HomeMy WebLinkAboutResolution - 3973 - Contract - TDOH - Health Services - 09_24_1992Resolution No. 3973
September 24, 1992
Item #28
RESOLUTION
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and
directed to execute for and on behalf of the City of Lubbock a contract by
and between the Texas Department of Health and the City of Lubbock for
health services, attached herewith, and all associated documents, which
shall be spread upon the minutes of the Council and as spread upon the
minutes of this Council shall constitute and be a part of this Resolution as
if fully copied herein in deta
Passed by the City Council thi
Ranette uoya, city becretary v `
APPROVED AS TO CONTENT:
(�� d��
Doug o an, Public Health
Adminis for
APPROVED AS TO FORM: ^
[7mia G. llaffaiver, first Ass
City Attorney
DGV:dw/Agenda-D1/Hea1th.Ree
September 14, 1992
y .
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, an officer or employee of congress, or an
employee of 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 enteringinto 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-111, "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
as placed when this transaction was made or entered into. Submission of
;ffail
certifica is a prerequisite for making or entering into this
ran tion ' pose by Section 1352, Title 31, U.S. Code. Any person who
to file require rtification shall be subject to a civil
t of no ess than , 00 and not more than $100,000 for each such
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gnature
David R. Langston
Name of Authorized Individua
September 24, 1992
Date
C3000376
Application or Contract Number
City of Lubbock, 1625 13th Street, Lubbock, Texas 79401
Name and Address of Organization
Resolution No." 397_t
a' September 24, 1992"
Item #28 L. a
TEXAS DEPARTMENT OF HEALTH CONTRACT
1100 West 49th Street
Austin, Texas 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS TDH Document No. C3000376
This contract is between the Texas Department of Health, hereinafter referred to
as RECEIVING AGENCY, and the party listed below as PERFORMING AGENCY and
includes general provisions and attachments detailing scope(s) of work and
special provisions.
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
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Mailing Address: P.O.Box 2548 Lubbock _
(City)
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X 7 408-25481
(Zipy
Street Address: 1902 Texas,Ave. Lubbock
different) --(city)
TX 794 -11171
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Authorized
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1 Contracting Entity: CITY OF LUBBOCK
tir difterent from
I-------------------------- -----------------------------=----------
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Payee Name: CITY OF LUBBOCK HEALTH DERARTMENT
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!(Must match wit ven or i en i ica ion num er s own a ow) I
Payee Address: P.O. Box 2000 Lubbock
match wi
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TX 79457 0 001
1(Must ven or i en ification number -shown Eelow
f State of Texas Vendor Identification No. (14 digits): 17560005906037
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I Finance Officer/Contact: Douiz Goodman
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1 Type of Organization: Cit
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Designate: Elementary/secondarysc oo
1 cit count other , .junior co ege, senior co ege
y, y, political subdivisions council of governments, judicial
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universe y I
I district, community services program, individual, or oher (define)
1
I Is this a small business No (Yes/No and/or minority/woman owned Nq
J Is this a non-profit business es ( es/No)
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(Yes/No} i
+ PAYEE AGENCY Fiscal Year Ending Month: SEPTEMBER
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J SUMMARY OF TRANSACTION:
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I Contract for Public Health services.
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COVER - Page 1
a' DETAILS OF AP_T.ACNM8MTS
1`
-_--Financial.. Assistance
At, ; TDH ; Tera ; Source of ; Direct f
Total Assistance ,
Mo. , Praarat , Benin , End , Funds* ; Atount ; Assistance Ataunt (TDH Shares '
O1 CRRlIdIL-LHS 9/ 1/92; SJ31J93; STATE 91,114.00; 210,895.00: 302.009.00;
1 I
02 NCR/FHS-LHS 9/ 1/92: 8/31/93 STATE ; 254,045.00 3I,404.00; 285,444.00;
03 ; HIV/EDUC-LRS ; 9/ 1/92: 8131193: STATE ; 36.000.00: .00; 36.000.00:
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04 HIV/CRC-LHS 9/ 1/92; 8/31/93, STATE 33,665.00: ,00, 33,665.00;
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TDR Docusent No, C3000376 TOTALS ! 414,824,00; 1 242.299.00; S 657,I23.00
*Federal funds are indicated by a nutber fro* the Catalog of Federal Dotestic Assistance ICFDA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS,
COVER - Page 2
U
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK TDB Document No.: C3000376
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY)
for and in behalf of.
David R. Langston, Mayor
(Name and Title)
Date: September 24, 1992
RECOMMENDED:
B
Y'
PERFORMING AGEMCT Director,.01
if different from person
authorised to sign contract)
APPROVED AS TO ,FORM:
7
G. Vandiver, First Assistant
City Attorney
IXAS DEPARTMENT OF HEALTH
RECRIVING AGENCY
(Signature of Jerson authorise
to sign contracts]
Roy L. Hogan, Assistant Deputy
Commissioner for Administration
(male and Title)
Date: �0
APPROVED AS TO FORM:
By: 1r'c
Office of General Counsel
COVER - Page 3
Page I of
ATTACHMENT 2
GRANT PROPOSAL EVALUATION FORM
COVER SHEET
GRANT NAME: Contract #C3000376 Contract for Public Health Services
GRANT AGENCY: Texas Department of Health
GRANT FISCAL PERIOD: 09/01/92 - 08/31/93
MONTH/DATE/YEAR T" MONTH/DATE/YEAR
CITY DEPARTMENT/INDIVIDUAL
PREPARING GRANT: Health Dept./R. D. Goodman
(Whom to contact in case of questions)
APPROVALS:
DIVISION DIRECTOR
71;� )4�t,-ram
ASSISTANT CITY MANAGER OR CHIEF OF POLICE
DEPUTY CITY
Upon completion of approvals, return to:
LG1.0 V i Q �;(
INDIVID
CITY
--z.
DATE
DATE
.7//yI9z
DATE
DATE
9 2-
DATE
4 by Q/IPs/92-
SECTION DEADLINE DATE
(IF APPLICABLE)
A25-1
Page 2 of
CITY OF LUBBOCK
GRANT PROPOSAL EVALUATION FORM
This form must be completed and signed by the appropriate individuals in order for
a grant application to be evaluated and approved by the City Manager.
I. State, as clearly as possible, the goals and objectives of the proposed
project for which a grant is being sought.
To continue to supplement the delivery of comprehensive public health
services in the following program areas:
1) HIV/AIDS
2) Maternal & Child Health
3) Immunization
4) Chronic Disease Prevention & Control
A. Is this the fulfillment of an Identifiable community (Lubbock) goal? If
so, list the source of the identified goal.
Yes
1) City Charter, Chapter 1, Article II, Section 23
2) City of Lubbock Health Plan 1988-89 (entirety)
B. Is this the fulfillment of an identifiable community (Lubbock) need? If
so, please provide quantifiable data (studies, etc.) that illustrate the
community need and how this grant will meet that need:
20,000 units of service were provided by this contract
last year
A25-2
Page 3 of
2. List at least three measures by which City Staff and City Council might be
able to evaluate the program in order to determine that it has reached the
goals and objectives described in Question I.
1) Number of people served
2) Number of immunizations- administered
3) Number of HIV tests performed
3. Will this program benefit the Lubbock community as a whole? If not, please
provide a detailed profile of the individuals or groups that will benefit
from the program.
Yes
4. Are other agencies (other than the City of Lubbock) available to administer
this program? If so, list the agencies:
Not in its entirety
A25-3
Page 4 of
5. Are other agencies administering similar programs? If so, list the other
agencies. If not, why not?
Yes - partial programs
Texas Tech University Health Sciences Center - Maternity Program
Lubbock Community Health Clinic - Immunizations
South Plains AIDS Resource Center & Lubbock MHMR - HIV Testing and
Counseling, HIV Education
6. Is the program or activity provided by this grant required by state or
federal law or required as a condition of other ongoing state or federal
programs? Please explain:
No
7. Does the grant require a local match? If so, in what amount? Is the match
in the form of cash or an in -kind contribution?
None
A25-4
Page 5 of
8. Is the grant for capital or operating programs? Please describe specifically
what the funds will be used for (personnel, supplies, services, capital
outlay, capital project, etc.).
Operating programs "
Personnel
Fringe Benefits
Supplies .
Contractual
Travel
Indirect Costs
A. If the grant is for capital outlay or a capital project, will it result
in ongoing City operational costs? If so, explain in detail.
N/A
B. If the grant is for an operating program or programs, is it a one-time
grant which will result in ongoing City expenses, if the program is to
be continued in the future? —
Ongoing contract
Refunded each year
A25-5
Page 6 of
C. Does the grant require continuation of the program, at City expense,
after grant funding has expired? If so, how long will the City be
obligated to expend local funds, and in what areas? Be specific.
M
9. Is the grant a one-time grant, a one-time grant with an option to renew the
grant, or an on -going grant? If the grant is ongoing, how many years has the
grant been provided to the City, and what year does the upcoming period
represent (2nd year, 5th year, etc.). If the grant has an option to renew,
how often can it be renewed, and what are the terms of renewal? Please
explain.
On -going
15+ years provided
Renewed yearly with contract renegotiation each year
10. Are indirect costs reimbursed by the grant?
Only for HIV -related activities
A25-6
Page 7 of
11. Are grant audit costs reimbursed by the grant?
FZM
12. What is the immediate (twelve-month) impact of the grant program on City
employee allocation and utilization? How will this affect their work hours,
productivity, etc. on City programs and activities?
Without this contract, most of Health Department programs would
be partially or completely unfunded. This contract will allow
current programs and staffing levels to continue.
Citizens of Lubbock would go without services.
13. What is the long-term (five-year) financial and manpower impact of the grant
program both on the community and on the City organization?
This contract is necessary to continue to meet the Health Care needs
of the community now and in the future.
A25-7
Page 8 of
14. Provide, in as much detail as possible, a 5-year Revenue and Expenditure
Projection for the grant related program beginning with the current year or
the first year this grant will be in effect. Show any on -going costs to the
City, even if the grant is only for one year. If the grant is renewable or
ongoing, show the estimated revenues and expenditures for future years that
you intend to renew/continue the grant (up to five years).
Be sure to fully explain the source and type of revenues (in -kind
contribution, reimbursement of expenses, etc.) and fully explain the specific
types of expenditures (payroll for 1/2 time clerk, purchase desk, capital
project construction, etc.). Attach additional sheets if necessary.
FYE
FOR GRANT FISCAL YEAR (From 1993 to 1997 )•
19 93 19 94 19 95 1996 1997
Revenues
Federal Grant
0
0
0
0
0
State Grant
657,123
657,123
657,123
657,123
657,123
Local Match
0
0
0
0
0
Other (Fees)
218,518
218,518
218,518
218,518
218,518
Total Revenues
875,641
875,641
875,641
875,641
875,641
FYE
FOR GRANT
FISCAL YEAR
(From 1993
to 1997 )•
1993
1994
1995
1996
1997
Expenditures
Personnel
536,928
536,928
536,928
536,928
536,928
Supplies
197,396
197,396
197,396.
197,396
197,396
Maintenance
Other Charges
116,539
116,539
116,539
116,539
116,539
Capital Outlay
24,778
24,778
24,778
24,778
24,778
Capital Project
Total Expenditures
875,641
875,641
875,641
875,641
-875,641
A25-8
a
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 1
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. C3000376
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
------------------------------------------------------
SUMMARY OF TRANSACTION:
Revision to public health services contract.
Attachment No. 02A — Amendment for Maternal and Child Health Family Health ;
Services for low income women and children. ;
All terms and conditions not hereby amended remain in full force and effect. ;
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK ;
Authorized Contracting Entity (type above .
if different from PERFORMING AGENCY)
in behalf of: ;
CI*of-perso
TEXAS DEPARTMENT OF HEALTH �
LUBBOCKPE RECEIVING AGENCY
Y: BY: -A.�'
( red (Signatureof per on authorizedto gn to sign contracts)
MAYOR Roy L. Hogan, Assistant Deputy
Commissioner for Administration
(Name and Title) (Name and Title)
January 7, 1993 t
Date: Date:
19 L-�
RECOMMENDED: APPR7tORN:
By:
1
By: �
(PERFORMING AGENCY Director, 0 face of Genfral ounsel
if different from person
authorized to sign contract.)
Cover - Page i
DETAILS OF ATT-ACH9ENTS
Att/; ;
;
Financial
Assistance ;
An, ; TDH ;
Tern ;
Source
of
Direct ;
Total Assistance ;
No, ; Program ;
Begin ;
End ;
Funds*
Amount ;
Assistance
Amount ITDH Share) ;
01 ; CRH/IIL-LHS ;
9/
1/92;
8/31193;
STATE
;
91,114.00;
_;
2101895.00;
302,009.00;
02A ; MCH/FHS-LHS ;
1
9/
1/92;
8/31/93;
STATE
364,981.00:
31,404.00:
396,385.00;
,
03 HIV/EDUC-LHS
9/
1/92;
8/31/93;
STATE
;
36,000.00;
.00;
36,000.00:
04 ; HIV/GHC-LHS ;
9/
1/92;
8131/93;
STATE
;
33,665.00;
.00;
33,665.00;
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TDH Document No. C3000376
TOTALS
; 525,760.00;
; 242,299.00;
# 168,059.00;
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 ATTACHMENT FOR DETAILS.
COVER - Page 2
TEXAS DEPARTMENT OF HEALTH
REVISED CONTRACT BUDGET
/------------------------------------------------ --------------------------------------\
--------------------------�-
------DIRECT ASSISTANCE
'
-----------------------------`-------------------�
Current Approved lChange, Requested '
(a) b
New or Revised
Budget
--- --,-Budget
,
,
(c)
1persolnel (No. Pos. 2)
31 404.000
.00 1
$31 404.00
,TravISTDoratoy Support
.00
.00 1
.00
Drugs1
.00
.00 1
.00
,Vaccines
.00
.00 I
.00
i 1
1 DirectAssistance
.00 1
,
.00 1
.00
1
1
1 TDH Financial Assist. 1
$254,045.00 1
110 936.00 1
.
$31,404 1
--------TDH-Share ,
$255,�4UD ;-�B�Dis
--------------------------------------------------------------------------------------\
FINANCIAL ASSISTANCE
lObject Class Categories j
1 9 ,Budget
Current Approved Change
(a) ,
Requested i
(b)
New or Revised +
Budget (c)
la. Personnel
$177,699.00
,
$98,616.00
$276,315.00 1
1b. Fringe Benefits
43 413.00
$7,320.00
50 733.00
c. Travel-----------------;----------------------
---------------�-------------------'
00 ; Y
00
00
1d. Equipment ,
00
►
Do
------------------------------------'-----------------------.00--------------------1
le. Supplies
16 733.00
16 733.00
1f. Contractual ,
$16,200.00 ;_
5 000.00
21 200.00
, 1
fig. Other '
;
-$
I--------------------------------------------------------------------------------------
- Total Direct Charges ;
$254,045.00 ;
$110,936.00 ;
.00
$364,981.00
� i. Indirect Charges-----'---------------:00-,--------
------.00-�---------------.00-
�----------------------------------------------------------------'
j. Total ;
$254,045.00 ;
$1100936.00 ;
----------------- 1
$364 981.00
1k. RECEIVING AGENCY share ;
$254,045.00 ;
$110,936.00 ;
1
$364,981.00 `
11. (Inc�udesGmAGRIjY share
.00
m. Program .Income 'i
Im.Pr------Incom--------------------------.00
I L
__---------------------------------------
100
,
1
'-------------------------- ----------------
Detail on Indirect Charges:
--------------------------
.00
1 Type of Rate (Mark one
Box) _ Provisional
Predetermined 1
1 Rate 0.00 Base
1
1----------------------------------------------
.(To Total Indirect ChargesXed
1
.00 1
1
'EXPLANATION OF CHANGE:
+serviase due to the expansion
1
of comprehensive Maternal and Child Health
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Rev. 03/91
GENERAL PROVISIONS FOR
TEXAS DEPARTMENT OF HEALTH CONTRACTS
PERFORMING AGENCY and RECEIVING AGENCY agree this contract, assurances,
general and/or special provisions, and attachment(s) with detailed scope(s) of
work and budget(s), as applicable, incorporate all covenants and agreements
pertaining hereto. No prior agreement or understanding, oral or otherwise, of
the parties or their agents will be valid or enforceable unless embodied in
this contract.
The person or persons signing and executing this contract on behalf of
PERFORMING AGENCY, or representing themselves as signing and executing this
contract on behalf of PERFORMING AGENCY, do hereby warrant and guarantee that
he, she, or they have been duly authorized by PERFORMING AGENCY to execute
this contract on behalf of PERFORMING AGENCY and to validly and legally bind
PERFORMING AGENCY to all terms, performances, and provisions herein set forth.
PERFORMING AGENCY hereby assures compliance with the following terms and
conditions unless otherwise specified in the attachment(s) hereto;
ARTICLE 1. Scope of Work
PERFORMING AGENCY will perform the work outlined in the Scope(s) of Work
contained in the attachment(s) hereto which is/are referenced in the Details
of Attachments and hereby incorporated and made a part of this contract, plus
amendments which may be added by additional attachment(s) from time to time as
hereinafter provided.
Satisfactory performance of this contract will be measured in part by:
(1) adherence to the contract; (2) results of CPA or State Auditor reports;
and, 3) timeliness, completeness, and accuracy of required reports.
ARTICLE 2. Term
The time period of this contract will be governed by the term(s) on the
attachment(s). No commitment of contract funds is permitted prior to the
first day nor subsequent to the last day of the term. The term may be
extended or shortened by amendment(s).
ARTICLE 3. Fundin¢
This contract.is contingent upon funding being available for the term of the
attachment(s) and PERFORMING AGENCY will have no right of action against
RECEIVING AGENCY. in the eventthat RECEIVING AGENCY is unable to perform its
obligations under this contract as a result of the suspension, termination,
withdrawal, or failure of funding to RECEIVING AGENCY or lack of sufficient
funding of RECEIVING AGENCY for any attachment(s) to this contract. If funds
become unavailable, provisions of the Termination Article will apply.
ARTICLE 4. Amendments
Contract attachment(s) may be amended, and such amendments will be in writing
and duly executed by the parties hereto.
1993 GENERAL PROVISIONS - Page 1 (5/92)
ARTICLE 5. Severability
If any provision of this contract will be construed to be illegal or invalid,
this will not affect the legality or validity of any of the other provisions
hereof. The illegal or invalid provision will be deemed stricken and deleted
herefrom to the same extent and effect.as if never incorporated herein, but
all other provisions will continue.
ARTICLE 6. Applicable Laws and Standards"
This contract will be governed by the laws of the State of Texas and
enabling state/federal regulations, including federal grant requirements
applicable to funding sources as set out in attachment(s) hereto, and Treasury
Circular 1075 (31 CFR Part 205) as applicable to advance of funds. If
PERFORMING AGENCY is a local governmental public health entity, this contract
will also be governed by the Local Public Health Reorganization Act, Chapter
121, Health and Safety Code.
PERFORMING AGENCY agrees Chapter 783, Texas Government Code Annotated
(Vernon's Pamphlet 1992), (Uniform Grant and Contract Management Act (UGCMA)),
as may be amended by revised federal circulars to be incorporated in UGCMA by
the Governor's Budget and Planning Office, applies as terms and conditions of
this contract, and the standards are adopted by reference in their entirety.
If a conflict arises between the provisions of this contract and UGCMA, the
provisions of UGCMA will prevail unless expressly stated otherwise. A copy of
this manual and its references are provided to PERFORMING AGENCY by RECEIVING
AGENCY upon request.
PERFORMING AGENCY must obtain prior approval from RECEIVING AGENCY for major
project changes which are specified in RECEIVING AGENCY's institutional prior
approval procedures. These procedures are incorporated by reference as a
condition of this contract.
In accordance with Section 1352 of Public Law 101-121, effective December 21,
1989, PERFORMING AGENCY is prohibited from using funds granted under this
contract for lobbying Congress or any agency in connection with a particular
contract. In addition, if at any time a contract exceeds $100,000, the law
requires certification that none of the funds provided by RECEIVING AGENCY to
PERFORMING AGENCY have been used for payment to lobbyists. Regardless of
funding source, and if a contract exceeds $100,000, a disclosure form must be
completed if PERFORMING AGENCY has any agreement with a lobbyist. This
certification and/or form is available upon request and must be forwarded to
RECEIVING AGENCY within 90 days of receipt.
PERFORMING AGENCY certifies by execution of this contract that its payment of
franchise taxes is current or, if PERFORMING AGENCY is exempt from payment of
franchise taxes, that it is not subject to the State of Texas franchise tax.
A false statement regarding franchise tax status will be treated as a material
breach of this contract and may be grounds for termination at the option of
RECEIVING AGENCY. If franchise tax payments become delinquent during the
attachment term, payments under this contract will be held until PERFORMING
AGENCY's delinquent franchise tax is paid in full.
1993 GENERAL PROVISIONS - Page 2
(5/92)
ARTICLE 7. Debarment and Suspension
PERFORMING AGENCY further certifies by execution of this contract that it is
not ineligible for participation in federal or state assistance programs under
Executive Order 12549, Debarment and Suspension. PERFORMING AGENCY certifies,
by submission of this contract, that neither it nor its principals is
presently debarred, suspended, proposed for debarment, declared ineligible, or
voluntarily excluded from participation in this transaction by any Federal
department or agency. Where the PERFORMING AGENCY is unable to certify to any
of the statements in this certification, PERFORMING AGENCY shall attach an
explanation. PERFORMING AGENCY specifically asserts that is has not knowingly
failed to pay a single substantial debt or a number of outstanding debts to a
federal or state agency or it is not subject to an outstanding judgment in a
suit against PERFORMING AGENCY for collection of the balance. A false
statement regarding PERFORMING AGENCY's status will be treated as a material
breach of this contract and may be grounds for termination at the option of
RECEIVING AGENCY.
ARTICLE 8. Assurances
r. . ......
PERFORMING AGENCY will establish safeguards to prohibit employees from using
their positions for a.purpose that constitutes or presents the appearance of
personal or organizational conflict of interest, or personal gain.
PERFORMING AGENCY will comply with the Intergovernmental Personnel Act of 1970
(42 U.S.C. SS 4728-4763) relating to prescribed standards for merit systems
for programs funded under one of the nineteen statutes or regulations
specified in Appendix A of the Office of Personnel Management's Standards for
a Merit System of Personnel Administration (5 CFR 900, Subpart F).
PERFORMING AGENCY will comply with all Federal and state statutes relating to
nondiscrimination. These include but are not limited to: Title VI of the
Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the
basis of race, color or national origin; Title IX of the Education Amendments
of 1972, as amended (20 U.S.C. SS 1681-1683, and 1685-1686), which prohibits
discrimination on the basis of sex; Section 504 of the Rehabilitation Act of
1973, as amended (29 U.S.C. S 794), which prohibits discrimination on the
basis of handicaps; the Americans with Disabilities Act of 19910 (P.L. 101-336)
which prohibits discrimination on the basis of disabilities; the Age
Discrimination Act of 1975, as amended (42 U.S.C. SS 63.01-6107), which
prohibits discrimination on the basis of age; the Drug Abuse Office and
Treatment Act of 1972 (P.L. 92-255), as amended, relating to nondiscrimination
on the basis of drug abuse; the Comprehensive Alcohol Abuse! and Alcoholism
Prevention, Treatment and Rehabilitation Act of 1970 (P.L. 91-616), as
amended, relating to nondiscrimination on the basis of alcohol abuse or
alcoholism; SS 523 and 527 of the Public Health Service Act of 1912 (42 U.S.C.
290 dd-3 and 290 ee-3), as amended, relating to confidentiality of alcohol and
drug abuse patient records; any other nondiscrimination provisions in the
specific statute(s) pertaining to applicable Federal assistance; and the
requirements of any other nondiscrimination statute(s) which may apply.
PERFORMING AGENCY will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification of violating facilities
1993 GENERAL PROVISIONS - Page 3 (5J92)
pursuant to EO 11738; (c) conformity of Federal actions to State (Clear. Air)
Implementation Plans under Section 176(c) of the Clear Air Act of 1955, as
amended (42 U.S.C. SS 7401 et seq.); and (d) protection of underground sources
of drinking water under the Safe Drinking Water Act of 1974, as amended, P.L.
93-523.
PERFORMING AGENCY will comply with P.L. 93-348 regarding the protection of
human subjects involved in research, development,' and related activities
supported by any applicable award of federal assistance.
PERFORMING AGENCY drill comply with, the Clinical Laboratory Improvement
Amendments of 1988 (CLIA), P.L. 100-578 (42 U.S.C. 263 a), which establish
Federal requirements for the regulation and certification of clinical
laboratories.
PERFORMING AGENCY will comply with the OSHA Regulations on Bloodborne
Pathogens, 56 Fed. Reg. 64175 (1991), 29 C.F.R. 1919.030, which' set safety
standards for those workers and facilities who may handle'bloodborne
pathogens.
PERFORMING AGENCY assures it will not transfer or assign its interest in this
contract without the written consent of the RECEIVING AGENCY.
ARTICLE 9. Standards For Financial Management
PERFORMING AGENCY will develop, implement, and maintain financial management
and control systems that meet or exceed the requirements of UGCMA. Those
requirements include at a minimum:
1. Financial planning including the development of budgets that adequately
reflect all functions and resources necessary to carry out authorized
activities and the adequate determination of costs;
2. Financial management system including accurate, correct, and complete
payroll, accounting, ' and financial reporting records, cost source
documentation, effective internal and budgetary controls, determination of
reasonableness, allowability, and allocability of costs, and timely and
appropriate audits and resolution of any findings; and,
3. Billing and collection policies including a charge schedule, a system for
discounting or adjusting charges based on a person's income and family
size, and a mechanism capable of billing and making reasonable efforts to
collect from patients and third parties.
ARTICLE 10. Allowable Costs and Audit Requirements
Only those costs allowable under UGCMA and any revisions thereto, plus any
applicable federal cost principles are eligible for reimbursement under this
contract.Applicable cost principles, audit requirements and administrative
requirements are as follows:
Audit Administrative
Applicable Cost Principles Requirements Requirements
A-87, State & Local Governments Circular A-128 UGCMA
To be eligible for reimbursement under -this contract, a cost must have been
1993 GENERAL PROVISIONS - Page 4 (5/92)
incurred within the attachment term and ,.paid by PERFORMING AGENCY prior to
claiming reimbursement from RECEIVING AGENCY or encumbered by the last day of
the attachment term and liquidated no later than 45 days after the end of the
attachment term.
Each PERFORMING AGENCY/AUTHORIZED CONTRACTING ENTITY receiving $25,000 or more
in total federal/state financial assistance during their fiscal year shall
arrange for an agency -wide financial and compliance audit of the PERFORMING
AGENCY'S/AUTHORIZED CONTRACTING ENTITY'S fiscal year. The audit must be
conducted by an independent CPA and must be in accordance with the applicable
OMB Circulars and Government Auditing Standards. Procurement of audit
services will comply with state procurement procedures, as well as provisions
of UGCMA.
Within 30 days of receipt of audit report, PERFORMING AGENCY/AUTHORIZED
CONTRACTING ENTITY will submit a copy to RECEIVING AGENCY'S Internal Audit
Division.
ARTICLE 11. Overtime Comvensation
None of the funds provided by attachment(s) will be used to pay overtime.
PERFORMING AGENCY will be responsible for any obligations of overtime pay due
employees.
ARTICLE 12. Terms and Conditions of Payment
For services satisfactorily performed pursuant to the Scope(s) of Work,
PERFORMING AGENCY will receive reimbursement for allowable costs.
Reimbursements will not exceed the total of each attachment(s) hereto and are
contingent on a signed contract.
Claims for reimbursement will be made on a State of Texas Purchase Voucher
(TDH Form #AG-37). Vouchers for reimbursement of actual expenses will be
submitted monthly within 20 days following the end of the month covered by the
bill. A make-up claim may be submitted as a final close-out bill not later
than 45 days following the end of attachment term(s). Advance payment may be
requested in accordance with the applicable provisions of this contract.
Payments made for approved claims or notice of denial of claims submitted
against attachment(s) to this contract will be mailed not later than 60 days
after receipt of monthly vouchers. Payment is considered made on the date
postmarked. Any reimbursements made by PERFORMING AGENCY to subcontractors
will be made in accordance with Article 601f, V.T.C.S.
Funding from this contract will not be used to supplant state or local funds,
but PERFORMING AGENCY will use such funds to increase state or local funds
currently available to PERFORMING AGENCY for a particular activity.
PERFORMING AGENCY further agrees to maintain to the best of :its ability its
current level of support, if any.
PERFORMING AGENCY will refund to RECEIVING AGENCY any funds PERFORMING AGENCY
claims and receives from RECEIVING AGENCY for the reimbursement. of costs which
are determined by RECEIVING AGENCY to be ineligible for reimbursement.
RECEIVING AGENCY will have the right to withhold all or part of any future
1993 GENERAL PROVISIONS - Page 5 (5/92)
payments to PERFORMING AGENCY to offset any reimbursement made to PERFORMING
AGENCY for any ineligible expenditures not refunded to RECEIVING AGENCY by
PERFORMING AGENCY.
Payment may be denied for noncompliance if required financial reports are not
on file for previous quarters or for the final period, or for failure to
respond to financial compliance monitoring reports, or if program requirements
are not met as specified in the Scope(s) of Work.
ARTICLE 13. Advance Payments
PERFORMING AGENCY may request, in writing, a one time advance with proper
justification and the concurrence of RECEIVING AGENCY. Amount of advance will
be determined by the amount and term of the attachment(s); however, for each
attachment, the amount of the advance will not exceed one -sixth (1/6th) of a
twelve-month attachment. Advance will be requested on a State of Texas
Purchase Voucher at the beginning of attachment period or at a single later
time in the attachment period if circumstances so warrant and the request is
approved. Advance funds will be liquidated during the attachment term so
that, after final monthly billing, PERFORMING AGENCY will not have advance
funds on hand. Advance funds may be drawn only to meet immediate cash needs
for disbursement (UGCMA and federal circulars).
Amendments to this contract may require upward or downward adjustment to the
allowable advance until it equates 1/6th of a twelve-month attachment or
approximates two months operating costs. In the case of a downward
adjustment, PERFORMING AGENCY and RECEIVING AGENCY will agree on the amount of
adjustment to the advance. RECEIVING AGENCY retains the option to reduce
future claims by the required amount. In the case of an upward adjustment and
PERFORMING AGENCY needs additional funds to meet immediate operating expenses,
PERFORMING AGENCY may submit to RECEIVING AGENCY a written justification and
State of Texas Purchase Voucher in the amount necessary to correct the ratio.
ARTICLE 14. Program Income
PERFORMING AGENCY will develop a fee for service system and a schedule of fees
for public health services in accordance with the provisions of Chapter 12,
Sub -chapter D, Health and Safety Code and the Texas Board of Health rules
covering Fees for Clinical Health Services (25 TAG, Sec. 1.91) and other
applicable laws provided, however, that a patient may not be denied a service
due to inability to pay.
All revenues received from the delivery of contract services will be
identified, reported, and utilized as provided in this article. Such program
income will be retained by PERFORMING AGENCY and: (1) be used by PERFORMING
AGENCY for any purposes which further the objectives of the program and the
Scope of Work for the attachment(s) and be deducted from total project costs;
or, (2) be deducted from total project costs.
This is according to RECEIVING AGENCY policy interpreting UGCMA, a copy of
policy is provided on request and is incorporated by reference as a condition
of this contract
1993 GENERAL PROVISIONS - Page 6 (5/92)
P
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ARTICLE 15. Financial Reports
Financial reports are required as provided in UGCMA and will be filed
regardless of whether or not expenses have been incurred.
Quarterly
Financial Status Report, State of Texas Supplemental Form 269a (TDH Form
'GC-4a), will be submitted within 30 days following the end of each quarter.
Annual/Final
A final financial report, Request for Advance or Reimbursement, Form 270
(TDH Form GC-10) will be submitted not later than 45 days following the end
of attachment term(s). If necessary, a State of Texas Purchase Voucher will
be submitted if all costs have not been recovered or a refund will be made of
excess monies if costs incurred were less than funds received.
ARTICLE 16. Reports and Inspections
'PERFORMING AGENCY will submit financial, program, progress, and other reports
`as requested by RECEIVING AGENCY in the format agreed to by the parties
Thereto.
!RECEIVING AGENCY and, when federal funds are involved, any authorized
nrepresentative (s) of the federal government have the right, at. all reasonable
:times, to inspect or otherwise evaluate the work performed or being performed
;hereunder and the premises in which it is being performed, including
subcontractors. PERFORMING AGENCY will participate in and provide reasonable
iaccess, facilities, and assistance to the representatives. All inspections
land evaluations will be performed in such a manner as will not unduly delay
;the work.
PERFORMING AGENCY agrees that RECEIVING AGENCY and the federal government, or
;any of their duly authorized representatives, will have access to any
1pertinent books, documents, papers, and 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
jattachment(s) will not foreclose the right of RECEIVING AGENCY to recover
;excessive or illegal payments.
Any deficiencies identified by RECEIVING AGENCY upon examination of PERFORMING
AGENCY's records will be conveyed in writing to PERFORMING AGENCY. PERFORMING
AGENCY's resolution of findings will also be conveyed in writing to RECEIVING
jAGENCY within 30 days of receipt of RECEIVING AGENCY's findings. A
,determination by RECEIVING AGENCY of either an inadequate or inappropriate
resolution of the findings may result in the withholding of funds or
suspension of the contract attachment(s). Any such withholding of funds or
suspension will remain in effect until the findings are properly remedied as
determined by RECEIVING AGENCY.
ERFORMING AGENCY will retain all such records for a period of three years
rom the date of the last expenditure report submitted under contract
ttachment(s) or until resolution of all audit questions, whichever time
1993 GENERAL PROVISIONS - Page 7 (5/92)
period is longer.
ARTICLE 17. Client Records
At the end of the attachment term, all client records are the property of
PERFORMING AGENCY. RECEIVING AGENCY retains the right to have access to the
records or obtain copies for audit, litigation, or other circumstances that
may arise.
If at any time during the attachment term(s), PERFORMING AGENCY and/or
RECEIVING AGENCY should decide to terminate the agreement, RECEIVING AGENCY
may require the transfer of client records upon written notice to PERFORMING
AGENCY. Records may be transferred to another entity that agrees to continue
the service or, at the option of RECEIVING AGENCY, the records may be
transferred to RECEIVING AGENCY headquarters.
ARTICLE 18. Confidentiality
PERFORMING AGENCY will have a system in effect to protect from inappropriate
disclosure of patient records and all other documents deemed confidential by
law which are maintained in connection with the activities funded under
contract attachment(s). Any disclosure of confidential patient information by
PERFORMING AGENCY, including information required by the Reports and
Inspections Article, will be in accordance with applicable law.
If providing direct client care, services, or programs, PERFORMING AGENCY
agrees to implement workplace policies based on the model guidelines adopted
by RECEIVING AGENCY and to educate employees and clients concerning the human
immunodeficiency virus (HIV) and its related conditions including acquired
immunodeficiency syndrome (AIDS). PERFORMING AGENCY agrees to develop and
implement policies regarding confidentiality of AIDS and HIV -related medical
information for employees of PERFORMING AGENCY and for clients, inmates,
patients, and residents served by PERFORMING AGENCY. Further, PERFORMING
AGENCY agrees to develop and implement an anti -discrimination policy assuring
all privileges and opportunities for any employee or client with a
communicable disease. HIV -related policies will be based on accurate
scientific information. Such policies will be consistent with the model
guidelines published by RECEIVING AGENCY and with state and federal laws and
regulations. A PERFORMING AGENCY that does not adopt a confidentiality policy
as herein required is not legally eligible to receive state funds until the
policy is developed and implemented.
ARTICLE 19. Equipment and Suyplies
Equipment is defined as tangible nonexpendable property with an acquisition
cost of over $500 and a useful life of more than one year. In accordance with
Article 601b, V.T.C.S., Section 8.02(c), title to all equipment purchased from
funds provided herein will be in the name of PERFORMING AGENCY throughout the
attachment(s) term(s).
Unless initially listed and approved in the attachment(s), prior written
approval from RECEIVING AGENCY is required for any additions to or deletions
of approved equipment purchases having an acquisition cost exceeding $500. To
receive approval, for data processing hardware and software purchases with an
1993 GENERAL PROVISIONS - Page 8 (5/92)
acquisition cost over $500, PERFORMING IAGENCY must submit a detailed
justification which includes description 'of features, make and model, and
cost, etc.
PERFORMING AGENCY will maintain an annual property and inventory listing and
submit a report (TDH Form GC-il) to RECEIVING AGENCY not later than 45 days
from the end of the attachment(s) term(s). PERFORMING AGENCY will administer a
program of maintenance, repair, and protection of assets under this
attachment(s) so as to assure their full availability and usefulness. In the
event PERFORMING AGENCY is indemnified, reimbursed, or otherwise compensated
for any loss of, destruction of, or damage to the assets provided under this
attachment(s), it will use the proceeds to repair or replace said assets.
PERFORMING AGENCY agrees that upon termination of attachment(s), title to any
remaining equipment purchased from funds as hereinabove provided will be
transferred to the RECEIVING AGENCY or any other party designated by the.
RECEIVING AGENCY; provided, however, that RECEIVING AGENCY may, at its option
and to the extent allowed by law, transfer title to such property to the
PERFORMING AGENCY.
ARTICLE 20. Subcontracting
PERFORMING AGENCY may enter into agreements with subcontractors unless
restricted or otherwise prohibited in specific attachment(s). Subcontracts,
if any, entered into by PERFORMING AGENCY will be in writing and subject to
the requirements of this contract. PERFORMING AGENCY agrees that it will be
responsible to RECEIVING AGENCY for the performance of any subcontractor. In
addition, if PERFORMING AGENCY elects to enter into an agreement which
subcontracts out a substantial portion of PERFORMING AGENCY's Scope of Work,
prior written approval must be obtained from RECEIVING AGENCY.
ARTICLE 21. Copyrights and Publications
PERFORMING AGENCY understands and agrees that where activities supported by
the contract attachment(s) produce original books, manuals, films, computer
programs (including executable computer programs and supporting data in any
form), or other original material, PERFORMING AGENCY may copyright such
material subject to any rights to same reserved by or vested in the federal
government or any agency thereof; however, RECEIVING AGENCY may grant to
PERFORMING AGENCY limited rights to produce, publish, and use such materials
as appropriate.
PERFORMING AGENCY may publish at its expense the results of contract
performance with prior RECEIVING AGENCY review and approval. Any publication
(written, visual, or sound) should include acknowledgment of the support
received from RECEIVING AGENCY and the appropriate federal agency, if
applicable. At least three copies of any such publication must be provided to
RECEIVING AGENCY. RECEIVING AGENCY reserves the right to require additional
copies before or after the initial review.
ARTICLE 22. Hold Harmless
PERFORMING AGENCY, which is not a state agency, assures that it. is an
independent contractor and not an agent, servant, or employee of the state.
Except to the extent that Chapter 104 of the Texas Civil Practice and Remedies
1993 GENERAL PROVISIONS - Page 9 (5/92)
Code is applicable to this contract, PERFORMING AGENCY agrees to hold
RECEIVING AGENCY and/or federal government harmless and to indemnify them from
and against any and all claims, demands, and causes of action of every kind
and character which may be asserted by any third party occurring or in any way
incident to, arising out of, or in connection with the performance of services
by PERFORMING AGENCY under this contract to the extent allowed by law, and to
the extent of damages permitted under Chapter 101 of the Texas Civil Practice
and Remedies Code.
PERFORMING AGENCY, by acceptance of funds provided through contract
attachment(s), agrees and ensures that personnel paid from these funds are
duly licensed and/or qualified to perform the required services.
ARTICLE 23. Bonding
Each person employed by PERFORMING AGENCY who handles funds under this
contract, including persons authorizing payment of such funds, will be covered
by the terms of a fidelity bond providing for indemnification of losses
occasioned by; (1) any fraudulent or dishonest act or acts committed by any of
PERFORMING AGENCY's employees either individually or in concert with others,.
and/or, (2) failure of PERFORMING AGENCY.or any of its employees to perform
faithfully his/her duties or to account properly for all monies and property
received by virtue of his/her position or employment. This fidelity bond
will be in the amount of not less than Ten Thousand Dollars ($10,000).
In the event that PERFORMING AGENCY, being an independent contractor,
maintains a self-insurance program that provides for the indemnification of
losses as described in the above paragraph regarding fidelity bonds, then
PERFORMING AGENCY will provide the RECEIVING AGENCY a certified statement
which summarizes its self-insurance plan. The certified statement will be
submitted at the time this contract is submitted for approval. Any changes to
said plan, which occur during the term of this contract period, will be
reported to RECEIVING AGENCY. The self-insurance program should be based on
the determination that the coverage can.be provided at a cost no greater than
the cost of obtaining equivalent coverage from an insurance company.
ARTICLE 24. Suspension/Termination
If PERFORMING AGENCY fails to comply with RECEIVING AGENCY's reporting
requirements, the program objectives, -. or the contract award conditions,
RECEIVING AGENCY may withhold payments. RECEIVING AGENCY will provide advance
written notice to PERFORMING AGENCY which will identify the deficiency and
RECEIVING AGENCY's intent to withhold payments if the deficiency is not
corrected within a specific number of days. When the deficiency is corrected,
RECEIVING AGENCY will release any withheld payments with no further action.
If PERFORMING AGENCY fails to comply with the terms, conditions, or standards
of this contract, RECEIVING AGENCY may suspend the contract attachment(s) and
prohibit PERFORMING AGENCY from incurring additional obligations of funds
pending either corrective action or termination. RECEIVING AGENCY will
provide written notice to PERFORMING AGENCY at least thirty (30) days in
advance of the suspension date. Such notice will detail the nature of
noncompliance and specify a correction date. PERFORMING AGENCY may request a
hearing on the proposed suspension if such request is made in writing within
ten (10) days from any final notification of suspension.
1993 GENERAL PROVISIONS.- Page 10 (5/92)
This contract or any attachment(s) hereto may, be terminated by either of the
parties hereto for noncompliance' by'the'oiherparty. A party intending to
terminate for noncompliance by the other party will provide written notice to
the other party at' least thirty (30) days prior to the intended date of
termination. Such notice will include the reasons for the termination and
will provide the other party an opportunity to rebut the reasons in writing.
A hearing may requested on the proposed termination if such request is made
in writing within ten (10) days from any final notification of termination.
By such termination, neither party may nullify obligations already incurred
for performance or failure to perform prior to the date of termination. Such
termination will not be an exclusive remedy but will be in addition to any
other rights and remedies provided by law or under this contract.
This contract or any attachment(s) hereto may be terminated in whole, or in
part, when both parties agree that continuation would not produce results
commensurate with further expenditure of funds. Both parties will agree on
the effective date and, in the case of partial termination, the portion to be
terminated. RECEIVING AGENCY will immediately send PERFORMING AGENCY written
notice of the terms agreed to and such notice will become a part of the
contract. PERFORMING AGENCY will not incur new obligations for the terminated
portion after the effective date of termination and will cancel as many
outstanding obligations as possible. RECEIVING AGENCY will allow full credit
to PERFORMING AGENCY for noncancelable obligations which were properly
incurred prior to the termination date.
This contract or any attachment(s) hereto may be terminated if funds allocated
for any attachment(s) hereto should become reduced, depleted, or unavailable
during any attachment(s) budget period, and RECEIVING AGENCY is unable to
obtain additional funds for such purposes. RECEIVING AGENCY will immediately
provide written notification to PERFORMING AGENCY of such fact and such
attachment(s) to this contract is/are terminated upon receipt of that
notification. PERFORMING AGENCY will not incur new obligations after the
effective date of termination and will cancel as many outstanding obligations
as possible. RECEIVING AGENCY will allow full credit to PERFORMING AGENCY for
noncancelable obligations which were properly incurred prior to the
termination date.
This contract or any attachment(s) hereto may be terminated in the event that
federal or state laws or other requirements should be amended or judicially
interpreted so as to render continued fulfillment of this contract, on the
part of either party, unreasonable or impossible. If the parties should be
unable to agree upon amendment which would therefore be needed to enable the
substantial continuation of the services contemplated herein, then, upon
written notification by RECEIVING AGENCY to PERFORMING AGENCY, the parties
will be discharged from any further obligations created under the terms of
this contract, except for the equitable settlement of the respective accrued
interests or obligations as of the date of termination.
ARTICLE 25. Personnel
All personnel funded by attachment(s) to this contract are employees of
PERFORMING AGENCY which will be responsible for their direction and control
and liable for any of their acts or omissions.
PERFORMING AGENCY will have in place legally sufficient Due Process Hearing
1993 GENERAL PROVISIONS - Page 11 (5/92)
Procedures for all of its employees filling state budgeted positions.
PERFORMING AGENCY will have full authority to employ, promote, suspend,
demote, discharge, and transfer within its organization any and all state
budgeted personnel funded by attachment(s) to this contract provided, however,
that any demotion, suspension, or discharge of such state budgeted employees
will be in accordance with the Due Process Hearing Procedures as set out
above. The only distinction between state budgeted and local paid employees
is that employees on state budgeted positions receive state benefits and are
subject to certain duties, obligations, and restrictions as state employees as
contained in state law. One such restriction, as contained in the State
Appropriations Act, is that no employee paid on a state budgeted position may
receive a salary supplement from any source unless specifically authorized in
the Appropriations Act or other state law. This prohibition includes, but is
not limited to, the payment to such employee of a so-called "flat rate" car
allowance or travel allowance. Any such.travel or per diem to these employees
must be on a reimbursement basis, supported by appropriate records, and may
not exceed the reimbursement for mileage and/or per diem allowed under the
Appropriations Act and current state travel regulations. This restriction
will apply whether travel funds are provided in attachment(s) under this
contract or from any other source.
PERFORMING AGENCY will utilize RECEIVING AGENCY's policies and procedures for
hiring and promoting individuals into state budgeted positions funded by
attachment(s) to this contract. qualifications of any individuals filling
these positions will be subject to approval of RECEIVING AGENCY's Bureau of
Personnel Management. The purpose of the approval is to ensure that
individuals occupying these positions meet minimum educational and experience
requirements.
PERFORMING AGENCY will maintain required records and submit documents
necessary to process personnel, payroll-, leave and time records, and travel
claims on state budgeted positions. PERFORMING AGENCY will be furnished by
RECEIVING AGENCY state warrants for salary compensation or travel
reimbursement for issuance to employees on state budgeted positions:
An independent audit is not required as a condition of this contract if -the
attachment provides assistance through assignment of state budgeted positions
and no funds are budgeted for local costs.
PERFORMING, AGENCY may be reimbursed for local personnel costs or other
categories of expense used to fulfill the scope of work of attachment(s) in
lieu of being furnished state payroll warrants after a state budgeted position
becomes vacant. Reimbursement will not exceed the balance of funds on the
state budgeted position after all benefits, obligations, and/or other
entitlements are met. PERFORMING AGENCY's Director, or other person(s)
authorized elsewhere in this contract, may submit a request for conversion.
RECEIVING AGENCY will transmit formal approval and a revised budget to
PERFORMING AGENCY to complete the conversion.
ARTICLE 26. Funding Participation Requirement
PERFORMING AGENCY agrees funds provided through this contract will not be used
for matching purposes in securing other funding.
1993 GENERAL PROVISIONS - Page 12 (5/92)
G.' p
ARTICLE 27. Performance -Based Attachments:
History
RECEIVING AGENCY is responsible for developing performance -based public health
services contracts in response to the State Auditor's Report. This system
will enhance service delivery and improve accountability and efficiency in
the management of public health dollars.
Plans for initial implementation were designed to use the model objectives
format stemming from recommendations of the Committee on Model Objectives for
Local Public Health in Texas. The committee was composed of representatives
of local health departments and RECEIVING AGENCY'S central and public health
region offices in consultation with the University of Texas School of Public
Health in Houston..
Purpose
The overall goal of performance -based contracts is improved public health
practices in Texas. The project is intended to:
-identify public health needs and establish priorities which provide a
rational basis for resource allocation;
-project realistic outcomes based on activities which can be accomplished with
current or planned resources, communicate needs, and build consensus at all
levels regarding directions to be taken in specific programs; and,
-institute a system for planning, implementing, managing, and evaluating
programs and monitoring progress toward reducing and/or alleviating public
health problems.
Required Program Areas
PERFORMING AGENCY has prepared outcome and process objectives, if they are
applicable and relative to the local needs and resources, for the following
program areas:
HIV/AIDS
Immunization
Food Protection
Maternal and Child Health
Chronic Disease Prevention and Control
These objectives are appended to the Community and Rural Health Attachment and
incorporated verbatim and made a part of this contract. PERFORMING AGENCY
agrees to monitor performance to evaluate progress towards these objectives.
Reporting requirements for the performance -based objectives will be agreed
upon by both parties.
Pilot Program Areas
RECEIVING AGENCY will provide training, written documentation, and ongoing
technical assistance to PERFORMING AGENCY in the development of performance -
based objectives for the following pilot program areas:
1993 GENERAL PROVISIONS - Page 13 (5/92)
Tuberculosis
Refugee Health
Public Health Promotion
Sexually Transmitted Diseases
For state fiscal year 1993, the parties recognize and agree that the
performance -based objectives for the pilot program areas are negotiable. If
PERFORMING AGENCY'S achievement is below the established levels, it will not
affect the right of PERFORMING AGENCY to funds provided through Attachment(s)
when the basic program scope of work has been fulfilled.
However, it is understood and agreed upon by both parties that PERFORMING
AGENCY will be required to append approved performance -based objectives for
the pilot program areas to the local health services contract for state fiscal
year 1994.
RECEIVING AGENCY contact for matters pertaining to the performance -based
public health services project is the Office of the Associate Commissioner for
Community and Rural Health.
1993 GENERAL PROVISIONS - Page 14 (5/92)
ADDENDUM TO GENERAL PROVISIONS FOR
TEXAS DEPARTMENT OF HEALTH CONTRACTS
ARTICLE 9. STANDARDS FOR FINANCIAL MANAGEMENT IS REVISED TO ADD A NEW PARAGRAPH:
In addition, PERFORMING AGENCY agrees to bill third party payors for services
provided under the Attachment(s), at no cost to the client. These potential
payors include, but are not limited to, Medicaid, private insurance carriers,
other available federal, state, local and private funds, etc. PERFORMING
AGENCY is required to become a Medicaid provider for applicable program
activities funded in the Attachment(s) hereto, and will maximize efforts to
obtain payment from Medicaid and all other available sources.
ARTICLE 14. PROGRAM INCOME IS REPLACED IN ITS ENTIRETY WITH THE FOLLOWING:
PERFORMING AGENCY will develop a fee for service system and a schedule of fees
for personal health services in accordance with the provisions of Chapter 12,
Sub -chapter D, Health and Safety Code and the Texas Board of Health rules
covering Fees for Clinical Health Services (25 TAC, Section 1.91) and other
applicable laws provided, however, that a patient may not be denied a service
due to inability to pay.
Both parties, agree all revenues directly generated by an Attachment(s)
supported activity or earned only as a result of the Attachment(s) during the
term of the Attachment(s) is considered program income. PERFORMING AGENCY
will retain the program income and use one of the following alternatives:
1. Where the PERFORMING AGENCY is reimbursed by RECEIVING AGENCY under a
cost reimbursement method, the additive or deductive alternatives for
program income may be used. Under the additive method, PERFORMING AGENCY
will add the program income to the funds already committed to the project
by both the RECEIVING AGENCY and PERFORMING AGENCY. Funds will be used to
further the program objectives of the State/Federal statute under which
the Scope';of Work for the attachment(s) was made. Under the deductive
method, the PERFORMING AGENCY will deduct the program income from the
total allowable costs to determine the net allowable costs.
2. Where the PERFORMING AGENCY is reimbursed by RECEIVING AGENCY under a
fixed price arrangement, only the deductive alternative for program income
will be used. PERFORMING AGENCY deducts the program income from the total
allowable project costs to determine the net allowable costs.
It is further understood that RECEIVING AGENCY will base future funding
levels, in part, upon the PERFORMING AGENCY's proficiency in identifying,
billing, collecting, and reporting income, and in utilizing it for the
purposes and conditions of the applicable Attachment(s).
Additional information is contained in RECEIVING AGENCY's Program Income
Policy interpreting UGCMA, which is incorporated by reference as a part of
this contract
1993 GENERAL PROVISIONS ADDENDUM - Page 1 (7/92)
DOCUMENT NO. C3000376
ATTACHMENT NO. 01
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: COMMUNITY AND RURAL HEALTH
TERM: September 1, 1992 THROUGH August 31, 1993
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will use direct assistance and/or financial assistance from
RECEIVING AGENCY to supplement the delivery of comprehensive public health
services. Comprehensive health services encompass a wide variety of personal
health services, environmental health services, and other needs of the
jurisdiction. Personal health services may include but are not limited to
adult health/chronic disease, HIV/AIDS, chronically ill/disabled children,
dental, immunization, laboratory, maternal and child health, public health
promotion/education, sexually transmitted disease control, and tuberculosis
control. Environmental health services/inspections may include but are not
limited to food, premise, swimming pool, vector control, and wastewater
control. Other services may be provided as needed when agreed to by both
parties.
PERFORMING AGENCY has prepared outcome and process objectives, if they are
applicable and relative to the local needs and resources, for the following
program areas:
HIV/AIDS
Immunization
Food Protection
Maternal and Child Health
Chronic Disease Prevention and Control
These performance -based objectives are incorporated and made a part of this
attachment and are hereinafter referred to as Exhibit A. PERFORMING AGENCY
agrees to maintain a monitoring system to evaluate progress towards these
objectives.
Reports of comprehensive health services performed will be submitted to
RECEIVING AGENCY, Community and Rural Health, in a format and time frame
agreed upon by both parties.
Direct assistance will be provided by RECEIVING AGENCY to PERFORMING AGENCY
for the implementation of an immunization program. The goal of the
immunization program is to prevent, control, and eradicate vaccine -preventable
disease by providing/administering biologicals, promoting immunization, and
applying epidemiologic/outbreak controls within budgetary constraints. This
will be accomplished by performing the following activities and reports.
A. Investigations/Control Measures
PERFORMING AGENCY will investigate 100% of suspected cases of measles,
rubella, pertussis, poliomyelitis, and diphtheria within 24 hours after a
-1-
report is received. PERFORMING AGENCY will investigate 90% of suspected mumps
cases and 100% of suspected tetanus cases within 48 hours after a report is
received.
For the above diseases, PERFORMING AGENCY will implement the most current
outbreak control procedures/measures and contact RECEIVING AGENCY, Immuniza-
tion Division, within 48 hours after an investigation is initiated.
B. Reporting Requirements
PERFORMING AGENCY understands that all vaccines used in RECEIVING AGENCY
Immunization Programs are purchased with public funds and must be accounted
for the same as other public property. PERFORMING AGENCY further understands
that vaccine loss, destruction, spoilage, or other waste, may be investigated
by the RECEIVING AGENCY, Immunization Division, who may then require
reimbursement or replacement of the lost vaccines.
PERFORMING AGENCY agrees to provide RECEIVING AGENCY, Immunization Division,
by January 31st, of each year, a report detailing storage measures and methods
used to control vaccine loss including method to monitor and record daily
vaccine storage temperatures. The report shall be submitted in a format
provided by RECEIVING AGENCY, Immunization Division.
PERFORMING AGENCY agrees to provide RECEIVING AGENCY, Immunization Division,
monthly reports of vaccine utilization/loss, within ten working days after the
end of each month, on forms provided by RECEIVING AGENCY (forms C5, C5A9 C33,
C33A). PERFORMING AGENCY will obtain monthly biological reports from private
physician offices and others who receive state supplied biologicals.
In addition to support for the above activities, RECEIVING AGENCY, Bureau of
Laboratories, agrees to provide direct assistance of laboratory supplies to
PERFORMING AGENCY to execute laboratory analyses for the following RECEIVING
AGENCY programs: milk bacteriology, syphilis serology, gonorrhea testing, and
other approved laboratory analyses.
PERFORMING AGENCY agrees to meet standards for such analyses as set forth by
RECEIVING AGENCY, Bureau of Laboratories, the Clinical Laboratories Improve-
ment Act, the Safe Drinking Water Act, The National Conference of Interstate
Milk Shippers, and/or the Public Health Service Grade A Pasteurized Milk
Ordinance.
PERFORMING AGENCY agrees to comply with the following: Texas Immunization
Laws, Rules and Regulations; Chapter 42, Human Resources Code; Sections 2.09 &
2.09A, Texas Education Code; and, Section 317 of the PHS Act as amended.
PERFORMING AGENCY agrees to closely adhere to both the spirit and ,intent of
the "Standards for Pediatric Immunization Practices," as recommended by the
National Vaccine Advisory Committee, approved by the U.S.P.H.S. and endorsed
by the American Academy of Pediatrics.
PERFORMING AGENCY will provide an estimated 13.000 clients with
services/units of service in or benefiting the county(ies)/area defined as:
-2-
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
Immunization Program Requirements: PERFORMING AGENCY understands that federal
law guarantees access to immunization services in public clinics regardless of
ability to pay. PERFORMING AGENCY further understands that the! bilingual
poster "Fees for Vaccine Administration," (form 6-36, available from the
Immunization Division) must be posted where they may be easily seen by
patients in each immunization waiting room.
PERFORMING AGENCY agrees that if fees are collected they will be kept
to a minimum and that no one may be denied immunization services because
of inability to pay the fee. Fee schedules will not be based upon a cost
per dose.
SECTION IV. BUDGET:
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to PERFORMING AGENCY for costs
incurred in carrying out approved activities.
Personnel
$53,698.00
Fringe Benefits
139416.00
Travel
.00
Equipment
.00
Supplies
.00
Contractual
24,000.00
Other
.00
Total Direct Costs
$91,114.00
Indirect
.00
TOTAL
$91,114.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
RECEIVING AGENCY financial assistance will not exceed $91,114.00.
-3-
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the
provision of materials or supplies such as vaccines in lieu of cash.
Personnel (03 position(s)) $69,612.00
Laboratory Support 14,000.00
Vaccine 127,283.00
TOTAL $210,895.00
Direct assistance for personnel in the amount of $69,612.00 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.
Direct assistance for public health laboratory services is provided by
RECEIVING AGENCY, Bureau of Laboratories, through requisition for
supplies processed in accordance with RECEIVING AGENCY guidelines.
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 attachment(s) benefiting
from this assistance.
RECEIVING AGENCY direct assistance will not exceed $210,895.00.
Total RECEIVING AGENCY assistance will not exceed $302,009.00.
-4-
TEXAS DEPARTMENT OF HEALTH LUBBOCK CITY HEALTH DEPARTMENT PAGE 643
OPERATING BUDGET FOR YEAR ENDING AUGUST 31, 1993
AS OF APRIL 30. 1992 BUDGET NO. L0000
H21311/K13028
CATE- DESCRIPTION OR TITLE
GORY
FUND
END
ITEM
JOB
PAY
PAY
EFFECTIVE MONTHLY
DESC.
MONTH
NO.
CLASS
GP
STP
DATE
RATE
1 NURSE II
STATE
AUG
018
4385
14
O5
SEP 92
2,316.00
LIC VOCATIONAL NURSE It
STATE
AUG
083
4412
10
04
SEP 92
1,771.00
ADMINISTRATIVE TECH I
STATE
AUG
104
1501
08
07
SEP 92
1,714.00
BUDGETED AMT
27,792.00
21,252.00
20,568.00
69,612.00
FY 1993
PERFORMANCE -BASED CONTRACT OBJECTIVES
11�
ATTACHMENT FOR
LUBBOCK CITY HEALTH DEPARTMENT
Health Department
City of Lubbock
1902 Texas Avenue
P.O. Box 2548
Lubbock. Texas 7940E-9961
June 1.1, 1992
Barbara N. Samuels, M.D., Director
Community Health Services,
Community and Rural Health
Texas Department of Health
1100 West 49th Street
Austin, Texas 78756-3199
Subject: Revised Performance Contracts
Dear Doctor Samuels:
This letter is in response to your letter dated May 15, 1992
pertaining to "Deadline -for final Performance Based Contract
Objectives." Enclosed please find the final revised performance
based contract project plans for Lubbock City Health Department
as negotiated with Regional staff and select Central Office
Program Managers. In answer to your three questions:
1. We agree with the Performance -based Contract Objectives
as negotiated and attached.
2. As the objectives have reached your office prior to
June 15 we do not anticipate funding being delayed.
3. The following are programs supported by Texas
Department of Health Funds:
Maternal Health Dental
Family Planning Sexually Transmitted Diseases
Immunization HIV/AIDS
Communicable Diseases Laboratory Services
Other programs operating out of the Health Department
but not funded by the Texas Department of Health
include:
swimming Pool
Sanitation
Institutional
Sanitation
Food Protection
Air Pollution
Animal Control
Guadalupe Primary Care
Rodent Control
Vector Control
Enteric Disease Investigation
Private Waste Disposal
Private Water Supplies
General Community Hygiene
Community Services
(for Utility Assistance
Care Clinic for and winterization)
Homeless Medicaid Qualification }
Guadalupe Early HIV
Intervention Clinic
There are many,, -many public health programs that we do
not have because of the lack of funding. If the State
has additional funds I would be happy to submit a
priority list of Community Public Health needs however,
I feel to answer your question on programs I do not
have would be to extensive to place in this memo.
Please call if you have any questions about these negotiated
revisions.
Sincerely,
R. Dou Goodman
Public Health Administrator
FOCUS: FOOD PROTECTION
Outcome Obiectives
- During fiscal 1992-93, the
average number of critical
violations per inspection
for food service establish-•
ments will be less than 1.3.
Process Objectives
- By January 1993, at least 80%
of all sanitarians conducting
retail food inspectionS will
receive field Standardization
training in accordance with
FDA guidelines.
- During fiscal 1992-93, all
foodborne illness complaints
will be documented properly
to identify complainant's
illness and investigated
within 24 hours.
Rev. 6/92
INDICATORS
- Average number of
critical violations
per food service
establishment.
Percent of
Standardized
Sanitarians.
- Elapsed times between
report of illness and
subsequent investiga-
tions.
FOCUS: FOOD PROTECTION
utcome_Obiectives
- During fiscal 1992-93, the
average number of critical
violations per inspection
for food service establish-
ments will be less than 1.3.
Process Objectives
- By January 1993, at least 80%
of all sanitarians conducting
retail food inspectionS will
receive field Standardization
training in accordance with
FDA guidelines.
- During fiscal 1992-93, all
foodborne.illness complaints
will be documented properly
to identify complainant's
illness and investigated
within 24 hours.
Rev. 6/92
INDICATORS
- Average number of
critical violations
per food service
establishment.
- Percent of
Standardized
Sanitarian .
- Elapsed times between
report of illness and
subsequent investiga-
tions.
HIV/AIDS PROGRAM
-
r
FY 81-92
. ►r' QQT•�Q „OBJECTIVE rC* , ...
EVALUATION FORj j,A
MONITORING PLAN
STRATEGIES -
L By 1995, the annual incidence of
0 Cases
Annually
Process Objectives and Activities
newly .diagnosed AIDS. drag infection will
.HIV
be no more than 35 neN eases per year.
PROCESS ONECTIVBs • , .. .
r • �., •�
if- During 1rY 9i-62i" OO ittdividuala
0Pre-test Counseled
Quarterly
Provide on -going CTPN program.
identified at high risk will be provided
Annually
Administer high -risk questionnaire
with pre -test HIV counseling.
to all patients in STD and
t
women's health clinics.
2. During FY 9142,j100% of clients with
9 reierre¢ for CTPN x 100
Quarterly
See Process Objective 01
an identified risk for HIV infection will
R HIV risk
Annually
be offered HIV pte-test counseling, test-
ing And post-test counseling from a TDH
certified counselor, either on -site or
through specific referral to an appropriate
counseling and testing site.
3. During FY 91-92, 80% of those tested
p DIV tented x 100
Quarterly
Stress importance of post-test
will receive post-test counseling.
A reeeiving.post-test
Annually
counseling.
counseling
Educate patient regarding meaning
of positive and negative test
results.
Provide convenient appointment
date and time; and confidential
setting.
4.1 By the end of FY 91-92, 95% of groups
gMps provided w/ apea
x 100 Annually
Provide on -going activities of HIV
requesting presentations on HIV/AIDS will
groups requesting speakers
AIDS Education Coordinator to:
be provided with knowledgeable speakers.
identify groups needing education
arrange for knowledgeable speakers
coordinate w/ other agencies thru:
personal contact ,
quarterly newsletter
page 1
ACTIVITY
EVALUATION FORHULA
MONITORING PLAN
8 TEGIES
1. At least 30 hours of testing and
0 hours
Quarterly
Provide 20 hours of testing at
counseling will be provided to identified
Annually
Health Dept, per week, excluding
high risk groups per week; to include
holidays.
on -site and off -site locations.
Provide 10 hours of testing at
off -site locations, per week,,"
excluding holidays..
2. Identified high risk individuals in
a individuals
Quarterly
See Process. -Objective #1. ►„r '-
STD and Women's Health clinics will
Annually
Provide on-401ng training cf',ptaff
receive counseling by appropriately
as HIV'counselors, by approved:
trained staff.
Counselor -Trainer. ,J%; s
3. Appointments will be scheduled for
0 a ppointmenta -
Quarterly
.,..
Provide convenient appointmeata
800 parsons to receive post-test
p
Annually
for patient counseling.
counseling.
4. During FY 91-92, 1,800 persons will
0 educated
Quarterly
Sae Process Objective 04. .
receive HIV/AIDS education arranged by
Annually
HIV/AIDS Education Coordinator.
PTA
.:,,� r: .. is • { . ; � , •r ..
r .
.
page 2 �t ''•r�"�M1�:
qw\diagram
f eJ•6;q
�liy • i=li • c •
I. By 1995, the vaccine -preventable
disease rate pill not;exeeed 20 per
1000000. population o.'. ,. s..
PROCESS OBJECTIVES
I. By the end of.FY 91-92, at least
75% of the two year old population
attending the Lubbock Health Department
Clinic will have completed primary
Immunizations, as recommended by AAP/CDC.
2. By the end of FY 91-921 100% of vaccine
Preventable diseases still be investigated
within 24 hours of reporting.
9. By the end of FY 91-92, 100% of the
area Independent School Districts will
receive information about the Health Dept.
Immunization Clinic hours and requirements
for -Texas Public Schools.
4. Ar the end of FY 91-92, increase
immunizations for Tetanus -Diphtheria.
Influenza and Pneumecoccal Pneumonia in
adult clients of the Health Dept. by 20%
over FY 89-90 (2,818).
ACTIVITIES -
1. Survey Immunization records of 100%
of two year olds attending the Health
Department.
2. Send reminders to all those with
delinquent immunizations.
IMMUNIZATIONS (VACCINE -PREVENTABLE DISEASES)
FY 91-02
MhUATION FQBMA MONITORING PLAN STRATEGIES
p vaccine -preventable Annually Process Objectives and Activities
diseases x 100,000
1.87
0 2 year olds in
comnli nce x 100
Annually
Conduct surveillance of records
0 2 year olds
of 2 year olds.
Notify by post card those with
delinquent immunizations.
9 investigated w/in
Annually
Assign 2 CHNs to communicable
-24 hours x 100
9 diseases reported
disease investigation as part of
their job duties.
p rQceivingormaD x 100
Annually
Prepare information flyers in
4 school districts
sufficient quantity for use by
area school districts and
Private schools.
FY 91-92 0 - 2 818
2,818 100
Annually
Advertise on Spanish radio station
x
when Influenza imm. is available
Evaluate every adult receiving
Health Dept. services for
Immunization needs.
Refer adults in need to Immuniza-
tion clinic.
A records surveyed
!1 records
Quarterly
Conduct on -going review of records
Annually
of children born in 1990.
z sent rem era
It delinquent
Quarterly
Hail post card reminders to all 2
Annually
year olds with delinquent
immunizations.
page 1
ACTIVITIES (con't) EVALUATION FQRMULA
MONITORING PLAN(
STRATEGIES
3. Provide immunization information 0 sent information x 100
Quarterly
See Process Objective $3.
to 100% of parents at time of spring # carolling children
Annually
kindergarten enrollment into area schools.
4. Provide at least 22 hours of 0 hours
Quarterly
Provide at least 4.5 hours of
immunizations clinic services each week.
Annually
clinic services 5"days per
week, excluding hglidayp,
• i �'Y •.t 1 x�!' i�e�Y .
:ts f �_
ty
Alt '
'y
qw\diagraw
pain N+�S4�s;
4S�T�OME OBJgCTt„VS
t. +' i► fl9dSi tliA,iloit;birthweight (less
.�han 2600 giA3.j percentage of Lubbock
Health'Dept4
..0atietita will be no
t.?kit hiahe�r.,than d.pet�aeti.of live births.
PRESS O�C'P�rj;g
'ROMEN'S HEALTH PROGRAMS
EVALUATION FO ry 91-92
RNULA WHIMUM PLAN
p LB._. F1 inf ate x 100
a deliveries
It Bythe, end.et,,FY:91-92; 50% of women • 9 admitted in
a�tbfidi LbbboC, 94 k Dept prenatal
care tll nod'mill' hll�' . Ifi ,tiAted care --drat t me e x 100
i total admissions
Nithih thbi�rsbih�brmoaths o! pregnancy.
40
2. baring FY 91292 .i00%'of women with
positive pre8nin�.# tests at the Lubbock
Health Dept. .pill bive,cotlnseling re-
gardingthe ifnporteflbk bf timely prenatal
care. ..
P counaeled_m PNC
women with positive x 100
pregnancy tests
Annually
STRATEGIES
Process Objectives and Activities
Conduct
Annually Activities,insuch 0as:
reach
Local churches.
Spanish radio station.
Providing pregnancy testing during
evening hours.
Quarterly Write as Standard of Care in
Annually Policy and Procedure Manual.
3. Dr.the end of FY 91-92, 70% of patients 0 women enrolled at
n
with pasitilre pregnancy tests at the Lubbock H�� with
Health Depta *ill bnroll.foz;prenatal ogre p women with P1,- x 100
at the Health Department,•:' positive
c ,0." tfir" Pregnancy teat
�`� AS�1virlEs •::�
I. Daring FY 91-92, provide at least 20 0 clinic hours
hours of prenatal care services each week.
2. During FY 9i-92i provide at least 5
hours of pregnancy testing and counseling
r each;rk k
9. During FY 91-92. the length of time
bet*een Identification of pregnancy and
:.',and first prenatal Arisit will be reduced
wi+11from 14,to 10 days or less.
9 testing hours
# days
Provide appointments to women who
qualify at the time of testing.
Quarterly
Annually
Provide 4 clinic hours 5 days per
week, excluding holidays.
Quarterly
Annually
Provide 1 hour of testing and
counseling, 5 days per week,
excluding holidays.
Evaluate the addition of 1 hour
each week, during evenings.
Annually
Provide sufficient staff to con-
duct enrollment interviews.
page 1
IY
•1
OUTCOME OBJECTIVE EVALUATION FORMULA MONITORING PLAN
2. By 1995, the percent of second or # G2 (or more) teens Annually Proc)e¢s'Op pa iyea and�Aa YI }pp
more births to women under 18 years old under 18 x 100 .'>'.
will not exceed 10% of teens receiving # teens receiving 649F
Health Department prenatal care services. prenatal care
PROCESS OBJECTIVES
i
1. During FY 91-92, the percentage of 0 post-partum.appto. i Quarterly! ProvidgI'op��o 'udvap`i,'dp� �putia
Lubbock Health Dept. prenatal clients kept x 100 l ;Annually t:� need tprF ¢ ► ua►'Qg�4� `-
seen for post-partum car® will be # post-partum pts. _. Canduat hOapP�aup¢a,;.� I
maintained at 60%. 4=air Health Do I, patients.'
Make post-Partum appt. be*ore-
hospital dipahArge i
Send I.Orto." 71?f0jum
a►;e ``� N�ek
.. ,�. ,1 , = • Follow
ACTIVITIES
ki 1. During FY 91-92, provide at least 20 # hours Quarterly'"'Providq��r'l� %14�
hours of family planning services each week. :+ 3g�:;.,.,.
Annually 5 daFp
•
2. During FY 91-92, 100% of patients # patients counseled Annually write.es SCatidard of Cerp;lq,,
receiving prenatal care will be counseled # patients receiving .Polio
regarding post-partum care and family y+d:gacAduyq Ma�}yA,'
prenatal care ,•.,
planning services. ;1 i fit ,- V ►�� *�s'- l i '
&
qw\diagrams A `
page ¢ "1
+
• 7J�1;' �E i-, � [:fats! It !
,)z S
DOCUMENT NO. C3000376
ATTACHMENT NO. 02
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF MATERNAL AND CHILD HEALTH.
TERM: September 1, 1992 THROUGH August 31, 1993
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will provide or assure the provision of the following health
services to women and children: family planning services, especially during
the first year post partum, and preventive child health services. Special
emphasis should be given to low income women and children. In addition, the
PERFORMING AGENCY will provide case management services to these women and
children with an emphasis on services to high risk individuals. Case
management services include an assessment of the individual's and family's
service needs and the development, implementation, and evaluation of a plan
to meet these needs.
Services will be performed in accordance with the guidelines for maternity,
family planning, child health, and case management services as promulgated by
RECEIVING AGENCY, Bureau of Maternal and Child Health. The Maternal and Child
Health Service Plan is incorporated herein and made a part of this contract.
Maternity, Family Planning, Child Health Clinic, and Case Management services
reports will be submitted to RECEIVING AGENCY, Bureau of Maternal and Child
Health, in a format and time frame to be agreed upon by both parties.
PERFORMING AGENCY will participate in the coordination of Maternal and Child
Health services under the leadership of RECEIVING AGENCY'S Public Health
Regional Director. The Public Health Region (PHR) will invite a broad -based
participation to its meetings to include community -based providers, city and
county officials, community health center personnel, migrant health center
personnel, and medical schools, and agricultural extension agents.
PERFORMING AGENCY will work with the PHR in order to coordinate services,
avoid duplication, report unmet needs of the community, and help to develop
"One Stomp Shopping Care Centers" where possible.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
General Provisions, PROGRAM INCOME Article, is modified for the purposes of
this attachment to comply with Section 2192(a), Title V, Social Security Act,
Maternal and Child Health Block Grant, which does not allow low income mothers
and children to be charged a fee for health services provided under this
attachment. The term "low income" refers to an individual or family on
Medicaid, income eligible for Medicaid, or with an income determined to be
below the nonfarm income official poverty line defined by the Office of
Management and Budget and revised annually in accordance with Section 624 of
-1-
T
r e
the Economic Opportunity Act of 1964. No individual may be denied services
because of the person's inability to pay.
General Provisions, REPORTS AND INSPECTIONS Article, is modified to include
the following:
PERFORMING AGENCY will provide unduplicated reports based on:
Patients receiving maternity, child health, family planning and case
management services including total number of patients seen.
SECTION IV. BUDGET:
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to PERFORMING AGENCY for costs
incurred in carrying out approved activities.
Personnel
$177,699.00
Fringe Benefits
43,413.00
Travel
.00
Equipment
.00
Supplies
16,733.00
Contractual
169200.00
Other
.00
Total Direct Costs $254,045.00
Indirect .00
TOTAL $254,045.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
RECEIVING AGENCY financial assistance will not exceed $254,045.00.
-2-
r
r
r
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the
provision of materials or supplies such as vaccines in lieu of cash.
Personnel [ 2 position(s)l $31,404.00
TOTAL $31,404.00
Direct assistance for personnel in the amount of $31,404.00 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 attachment(s) benefiting
from this assistance.
RECEIVING AGENCY direct assistance will not exceed $31,404.00.
Total RECEIVING AGENCY assistance will not exceed $285,449.00.
-3-
• � .i '
ter
♦
LUBBOCK CITY/FAMILY HEALTH
SERVICES PAGE 644
TEXAS DEPARTMENT OF HEALTH
PHR
2
OPERATING BUDGET FOR YEAR ENDING
AUGUST 31. 1993
AS OF APRIL 30 1992
H21311/K13028
BUDGET NO. LC301
CATE- DESCRIPTION OR TITLE
FUND
END ITEM JOB
PAY
PAY EFFECTIVE MONTHLY
BUDGETED AMT
GORY
DESC.
MONTH NO. CLASS
GP
STP DATE RATE
1 CLERICAL SUPERVISOR II
STATE
AUG 088 0063
07
01 SEP 92 1.345.00
16,140.00
COMMUNITY SERV AIDE III
STATE
AUG 131 5503
06
01 SEP 92 1,272.00
15,264.00
31,404.00
x
DOCUMENT NO. C3000376
ATTACHMENT NO. 03
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: HIV DIVISION
TERM: September 1, 1992 THROUGH August 31, 1993
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY agrees to conduct health education/risk reduction projects
which prevent infection and reduce the transmission of human immunodeficiency
virus/acquired immunodeficiency syndrome (HIV/AIDS). Project activities and
materials will be appropriate to the general public or the target populations
identified in PERFORMING AGENCY'S objectives. Strategies to accomplish the
projects must demonstrate cost-effectiveness, innovation, coordination, and
collaboration with other community efforts —
All information and education materials developed and provided by PERFORMING
AGENCY will be accurate, comprehensive, and consistent with current findings
of the United States Public Health Service.
PERFORMING AGENCY agrees that all activities will be performed in accordance
with PERFORMING AGENCY'S objectives, activities work plans, and detailed
budget as approved by RECEIVING AGENCY. All of the above named documents
are adopted by reference as part of this Attachment. Any revisions to said
documents will be approved by RECEIVING AGENCY and transmitted in writing to
PERFORMING AGENCY.
PERFORMING AGENCY agrees to comply with the following:
Chapters 81 and 85 of the Health and Safety Code.
PERFORMING AGENCY will provide an estimated 2.151 clients with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
RECEIVING AGENCY will supply PERFORMING AGENCY with the most current version
of the document entitled "Content of AIDS -Related Written Materials,
Pictorials, Audiovisuals, Questionnaires, Survey Instruments, and Educational
Sessions in Centers for Disease Control Assistance Programs," and its preface
which is written by RECEIVING AGENCY. PERFORMING AGENCY has provided
RECEIVING AGENCY with written acknowledgement of receipt and assurance of
compliance with these guidelines. All of the above referenced documents are
incorporated as part of this Attachment as though written herein verbatim.
Due to the sensitive and highly personal nature of HIV/AIDS-related
-1-
0
information, strict adherence to the General Provisions Confidentiality
Article is required. PERFORMING AGENCY success depends upon whether persons
at risk believe that the program observes this principle.
Program reports are due no later than the 20th of the month following the end
of each quarter.
PERFORMING AGENCY will authorize their staff to attend training, conferences,
and meetings for which funds were budgeted and approved by RECEIVING AGENCY.
SECTION IV. BUDGET:
Personnel
$26,252.00
Fringe Benefits
6,038.00
Travel
780.00
Equipment
.00
Supplies
292.00
Contractual
.00
Other
1,538.00
Total Direct Costs $34,900.00
*Indirect 1,100.00
TOTAL $36,000.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements will not exceed $36,000.00.
*The negotiated amount is less than UGCMA, Table 1.
-2-
DOCUMENT NO. C3000376
ATTACHMENT NO. 04
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: HIV DIVISION
TERM: September 1, 1992 THROUGH August 31, 1993
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY agrees to conduct counseling, testing, referral, and partner
notification (CTRPN) activities to help reduce the spread of human
immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS). CTRPN
activities include establishing and maintaining anonymous and/or confidential
HIV testing programs for persons at risk of HIV infection due: to individual
sexual behavior, intravenous drug abuse, or other risk behaviors.
All information and education materials developed and provided by PERFORMING
AGENCY will be accurate, comprehensive, and consistent with current findings
of the United States Public Health Service.
PERFORMING AGENCY agrees that all activities will be performed in accordance
with PERFORMING AGENCY'S objectives, activities work plans, and detailed
budgets as approved by RECEIVING AGENCY. All of the above named documents
are adopted by reference as part of this Attachment. Any revisions to said
documents will be approved by RECEIVING AGENCY and transmitted in writing
to PERFORMING AGENCY.
PERFORMING AGENCY will provide CTRPN services to the target population
defined as:
1. Males who routinely have sex with other males.
2. Males who occasionally have sex with other males.
3. Males who have sex with males and females.
4. Males and females with multiple sex partners.
5. Persons with a history of sexually transmitted diseases.
6. Persons with a history of high risk behavior.
PERFORMING AGENCY will perform the following Counseling and Testing Services:
1. Offer voluntary anonymous and/or confidential HIV testing to clients who
may want to be tested.
2. Provide culturally sensitive and effective pretest and posttest
counseling based on Centers for Disease Control (CDC) approved model.
3. Publicize HIV counseling and testing services so that potential clients
will know where and when services are available.
4. Offer HIV counseling and testing services at a location that is
convenient for the majority of the target population and during hours
established to reach these clients.
-1-
ti t rr;
• 1 0
5. Use scannable forms supplied by RECEIVING AGENCY for collection of
demographic information and blinded test result data. Activities will
be performed in accordance with TDH HIV Counseling and Testing Report
Form Manual (1-92).
6. Utilize RECEIVING AGENCY'S Laboratory for all ELISA and Western Blot
testing.
7. PERFORMING AGENCY will develop and maintain a referral plan by which
reciprocal linkages are established with other service providers
(especially other RECEIVING AGENCY funded providers) for the purpose of:
a. ensuring that behavior changes occur and are sustained;
b. providing psychosocial services;
c. medical intervention;
d. substance abuse treatment;
e. family planning services;
f. financial and legal services;
g. case management;
h. long term care.
PERFORMING AGENCY will perform the following Partner Notification Services:
1. All partner notification services are to be consistent with RECEIVING
AGENCY'S Serologic Test Counseling and Partner Notification Techniques
guidelines which are incorporated by reference and made: a part hereof.
2. Encourage HIV+ clients to voluntarily refer their sexual and/or needle
sharing partners for HIV counseling and testing.
3. Encourage intravenous drug users (IVDU) to voluntarily refer their
sexual and/or needle sharing partners for HIV counseling and testing.
4. If the client wishes to make the partner notification personally,
provide guidance in making contact.
5. If the client does not want to make the partner notification, but wishes
partners to be notified, elicit adequate information for STD personnel
to make the notification. Elicited information will be referred to the
local health department/regional STD program receiving funds for partner
notification activities. The local health department/regional STD
program personnel will make the partner notification.
PERFORMING AGENCY agrees to comply with the following CTRPN Quality Assurance
Guidelines:
1. PERFORMING AGENCY assures that pretest and posttest counseling sessions
are performed by staff who have received counseling training from a
course approved by RECEIVING AGENCY.
2. PERFORMING AGENCY will conduct monitoring of counseling, testing,
referral, and partner notification sessions. Through use of Quality
-2-
Assurance Systems (OAS) the PERFORMING AGENCY program manager will
possess current information and will monitor counselor performance (at
least monthly for months 1-6 of employment, bimonthly for months 7-12,
and quarterly for experienced counselors whether directly supervised or
on independent assignment. A written record (TDH skills assessment form
or other TDH approved model) of the monitored session is to be kept on
file.
3. PERFORMING AGENCY agrees to facilitate RECEIVING AGENCY review of
scheduled counseling, testing, referral, and partner notification
sessions.
PERFORMING AGENCY agrees to comply with Chapters 81 and 85 of the Health and
Safety Code.
PERFORMING AGENCY will provide an estimated 1,500 clients with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
RECEIVING AGENCY will supply PERFORMING AGENCY with the most current version
of the document entitled "Content of AIDS -Related Written Materials,
Pictorials, Audiovisuals, Questionnaires, Survey Instruments, and Educational
Sessions in Centers for Disease Control Assistance Programs," and its preface
which is written by RECEIVING AGENCY. PERFORMING AGENCY has provided
RECEIVING AGENCY with written acknowledgement of receipt and assurance of
compliance with these guidelines. All of the above referenced documents are
incorporated as part of this Attachment as though written herein verbatim.
Due to the sensitive and highly personal nature of HIP/AIDS-related infor-
mation strict adherence to the General Provisions Confidentiality Article
is required. PERFORMING AGENCY success depends upon whether persons at risk
believe that the program observes this principle. In addition to these
conditions, PERFORMING AGENCY will comply with TDH Bureau HIV STD Control's
HIV Serologic Testing and Documentation Guidelines. All of the above
referenced documents are incorporated as part of this Attachment as
though written herein verbatim.
Program reports are due no later than the 20th of the month following the
end of each quarter.
PERFORMING AGENCY will authorize their staff to attend training, conferences,
and meetings for which funds were budgeted and approved by RECEIVING AGENCY.
-3-
� � r
SECTION IV. BUDGET:
Personnel $23,830.00
Fringe Benefits 5,958.00
Travel 700.00
Equipment .00
Supplies 1,500.00
Contractual .00
Other 500.00
Total Direct Costs $32,488.00
*Indirect 1,177.00
TOTAL $33,665.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements Will not exceed $33,665.00.
*The negotiated amount is less than UGCMA, Table 1.
-4-
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS "78756-3199
CONTRACT CHANGE NOTICE NO. 5
STATE OF TEXAS TDH Document No. C3000376
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
-------------------------------------------------------------------------------
SUMMARY OF TRANSACTION:
Revision to public health services contract.
Attachment No. 05A — Amendment for WIC program to provide group nutrition
education, individual counseling and prescribed foods at
no cost to individuals identified as having nutritional
deficiencies.
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN,
CITY G= LUBBOCK
Authorized Contracting Entity (type above
if different from PERFORNING AGENCYI
farmed in behalf of:
PERFORMING WNqY
Lo
BY: ' _
(Signal of person au:)—thor ed
to siyn contracts)
David R. Langston, Mayor
(Name and Titlel
Date:
RECONNENDED:
By:
(PERF KING AGENCY tor.
if different from er an
authorized to sign Ntractl
Cover - Page i
TEXAS OEPARTNENT OF HEALTH
RECEIVING AGENCY
( a ure of person authorized
o sign contracts)
Linda Farrow. Chief
Bureau of Financial Services
(Name and Title)
Date: _a
APPROVED AS
By:
Office
DETAILS OF ATTACHMENTS
Att/;
;___Financial
Assistance
Am. TDH
Term
Source of
Direct
Total Assistance
No. ', Program ,_
Begirt '
End '
Funds%
Amount
assistance
Amount (TDH Share)
OtA CRN/Idl-LHS
9/ 1/92,
8/31/93;
STATE
116.843.00;
185,156.00;
302.QG9.GG'
02A MCH/FHS-LHS
9/ 1192;
8/31/93:
STATE
364,981.00'
31.404.00,
396,385.110'
03 HiV/EDUC-LHS ;
9/ 1/92;
8/31/93:
STATE
36.000.00;
.00;
36,000. G'
1 1
04 HIV/GHC-LHS
9/ 1/92'
8I31/93,'
STATE
33.665.00,
.00,
33.665.G0
t t ,
05A ; YIC/CARD-LHS
4/ 1/93:
9/30l93;
10.557 STATE
.00;
.00,
.Q0:
06 IMM/SPEC-LHS ;
5/ 1/93;
8131193:
STATE
20,562.00;
.00;
20.552,00'
1 1 ,
1 1 I
I 1 ,
t 1 1
t
1
!
e
I
1 1 1
1 I ,
1 1 1
1 t ,
,
•
+
1
1
I I 1
1 1 1
---------------------------------------------------------------------------------------------------------------------
TDH Document No. C3000376
TOTALS
b 572,051.00:
$ 216.570.00:
'
$ 788.621.00'
Change No. 05
1
1
1
I
t
$Federal funds are indicated by a
;
I
� '
Federal Domestic Assistance 1CFDA1. if
I
applicable.
number from the Catalog of
REFER TO BUDGET SECTION
OF ANY ZERO AMOUNT
ATTACHMENT FOR DETAILS.
COVER - Page 2
DOCUMENT NO. C3000376
ATTACHMENT NO. 05A
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF WOMEN, INFANTS, AND CHILDREN'S NUTRITION
TERM: April 1, 1993 THROUGH September 30, 1993
It is mutually agreed by and between the contracting parties to amend the
conditions of Document No. C3000376-05 as written below. All other conditions
not hereby amended are to remain in full force and effect.
SECTION I. SCOPE OF WORK, first paragraph, is amended to incorporate
immunization activities, and reads as follows:
PERFORMING AGENCY will provide supplemental food instruments, nutrition
education, and immunizations as an adjunct to good health care at no cost
to low income pregnant and postpartum women, infants, .and children
identified to be at nutritional risk. In meeting this goal, PERFORMING
AGENCY will:
SECTION I. SCOPE OF WORK, is amended by adding paragraph F. regarding
immunization activities which reads as follows:
F. Review the immunization record of WIC program applicants/participants
and provide immunizations as needed in accordance with Immunization
Policies provided by RECEIVING AGENCY to PERFORMING AGENCY using staff
funded under this attachment. (See new paragraph relating to reimburse-
ment for immunization activities added to SECTION III. SPECIAL
PROVISIONS, Terms and Conditions of Payment.)
The original paragraphs of SECTION III. SPECIAL PROVISIONS, which modify the
General Provisions, Terms and Conditions of Payment Article, are replaced in
their entirety as shown below. Items 4 and 5 are new provisions relating to
reimbursement for expansion of the WIC program to NEW participants and
reimbursement for new immunization activities.
The participant caseload quantity will be assigned by RECEIVING AGENCY by
giving written notice to PERFORMING AGENCY and may be subject to change
from time to time upon written notice to PERFORMING AGENCY from RECEIVING
AGENCY. PERFORMING AGENCY assumes liability for all foods costs
resulting from PERFORMING AGENCY exceeding assigned caseload maximum.
The number of individuals served in excess of assigned caseload are not
to be included in the calculation of earned administrative funds as
described below.
RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative
costs which include participant referral, vendor evaluation and'monitor-
ing, nutrition education, general administrative support, start' -up costs,
outreach, applicant screening, and food card issuance.
Administrative costs will be reimbursed based on actual costs, but not to
exceed the "maximum reimbursement" set out below, based upon the sum of
-1-
the participants who actually receive food instruments each month plus
infants who do not receive any food instruments whose breastfeeding
mothers were participants, to the extent that the total so derived does
not exceed the PERFORMING AGENCY'S total assigned caseload within any
given month. Surplus funds (the amount by which maximum reimbursements
exceed actual cost) can be accumulated and carried forward within the
attachment term. The time period during which surpluses may be recovered
will be determined by the RECEIVING AGENCY.
PARTICIPANTS SERVED PER MONTH MAXIMUM REIMBURSEMENT
First 500 participants served
$
9.12
per
participant
Next 1000 participants served
$
7.47
per
participant
Next 8500 participants served
$
5.00
per
participant
All additional participants served
$
4.79
per
participant
PERFORMING AGENCY agrees that:
(1) not less than 20% of total administrative costs will be separately
identified and documented as expenditures directly related to
nutrition education;
(2) RECEIVING AGENCY will reimburse PERFORMING AGENCY for administrative
expenses at a rate not greater than five times the amount of
properly documented expenditures for nutrition education, but not
more than is earned based on actual participation not to exceed
PERFORMING AGENCY'S assigned participant caseload;
(3) RECEIVING AGENCY will increase the maximum reimbursement to PERFORM-
ING AGENCY by an additional $.50 per each pregnant and breastfeeding
women participating in the PERFORMING AGENCY'S Program;
(4) RECEIVING AGENCY will further increase the maximum reimbursement to
PERFORMING AGENCY for efforts to expand the program to unserved
women, infants, and children eligible for WIC benefits. For the
period of May 1, 1993, through May 31, 1993, RECEIVING AGENCY will
pay PERFORMING AGENCY a one-time amount of $20.00 for each NEW preg-
nant and breastfeeding women participant and $10.00 for all other
NEW participants enrolled. RECEIVING AGENCY reserves the right to
extend such funding into later months of the contract attachment
with written notice to PERFORMING AGENCY.
NEW clients will be calculated separately for each month by sub-
tracting the previous month's reported participation from the cur-
rent month's participation. NEW clients will be counted for expan-
sion reimbursement only once. Therefore, each subsequent month's
participation level must be at a higher level than the previous'
month in order to qualify for new client expansion reimbursement.
(5) for the period of July 1, 1993, through September 30, 1993,
PERFORMING AGENCY will review immunization records of WIC program
applicants/participants and provide needed immunizations to such
-2-
children using staff funded under this attachment. PERFORMING
AGENCY will be reimbursed an amount not to exceed $28.700.32
for actual costs associated with performing this task in accordance
with the Clinic Checklist (budget plan) submitted by PERFORMING
AGENCY to RECEIVING AGENCY.
(6) RECEIVING AGENCY will identify annually to PERFORMING AGENCY an
amount of funds that must be spent for breastfeeding promotion.
Nutrition education expenditures must be supported by documentation
of participant attendance or non-attendance. The: breastfeeding
allocation of funds to the PERFORMING AGENCY will be based on the
RECEIVING AGENCY'S proportional share of the statewide combined
total of pregnant and breastfeeding participants as reported to the
RECEIVING AGENCY. For a PERFORMING AGENCY whose monthly participat-
ion falls below 500, RECEIVING AGENCY has the option to compute the
sliding scale allowable at a 500 participant level with the stipula-
tion that the 20% nutrition education expenditure requirement is
met. RECEIVING AGENCY reserves the right to exclude and/or recover
any expenditures that have been claimed and/or paid that are not
authorized by the regulations and/or directives pertaining to the
program.
RECEIVING AGENCY also reserves the right to withhold a proportionate
amount of earned administrative funds when evidence exists that
nutrition education and/or breastfeeding promotion is not being
provided by PERFORMING AGENCY, or PERFORMING AGENCY is not complying
with the provisions of USDA and/or RECEIVING AGENCY directives.
(7) RECEIVING AGENCY reserves the right to grant exceptions to the above
funding formula(s) to serve the best interest of the Texas WIC
Program.
-3-
TEXAS DEPARTMENT OF HEALTH
1100 WEST .49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 6
STATE OF TEXAS TDH Document No. C3000376
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTHDEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
------------------------------------------------------------•-------------------
SUMMARY OF TRANSACTION: ,
Revision to public health services contract.
Attachment No. 06A - Institutional Prior Approval for Immunization Division to,'
fund a special immunization initiative to increase
Immunity levels for preschool children for measeles, ;
mumps, rubella, Haemophilus influenzae type b, diptheria,:
tetanus, pertussis and polio. ;
,
All terms and conditions not hereby amended remain in full force and effect. ;
,
RECEIVING AGENCY
Texag Department of He 1
By:
(Signature of person authorized
to sign)
,
Glenn W. Rust, Acting Director
Grants Management Division
(Name and Title)
Date:
,
,
Cover - Page 1
DETAILS OF ATTACHMENTS
R6W ;
Financial
Assistance
Am.
TDH ;
Term ;
Source of
Direct ;
Total Assistance
No.
Program ;_ Begin ;
End
Funds*
Amount ;
Assistance
Amount )TDH Share)
01A
; CRH/I5l-LHS ; 9/
1/92;
8/31/93;
STATE
116.843.00:
185,156.00;
302.009.00'
i
1 1
1
I
I
02A
; MCH/FHS-LHS 9/
1/92;
8/31/93;
STATE ;
364.981.00:
31,404.00;
396.3E5.G0,'
I 1
1
f
'
'
'
03 ;
HIV/EDUC-LHS ; 9/
1/92;
8/31/93;
STATE ;
36,000.00:
.00;
36.000,00
04 ;
HIV/GHC-LHS 9/
1/92;
8/31/93;
STATE ;
33,665,00:
.00;
33.S65. 0;
i I
1
i
05A ;
MIC/CARD-LHS ; 4/
1/93;
9/30/93;
10.557 STATE ;
.00;
,00;0
I 1
,
I
,
,
1
1
06A ;
IMM/SPEC-LHS ; 5/
1/93:
8/31/93:
STATE ;
20.562.00:
1
,00;
20,562.�0;
'
1 I
! I
,
;
1 I
,
!
}
!
1 1
,
1 1
1 1
,
,
1
1
t
1 1
t
!
I
!
I
I
f
I
1
1 1
,
f t
1 1
1
I
!
1
I
1
!
I
1
1
I 1
1 1
,
1
}
1 I
,
1 1
�
I I
I
I
1
t
.--------------------------------------------------------;-----S-----
TDH Document No. C3000376
TOTALS
---------------------------------------------�
,00;
$ 216,570.00;
$ 788,621,00;
Change No. 06
,
aFederal
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
TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: IMMUNIZATION - SPECIAL - LHS
Performing Agency: LUBBOCK CITY HEALTH DEPARTMENT
TDH Document No. C3000376 Change !# 6 Term: May 1. 1993 _- August 31. 1993
Attachment/Amendment No 06A IAC No. ( - )
REVISED CONTRACT BUDGET
/------------------------------------------------------------------
\
FINANCIAL ASSISTANCE
,Object Class Categories ;
Current Approved ;Change
Budget (a) ;
Requested ;
New or Revised '
!
'
'---
Budget (c)
9
a.
Personnel
$17,098.00
($17,098.00);
'
--------------------------
;b.
---------------------------------------
Fringe Benefits '
.00 ,
-------- --
---------------------------------------------------------------------
.00
;c.
Travel
.00 ,
.00
'
;
'--------------------------
--
.00
;d.
Equipment
$2,264.00
------
$2,264.00 �
--------------------------
------------------------------------------------------------
,
:e.
Supplies
$1,200.00
.00
,
$1,200.00
--------------------------------------------------------------------------------------;
,f.
---
Contractual
.00
$17,098.00
$17,098.00
----------------------------------------------------------------------------
Other
-
,9•
'-------------------------
---------
.00 ,
.00 "
.00 ,-
:h.
'---------------------------------------------------------
Total Direct Charges
$20,562.00
.00
'
20 562 00
;i.
Indirect Charges
.00
--------- .00 �-------------------
�
__
--------------------------------
--------------------
,
.00 ,
:j
-----------------------------------$-----------------------.00
TOTAL
-
---------------
' $20,562.00,
;k.
'---------------------------
RECEIVING AGENCY share
20 562 00
'
20 562 00
'l.
PERFORMING AGENCY share;
.00
_ _
'
00
,
(Includes m. PI)
,---------------------------------------------
--------------------
'm.
Program Income �
.00,
.
.00
.00
'-------
_ _ ----------------------------------------------------------
,
.00�-------------------�
,
;Detail
on Indirect Charges:
Type of Rate (Mark one
Box) _ Provisional
Predetermined
_ Final
_
Fixed
Rate 0.00 Base
.00 Total Indirect
_
Charges
;
.00
-----------------------------------------------------------------
;EXPLANATION OF CHANGE
;
'Reallocate funds from personnel to contractual.
Form
No. GC-9
'
Rev.
03/91
Texas Department of Health
David R. Smith, M.D. 1100 West 49th Street
Commissioner Austin, Texas 78756-3199
(512)458-7111
August 19, 1993
DOUG GOODMAN
PUBLIC HEALTH ADMIN.
LUBBOCK CITY HEALTH DEPARTMENT
P. 0. BOX 2548
LUBBOCK, TX 79408-2548
TDH Document No. C3000376
Change No. 05
Dear Mr. Goodman:
Robert A. MacLean, M.D.
Deputy Commissioner
I have enclosed an approved copy of your public health services contract. Please
file it with the office of record for your agency.
If we may be of further assistance, please call us at 512/458-74.70.
Sincerely,
tdL4� -
"47&
/1 Glenn W. Rust, Acting Director
Grants Management Division
GWR:am
Enclosure
STATE OF TEXAS
COUNTY OF TRAVIS
TEXAS DEPARTMENT,OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 7
TDH Document No. C30O0376
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
---------------------------------------------------
SUMMARY OF TRANSACTION:
Revision to public health services
contract.
Attachment No. 04A — Amendment for
counseling, testing, referral, and partner ;
notification for HIV general health care services.
;
All terms and conditions not hereby
amended remain in full force and effect.
;
EXECUTED IN OUPLAICATE ORIGINALS ON THE: DATES SHOWN.
CITY OF LUBBOCK
;
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY)
;
for and bahalf of:
LUBBOCK 'Y HEALTH D ENt
TEXAS DEPARTMENT OF HEALTH
'
PERFORMIN
RECEIVING AGENCY
s BY:
'
(Signature o p rson authorized VIs.
0
t re of person authorized
to sign contracts)
to sign contracts)
=
Linda Farrow, Chief
DAVID R. LANGSTON, MAYOR
Bureau of Financial Services
;
(Name and Title)
(Name and Title)
' Date:
Date: 4' - x
RECOMMENDED:
APPROVED AS T ORH:
BY:
By:
(PERFORMING AGE Director,
Off'lce of Genera Counsel
if different f person
;
authorized to sign contract{
Corer - Page t
DETAILS OF �ATTA"CHMENTS
Att/;
;
Financial
Assistance
Am. TDH
Na. ; Program
Term ;
Source of ;
Fundsx ;
Amount
: Direct
Assistance
Total Assistance '
(TDH Share) ;
Beoin ; End ,
01A ; CRH/IIL-LHS ;
9/
1/92;
8/31/93:
STATE
116,843,00;
_;--Amount
185,166.00;
302,009.00:
02A ; MCH/FHS-LHS
9/
1/92;
1
8/31/93;
,
STATE ;
364,981.00:
31,404.O0:
396,385.00;
f
03 HIV/EDUC-LHS '
1
9/
1/92;
8/31/93;
STATE
�
1
36,000.00;
,
,00;
'
36,000.00;
04A ; HIV/GHC-LHS ;
9/
1/92:12/31/93:
STATE 93.118
44,950.00:
.00;
44,950.00
05A ; WIC/CARD-LHS ;
4/
1/93;
9/30/93:
10.557 STATE
.00;
.00;
.00;
06A ; IMM/SPEC-LHS ;
5/
1/33:
8/31/93:
STATE ,
20,562.00,
.00;
'
20,562.00;
1
1
'
I
1
I
1
'------------------------------------------------------------------------------
I
TDH Document No. C3000376
TOTALS
-------------------------
1
:
Change No. 07
$ 583,336.00;
S 216 510.00'
i
799,906.00
IxFederal
Federal Domestic Assistance (CFDA), if
applicable.
funds are indicated by a
number from the Catalog of
REFER TO BUDGET SECTION
OF
ANY ZERO AMOUNT
ATTACHMENT FOR DETAILS.
COVER - Page 2
TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: HIV -GENERAL HEALTH CARE-LHS
Performing Agency: LUBBOCK CITY HEALTH DEPARTMENT
TDH Document No. C3000376 Change # 7 Term: September 1, 1992 -December 31. 1993
Attachment/Amendment No 04A IAC No ( )
REVISED CONTRACT BUDGET
/------------------ -----------------------------------------------
FINANCIAL ASSISTANCE
----------
;Object Class Categories
Current Approved ;Change Requested ; New or Revised ;
Budget (a)
----------------------------------------------,----
(b) , Budget (c)
;a. Personnel
'
$23,830.00 ; $8,340.00 $32,170.00 ;
-------------------------- -----------------------------------------------------------
b. Fringe Benefits
$5,958.00 ' '
'
2 092.00 $8,050.00 ;
----------------------
;c. Travel
,
700.00 ; 128.00 $828.00
;d. Equipment
'---------------------
_ ,
'
'
.00 00
;e. Supplies1
'----------------
$1,500.00 ; $205.00 $1,705.00 ;
;f. Contractual
'
'
------------------------------------------------------
,00 00 00 '
Other
,g. ;
--------------------------
$500.00 ; $500.00
--------------------------------------------------------
;h. Total Direct Charges ;
--
$32 488.00
--------------------------------------------
1 $10,765.00 ; $43,253.00
;i. Indirect Charges
—
$1'177.00 '
$520.00 , 1 697 00*
-------------------------- -----------------------------------------------------------
:j. TOTAL
,
$33,665.00 ; $11,285.00 ; $44,950.00 ;
-------------------------- ----------------------------------------------------------
:k. AGENCY share ;
$33,665.00 ' '
, $11,285.00 ; $44,950.00 ;
;1. PERFORMING AGENCY share
-----------------------
------.00-----.00
'
(Includes m.. PI)
,
-------------------------- ---------------------------------------------------------
,
:m. Program Income
'
------------------------------------
,00 .00 00
;Detail on Indirect Charges:
, -------------------------------------------
;
Type of Rate (Mark one
Box) _ Provisional Predetermined
Rate 0.00 Base
_
_ Final _ Fixed
.00 Total Indirect Charges ;
---------------------------------------------------------
.00
;EXPLANATION OF CHANGE:
----------------------------- '
;
:Increase to add federal funds
in
and also extend term through 12/31/93 to align
,contract the federal year.
,
;Revised number to be served:
1,700 ;
;* Indirect cost is based on UGCMA, Table 1. ;
Form No. GC-9
Rev. 03/91