criteria specified in attached Exhibit A, during the term of
this Attachment. One of these assessments may be conducted in cooperation with RECEMNG
AGENCY. Assessment results shall be reported to RECEIVING AGENCY, Immunizatio~
Division Director not more than two weeks after the assessments are completed. An electronic fIle
(either a backup or transfer file) for each clinic assessment should contain the following
information:
*
Date of assessment;
Name and address of assessment site (including county and TDH public health
region);
Contact name (preferably the name of individual that performed assessment);
Name of organization;
Site(s) covered by filing system;
Description of files that were used for the assessment (e.g., card files, medical
records);
Criteria for excluding records (if any); and
Estimated "active" client population, sampling interval, and sample size.
*
*
*
*
*
*
*
SECTION II. SPECIAL PROVISIONS
General Provisions, REPORTS AND INSPECTIONS Article, is amended to include the following
paragraph:
PERFORMING AGENCY will submit quarterly reports and an Annual Expenditures Report to
the appropriate Public Health Regional Director in the format specified by RECEIVING
AGENCY 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 Attachment, General Provisions, OVERTIME
COMPENSATION Article, is not applicable, and PERFORMING AGENCY agrees to comply
with the following paragraphs:
A TT ACHMENT - Page 6
PERFORMING AGENCY is authorized to pay employees who are not exempt under the
Fair Labor Standards Act (FLSA), 29 USC, Chapter 8, !l 201 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 work 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 is responsible for documenting proper authorization or
approval for any work performed by exempt or non-exempt employees in excess of 40
hours in a workweek.
ATTACHMENT - Page 7
SECTION m. BUDGET:
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the provision of supplies
such as vaccines in lieu of cash.
PERSONNEL
TRAVEL
LABORATORY SUPPORT
VACCINE
OTHER
$1,398.00
0.00
0.00
77,682.00
0.00
TOTAL
$79,080.00
If applicable, direct assistance for personnel is shown on the attached list of positions and
budgetary amounts which is an integral part of this Attaclunent. State salary warrants for net
earnings will be issued in accordance with state regulations.
Financial status reports (FSRs) are not required on direct assistance. Program income generated
from activities supported with direct assistance will be reported on FSRs required for ftnancial
assistance provided through this Attaclunent, if applicable, or through other program
Attaclunents(s) benefttting from this assistance.
RECEMNG AGENCY direct assistance will not exceed $ 79,080.00.
ATTACHMENT - Page 8
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to Performing Agency for costs incurred in
carrying out approved activities.
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$99,078.00
20,928.00
0.00
0.00
0.00
0.00
0.00
TOTAL
$120,006.00
RECEMNG AGENCY fInancial assistance will not exceed $120,006.00.
TOTAL RECEIVING AGENCY assistance will not exceed $199,086.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 15th
of October.
A TT ACHMENT - Page 9
EXHIBIT A
Assessments for these facilities can be automated using the (CAS A) import feature. The
following issues must be considered prior to an automated assessment:
*
Shall be validated with at least one manual assessment.
Can only be used if C'nmpl..t.. immunization histories are entered into computer
tI"r-.h3Y'.
Methodology used for an automated assessment must be approved by RECEIVING
AGENCY as meeting contract requirements.
Complete enumeration should be perfonned (i.e., CASA sampling feature is not used)
,
*
*
*
Assessment Criteria #1
CASA CliniclProvider Site Requirements
CASA Client Information
Dale of ~usmelll
Common R..i.... Dale of 01102196 for Children 24 to JS MonJlu of Age
Provider Type
Nome oC ClinicIProvider Site
Reviewer IniliW
City
Estimeled 'A<:ric" CIicnt PopuIetion and Semple Size for Children Born in 1993
FULL Last and Fu>t Name
Date oCBixtb (Between 01/01/93 and 12/31/93)
Cllcnt Zipcode
Moved or Gone Elsewhere
Number OCVlSits (Medical Charts Only)
Shot Type
Shot Detc
Assessment Criteria #2
CASA CliniclProvider Site Requirements
CASA Client Information
Dale of ~es.mu1ll
Common R.vi.... Dale of01/02I96for Children 12 to 24 MonJlu of Age
ProviderType
Nome oC CliniclProvider Site
Reviewer Initials
City
Estimated' Active' Client Population and Somple Size for Childn:n 12 to 15
Months oC Age as oC01/02196
FULL Last and FIrSt Name
Date oCBixtb (Between 01/01/93 and 12/31/93)
Client Zipcode
Moved or Gone Elsewhere
Number DC Visits (Medical Charts Only)
Shot Type
Shot Detc
TEXAS DEPARTMENT OF HEALTlf
OPERATING BUOGET FOR YEAR ENDING
AS OF JUNE 30, 1997
HZ131l/K130Za
PARIS-LA"AR COUNTY HEALTH DEPT
PHR 04
AUGUST 31, 199a
PAGE 924
CATE- DESCRIPTION OR TITLE
GORY ,
1 COMMUNITY SERV AIDE II
FUND END ITEM JOa
DESC. MONTH NO. CLASS
STATE AUG 010 5502
BUDGET NO. PAOOO
PAY PAY EFFECTIVE ~HTHLY
GP STP DATE RATE
04 08 SEP 97 1.398.00
BUDGETED AKT
1,398.00
i,398.00 *
CERTIFICATION REGARDING LOBBYING
CERllFICA nON 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-Ill, "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
docwnents 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
11-11-97
Date
ANTHONY THEL, ADMINISTRATOR
Print Name of Authorized Individual
7560022067 98-04
Application or Contract Nwnber
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name
P. O. BOX 938
PARIS, TX 75460-0938
~
"
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560022067 98
CONTRACT CHANGE NOTICE NO. ~
The Texas Department of Health, 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 parties thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO.05: BCH - CASE MANAGEMENT
All terms and conditions not hereby amended remain in full force and effect.
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
(Signature of person authorized to sign contracts)
By:
By:
........
Date:
12-01-97
Linda Farrow, Chief
Bureau of Financial Service~
~ame ~,Ie
Date: !;h
MICHAEL E. MALONE, CITY MANAGER
~ame and Title)
By:
(PE
CONTRACT APPROVED AS TO FORM BY OFFICE OF
GENERAL COUNSEL
RECOMMENDED:
DM GMD - Rev. 12/95
.
..
.HIBtT C
Cover Page 1
DETAILS OF ATTACHMENTS
AttI TDH Term Financial Assistance Direct Total Amount
Amd Program! Assistance (TDH Share)
No. 10 Begin End Source of Amount
Funds*
01 BCNS/CARDS 10/01/97 09/30/98 10.557 93.268 0.00 0.00 0.00
02 PRIMARY 09/01/97 08/31/98 State 211,415.00 0.00 211,415.00
03 PHR 4/5-EPSD 09/01/97 08/31/98 State 11,497.00 0.00 11 ,497.00
04 ORASN AC 09/01/97 08/31/98 State 93.991 120,006.00 79,080.00 199,086.00
05 BCH/CASE 09/01/97 08/31/98 State 52,373.00 0.00 52,373.00
TDH Document No.7560022067 98 Totals $395,291.00 $79,080.00 $474,371.00
Change No. 04
*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.
......-.
Cover Page 2
DOCUMENT NO. 7560022067 -98
ATTACHMENT NO. 05
~c
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF CHILDREN'S HEALTH
TERM: September 01, 1997
SECTION 1. SCOPE OF WORK:
THRU: August 31, 1998
PERFORMING AGENCY will provide comprehensive case management services to individuals
who are under the age of twenty-one (21) and meet the RECEIVING AGENCY'S eligibility
requirements as defmed in the 1998 Bureau of Children's Health Request for Proposal (RFP).
Services will be based on the FY98 RFP and PERFORMING AGENCY'S response to it,
including any revisions as agreed to and approved by RECEIVING AGENCY Program. These
documents are incorporated by reference.
PERFORMANCE MEASURES:
RECEIVING AND PERFORMING AGENCIES agree that the following performance measures
will be used to assess, in part, PERFORMING AGENCY'S effectiveness in providing the services
set forth in this contract Attachment without waiving the enforceability of any of the other terms
of the contract:
100% of eligible children will be current with scheduled Texas Health Steps services or informed
of and referred to Texas Health Steps services.
50 % of children enrolled in case management services will have a medical provider for preventive
and primary care.
PERFORMING AGENCY will provide a list of active clients to RECEIVING AGENCY,
Regional Director of Social Work Services, within 30 days of the end of each quarter. '......
PERFORMING AGENCY agrees to submit quarterly progress reports to RECEIVING AGENCY
Program within 30 days of the end of each quarter which document the accomplishments, impact,
and progress in achieving the work plan goals and objectives contained in PERFORMING
AGENCY'S response to the BUREAU OF CHILDREN'S HEALTH FY98 RFP. The quarterly
progress report will be in the format specified by RECEIVING AGENCY. Reports will also
document PERFORMING AGENCY'S progress in meeting the above performance measures.
PERFORMING AGENCY will provide services in or benefiting the county/(ies)/area defined as:
Lamar .
SECTION II. SPECIAL PROVISIONS:
ATTACHMENT - Page 1
PERFORMING AGENCY will allow RECEIVING AGENCY to conduct on-site quality assurance ):_
reviews as deemed necessary by RECEIVING AGENCY. Unsatisfactory review fmdings may
result in implementation of General Provisions, SANCTIONS Article.
PERFORMING AGENCY will notify RECEIVING AGENCY immediately in the event of any
significant change affecting PERFORMING AGENCY'S identity, ownership or control, name,
governing board membership, vendor identification, medical or program director, or address.
Failure to disclose the required information or inaccurate disclosure by PERFORMING AGENCY
may be treated as a material breach of this contract and may be grounds for termination.
.......
ATTACHMENT - Page 2
SECTION ill. BUDGET:
,~
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$37,134.00
10,762.00
2,639.00
0,00
615.00
0.00
1,223.00
TOTAL
$52,373.00
Total reimbursements will not exceed $ 52,373.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 15th
of October.
. __ .. .__ .u__,__,.
........ ..
ATTACHMENT - Page 3