1996-135-RES WHEREAS, STATE OF TEXAS IS A FUNDING PARTNER WITH THE COUNTY OF LAMAR AND COP
RESOLUTION NO. 96-135
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 14th day of
October, 1996, in Resolution No. 96-112, authorize the execution of a Contract for Public Health
Services, TDH Document No. 7560022706797, and the Contract Change Notices Nos. 01 and
02 thereto, which are the conduits 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 Nos. 03, 04 and 05, attached hereto as Exhibits A, Band C, 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 Nos. 03. 04 and 05 to the Contract for Public Health
Services, TDH Document No. 7560002206797. attached hereto as Exhibits A, Band C, 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 Change Notice Nos. 03. 04 and 05 under the terms and conditions and
in the form shown in Exhibits A, Band C, attached hereto.
PASSED AND AIlOPlED ilii. 9. d,y Of""~~
Eric S. Clifford, Mayor
ATTEST:
'----0r\ ~...,: ,
Mattie Cunningham, City Clerk
~
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
TDH Document No.7560022067 97
CONTRACT CHANGE NOTICE NO. QJ.
COUNTY OF TRAVIS
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 panies thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 04: PHR 4&5 - EPSDT
All terms and conditions not hereby amended remain in full force 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:
RECEIVlNG AGENCY:
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
(Signature of person authorized to sign contracts)
N
By:
MIKE MALONE, CITY MANAGER
(Name and Title)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date:
Date:
11- 15"-9(:,
RECOMMENDED:
APPROVED AS TO FORM:
By:
By~iJ~iiP IIrt a 1m
DM GMD - Rev. 12/95
"
EXHIBIT A
Cover Page 1
DETAILS OF ATTACHMENTS
AttI TDR Tenn Financial Assistance Direct Total Amount
Amd Program! .' Assistance (TDR Share)
No. m Begin End Source of Amount
Funds"
01 BNS/CARDS 10/01/96 09/30/97 10.55793.268 0.00 0.00 0.00
02 PRIMARY 09/01/96 08/31/97 State 211,415.00 0.00 211,415.00
03 ORAS/V AC 09/01/96 08/31/97 Slate 93.991 104.628.00 94,014.00 198,642.00
04 PHR4&5/EPSDT 09/01/96 08/31/97 Slate 11,497.00 0.00 11,497.00
TDR Document No.7560022067 97 Totals $327,540.00 $94,014.00 $421,554.00
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. 7560022067-97
ATTACHMENT NO. 04
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: PUBLIC HEALTH REGION 4&5
TERM: September 01, 1996
THRU: August 31, 1997
SECTION I. 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 eligibles by conducting the following activities:
A. Conduct EPSDT Outreach Activities in order to increase the awareness of the EPSDT
Program and provision of EPSDT medical screenings.
For purposes of this Attachment, EPSDT Client Outreach is defmed as any efforts,
strategies, plans, events, organized activities, and course of action taken to advertise,
educate, or in some way increase EPSDT medical screenings. Activities may include (but
are not limited to):
1. The development of innovative methods for informing EPSDT/Medicaid eligible
clients about the EPSDT Program using personal contacts in a variety of settings;
2. Conducting educational and informational sessions in targeted areas of the service
area regarding the EPSDT Program; and/or
3. The provision of information to EPSDT/Medicaid clients regarding the location of
EPSDT services, support services, and transportation assistance.
B. PERFORMING AGENCY will provide to RECEIVING AGENCY both statistical and
narrative reports delineating various EPSDT outreach activities. PERFORMING
AGENCY will provide to RECEIVING AGENCY reports by the 30th day of each month
for the previous months's EPSDT outreach activities. Reports will be submitted in
accordance with EPSDT and Public Health Region 4/5 requirements (Exhibit A).
ATTACHMENT - Page 1
"
....,.-
C. RECEIVING AGENCY will provide to the PERFORMING AGENCY the following:
1. Listing (EPSDT Workload Planning Report) of EPSDT !Medicaid eligible clients
in the service area;
2. Listing of active EPSDT/Medicaid medical and dental providers in the service
area;
3. RECEMNG AGENCY-EPSDT Program written materials for clients and staff;
and,
4. Training for PERFORMING AGENCY staff involved in EPSDT outreach
activities (regarding the EPSDT Program, Medicaid information, and other
information as needed).
D. PERFORMING AGENCY agrees to comply with Medicaid Federal law (Title XIX of the
Social Security Act, as amended), Federal Regulations (42 CFR 441.50 through 42 CFR
441.62), the Texas State Plan for Medical Assistance, and EPSDT Program rules (25
Texas Annotated Code, Chapter 33).
PERFORMING AGENCY will provide services in accordance with Exhibit A, Work Plan, as
attached and made part of this Attachment.
PERFORMING AGENCY will provide an estimated ~ clients with services/units of service
in or benefiting the county(ies)/area dermed as: Lamar.
SECTION II. SPECIAL PROVISIONS:
PERFORMING AGENCY agrees to:
1. Adhere to RECEMNG AGENCY requirements for confidentiality of
EPSDT/Medicaid client information;
2. Observe client choice of EPSDT service providers;
3. Obtain RECEMNG AGENCY approval of all client informing materials,
developed by the PERFORMING AGENCY, prior to the distribution of such
materials; and,
ATTACHMENT - Page 2
"
..,..,-
4. Use EPSDT Outreach funds included in this contract Attachment for outreach only.
PERFORMING AGENCY will not use these funds for the provision of EPSDT
services, including EPSDT medical screenings, and will keep these funds separate
from payments received for the performance of EPSDT services.
ATTACHMENT - Page 3
"
....;<
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 4
"
.".~.
EXHIBIT A
WORK PLAN
1. OUTREACH .,;,.'1D 11'lFOR.\-1L.'1G ACTMTIES
Outre:lch is a term given to the effortS. strategies. plans, events. organized activities. and
courses of action taken to advertise, educate about. or in some way incre:J.Se EPSDT
screens.
Informing me:J.IlS telling Medicaid eligibles under 21 ye:J.rS of age and MediC:J.id eligible
pregnant women of the availability and importance of using EPSDT preventive health
services (medical screening and dental services). other medically necessary diagnosis and
treaanent services and encouraging them to access services to which they are entitled.
This includes specific informing activities targeted to "at risk" groups. i.e., ftrst time
eligible, those not using the program, infants, adolescents, and mothers with babies.
Informing techniques/methods must be low literacy, bilingual and culturally relevant.
Outre:J.ch methods must be adapted to meet the oeeds of targeted at-risk populations.
Outreach activities must be coordinated with other agencies and groups which provide
ou=ch within a co=unity or geographic are:J.. This may include: churches, public
health providers. family planning providers, managed care providers. VISTA. targeted
case management providers. etc.
Client information must cover:
. Benefits of preventive health services
. Wha[ services are available
. Where services are available
. How services can be obtained
. Transportation and scheduling assistance for EPSDTlMedica.id services
. Services are provided at no financial cost to the client
. Freedom [0 choose provider
. Client responsibilities. Le.. keeping appoinanents. rescheduling appoinanents.
taking MediC:J.id card and immunization records to appoinaneDIS. etc.
Record Keevina and Documentation ReQuirements
A report is to be'submiaed to the Public Health Region 4/5 contract staff on or before the lOth
day of each month and will include at a minimwn the activities performed in the previous month.
These activities will include:
. Number of clients outreached by county
. Methods of client outre:J.ch used
"
".."
. Targeted population defined
. Samples of outreach materials used
. Number of clients who called. the type of assisLlIlce requested by mutually defined
categories and geographic location
. Number of murually defmed cype of written materials mailed to providers and
clients (e.g.. Provider lists, THSteps fact shee:s, etc.)
. Provider access problems referred to RECENING AGENCY contract staff and
corrective action initiated
. Number of clients with abnormalities
. Number of clients contacted for follow-up
. Number of clients scheduled for follow-up appointment
. Number of clients w.ho kept appointments
. Number and type of provider contacts
. Plans for outreach evaluation
. Plans for corrective action
The report format will be provided to PERFORMING AGENCY by RECENING AGENCY.
Automated Record Keepincr and Documentation
RECEIVING AGENCY has developed an automated reporting system that has the capacity to
capture and disseminate data elements required for reporting on activities related to Client Support
Services and Targeted Outreach. It will include the ability to determine the following:
. number of written offers of outreach mailed to recipients
. number of requests for outreach by health care providers
. number of recipients who did not respond to the initial written offer of outreach
within 45 days
. number of recipients who did noc receive oral outreach within 45 days of receipt
of outreach lists
. number of recipients who responded to the initial written offer of outreach and the
number who requested each method of outreach
. number of recipients who received each method of outreach
. number and status of recipients identified on earlier outreach lists who did not
receive oral outreach in prior months who requested services
RECEIVING AGEJ.'fCY Client Activity Reporting of EPSDT Services (CARES) data entry
forms. provided to PERFORMING AGENCY by RECEIVING AGENCY, will be submitted to
Public Health Region 4/5 contract staff weekly. CARES data entry forms will be completed by
outre:lCh staff tq document each client contact as follows:
. Outreach and informing activities
. Client support services
. Client follow-up
,.
2. CLIENT FOLLOW-UP
A systematic approach for ensuring the timely d~!ivery of diagnosis/treannent services for
clients with abnormalities identified during an EPSDT medical screen. "Timely" means
as soon as possible, not to exceed 120 days from the date of the medical screen. Follow-
up activities include:
. A system developed in coordination with TDH to identify clients with
screening abnormalities requiring follow-up diagnosis and/or treaonem.
. Contacting clients with identified screening abnormalities to encourage
them to follow through with the recommended plan of care and to offer
assistance with scheduling and transportation to complete referrals.
See "Support Services";
. Providing needed assistance with scheduling and transportation when clients
request help;
. Devising and implementing in coordination with TDH, a tracking system
to determine the number of clients who received diagnosis and treaonent
for screening abnormalities with and without the provision of support
services:
. Ensuring client freedom of choice of provider; and
. Responding to providers' request for assistance with needed client follow-
up.
. Plan for follow-up activities evaluation; and
. Plan for corrective action.
Documentation for follow-up activities must include the following information on each
client:
.
Name
Date of birth
Medicaid client number
Address, city, state, ZIP code, and telephone number
Date of screening
Documentation of problem(s) identified
Date(s) and method(s) of client contact(s) concerning follow-up
diagnosis and treatment services.
Notation of assistance with transportation and/or scheduling
Appointment date for the needed service
"
.
.
!
.
.
.
.
.
....,.
. Date appointment kept
Monthly activity reports, submitted to the TDH cO!l~act staff, must include the following
elements:
. Number of clients with abnormalities
. Number of clients contracted for follow-up
. Number of clients scheduled for follow-up appointments
. Number of clients with kept appointments
These reports are to be submitted by the 30th day of each month for activities performed during
the previous month.
"
.,._,..
3. SUPPORT SERVICES
Services performed in cooperation with EPSDT /Medicaid clients to assist them in
obtaining, on a timely basis, needed health care services, and to help clients effectively use
resources to which they are entitled. "Timely" means as soon as possible, not to exceed
30 days for the receipt of the requested service.
Examples of support services include, but are not limited to:
. Regional/community-based, accessible, bilingual, and culturally-relevant 1-800
client information/referral/ assistance telephone number to respond to at least the
following:
. Requests for EPSDT/Medicaid services;
. Requests/cancellations for assistance with scheduling and transportation for
EPSDT services;
. Problems and complaints;
. EPSDT/Medicaid program benefits;
. Information and referral;
. EPSDT/Medicaid client eligibility information; and
. Provider notification of client "no show", rescheduling, and assistance with
client follow-up;
. Mailing written materials to providers and clients (i.e., EPSDT provider lists), and
. Identification of provider access problems and report of same to TDH contract staff
within 48 hours.
. These same services can be provided/supplemented by community-based workers.
. Plan for support services evaluation; and
. Plan for corrective action
Monthly activity reports, submitted to the TDH contract staff, must include the following
elements:
On or before the 10th of the month, a report is to be submitted to regional staff detailing
the previous month's activities. Elements of the report must include at least the following:
. Monthly reports on number of clients who called, date of request; the type of
assistance requested by mutually defined categories and geographic location;
. Monthly telephone company reports identifying the completion rate for the number
of time the 1-800 number was dialed; "
....,'
. Monthly reports of number and mutually defined type of written materials mailed
to providers and clients (e.g., providerJists, EPSDT fact sheets, etc.);
. Monthly reports of provider access problems referred to TDH contract staff and
corrective action initiated.
"
.,.c,-
4. PROVIDER RELATIONS
. Specific action taken with EPSDT/M,edicaid providers to maintain active
participation in the EPSDT program. These activities include, but are not limited
to:
. Initiation and promotion of successful/continuing relationships between
EPSDT program staff, EPSDT/Medicaid providers and EPSDT clients;
. Assisting in removing barriers to participation for EPSDT clients and
providers; '_
. Communicating with providers clearly, accurately, and promptly regarding
programs and procedures.
. Responding promptly and effectively to providers' questions and problems;
. Discussing with current providers to identify ways they can increase the
number of screens performed;
. New provider training and technical assistance subsequent to EPSDT
program enrollment to include:
. Acquisition of medical and dental billing supplies;
. Program policies and procedures training to provider staff upon
request;
. Obtaining program policy interpretation from the department's contract
staff;
. Facilitation request for professional health training;
. Responding to questions/problems form providers, including areas related
to the following:
. Policy research utilizing
NHIC's Medicaid Provider Procedures Manual, NHIC's lists of commonly asked questions,
Medicaid bulletins, and correspondence from NHIC (e.g., lead, immunizations);
. Provider assistance in identifying resources to resolve payment
related problems with the department's health insuring agent; and
. Provider assistance in resolving client related issues (e.g., client's,.
".,-~ '
failure to keep appointments, clients who fail to follow
recommended treatment, or clients who require follow-up and are
mentally limited and need.help);
. Contractors will cooperate with Regional EPSDT staff to insure that their
contract activities are compatible with the contract responsibilities of the
department's health insuring agent;
. Plan for provider recruitment and provider relations evaluation; and
. Plan for corrective action
Provider Record keeping/documentation.
A report is to be submitted to the Regional contract staff on or before the 10th day of each
month to include activities perfonned during the previous month. These activities include:
. Number of provider contacts;
. Type of provider contacts;
. Location of provider;
. Type of activity perfonned (by mutually agreed upon categories);
. Number of new/re-enrolled providers;
. Outreach evaluation plan for provider recruitment/relations activities; and
. Corrective action plan.
,.
....r.
,".,'
~
.'
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No.7560022067 97
CONTRACT CHANGE NOTICE NO. (M
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: LABORATORIES
Alllerms 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)
Linda Farrow. Chief
Bureau of Financial Services
(Name and Tille)
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
By:
MIKE MALONE, CITY MANAGER
(Name and Title)
Date:
Date:
f(-/9-9l::.
RECOMMENDED:
APPROVED AS TO FORM:
By:
BxL~0~~~
W)V 1 8 19$
Office of General Counsel
OM GMO - Rev 12/95
.,.,'
Cover Page 1
EXHIBIT 8
"~.:."
.ETAILS OF ATTACHkENTS
Alii TDH Term Financial Assistance Direct Total Amount
Amd' Program! Begin Assistance (TDH Share)
No. 10 End Source of Amount
Funds'
01 BNSICARDS 10/01/96 09130/97 10.557 93.268 0.00 0.00 0.00
02 PRIMARY 09/01/96 08/31/97 State 211.415.00 0.00 211,415.00
03 ORAS/V AC 09/0 1/96 08/31/97 State 93.991 104,628.00 94,014.00 198,642.00
04 PHR4&5/EPSDT 09/01/96 08/31/97 Slate 11,497.00 0.00 11,497.00
05 LAB 09/01/96 08/31/97 State 300.00 500.00 800.00
TDH Document No.7560022067 97 Totals $327,840.00 $94,514.00 $422,354.00
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. 7560022067-97
ATTACHMENT NO. 05
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF LABORATORIES
TERM: September 0 I, 1996 IHRU: August 31, 1997
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY laboratory agrees to provide testing services on specimens received in
support of the following statewide programs:
Milk and Dairy Products Division (Milk Bacteriology and Chemistry)
Bureau ofHIV/SID Prevention (Syphilis, Gonorrhea, and/or Chlamydia)
TB Elimination Division (Tuberculosis Testing)
Infectious Disease, Epidemiology & Surveillance Division (Outbreak Investigations)
Women's Health Division (Health Screening)
Seafood Safety Division (Shellfish Testing)
PERFORMING AGENCY will provide a monthly activity report according to the attached format
within ten days of the end of the reporting month.
PERFORMING AGENCY agrees to meet standards for such analyses as set forth by RECEIVING
AGENCY, Bureau of Laboratories, the Clinical Laboratory Improvement Act, the Safe Drinking
Water Act, the National Conference ofInterstate Milk Shippers, and/or the 1993 U. S. Public Health
Service Grade "A" Pasteurized Milk Ordinance, 25 T AC, Chapter 217.
PERFORMING AGENCY will provide specimens/samples in or benefiting the geographic area
defined as
SECTION II. SPECIAL PROVISIONS:
General Provisions, PROGRAM INCOME Article, paragraph two, is not applicable to this
Attachment. However, additional instructions regarding program income follow in the next three
paragraphs.
PERFORMING AGENCY is required to bill Medicaid for the following laboratory tests performed
for Medicaid eligible patients: syphilis serology screening, syphilis serology confirmation, and
gonorrhea and chlamydia diagnosis. PERFORMING AGENCY will use their own billing system
or may use the automated system provided by NHIC, the Medicaid fiscal intermediary.
..~.
ATTACHMENT - Page I
.' In keeping with RECEIVING AGENCY'S entrepreneurial efforts, it is RECEIVING AGENCY
program's intent to encourage the use of locally eamed Medicaid funds to pay for or offset
significantly the cost of the statewide syphilis, gonorrhea, and chlamydia testing programs. To
accomplish this, PERFORMING AGENCY laboratories should bill Medicaid for eligible patients,
and purchase testing reagents for syphilis, gonorrhea, and cWamydia, in part or whole, at a state
negotiated price, to cover the current and expanding workload.
Program income in excess of the reagent costs should be utilized by PERFORMING AGENCY to
further the program objectives of the state statute under which the Scope ofW ork for the Attachment
was made.
General Provisions, FINANCIAL REPORTS Article is not applicable to this Attachment.
REIMBURSEMENT:
Support for this Scope of Work is provided by RECEIVING AGENCY under fmancial assistance
Supplies category and under direct assistance laboratory Support category for supplies through
reagents drop-shipped. Funding provided under Supplies must be used for requisition of supplies
to support RECEIVING AGENCY'S testing requirements. It is the PERFORMING AGENCY'S
responsibility to maintain all appropriate records required for audits that may be performed by
RECEIVING AGENCY. Any change in the allotment amount must be approved by RECEIVING
AGENCY'S Chief, Bureau of Laboratories.
ATTACHMENT - Page 2
SECTION III. 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
$0.00
0.00
500.00
0.00
0.00
TOTAL
$500.00
If applicable, direct assistance for personnel is shown on the attached list of positions and
budgetary amounts which is an integral part of this Attachment. 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 financial
assistance provided through this Attachment, if applicable, or through other program
Attachments(s) benefitting from this assistance.
RECEIVING AGENCY direct assistance will not exceed $ 500.00.
A IT ACHMENT - Page 3
.'
.'
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
$0.00
0.00
0.00
0.00
300.00
0.00
0.00
TOTAL
$300.00
RECEIVING AGENCY fmancial assistance will not exceed $300.00.
TOTAL RECEIVING AGENCY assistance will not exceed $800.00.
.-~^
A TT ACHMENT - Page 4
..
,..".
Monthly Laboratory RepL (
For Month
Vear
"
Reporting Laboratory:
Milk Testing
Bulk Products Tested
Number Performed
Raw Products Tested
Dairy Water Tested
Water Testing
I Total CoUfonn Tests
Fecal CoUfonn Tests
HIV/STD Testing
HIV Tests
RPR Card Tests
VORL Tests
MHA- TP Tests
FTA-ABS Tesls
Gonorrhea Culture Tests
Gonorrhea Genprobe Tests
Chlamydia Genprobe Tests
Tuberculosis Testing
Cultures Perfonned
Culture Positive
Drug Susceptibility Tests
Outbreak Studies
Food Outbreaks Investigated
Infectious Disease Outbreaks Investigated
Woman and Children Testing
I Nwnber Health Screening Tests Perfonned
Shellfish Analysis
I Nwnber Shellfish Samples Analyzed
..,.,'
.-
f)
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No.7560022067 97
CONTRACT CHANGE NOTICE NO. Q.l
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 he,einafter referred to as PERFORMING AGENCY. The parties thereto now
desire to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO. 06: W&C/CHILDREN'S CASE MANAGEMENT
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
t:.~)
....\
CITY OF PARIS
i I
t,1,
. ";
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
..,
.'
PERFORMING AGENCY:
RECEIVING AGENCY:
. .,
.. ~
(Signarure of person authorized to sign contracts)
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
By:
MIKE MALONE, CITY MANAGER
(Name and Title)
Linda Farrow. Chief
Bureau of Financial Services
(Name and Title)
Date:
Date:
RECOMMENDED:
APPROVED AS TO FORM:
By:
ByxbJdAiPfkttl,;;o Nov 2 ;:
Office of General Counsel
CT GMO - Rev. 12/95
......
t.
Cover Page 1
EXHIBIT :-
.-,,,.'
_ ETA I L S 0 FAT T A C H j,,~ E N T S
All/ TDH Term Financial Assistance Direct Total Amount
Amd Program! Begin Assistance (TDH Share)
No. ID End Source of Amount
Funds"
01 BNS/CARDS 10/01/96 09/30/97 10.557 93.268 0.00 0.00 0.00
02 PRIMARY 09/01/96 08/31/97 State 211,415.00 0.00 211,415.00
03 ORASIV AC 09/01/96 08/31/97 State 93.991 104,628.00 94,014.00 198.642.00
04 PHR4&5/EPSDT 09/01/96 08/31/97 State 11,497.00 0.00 11,497.00
05 LAB 09/01/96 08/31/97 State 300.00 500.00 800.00
06 W&C/CASE 09/01/96 08/31/97 State 52,373.00 0.00 52,373.00
TDH Document No.7560022067 97 Totals $380.213.00 $94,514.00 $474.727.00
Change No. 05
"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.
.'
,
"
L,
.
.~
.
.~...
,
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Cover Page 2
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DOCUMENT NO. 7560022067-97
ATTACHMENT NO. 06
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEMNG AGENCY PROGRAM: BUREAU OF CHILDREN'S HEALTH
TERM: September 01, 1996
THRU: August 31, 1997
SECTION 1. SCOPE OF WORK:
PERFORMING AGENCY will deliver comprehensive case management services to individuals
who meet the RECEMNG AGENCY'S eligibility requirements as defined in the Bureau of
Women and Children Case Management Request for Proposal (RFP) due June 4th, 1996.
Case management services will include assessment of the client's overall service needs and the
development and implementation of a course of action or plan for meeting those needs. The plan
will be family centered, community-based, culturally sensitive, comprehensive, and is intended
to assist those clients who need a variety of services.
Activities will be performed and the Fiscal Year 1997 Quarterly Reports will be submitted as set
out in the Case Management RFP and the PERFORMING AGENCY'S response to the RFP.
These documents are incorporated by reference as a part of this Attachment.
PERFORMING AGENCY agrees to comply with Chapter 35, Health and Safety Code, Children's
Health Services Act.
PERFORMING AGENCY will provide an estimated 25.Q clients with services/units of service in
or benefiting the county(ies) defined as: Lamar.
SECTION II. SPECIAL PROVISIONS:
None.
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ATTACHMENT - Page 1
.,SECTION III. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQillPMENT
SUPPLIES
CONTRACTUAL
OTHER
$35,198.00
7,786.00
4,000.00
0.00
2,389.00
0.00
3,000.00
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.
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A TT ACHMENT - Page 2
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