05-F Health Contr Chg Ntc 01DRAFT
J:\Attorney\Lisa\Resolutions\CiJRRENT\IIealth Contract 2003 COl Res.wpd
August 7, 2002
RESOLUTION NO.
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF PARIS,
PARIS, TEXAS, APPROVING AND AUTHORIZING THE EXECUTION OF
CONTRACT CHANGE NOTICE NO.O1(ATTACHMENTS NOS. 02, 03, AND
04) TO THE CONTRACT FOR PUBLIC HEALTH SERVICES, TDH
DOCUMENT NO. 7560022067-2003; 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 City Council of the City of Paris did heretofore, on the 8th day of July,
2002, in Resolution No. 2002-119, authorize the execution of a Contract for Public Health
Services, TDH Document No. 7560022067-2003, which is the conduit through which the state
funds are received; and,
WHEREAS, said contract is in need of amendment, and it is deemed appropriate that the
form of Contract Change Notice No. 01 (Attachments Nos. 02, 03, and 04), 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 Change Notice No. O 1 to the Contract for Public
Health Services, TDH Document No. 7560022067-2003, 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, Contract Change Notice No.
0 1 (Attachments Nos. 02, 03, and 04), 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 12th day of August, 2002.
Michael J. Pfiester, Mayor
ATTEST:
Mattie Cunningham, City Clerk
APPROVED AS TO FORM:
Larry W. Schenk, City Attorney
~
Grants Management Division
Contract Development Section '
1100 W. 496 St
Austin, Texas 78756
Phone: (512)458-7470
Fax: (512)458-7736
T4
TDH DOCUMENTS
PLEASE SIGN AND RETURN THIS SET OF '
I
CONTRACT DOCUMENTS AND ANY
~
ATTACHED FORMS
In the enclosed self-addressed envelope to:
TDH Grants Management Division
Attention: Contract Development Section
EXHIBIT A.
a
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
ConVact Change Notice No. Ol
The Texas Depu[ment of Heal[h, hereinafter referzed [o as RECEIVING AGENCY, did heretofore enter in[o a conVac[ in wri[ing
with PARIS-LAMAR COUNTY HEALTH DEPARTMENT hereinafter referred to as PERFORMING AGENCY. The parties thereto
now desire to amend such wntract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT NO. 02 : AC FAM. HEALTH-PRIMARY HEALTH CARE
ATT NO. 03 : OPHP - LOCAL PUBLIC HEALTH SYSTEM
ATT NO. 04 : IMMUNIZATION DIVISION - LOCALS
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Convacting Entiry (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY:
RECEIVING AGENCY :
PARIS•LAMAR U TY HEALTIi DEPARTMENT TEXAS, RTMENT OF HE LTH
A
gy; gy; C/' I~~ u ,
(Signature of person authoriz ro sign) (Signature of person authorized ro sign)
MICBAEI. MALONE. CITY MANAGER
(Name and Tide)
Date: 07/25/02
By:
ector, if
to sign c
Melanie A. Doyle, Director
Grants Manasement Division
(Name and Title)
Date: /I ~IO~DO~
TDH Document No. 7560022067 2003
Cover Page 1
DETAILS OF ATTACHMENTS
A[U
Amd
TDH
Pro
ram
Term
Financial Assistance
Direc[
Total Amount
No.
g
ID
Begin
End
Source of
Funds*
Amount
Assis[ance
(TDH Share)
Ol
OPHPBIOTERR
06/01/02
08/31/03
93.283
87,190.00
0.00
87,190.00
02
ACFH/PHC
09/01/02
08/31/03
State
180,000.00
0.00
180,000.00
03
OPHP/LPHS
09/01/02
08/31/03
State 93.991
120,519.00
0.00
120,519.00
04
IMM/LOCAL,S
09/01/02
08/31/03
State
50,02100
0.00
50,023.00
TDH Dowment No.7560022067 2003 Totals
Chan e No. Ol
$437,732.00
$ 0.00
$437,732.00
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACI-IMENT FOR DETAII,S.
Cover Page 2
DOCUMENT NO. 7560022067-2003
ATTACHMENT NO. 02
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECENING AGENCY PROGRAM: ASSOCIATE COMMISSIONER FOR FAMILY
HEALTH
TERM: September 01, 2002 THRU: August 31, 2003
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY shall deliver comprehensive health care services to eligible low-
income individuals as authorized under the Health and Safety Code, Chapter 31, Texas Primary
Health Caze 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. The following documents aze incorporated by reference and made a part of this
contract Attachment. These include:
• RECENING AGENCY Family & Community Health Services Grants FY2002
Competitive Request For Proposal (RFP);
• PERFORMING AGENCY FY2002 Competitive Application and any revisions;
• RECENING AGENCY'S Primary Health Caze Program Rules, 25 TAC, Chapter 39;
• RECENING AGENCY'S Primary Health Care (PHC) Handbook, and any revisions;
• Texas Primary Health Care Services Act, Health and Safety Code, Chapter 31;
• RECENING AGENCY'S Client Services Standazds for Public Health and Community
Clinics, revised June 1997;
• RECENING AGENCY'S Minimum Standards for Diabetes Caze in Texas, June 1999;
• RECENING AGENCY Family Planning Standazds and Rules, 25 TAC Chapter 56;
• American College of Obstetricians and Gynecologists (ACOG) 1999 Compendium,
December 31, 1998, Copyright 1999; ACOG Guidelines for Women's Health Care,
Copyright 1996; ACOG Guidelines for Perinatal Caze, 4th Edition, Copyright August,
1997;
• Sterilization, 42 CFR Part 50, Subpart B;
• Case Management standazds and guidelines, 25 TAC § 37.84;
• American College of Obstetricians and Gynecologists (ACOG) 1999 Compendium,
December 31, 1998, Copyright 1999; ACOG Guidelines for Women's Health Caze,
Copyright 1996; ACOG Guidelines for Perinatal Care, 4th Edition, Copyright August,
1997;
• American Academy of Pediatrics (AAP) Bright Futures: Guidelines for Health
Supervision of Infants, Children and Adolescents (National Center for Education in
ATTACHMENT - Page 1
Maternal and Child Health, 1994); Guidelines for Adolescent Preventive Services
(GAPS) (American Medical Association, 1995); Guidelines for Health Supervision III
(American Academy of Pediatrics, 1997);
• American Dental Association, Regulatory Compliance Manual, 1992; and,
• Changes in income guidelines as determined by RECENING AGENCY.
Within thirty (30) days of receipt of an amended standazd(s) or guideline(s), PERFORMING
AGENCY shall inform RECENING AGENCY Program, in writing, if it will not continue
performance under this Attachment in compliance with the amended standard(s) or guideline(s).
RECENING AGENCY may terminate the Attachment immediately or within a reasonable
period of time as determined by RECENING AGENCY.
PERFORMANCE MEASLTRES
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, refenal and PHC eligibility services (PHC-200)
• 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 shall report quality measures on the:
• Clinical Process = Outcome Measures report (PHC-301)
• Client Satisfaction Survey (PHC-302) (annual)
PERFORMING AGENCY shall use the required eligibility system as described in the PHC
Handbook or other system designated by RECEIVING AGENCY as the initial step.
CO-PAY
PERFORMING AGENCY may, except PERFORMING AGENCIES that are Loca] Health
Departments, assess a co-pay from clients provided services by RECEIVING AGENCY under
this Attachment if the co-pay is assessed according to the established fee schedule adjusted for
family size and income as published in the Primary Health Care (PHC) Handbook. 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 TAC § 191.
ATTACHMENT - Page 2
PERFORMING AGENCY shail 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 a(lowable costs to RECENING AGENCY Program.
When each client is enrolled, the client shall be assigned to a specific primary caze provider for
preventive, episodic and chronic caze to foster continuity and efficiency of care.
PERFORMING AGENCY shall provide services to 1,000 clients who live or who receive
services in the following county(ies)/area: Delta, Fannin, Hopkins, Lamar, Red River, Titus.
SECTION H. SPECIAL PROVISIONS
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shall submit a Program Services Report on or before the
following dates: January 15, April 15, July 15 and October 15. A final Program Services
Report shall be submitted on or before November 15. RECEIVING AGENCY Program
requires comprehensive reports which allow the Program to assess the volume and
quality of services being provided.
ATTACHMENT - Page 3
SECTION III. BUDGET:
PERSONNEL $108,339.00
FRINGE BENEFITS 259661.00
TRAVEL 1,500.00
EQUIPMENT 0.00
SUPPLIES 6,500.00
CONTRACTUAL 30,000.00
OTHER 8,000.00
TOTAL DIltECT CHARGES $180,000.00
INDIRECT CHARGES $0.00
TOTAL $180,000.00
Total reimbursements will not exceed $180,000.00.
Financial status reports are due the 30th of December, 30th of Mazch, 30th of June, and the 30th
of November.
ATTACHMENT - 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 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 modi£cation 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 of£cer or employee of any
agency, a member of Congress, an of£►cer or employee of Congress, or an
employee of a member of Congress in connection wit6 this federal coutract, grant,
loan, or cooperative agreement, the undersigned shall complete and submit Standard
Form-111, "Disclosure Form to Report Lobbying," in accordauce with iNs
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 disciose 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 t,"n $100,000 for each such failure.
07/25/02
Date
Name of Authorized Individual
7560022067 2003-02
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH.
PARIS, TX 75460-0000
DOCUMENT NO. 7560022067-2003
ATTACHTENT NO. 03
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: OFFICE OF PUBLIC HEALTH PRACTICE
TERM: September Ol, 2002 THRU: August 31, 2003
SECTION I. SCOPE OF WORK:
LOCAL PUBLIC HEALTH SUPPORT FUNDS
PERFORMIING AGENCY shall use direct assistance and/or financial assistance, as specified in
SECTION III., BUDGET, from RECEIVING AGENCY to develop local pubiic health systems
and infrastructure through carrying out one or more of the following essential public health
services as specified in PERFORMING AGENCY'S FY 03 Service Delivery Plan, which is
adopted by reference:
• Monitor [he health status of individuals in the community to identify community
health problems;
• Diagnose and investigate community health problems and community health hazards;
• Inform, educate, and empower the community with respect to health issues;
• Mobilize community partnerships to identify and solve community health problems;
• Develop policies and plans that support individual and community efforts to improve
health;
• Enforce laws and rules that protect the public health and ensure safety in accordance
with those laws and rules;
• Link individuals who have a need for community and personal health services to
appropriate community and private providers;
• Ensure a competent workforce for the provision of essential public health services;
• Research for new insights and innovative solutions to community health problems;
and
• Evaluate the effectiveness, accessibility and quality of personal and population based
health services in a community.
For the purpose of these grant funds Local Public Health Systems aze defined as the human,
informational, financial and organizational resources, including public, private and voluntazy
organizations that contribute to the public's health [Source: Mobilizing for Action through
Planning and Partnerships (MAPP) from the National Association of County and City Health
Officials].
Two types of support are available under this program:
ATTACHIMENT - Page 1 '
(1) Direct assistance in the form of state-paid positions andlor
(2) Financial assistance from
a. General Revenue funds; and,
b. Federal Preventive Health and Health Services Block Grant.
DIItECT ASSISTANCE
State-paid positions under this contract Attachment shall perform activities as specified in
PERFORMING AGENCY'S FY 03 Service Delivery Plan.
FINANCIAL ASSISTANCE
PERFORMING AGENCY shall direct funds toward developing a functional and effective public
health system(s) with the specific goal of improving public health capacity to respond to both
emergency and continuing public health threats.
PERFORMANCE MEASURES
The following performance measure(s) will be used to assess, in part, PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment,
without waiving [he enforceability of any of the other terms of the contract.
For the General Revenue and/or Preventive Health and Health Services Block Grant funds the
PERFORMING AGENCY must:
1. Base all activities on the PERFORMIIJG AGENCY'S approved Worksheet for Local
Public Health Preparedness and Response for Bioterrorism. This worksheet
(www.tdh.state.tx.us/ophp/pubs/plan.pdf) should have been completed prior to August
31, 2002.
2. Identify local public health system members critical to improving public health capacity
to respond to both emergency and continuing public health threats (i.e. hospitals, EMS,
fire, police, first responders).
3. Identify a small, but representative group of stakeholders who contribute to or benefit
from public health to help guide the LPHS development process.
4. Convene members of the LPHS for the purpose of developing and carrying out a(3-6
page) LPHS strategic plan for improving public health capacity to respond to both
emergency and continuing public health threats.
ATTACHIVIEN'T - Page 2
Targets & Deliverables by Quarter:
Quarter 1
Quarter 2
Quarter 3
Quarter 4
Target: Identification of LPHS
partners and stakeholders (i.e. those
organizations and individuals critical
to improving public health capacity to
respond to both emergency and
continuing public health threats).
Target: Identification of existing
LPHS assets and needs;
Target: Development of an LPHS
strategic plan [goal(s); objectives;
strategies/activities; timelines].
Target: Finalized LPHS strategic plan
[goals(s); objectives;
strategic/activities; timelines] with
evidence of progress on implementing
the plan.
Deliverable November 15. 2002: A
database (name, address, phone
number and e-mail address) of LPHS
partners and stakeholders submitted to
the TDH Regional Director.
Deliverable Februazv 15, 2003: A
short (3-4 page ) summazy report of
the assets and needs of the LPHS
submitted to the TDH regional
director.
Deliverable Mav 15. 2003: A draft
(3-6 page) LPHS strategic plan that
improves public health capacity to
respond to both emergency and
continuing public health threats
submitted to the TDH regional
director.
Deliverable Aueust 30. 2003: A final
(3-6 page) LPHS strategic plan that
improves public health systems
capacity to respond to both emergency
and continuing public health threats
submitted to [he TDH regional
director.
A resource http://www.phppo.cdc.eov/documents/(ocalinventorv.PDF
SECTION II. SPECIAL PROVISIONS:
General Provisions, Reports Article, is revised to include the following paragraph:
PERFORMING AGENCY shal] submit an Annual Budget and Expenditures Report to the
appropriate RECEIVING AGENCY Regional Director by October 31, 2003;
ATTACFIlvIENT - Page 3 -
SECTION III. BUDGET:
@
PERSONNEL
$87,979.00
FRINGE BENEFITS
32,540.00
TRAVEL
0.00
EQUIPMENT
0.00
SUPPLTES
0.00
CONTRACTUAL
0.00
OTHER
0.00
TOTAL DIl2ECT CHARGES $120,519.00
INDIl2ECT CHARGES $0.00
TOTAL $120,519.00
Total reimbursements will not exceed $120,519.00.
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 30th
of November.
ATTACHvv1EENT - 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 of the
undersigned, to any person for influencing or attempting to influence an offcer or an
employee of any agency, a member of Congress in connection with the awarding of any
federal contract, the makiug of any federal grant, the making of any federal loan, the
entering into of any cooperative agreement, and the extension, continuatiou, 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 of£cer 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-I11, "Disclosure Form to Report Lobbying," in accordance with it's
iastructions.
(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 accordiugly.
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 $10,0 and not more than $100,000 for each such failure.
07/25/02
Signature Date
MICHAEL MAiANE, CITY MANAGER
Print Name of Authorized Individual
7560022067 2003-03
Application or Contract Number
PARIS-LAMAR COUNTY HEALTH DEPARTMENT
Organization Name and Address
740 SOUTHWEST 6TH.
PARIS, TX 75460-0000
DOCUMENT NO. 7560022067-2003
ATTACfIMENT NO. 04
PERFORMING AGENCY: PARIS-LAMAR COUNTY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
TERM: September 01, 2002 THRU: August 31, 2003
SECTION I. SCOPE OF WORK:
The goal of RECEIVING AGENCY Program is to prevent, control, and eliminate vaccine-
preventable diseases by providing and administering biologicals, promoting immunizations,
conducting vaccine-preventable disease surveillance, assessing vaccine coverage levels, and
applying principles of epidemiology and outbreak control measures within budgetary constraints.
PERFORMING AGENCY shall implement an immunization program for children, adolescents,
and adults, with special emphasis on accelerating interventions to improve the immunization
coverage of children two years of age or younger (less than 36 months of age). PERFORMING
AGENCY shall incorporate traditional and non-traditional, systematic approaches designed to
eliminate barriers, expand immunization delivery, and establish uniform policies.
PERFORMING AGENCY shall provide services as outlined in PERFORMIING AGENCY'S
Fiscal Yeaz (FY) 2003 Contract Renewa] Budget and Work Plan and revisions, if any, as agreed
to and approved by RECEIVING AGENCY Program. These documents are adopted by
reference and made a part of this contract Attachment. Any revisions to these documents shall
be approved by RECEIVING AGENCY Program and transmitted in writing to PERFORMING
AGENCY.
PERFORMING AGENCY shall report all reportable conditions as specified in 25 TAC Part I
§§97.1 - 97.6 and 97.101 - 97.102.
PERFORMING AGENCY shall report all vaccine adverse event occurrences in accordance with
the National Childhood Vaccine Injury Act of 1986.
PERFORMING AGENCY shall inform and educate the public about vaccines and vaccine-
preventable diseases.
PERFORMIIVG AGENCY shall develop policies and plans that support individual and
community-based immunization strategies and evaluate effectiveness, accessibility, and quality
of personal and population-based immunization services and program activities.
AT"TACHIvIENT - Page 1
PERFORMING AGENCY shall ensure a health caze workforce that is knowledgeable about
vaccines,vaccine-preventable diseases,and delivery of vaccination services.
PERFORMING AGENCY shall comply with written policies and procedures provided by
RECEIVING AGENCY Program in managing state-supplied vaccines, including guidelines for
proper storage and handling of vaccines.
PERFORMING AGENCY shall not deny vaccinations to recipients because they do not reside
within PERFORMING AGENCY'S jurisdiction.
PERFORMING AGENCY shall maintain an accurate, up-to-date list of clinics and si[es where
public sector (free or low cost) immunization services are offered in PERFORMING
AGENCY'S local azea.
No fee may be charged for vaccines provided by RECEIVING AGENCY Program. All vaccines
obtained from RECEIVING AGENCY Program shall be used solely for purposes of this contract
Attachment and shall not be sold to agencies or individuals.
PERFORMING AGENCY shall not collect vaccine administration fees from Medicaid
recipients. Vaccine administration fees collected from non-Medicaid patients shall be kept within
guidelines established by RECEIVING AGENCY. In accordance with 25 TAC §1.91, no one
shall be denied immunization services in public clinics because of inability to pay [he
administration fee. Fee schedules shall not be based on vaccine type, formulation, or dose in
series. A copy of PERFORMING AGENCY'S fee schedule shall be submitted to RECENING
AGENCY Program by October 15th.
All equipment and vaccine used by PERFORMING AGENCY which aze provided by
RECEIVING AGENCY Program, shall be accounted for as public property. RECEIVING
AGENCY Program will investigate equipment or vaccine ]oss, destruction, spoilage, or other
waste and may require PERFORMING AGENCY to replace or reimburse RECEIVING
AGENCY Program.
PERFORMING AGENCY shall provide the parent, managing conservator, or guazdian of each
patient with a form that is approved by RECEIVING AGENCY Program in compliance with 25
TAC, Chapter 100 to authorize participation in the statewide immunization regis[ry (ImmTrac).
PERFORMING AGENCY shall provide RECEIVING AGENCY Program weekly data transfers
of all vaccines administered in a format that is compatible for inclusion in the statewide
immunization registry (ImmTrac).
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
ATTACHRENT - Page 2
unless amended. The following documents are incorporated by reference and made a part of this
contract Attachment.
• PERFORMING AGENCY'S FY 2003 Contract Budget and Work Plan, and any
revisions;
• Human Resources Code §42.043, VTCA;
• Education Code §§38.001-38.002, VTCA;
• Health and Safety Code §§81.023 and 161.001-161.009, VTCA;
• 25 TAC Chapter 97;
• 25 TAC, Chapter 96;
• 25 TAC, Chapter 100;
• 42 USC §§247b and 300 aa-25;
• Omnibus Budget Reconciliation Act of 1993, 26 USC §4980B;
• RECEIVING AGENCY'S Client Services Standards for Public Health and
Community Clinics, revised June 1997;
• RECEIVING AGENCY'S Vaccine-Preventable Disease Surveillance guidelines,
http://www.[dh.state.tx.us/immunize/docs/guide.htm;
• RECEIVING AGENCY'S Pharmacy guidelines;
• Centers for Disease Control and Prevention's Advisory Committee on
Immunization Practices (ACIP) guidelines, including the statement:
"Immunization of Health-Caze Workers"; and
• Standazds for Pediatric Immunization Practices, Februazy 1996, recommended by
the National Vaccine Advisory Committee, approved by the United States Public
Health Service, and endorsed by the American Academy of Pediatrics.
Within thiRy (30) days of receipt of an amended standazd(s) or guideline(s), PERFORNIING
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 guideline(s).
RECENING AGENCY may ternvnate the Attachment immediately or within a reasonable
period of time as deternuned by RECEIVING AGENCY.
PERFORMANCE MEASURES
The following performance measure(s) will be used, in part, to assess PERFORMING
AGENCY'S effectiveness in providing the services described in this contract Attachment to the
service area, without waiving the enforceability of any of the terms of the contract.
PERFORMING AGENCY shall investigate 100% of all reported vaccine-preventable
diseases in accordance with RECEIVING AGENCY'S Vaccine-Preventable Disease
Surveillance Guidelines.
PERFORMING AGENCY shall investigate 100% of suspected hepatitis B infections in
pregnant women to assure appropriate treatment and follow-up as directed by Health and
ATTACHNffiN'T - Page 3
Safety Code §81.090 and RECEIVING AGENCY'S Vaccine-Preventable Disease
Surveillance Guidelines.
PERFORMING AGENCY shall submit to RECEIVING AGENCY Program the monthly
reports of doses administered by the fifteenth calendar day of each month for the previous
calendar month, in a format approved by RECEIVING AGENCY Program. The monthly
vaccine biologicals order form must be submitted in accordance with the schedule
provided to PERFORMING AGENCY by RECEIVING AGENCY Program.
PERFORMING AGENCY shall implement an immunization reminder and/or recall
system to notify parents or guardians of children less than 36 months of age when
immunizations aze due. The notifications may be automated or manual and may consist
of mail or telephone contacts.
PERFORMING AGENCY shall conduct immunization audits in childcare facilities and
registered family homes as assigned by RECEIVING AGENCY Program.
PERFORMING AGENCY shall conduc[ immunization audits and surveys in public and
private schools as assigned by RECENING AGENCY.
PERFORMING AGENCY shall conduct annual assessments in 100% of sub-contracted
entities and WIC clinics using the Assessment, Feedback, Incentives, and eXchange
(AFIX) methodology. PERFORMING AGENCY shall submit assessment results to
RECEIVING AGENCY Program within two (2) weeks after completion.
PERFORMING AGENCY shall conduct follow-up monitoring visits of Texas Vaccines
for Children Program (TVFC)-enrolled provider sites using the RECEIVING
AGENCY'S monitoring tool and methodology. PERFORIVIING AGENCY shall submit
monitoring report to RECEIVING AGENCY Program within two (2) weeks after
completion of visit.
PERFORMING AGENCY shall recruit and enroll providers into the TVFC program.
SECTION II. SPECIAL PROVISIONS
General Provisions, Reports Article, is revised to include the following:
PERFORMING AGENCY shal] submit quarterly program reports to RECEIVING
AGENCY Program according to the following timelines and in the formats provided by
RECENING AGENCY Program.
ATTACHIMENT - Page 4
NAME OF REPORT
APPLICABLE QUARTERS
DUE DATES
Immunization Program -
September, October, November
December 30
Performance Measure
December, January, February
March 30
Quarterly Report
March, April, May
June 30
June, July, August
September 30
Immunization Program -
September, October, November
December 30
Recruitment Quarterly Report
December, Januazy, February
March 30
Mazch, April, May
June 30
June, July, August
September 30
For immunization activities performed under this contract Attachment, General Provisions,
Overtime Compensation Article is not applicable. In addition, PERFORMING AGENCY shall
comply with the following paragraphs:
PERFORMING AGENCY is authorized to pay employees who aze not exempt under the
Fair Labor Standards Act (F'LSA), 29 USC, Chapter 8, §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 aze exempt under FZSA
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 wouid be disruptive to
normal business operations.
Authorization for payment under this provision is limited to work directly related to
immunization activities and shall be in accordance with the amount budgeted in this
contract Attachment. PERFORMING AGENCY shall document proper authorization or
approval for any work performed by exempt or non-exempt employees in excess of forty
(40) hours per work week.
ATTACHIvIENT - Page 5
SECTION III. BUDGET:
PERSONNEL
$29,081.00
FRINGE BENEFITS
8,724.00
TRAVEL
2,180.00
EQUIPMENT
0.00
SUPPLIES
6,928.00
CONTRACTUAL
500.00
OTHER
2,610.00
TOTAL DIRECT CHARGES $50,023.00
INDIRECT CHARGES $0.00
TOTAL $50,023.00
Total reimbursements will not exceed $50,023.00.
Financial status reports are due the 30th of December, 30th of Mazch, 30th of June, and the 30th
of November.
ATTACHIvIENT - Page 6