1997-125-RES WHEREAS, STATE OF TEXAS IS A FUNDING PARTNER WITH THE COUNTY OF LAMAR AND COP
.
.
RESOLUTION NO. 97- 125
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, said contract has been amended, and it is deemed appropriate that the form
of the Contract Change Notice 01, 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 Change Notice No. 01 to the Contract for Public Health Services, TDH
Document No. 75600022067 98, attached hereto as Exhibit A, 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 Notice No. 01 under the terms and conditions and in the forms
shown in Exhibit A, attached hereto.
PASSED AND ADOPTED this 13th day of October, 1997.
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-
Eric S. Clifford, Mayor
ATTEST:
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Mattie Cunningham, City Clerk
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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. Ql
The Texas Deparunent 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:
ATI. NO. 02: PRIMARY HEALTH CARE PROGRAM/COPC
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 HEALm DEPARTMENT
TEXAS DEPARTMENT OF HEALm
~~
ture of person authorized to sign contracts)
By:
(Signature of person authorized to sign contracts)
MICHAEL E. MALONE, CITY MANAGER
(Name and Tille)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Tille)
Dale:
09-22-97
Date:
q -IS-9'1
APPROVED AS TO FORM:
By:
(pERFO
By:
xl4btU?fj,~Q;
SEP 1 ! AI7
Office of General Counsel
DM GMD - Rev. 12/95
EXHIBIT A
Cover Page 1
Db. A I L S 0 FAT T A C H M E l'l T S
AttI TDH Term Financial Assistance Direct Total Amount
Amd Program! Begin End Source of Assistance (TDH Share)
No. 10 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 Stale 211,415.00 0.00 211.415.00
TDH Document No.7560022067 98 Totals $211.415.00 $0.00 $211,415.00
Change No. 01
.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 ATIACHMENT FOR DETAILS.
Cover Page 2
DOCUMENT NO. 7560022067-98
ATTACHMENT NO. 02
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: PRIMARY HEALTH CARE PROGRAM/COPC
TERM: September 01, 1997
THRU: August 31, 1998
SECTION 1. SCOPE OF WORK
PERFORMING AGENCY will 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". Services delivered under this Attachment will be in compliance with
PERFORMING AGENCY'S application as approved by RECEIVING AGENCY Program, the
Request for Proposal (RFP), the Primary Health Care Program Rules, 25 TAC, Chapter 39, the
RECEIVING AGENCY'S Primary Health Care (PHC) Handbook, with amendments current as
of the effective date of the contract. PERFORMING AGENCY will comply with changes in
income guidelines as determined by RECEIVING AGENCY. The above referenced documents
are adopted by reference as part of this Attachment.
PERFORMING AGENCY agrees to comply with the Health and Safety Code, Chapter 31,
"Texas Primary Health Care Services Act".
PERFORMING AGENCY will provide services in accordance with the Client Services Standards
for Public Health and Community Clinics. PERFORMING AGENCY is also responsible for
requesting and complying with the service-specific standards/guidelines set by RECEIVING
AGENCY'S programs for the particular client services provided.
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 the
services set forth in this Attachment, without waiving the enforceability of any of the other terms
of the contract.
PERFORMING AGENCY must report on:
. screening, referral and PHC eligibility services (PHC-2oo)
ATTACHMENT - Page 1
. client intake - new and recertified clients (PHC-200)
. number of PHC eligible clients receiving medical services (PHC-200)
. clients served by quarter (PHC-200)
. cost and type of services provided (PHC-200)
. client demographic data (PHC-300) (annual)
PERFORMING AGENCY must report quality measures on the:
. Clinical Process = Outcome Measures report (pHC-301)
. Client Satisfaction Survey (pHC-302)
PERFORMING AGENCY will use the required eligibility system as described in the PHC
Handbook and use TESS (Texas Eligibility Screening System) as the initial step,
PERFORMING AGENCY will 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.
PERFORMING AGENCY agrees that, when each client is enrolled, the client will be assigned
to a specific primary care provider for preventive, episodic and chronic care to foster continuity
and efficiency of care.
PERFORMING AGENCY will provide an estimated .l.2QQ clients with services/units of service
in or benefiting the county(ies)/area defmed as: Lamar.
SECTION II. SPECIAL PROVISIONS
General Provisions, REPORTS AND INSPECTIONS Article, is revised to include the following:
PERFORMING AGENCY will submit a Program Services Report quarterly on a form that
has been furnished by RECEIVING AGENCY Program by the thirtieth (30th) of the
month following a quarter. A final Program Services Report will be submitted no later
than sixty (60) days after the end of the Attachment term. The RECEIVING AGENCY'S
Program requires comprehensive reports which allow the Program to assess the volume
and quality of services being provided.
ATTACHMENT - Page 2
SECTION ill. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
$125,641.00
27,641.00
1,500.00
0.00
14,633.00
32,000.00
10,000.00
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 15th
of October.
A TT ACHMENT - Page 3
C .aIFICA TION REGARDING LOBB\ .. ~G
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 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 wiIl 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
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.
Si,,;;.,re ,4, /~/~
ANTHONY BETHEL, ADMINISTRATOR
Print Name of Authorized Individual
09-22-97
Date
7560022067 98-02
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name
P. O. BOX 938
PARIS, TX 75460-0938