HomeMy WebLinkAboutResolution - 4644 - Contract - TDOH - Public Health Services - 10_20_1994Resolution No. 4644
Item No. 15A
City Council Date 10/20/94
BE IT RESOLVED BY THE CITY COUNCII. 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 Public Health Services Contract by and
between the City of Lubbock and the Texas Department of Health, attached hereto, 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 detail.
Passed by the City Council this 20t day off October , 1994.
.VID R.
ATTEST:
Betty W Johnson, Ci Secretary
APPROVED IAS TO CONTENT:
Doug Goode*-4)irector of Health and
Community Aces
APPROVED, AS TO FORM:
G. V�ndiver, First Assistant City Attorney
sqAemter k IM
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-9199
CONTRACT CHANGE NOTICE NO. 4
dtATE OF TEXAS TOH Document No. C5000255
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. ;
Att. No. 10 — Amendment to add a new
Attachment for Bureau of Laboratories to ;
provide funds to test
and provide annual reports on the work— ;
load indicated.
;
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)
;
for and in behalf of:
!; LV880CK CITY HEIL DEPARTMEKT
TEXAS OEPARTKEHT OF HEALTH '
,
-RFORNI ENCY
RECEIVING AGENCY ;
tV
,
By:
B
(Signat person authorize
at of person authorized
to sign contracts)
to sign contracts) ;
Linda Farrow, Chief ;
David R. Langston, Mayor
Bureau of Financial Services ;
{Name a(d Title)
(Nameand Title)
O
Date:
Date:
R E0:
APPROVED AS TO FORM: '
By:
By: Alfl J'&Q,
(PERFORMING AGENCY Director,
Office of General Counsel
if different from person
;
authorized to sign contract)
;
,
Cover - Page i
DETAILS OF ATTACHMENTS
Att/;
;
;
Financial
Assistance ;
v 1;
At.
; TDH
Term ;
Source
of ;
;
Direct ;
Total Assistance ;
No.
; Program
; Begin
;
End ,
Funds*
;
Amount ;
Assistance ;
Amount (TDH Share) ;
01
; HIV/GHC-LHS
; 1/
1/94:12/31194:
93.940
;
35,000.00:
.001
35,000.00
02A
; HIV/EDUC-LHS
; 9/
1/94:
8/31/95:
STATE
;
43,471.00:
.00;
43,471.00
03
; MID-LHS
; 9/
1/94:
8/31/95;
STATE
;
.00;
.00;
.00
04
; HIV/SURV-LHS
; T/
1/94:12/31/941
93.118
;
20,096.00:
.00;
20,096.00:
05
; TB/OR/ST-LHS
; 9/
1/94:
8/31/95:
STATE
;
20,073.00:
.00:
20,073.00:
06
; ORP-LHS
; 9/
1/941
8/31/95:
STATE
;
119,182.00,
43,440.00;
152,622.00;
OT
; INK/OPTS-LHS
; 9/
1/94:
8/31/95:
STATE
;
68,356.00:
140,011.00;-
208,367.00:
08
; VIC/FHS-LHS
; 9/
1/94:
8/31/95:
STATE
;
364,981.00;
32,515.00:
397,597.00:
09
; HIV/EIP-LHS
; 9/
1/94:
3/31/95:
93.911
;
47,194.00:
.00:
47,194.00:
10
; LAB-LHS
; 9/
1/94:
8/31/95:
STATE
;
.00;
76,000.00:
76,000.00:
---------------
--------------------------------------------------------------------------------------------------�
TDH
Document No. C5000255
TOTALS ;
: 718,353.00:
ii 292,067.00:
: 1,010,420.00;
Change
No. 04
=Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFOA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
COVER - Page 2
DOCUMENT NO. C5000255
ATTACHMENT NO. 10
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF LABORATORIES
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY laboratory agrees to test and provide reports to RECEIVING
AGENCY'S, BUREAU OF LABORATORIES, as requested to the appropriate categories
below in support of RECEIVING AGENCY statewide programs:
Milk bacteriology and chemistry; Syphilis serology; Gonorrhea and/or chlamydia
testing; Tuberculosis testing; and Other approved analyses. .
PERFORMING AGENCY agrees to meet standards for such analyses as set forth by
RECEIVING AGENCY, Bureau of Laboratories, the Clinical Laboratory Improvement
Act, the Safe Drinking Water Act, the National Conference of Interstate
Milk Shippers, and/or the Public Health Services Grade A Pasteurized Milk
Ordinance.
PERFORMING AGENCY will provide an estimated 46,500 specimen/samples in or
benefiting the geographic area defined as
LUBBOCK COUNTY AND BORDERING COUNTIES.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
General Provisions, PROGRAM INCOME Article, paragraph two, is not applicable
to this Attachment. However, additional instructions regarding program income
follow in the next two paragraphs.
In keeping with the RECEIVING AGENCY'S entrepreneurial efforts, it is the
RECEIVING AGENCY'S intent to encourage the use of locally earned Medicaid
funds to pay for or offset significantly the cost of the statewide syphilis,
gonorrhea, and chlamydia testing programs. To accomplish this, PERFORMING
AGENCY laboratories agree to bill Medicaid for eligible patients for the
following laboratory tests: syphilis serology screening, syphilis serology
confirmation, and gonorrhea and chlamydia diagnosis.
Program Income in excess of the reagent costs must be utilized by the
PERFORMING AGENCY to further the program objectives of the State statute
under which the Scope of Work for this Attachment was made.
General Provisions, FINANCIAL REPORTS Article is not applicable to this
Attachment.
-1-
SECTION IV. BUDGET:
Support for this scope of work is provided in part by the RECEIVING AGENCY,
Bureau of Laboratories, through supplies ordered directly from RECEIVING
AGENCY warehouse stocks or through reagents drop -shipped from vendors or from
RECEIVING AGENCY to the value limit set out below. Requisitions for supplies
will be processed in accordance with RECEIVING AGENCY guidelines. Any change
in the allotment amount must be approved by RECEIVING AGENCY, Chief, Bureau of
Laboratories.
WAREHOUSE ALLOTMENT-$6,100.00 REAGENT ALLOTMENT-$69,900.00
TOTAL ALLOTMENT-$76,000.00
CPZ
TEXAS DEPARTMENT OF HEALTH Resolution
1100 WEST 49TH STREET October 20,
AUSTIN, TEXAS 78756-3199 Item #15A .
' .CONTRACT CHANGE NOTICE NO. 1 '
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. C5000255
No.4644
1994
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.
Amendment to add new attachments for HIV Division (02), Milk and Dairy
Products Division (03), HIV Division (04), and Tuberculosis Elimination
Division (05), Office of Regional Programming (06), Immunization
Division (07), and Bureau of Women and Children (08). Revised General
Provisions attached.
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHORN.
CITY OF LUBBOCK
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY)
-far--ud in behalf of:
UBBOCK HEILUZURaERT
TEXAS DEPARTMENT OF HEALTH
AG CY
RECEIVING AGENCY
By. ,
( nature of person authorized
( i at a of person authorized ;
to sign contracts)
o sign contracts) ;
Linda Farrow, Chief
David R. , Lan stonMayor
8 Y
Bureau of Financial Services ,
(Name and Title)
(Name and Title)
' Date: October 20, 1994
Date:
RECOMMENDED:
APPROVED AS TO ORM:
By
By:
}
(PERFORMING AGENC )re tor.
Office of General Counsel
if different from person
authorized to sign contract)
,
:
,
Cover - Page 1 RECEIVED
NOV 101994
LUaM CITY HEALTH DEFL
` iv. ' •! DETAILS OF ATTACHMENTS ; t
Att/;
Financial Assistance
;
; Am.
; TON
'Ire ra
Source
of
Direct ;
Total Assistance '
No.
; Program
Begin End
Funds=
Amount
Assistance ;
Amount (TON Share)
01
; HIV/GHC- A ;
1/
1/9412/31/94;
93-40
; ?5.000.00;
.00;
35.OGO.GG;
1
02
1
; HIV/EOUC-LHS ;
i
9/
li94; 8131/95;
1
STATc
43.471.00;
I
.00;
42.471.00;
1
03
R&D-LHS ;
9/
1/94'. e131%95;
STATE
.00;
.00;
.00;
r
1
04
; HIV/SURV-LHS '.
7i
t/94;12131/94;
93.118
; 20.096.00;
.00;
20,095.00;
1
05
; TB/OR/ST-!HS '.
9/
1194:.9131i95;
STATH
20.073.00;
.00;
20.G73.07'.
06
Opp-LHS ;
V
1/94; 131/95;
STAT.
112.182.00:
43.440.00.
162.c22.30;
07
I
10V OPTS-:HS '
91
1/94; 81'i1/95;
STATE
68.356.00;
1.0.011.00;
208.367.00'
I
I
I
1
I
' 38
I
MaC/FfS- HS
9/
1/94; 8/31/95:
STATE
364.981.00;
1.2.616.00:
397..97.00i
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---------------- - - - - - - - - - - - - - - - - - - - - - - - - - I
TDH Docurent No. C5000255 TOTALS ; S 671,159.00; t 216,067.0G; t W ,226.00;
' Change No. 01
=Federal funds are indicated t•r a number frog the Catalog of Federal Domestic Assistance 1CFDA1, if aaol;caele.
REFER TO BUDGET SECTION OF ANY 7FRO AMOUNT ATTACHMENT FOR DETAILS.
i f L
GENERAL PROVISIONS.FOR
TEXAS DEPARTMENT OF HEALTH CONTRACTS
PERFORMING AGENCY and RECEIVING AGENCY,agree this contract, assurances, general
and/or special provisions, and Attachments) with detailed scope(s) of work and
budget(s), as applicable, incorporate tall covenants and agreements pertaining
hereto.No prior agreement or understanding; oral or otherwise, of the parties
or their agents.will be,vali& 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. Scone 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 Attachments) -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. Funding
This contract is contingent, upon funding being available for the term of the
Attachment(i) and PERFORMING AGENCY will, have no right of action .against
RECEIVING AGENCY in the event that 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.
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.
1395'GENERAL PRbVISIONS - Page 1 (5/94)
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. 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 written, approval from RECEIVING AGENCY for
major project changes which are specified in RECEIVING AGENCY's institutional
prior approval policy and the applicable Administrative Requirements and Cost
Principles. Copies of these documents are provided to PERFORMING AGENCY, by
RECEIVING AGENCY and are incorporated by reference as a condition of this
contract.
In accordance with Section 1352 of Public Law 101-121, effective December 22,
1989, PERFORMI,NG 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.
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 it 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.
1995 GENERAL PROVISIONS - Page 2 (5/94)
i
ARTICLE S. Assurances
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 all federal and state statutes, as amended,
relating to nondiscrimination. These include but are not limited to: Title VI
of the Civil Rights Act of 1964, (42 USC Sec. 2000e, et. seq.) which prohibits
discrimination on the basis of race, color or national origin; Title IX of the
Education Amendments of 1972, (20 USC Sec. 1681-1683 and 1685-1686), which
prohibits discrimination on the basis of sex; the Rehabilitation Act of 1973, (29
USC Sec. 794), which prohibits discrimination on the basis of handicaps; The
Americans with Disabilities Act of 1990 (42 USC Sec. 12101 et. seq.), which
prohibits discrimination on the basis of disabilities; The Age Discrimination Act
of 1975, (42 USC Sec. 6101-6107), which prohibits discrimination on the basis of
age; The Drug Abuse, Prevention, Treatment, and Rehabilitation Act, (21 USC Sec.
1101 et. seq.), relating to discrimination on the basis of drug abuse; the Age
Discrimination in Employment Act of 1967, (29 USC Sec. 621-634), which prohibits
discrimination in employment on the basis of age; the Comprehensive Alcohol Abuse
and Alcoholism Prevention, Treatment, and Rehabilitation Act of 1970, (42 USC
Sec. 4541 et. seq.), relating to nondiscrimination on the basis of alcohol abuse
or alcoholism; The Public Health Service Act of 1912, (42 USC Sec. 290dd-3 and
290ee-3), 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 federal or state statu h m ght apply to this contract.
��i'TOa � `t"(115 C..O��,'ES"QG-�'lent
��/
^PERFO ING AGENCY will comply with en tal 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
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 will 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;
1995 GENERAL PROVISIONS - Page 3 (5/94)
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.
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 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
Attachment (s). 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 Attachment(s) a cost must have been
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 Compensation
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
1995 GENERAL PROVISIONS - Page 4 (5/94)
C
.1 F
Form 8-13). Vouchers for reimbursement of actual expenses .will be submitted
monthly within 20 days following the'erid 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 month 1y'vou&hers. 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.
PERFORMING AGENCY may request, in writing, to be placed on Direct Deposit status.
If this request is approved by RECEIVING AGENCY, PERFORMING AGENCY will no longer
receive copies of reimbursement vouchers.
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 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
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 Payment
According to Treasury Circular 1075 (31 CFR Part 205) and RECEIVING AGENCY
procedures, PERFORMING`AGENCY may request, in writing, a one time advance with
written justificationand 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 Attachment(s) 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.
1995 GENERAL PROVISIONS - Page 5 (5/94)
ARTICLE 14. Program Income
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) are considered program income. This income will be identified and
reported quarterly and annually utilizing the report forms identified- in the
Financial Reports Article of these provisions. 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.- Program income earned in a
current budget period and not expended in that budget period may be
carried forward to the next budget period but must be spent in the next
budget period, or deducted from program expenditures. This policy will
apply unless specifically stated otherwise in the Special Provisions of
the contract Attachment(s). 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).
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.
Ouarterly
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.
1995 GENERAL PROVISIONS - Page 6 (5/94)
t t \` , ' I 11
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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 hereto.
RECEIVING AGENCY and, when federal funds are involved, any authorized
reptesentative(s) of the federal government have the right, at all reasonable
times, to inspect or otherwise evaluate the work (including client or patient
records) performed or being, performed hereunder, and the premises in which it is
being performed, including subcontractors. PERFORMING AGENCY will participate
in and provide reasonable access, facilities, and assistance to the
representatives. All inspections and 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 pertinent
books, documents, papers, and client or`patient records of PERFORMING AGENCY for
the purpose of making audit, 'examination, excerpts, and transcripts of
transactions related to contract Attachment(s). RECEIVING AGENCY will have the
right to audit billings both before and after payment. Payment under
Attachment(s) will not foreclose the right of RECEIVING AGENCY to recover
excessive or illegal payments.
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
AGENCY within 30.days of receipt of RECEIVING AGENCY's findings. A determination
by RECliVING`AGENCY of either an inadequate or inappropriate resolution of the
findings may result in the withholding of funds. Any such withholding of funds
will remain in effect until the findings are properly remedied as determined by
,RECEIVING AGENCY.
;PERFORMING AGENCY will.retain.all such records for a period of three years from
the date of the last expenditure report submitted under contract Attachment(s)
or until resolution of all audit questions, whichever time period is longer.
ARTICLE 17. Client Records
,.At the end. of the Attachment term, all client records (including patient records)
are'.the property of PERFORMING AGENCY. RECEIVING AGENCY retains the right to
have access to the records or obtain'copies for audit,, examination, evaluation,
inspection, 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 (including patient records) upon written notice to
.PERFORMING AGENCY, either to another entity that agrees to continue the service
or -to RECEIVING'.AGENCY.
ARTICLE 16. Confidentiality
PERFORMING AGENCY will have a system in effect to protect client or patient
,records and all other documents deemed confidential by law which are maintained
in*aorinection with the activities funded under contract. Any disclosure or
transfer of confidential client or 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
1995 GENERAL`PROVISIONS - Page 7- (5/94)
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 Supplies
Equipment is defined as tangible nonexpendable property with an acquisition cost
of over $1,000 and a useful life of more than one year with the following
exceptions: Fax Machines, Stereo Systems, Cameras, Video Recorder/Players,
Microcomputers, and Printers. These exception items will still be considered
equipment if their unit cost is over $500. In accordance with Health & Safety
Code, Section 12.053, 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 meeting the above equipment definition. To receive approval
for .data processing hardware and software, PERFORMING AGENCY must submit a
detailed justification which includes description'of features, make and model,
and cost, etc.
PERFORMING AGENCY will maintain a property inventory listing and submit an annual
cumulative report (TDH Form GC-11) to RECEIVING AGENCY no later than October 15th
of each year. 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. Couvrishts, Publications, and Patents
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
1995 GENERAL PROVISIONS - Page 8 (5/94)
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.
PERFORMING AGENCY and any subcontractor, as appropriate, must comply with the
standard patent rights clauses in 37 CFR Sec. 401.14 or FAR 52.227.11.
ARTICLE 22. Hold Harmless
PERFORMING AGENCY, as an independent contractor, agrees to hold RECEIVING AGENC
and/or federal government harmless and to indemnify them from any and all
C
liability, suits, claims, losses, damages and judgments, and shall pay all costs
kt
fees and damages to the extent that such costs, fees and damages arise from +
performance or non-performance of PERFORMING AGENCY under this contract/— �eKt._
Likewise, RECEIVING AGENCY, as a state governmental agency, agrees to. hold
PERFORMING AGENCY harmless and to indemnify it against any and all liability, OxttLlo0 Iz
suits, claims, losses., damages and judgments to the extent authorized by the
governmental liability provisions of Title 5 of the Civil Practices and Remedies
Code, Vernon's Texas Codes Annotated.
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
PERFORMING AGENCY is required to carry an adequate fidelity bond or insurance
coverage that protects each employee of the PERFORMING AGENCY handling funds
under this contract, including person(s) authorizing payment of such fund. The
fidelity bond or insurance will provide. 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.
ARTICLE 24. 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 RECEIVIIp
AGENCY's intent to withhold payments if the deficiency is not corrected.withi
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 terminate the contract Attachment(s) for non-compliance.
This contract or any Attachment(s) hereto may be terminated by either of the
parties hereto for noncompliance by the other party. . 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 be
1995 GENERAL PROVISIONS - Page 9 (5/94)
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 Attachments) 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
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
1995 GENERAL PROVISIONS - Page 10 (5/94)
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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 war..xants`.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 unless otherwise directed or
approved by RECEIVING AGENCY.
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 and requirements of
the Legislature. 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;
f, 1995 GENERAL.PROVISION-S Page 1I (5/94)
- 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:
Food Protection HIV/AIDS
Public.Health Promotion Refugee Health
Immunization Initiative Sexually Transmitted Diseases
Women & Children Tuberculosis Elimination
Chronic Disease Prevention & Control
These objectives are.appended to the office of Regional Programming Attachment
and.incorporated verbatim and made a part of this contract. PERFORMING AGENCY
agrees to monitor and report progress towards these objectives on a quarterly and
annual basis. The reporting requirements and format 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:'
Dental Health Services
Nutrition Services
For state fiscal year 1995, 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.
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 Regional Programming.
1995 GENERAL PROVISIONS - Page 12 (5/94)
DOCUMENT NO. C5000255
ATTACHMENT NO. 02
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: HIV DIVISION
TERM: September 1, 1994 THROUGH August 31, 1995
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 tc 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 RECEIVING AGENCY's (TEXAS DEPARTMENT OF HEALTH) program rules, guide-
lines, and request for proposal (RFP) and 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 5,000 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 of the 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.
-1-
PERFORMING AGENCY, or any subcontractor, shall not transfer a client record
(including a patient record) to another entity or person without written
consent from the client or patient, or someone authorized to act on his or her
behalf; however, the RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) may require
PERFORMING AGENCY, or any subcontractor, to transfer a client or patient
record to the RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) if the transfer
is necessary to protect either the confidentiality of the record or the health
and welfare of the client or patient.
The RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) shall have-accetss to a
client record (including a patient record) in,tha,possession of PERFORMING
AGENCY, or any subcontractor, under authority of the Health and Safety Code,
Chapters 81 and 85, and the Texas Revised Civil Statutes, Article 4495b
(Medical Practice Act). In such cases, the RECEIVING AGENCY (TEXAS DEPARTMENT
OF HEALTH) shall keep confidential any information obtained from the client
or patient record, as required by the Health and Safety Code, Chapter 81, and
the Texas Revised Civil Statutes, Article 4495b.
Due to the sensitive and highly personal nature of HIV/AIDS-related
information, strict adherence to the General Provisions Confidentiality
Article is required.
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
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Total Direct Costs
Indirect
TOTAL
$25,300.00
7,178.00
1,840.00
.00
1,798.00
3,640.00
2,050.00
$41,806.00
1,665.00 *
$43,471.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements will not exceed $43,471.00.
* Indirect cost is based on UGCMA, Table 1.
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r
DOCUMENT NO. C5000255
ATTACHMENT NO. 03
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: MILK AND DAIRY PRODUCTS DIVISION
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will provide analyses of milk samples. Analyses will meet
laboratory proficiency standards as set forth by the National Conference of
Interstate Milk Shipments and the 1978 U.S. Public Health Service Grade "A"
Pasteurized Milk Ordinance. PERFORMING AGENCY will:
1. Perform to completion and report out by mail as soon as possible all
required and/or requested tests. The date of completion of testing will
not exceed 48 hours from the date of sample submission to PERFORMING
AGENCY laboratory. (Mailers will be supplied by RECEIVING AGENCY).
2. Send original copies of laboratory results forms to RECEIVING AGENCY, Milk
and Dairy Products Division, 1100 West 49th Street, Austin, Texas 78756,
to be microfilmed and returned to PERFORMING AGENCY.
3. Submit monthly vouchers which include total number and kinds of tests
performed to RECEIVING AGENCY, Milk and Dairy Products Division.
PERFORMING AGENCY agrees to comply with:
Chapter 435, Health and Safety Code, Dairy Products.
PERFORMING AGENCY will provide an estimated 455 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:
General Provisions, FINANCIAL REPORTS Article, does not apply to this
Attachment.
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f � r
SECTION IV. BUDGET:
Laboratory analyses will be performed at a rate per sample and per test not to
exceed the following schedule:
RAW SAMPLES PASTEURIZED SAMPLES
SPC $ 3.00 SPC $ 3.00
Somatic Cell 5.00 Coliform 2.00
Growth Inhibitors 2.00 Growth Inhibitors 2.00
Freezing Point 1.00 Phosphatase 3.00
Cryoscope 1.00
TOTAL $ 11.00 TOTAL $ 11.00
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DOCUMENT NO. C5000255
ATTACHMENT NO. 04
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: HIV DIVISION
TERM: July 1, 1994 THROUGH December 31, 1994
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will conduct active surveillance and reporting activities
for human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome
(AIDS).
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 plan, and detailed bud-
get as approved by RECEIVING AGENCY. All of the above named documents are
adopted by reference as part of this Attachment.
The activities required to carry out these projects are outlined in the
Centers for Disease Control (CDC) and RECEIVING AGENCY'S program guidelines
and protocols and RECEIVING AGENCY'S grant applications and awards by CDC,
which are the bases for this Attachment. A copy of each document has been
provided to the PERFORMING AGENCY.
PEDIATRIC HIV INFECTIONS
PERFORMING AGENCY will be responsible for soliciting reporting of
HIV infections occurring in children 0-12 years of age. PERFORMING AGENCY
agrees to:
1. Initiate and maintain effective communications and working
relationships with pediatricians, pediatric care facilities,
and laboratories within PERFORMING AGENCY'S geographic
jurisdiction, in an effort to solicit reporting.
2. Assist RECEIVING AGENCY in conducting no -identified -risk (NIR)
investigations for those cases in which mode of exposure is
incomplete.
3. Follow-up and complete CDC data collection forms on unreported
cases identified through the RECEIVING AGENCY'S review of
alternate record systems.
ALL AIDS CASES
PERFORMING AGENCY will be responsible to the RECEIVING AGENCY for the design,
maintenance and evaluation of an active surveillance system for AIDS cases.
For the purposes of this Attachment, an AIDS case is defined by CDC in its
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.t '
December 18, 1992 MMWR publication, Vol. 41, No. RR-17. PERFORMING AGENCY
agrees to:
1. REPORTING
a. Establish and maintain communications with key community and medical
groups/individuals and laboratories with PERFORMING AGENCY'S geo-
graphic jurisdiction.
b. Collect reports of AIDS cases diagnosed and/or treated within the
PERFORMING AGENCY'S geographic jurisdiction.
c. Report cases to the RECEIVING AGENCY HIV/AIDS Surveillance Program
on a weekly basis.
2. REGISTRY MAINTENANCE
a. Maintain a case file on all confirmed and suspected cases of AIDS
diagnosed and/or treated within the PERFORMING AGENCY'S geographic
jurisdiction.
b. Maintain a current list of key reporting sources.
3. SYSTEM EVALUATION
a. Review and provide thorough follow-up on a minimum of 80% of suspects
identified by RECEIVING AGENCY'S alternate record review systems in
order to enhance case ascertainment and validate the effectiveness of
local surveillance efforts.
b. Track reporting by local sources in order to monitor the level of
compliance to reporting laws and level of case ascertainment.
4. EPIDEMIOLOGIC INVESTIGATIONS
a. Initiate epidemiologic investigations on newly reported NIR cases
within five days of receipt of case report through contact with
appropriate health care provider or the review of medical records.
b. Assist the RECEIVING•AGENCY with other epidemiologic investigations
as deemed necessary by the RECEIVING AGENCY or CDC.
5. DATA ANALYSIS
Demographic analyses of local data may be released as public
information as long as an individual is not identified.
6. CONFIDENTIALITY
a. Store all case files and computer diskettes containing patient
information in a locking file cabinet when not in use. The locking
file cabinet and surveillance computer must be kept in a locked room,
-2-
0
with limited, controlled access.
b. Utilize passwords to access procedures for computer databases con-
taining HIV/AIDS case data. Passwords should be changed monthly and
known only to surveillance personnel.
c. Limit the number of persons who have keys to registry files to persons
directly involved in case reporting.
d. Require a statement of confidentiality be signed by all personnel having
access to HIV/AIDS case files and computer diskettes and kept on file by
PERFORMING AGENCY.
e. Shred any document to be disposed of that contains patient information.
HIV INFECTIONS
PERFORMING AGENCY will be responsible for conducting active surveillance for
the reporting of confirmed HIV infections. PERFORMING AGENCY agrees to:
1. Establish and maintain communications with key community and medical
groups/individuals and laboratories within PERFORMING AGENCY'S
geographic jurisdiction.
2. Collect reports of confirmed HIV infections made by or under the
standing orders of a physician, and which are based upon acceptable
laboratory tests results.
3. Report HIV infections to the RECEIVING AGENCY HIV/AIDS Surveil-
lance Program on a weekly basis.
PERFORMING AGENCY agrees to comply with Chapters 81 and 85 of the Health and
Safety Code and relevant portions of Chapter 6A (Public Health Service) of
Title 42 (The Public Health and Welfare) of the United States Code, as
amended.
PERFORMING AGENCY will provide an estimated 75 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 of the Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
PERFORMING AGENCY, or any subcontractor, shall not transfer a client record
(including a patient record) to another entity or person without written
consent from the client or patient, or someone authorized to act on his or her
behalf; however, the RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) may require
PERFORMING AGENCY, or any subcontractor, to transfer a client or patient
record to the RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) if the transfer
-3-
� • r
is necessary to protect either the confidentiality of the record or the health
and welfare of the client or patient.
The RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) shall have access to a
client record (including a patient record) in the possession of PERFORMING
AGENCY, or any subcontractor, under authority of the Health and Safety Code,
Chapters 81 and 85, and the Texas Revised Civil Statutes, Article 4495b
(Medical Practice Act). In such cases, the RECEIVING AGENCY (TEXAS DEPARTMENT
OF HEALTH) shall keep confidential any information obtained from the client
or patient record, as required by the Health and Safety Code, Chapter 81, and
the Texas Revised Civil Statutes, Article 4495b.
PERFORMING AGENCY will submit quarterly activity reports within 20 days after
the end of each quarter, that are prepared in the format provided by the
RECEIVING AGENCY.
Due to the sensitive and highly personal nature of HIV/AIDS-related informa-
tion, strict adherence to the General Provisions Confidentiality Article is
required.
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
$9,900.00
Fringe Benefits
2,772.00
Travel
2,964.00
Equipment
1,500.00
Supplies
1,560.00
Contractual
.00
Other
1,400.00
Total Direct Costs $20,096.00
Indirect .00
TOTAL $20,096.00
Financial status reports (FSRs) are due the 3Oth of October and January
and the 15th of February.
Total reimbursements will not exceed $20,096.00.
* Equipment list attached.
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u
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
PROGRAM WITHIN
RECEIVING AGENCY: HIV DIVISION
TDH DOC. NO: C5000255
ATTACHMENT NO: 04
EQUIPMENT LIST
No.of Unit
Item Description Units Cost Extension
1 486/33MH IBM Compatible PC Computer 1 1500 $ 1,500.00
(with color monitor) 4MB Memory
upgrade.
TOTAL $ 1,500.00
Items may be brand name, if specified, or equivalent.
S
DOCUMENT NO. C5000255
ATTACHMENT NO. 05
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: TUBERCULOSIS ELIMINATION DIVISION
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will develop and carry out expanded outreach services to
individuals of identified sub -groups who have tuberculosis or are at high
risk of developing tuberculosis. To implement this program PERFORMING
AGENCY will:
(1) Utilize directly observed therapy (DOT) to increase the individual's
compliance in taking therapeutic treatment (or corrective therapy) or
adhering to prescribed preventive therapy.
(2) Ensure appropriate patient management by enhancing individual's con-
formity with scheduled clinic appointments and procedural instruc-
tions.
(3) Enhance investigation and surveillance of individuals to ensure
follow-up and adequate treatment.
(4) Establish a tuberculosis registry and/or information network (or data
system) by which high risk sub -groups in the county(ies)/area can be
effectively managed for the purpose of optimizing outreach resources
and program evaluation.
(5) Establish records and periodic reports as specified by the Tuber-
culosis Elimination Division. In addition to other reports, a written
quarterly account and statistical report evaluating the project pro-
gression may be requested.
PERFORMING AGENCY will provide an estimated 225 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:
General Provisions, Reports and Inspection Article, is amended to include the
following:
PERFORMING AGENCY will submit quarterly programmatic reports that include
the information listed below:
- Number of patients who started Directly Observed Therapy (DOT).
-1-
- Statement of activities in jails, nursing homes, homeless shelters,
drug treatment centers and community based organizations.
Results of any skin test screening conducted or reported to have been
conducted regarding the number tested, the number read and the number
of positive skin tests for:
- Schools - Jails
- Homeless Shelters - Nursing Homes
- Drug Treatment Centers - MHMR Facilities
- Number of patients whose tuberculosis medications were prescribed
by private physicians and by the local health department.
Outreach workers employed under this Attachment should be recruited
from the same linguistic, cultural, social and ethnic groups as the
patients for whom outreach activities are directed.
SECTION IV. BUDGET:
Personnel $14,290.00
Fringe Benefits 3,573.00
Travel 1,375.00
Equipment .00
Supplies .00
Contractual .00
Other .00
Total Direct Costs $19,238.00
Indirect 835.00 *
TOTAL $20,073.00
Financial status reports (FSRs) are due the 30th of December, March,
June, September and the 15th of October.
Total reimbursements will not exceed $20,073.00.
*Indirect cost is based on UGCMA, Table 1.
-2-
DOCUMENT NO. C5000255
ATTACHMENT NO. 06
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: OFFICE OF REGIONAL PROGRAMMING
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
Comprehensive Public Health Services
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 preventive services, HIV/AIDS, chronically ill/disabled children.
dental, immunization, laboratory, women and children, public health promotion/
education, sexually transmitted disease control, and tuberculosis elimination.
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 Public Health Promotion
Immunization Refugee Health
Food Protection Sexually Transmitted Disease
Women and Children Tuberculosis Elimination
Chronic Disease Prevention and Control Dental Health Services
Nutrition Services
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 and report progress towards these
objectives on a quarterly and annual basis. Quarterly monitoring reports are
due no later than 45 days after the end of each quarter, and a cumulative
annual report is due no later than 60 days after the end of the Attachment
term.
All performance monitoring reports will be submitted by PERFORMING AGENCY to
the respective RECEIVING AGENCY Public Health Region. The Public Health
Region will review and forward the reports to RECEIVING AGENCY Office of
Regional Programming. The format for performance -based monitoring reports
will be agreed upon by both parties prior to the due date of the first
Quarterly report.
PERFORMING AGENCY will provide an estimated 6,500 clients with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
-1-
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 immuni-
zation services in public clinics regardless of ability to pay. PERFORMING
AGENCY further understands that the bilingual poster "Fees for Vaccine Admin-
istration," (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 fees collected will be kept within guidelines
established by RECEIVING AGENCY and that no one may be denied immunization
services because of inability to pay the fee. Fee schedules will not be based
on per dose charges.
SECTION IV. BUDGET:
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to PERFORMING AGENCY for costs
incurred in carrying out approved activities.
Personnel
$81,766.00
Fringe Benefits
13,416.00
Travel
.00
Equipment
.00
Supplies
.00
Contractual
24,000.00
Other
.00
Total Direct Costs $119,182.00
Indirect .00
TOTAL $119,182.00
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 $119,182.00.
-2-
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the
provision of supplies such as vaccines in lieu of cash.
Personnel (02 position(s)] $43,440.00
TOTAL $43,440.00
Direct assistance for personnel in the amount of $43,440.00 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 $43,440.00.
Total RECEIVING AGENCY assistance will not exceed $162,622.00.
-3-
ti LUBBOCK CITY HEALTH DEPARTMENT PAG€ .834�
TEXAS DEPARTMENT'OF HEALTH PHR 1 `
OPERATING BUDGET FOR YEAR ENDING AUGUST 31, 1995
AS OF APRIL 30, 1994 BUDGET NO. LCO00
H21311/K13028
CATE- DESCRIPTION OR TITLE FUND END ITEM JOB PAY PAY EFFECTIVE MONTHLY
GORY DESC. MOUTH NO. CLASS GP STP DATE RATE
i LIC VOCATIONAL NURSE II STATE AUG 083 4412 10 04 SEP 94 1.839.00
ADMINISTRATIVE TECH I STATE AUG 104 1501 08 07 SEP 94 1,781.00
BUDGETED AMT
22,068.00
21,372.00
43,440.00
.Y
` r r
� • I
FY 1995
PERFORMANCE -BASED OBJECTIVES
EXHIBIT A FOR
OFFICE OF REGIONAL PROGRAMMING
ATTACHMENT FOR
LUBBOCK CITY HEALTH DEPARTMENT
PERF'ORMANC&BASED CONTRACT OBJECTIM
FOR E Y 1995
DISCLAIMER SHEET
List programs you DO NOT provide. If there is more than one program, use a separate
disclaimer sheet for each one.
LOCAL HEALTH DEPARTMENT: City of Lubbock Health Department
PROGRAM NOT PROVIDED: Chronic Disease
SIGNATURE: �` D
TITLE:
PHONE NUMBER: m6) 767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding to provide services.
FE0 1
0�
From:•
To:
Date:
Subject:
CC:
X-pmrgc :
X-mailer:
DENTAL/CAIELLO
CRH/KSHIELDS
Mon, 11 Apr 1994 14:20:09 CST
City of Lubbock - Dental
TDHROI/DDrennan
1
PMail v3.0 (R1)
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT: City of Lubbock
PROGRAM: Dental
TDH REVIEWER: C. Aiello
TDH REVIEWER'S PHONE NUMBER: 512-458-7526
DATE:April 11, 1994
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
Comments only. No revisions necessary.
X Suggestions for FY 1996. No revisions necessary at this time.
No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
Process objectives look fine. For FY 96 an outcome objective might
focus on the reduction of dental caries. (See skelton objectives.)
oIC�RH/KSHIELDS ,
From: �TDHR01/TSNELL
Date: 25 Jan 94 16:40:35
Subject: LHD NAME AND PROGRAM INITIALS
CC: TSNELL
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT:LUBBOCK CITY HEALTH DEPT
PROGRAM:DENTAL PGM
TDH REVIEWER:DR. D DRENNAN
TDH REVIEWER'S PHONE NUMBER:806-744-3577
DATE :"1-25-94
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:CATHY ALLEN
TITLE:NURSE
DATE:1-25-94
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
PBO'S WERE REVISED THROUGH CONSULTATION WITH CATHY ALLEN. REVISIONS
WERE COMPLETED ON PROPER FORMAT AND ARE READY FOR AUSTIN REVIEW.
kThanks
JTommy Snell
MPHR 1, Lubbock
REGION
PROGRAM
CONTACT
FY 1995
PAGE 1
PERFORMANCE BASED OBJECTIVES (CONTRACT) - 1994
CITY OF LUBBOCK HEALTH DEPARTMENT
PHR 1
OUTCOME
By 2000, 2,600 eligible Lubbock County Cumulative # of new (annual unduplicated count) eligible
children will have received services at the County children seen in the Dental clinic from FY 95-FY
LCHD Dental clinic. 99.
Note: Program qualification is
determined by family size, income and lack
of health care resources (insurance,
Medicaid).
PROCESS
During FY 95, LCHD staff will:
P-i .1 520 new eligible children will receive dental # of first time eligible children receiving dental health
<. services at the LCHD. services during FY 95.
P-1.2 Provide 90% of requested emergency dental Emergency services provided within 48 hours of request
services for eligible children within 48 hours. # of requests for emergency services
PHR1
Dental
Cathy Allen
P-1 3 Provide an appointment within 60 days for # of eligible children seen within 60 days of request
all eligible children requesting services. # of eligible children requesting appointments
P.-1y4 Will counsel all children seen at LCHD # of eligible children counseled '
regarding preventive dental care. # of eligible children seen
P-1.5 Will contact all dental no-shows for follow-up # follow-up contacts for "no-show" appointments
appointments. # "no-show" appointments
School nurses will attend an inservice I # school nurses attending inservice
regarding LCHD Dental clinic services.
REGION PHR1
PERFORMANCE BASED OBJECTIVES (CONTRACT) - 1994
CITY OF LUBBOCK HEALTH DEPARTMENT
PHR 1
PROGRAM Dental
CONTACT Cathy Allen
FY 1995
PAGE 2
PROCESS
To: 'CRH/KSHIELDS
From: "Billie Ray" <TDHR01/BRAY>
Date: 8 Feb 94 09:38:54
Subject: LHD NAME AND PROGRAM INITIALS
CC: TDHR01/TSnell
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT: Lubbock City Health Department
PROGRAM: HIV
TDH REVIEWER: Billie L. Ray
TDH REVIEWER'S PHONE NUMBER: (806) 744-3577
DATE: 2/8/94
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
X Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
This program is well established and objectives clearly defined to
meet HIV program needs for specified area.
Billie Ray
HIV Prevention Coordinator
Tel: 806/744-3577
FAX: 806/741-1366
n
PROGRAM: HIV
CITY OF LUBBOCK HEALTH DEPARTMENT (LCHD)
PERFORMANCE BASED OBJECTIVES — 1994
SURROGATE OUTCOME
0-1
By 2000,25% cyf all Lubbock citizens receiving HIV
Total # of citizens tested for HIV
educaflon vAll seek counseling and testing for HIV
Total # of cftlzens receMng HIV educatlon
from any of the certffled HIV counselors In Lubbock.
PROCESS
P-1.1
During FY 94-95, the LCHD certirted HIV educator will
# persons given referml cards
distdWe referml cards for HIV testing and counseling
# of persons educated by LCHD HIV educator
to 100% of InclMduals educated.
P— 1.2
During FY 94-95, LCHD staff will schedule 100% of
# of persons scheduled In I month
_
those inclMduals requesting HIV Counseling and
# of persons requesfing HIV C&T
Testing within one month of the request.
ACTIVITIES
MONITORING COMPLETED DATE:
new opportunfts for educating cftizens about HtV.
100% of patients seeking testing how they knew
about the HIV services at LCHD.
SURROGATE OUTCOME
0-2
By 2000,90% of LCHD clients who test
# HIV positive crients aftencling I session
posftW for HIV infection and who receNe post—test
# of LCHD clients testing HIV posftW &
counselling at LCHD vAll attend one appointment at
receiving post—test counsefina
La Clinica do Buena Salud for HIV Early Interienton
Health Services.
PROCESS
P-2.1
During FY 94-95, LCHD HIV Counselor vAll schedule
# of persons sceduled for post—tw wfthin
100% of Incilviduals testing for HIV Infection a post—
3 weeks of test.
test counseling appointment vAhln thme weeks of
# of InclMduals testing for HIV at LCHD
Inftial appointment.
P-2.2
During FY 94-95, LCHD HIV Counselor will refer and
# of LCHD patients referred
make an appointment to La ClInIca de Buena Salud
# of LCHD clients testing HIV posItIve
for 100% of an LCHD patients testing posfttve for HIV
and receMng post—test counseling.
J
From: ' ', ,"Wanda Gibson" <DISCON/WGIBSON> ,
To: CRH/KSHIELDS
Date: Tue, 12 Apr 1994 11:09:48 CST
Subject: LUBBOCK CITY H.D. - IMM
CC: TDHR01/TSNELL
X-pmrgc: 1
X-mailer: PMail v3.0 (R1)
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT: LUBBOCK CITY HEALTH DEPT
PROGRAM: IMMUNIZATIONS
TDH REVIEWER: TOMMY SNELL
TDH REVIEWER'S PHONE NUMBER: 806-744-3577
DATE: 4-12-94
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
X No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
To: 5 CRH/KSHIELDS '
From: TDHR01/DWILSON
Date: 31 Jan 94 10:44:14
Subject: LHD NAME AND PROGRAM INITIALS
CC: JMORGAN, TSNELL
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT:LUBBOCK CITY HEALTH DEPARTMENT
PROGRAM:IMMUNIZATION
TDH REVIEWER:DL WILSON
TDH REVIEWER'S PHONE NUMBER:(806) 744-3577
DATE:
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:MARILYN MITCHELL, RN
TITLE:COMMUNICABLE DISEASE PROGRAM MANAGER
DATE:JANUARY 31, 1994
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
X No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
REGION: PHR 1
PROGRAM: iMMUNIZATIONS
CONTACT: MARILYN MITCHELL
FY 1994
oeftp
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
OBJECTIVE S AC ES .
1N lCATO S...:::....:..:......:...
M ...titll' .....t.
OUTCOME
0-1
Bv 2000 90% of children 2 years of age In Lubbock
# of children under 2 pars of age vaccinated
will have received adequate vaccine for age.
# of children 2 years and under
PROCESS
P-1.1
By the end of FY 94-95 97% of children 2 years of age
# of childem 2 years of age or under sent due
or under seen in the immunization clinic will be sent
or past due reminders
reminder notices of vaccines due or past due.
# of children 2 Vars of age or under seen in
immunization clinic
P-1.2
By the end of FY 94-95 the immunization program wig
coordinate public Frdomtation support on the
# of omanizations providing public Information
Importance of vaccines for children 2 years of age or
support
under from at least 2 organizations who sypport
services to that target aroup in Lubbock.
P-1.3
By the end of FY 94-95 CLHD win dmml2p a plan to
administer vaccines to under vaccinated children of
dmmlop plan
Lubbock in their homes or close proximity to their
homes.
A-1.1
ACTMTiES
MONITORING COMPLETED DATE:
Survey 100% Immunization records of 2 year olds
sttending Health artment immunization clinic
4-1.2
for vaccines due or post due.
A-1.3
Mail reminders to 97% of children under 2 years of age.
Operate immunization clinic 37 hours each 5 day work
A-1.4
week.
Conduct a needs assessment to determine number an
locations of Inadequately Immunized children 2 years
A-1.5
of age or younger.
Meet with UnlversftyMedical Center and Junior League
of Lubbock to enhance vaccine awareness.
To: {CRH/KSHIELDS
From: TDHR01/PMCLEMORE
Date: 25 Jan 94 15:41:51
Subject: LHD NAME AND PROGRAM INITIALS
CC: TSnell
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT:Lubbock City Health Department
PROGRAM:Women's Health
TDH REVIEWER:Joan Hoffmaster
TDH REVIEWER'S PHONE NUMBER:806-744-3577
DATE:1/25/94
------------------------------------------------------------ ----
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
Comments only. No revisions necessary.x
Unsure of problem areas (this may signify the two identified areas?)
Suggestions for FY 1996. No revisions necessary at this time.
No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
REGION: PHR 1
PROGRAM: WOMEN'S HEALTH
CONTACT: MARY STRANGE
FY 1994
PAGE I
CITY OF WBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
.
..........
..........
. . . .. ....
..... ........ . . . . ....
.......
SURROGATE OUTCOME
0-1
By 2000, 90% of patients enrolled In the Lubbock City
# of enrolled patients having 9 or more visits
Health Department (LCHD) prenatal care clinic will
# of patients enrolled In LCHD prenatal cfinfc
—
exhibit adeguate prenatal care by having a minimum
of nine clinic visits.
PROCESS
During FY 94-95, LCHD Staff YAII:
P-1.1
Counsel 100% of pregnant women enrolled In LCHD
# of pregnant women counseled
prenatal clinic about the Importance of repular
# of pregnant women enrolled In clinic
clinic visfts.
P-12
Provide an appointment within two weeks of diagnosis
# women niven appointment In 2 wks.
of pregnancy to 95% of women requesting LCHD
# women requesting LCHD prenatal care
prenatal care.
ACTIVITIES
MONITORING COMPLETED DATE:
A-1.1
Durinfl FY 94-95, a licensed nurse will counsel 100%
of patients obtaining a positive pregnancy test result
at LCHD about the value of early and on —going
prenatal care.
A-1.2
Clients YAH have access to pamphlets regardinn the
vakta of early and on—aoina prenatal care.
A-1.3
Staff WH contact pregnant women who fall to keep their
clinic appointments within no more than five working
days* and will take appropriate action.
SURROGATE OUTCOME
0-2
By 2000, 70% of Health Department female clients
# LCHD female clients retumlng for exam
vAll exhibit preventive health cam practices by
# of LCHD female clients
returning for annual or post parturn examinations.
PROCESS
Dudna FY 94-95,
P-21
LCHD staff vAll counsel 100% of women recelvina
# HD female clients counseled
prenatal or women's health care about the Importance
# of LCHD female clients
of annual preventive health care exams.
m
REGION: PHR 1
PROGRAM: WOMEN'S HEALTH
CONTACT: MARY STRANGE
FY 1994
PAGE 2
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
71ES:;�::::::::>«::>:<:<_><;w_:<:::.,::<�
PROCESS
During FY 94-95:
P-2.2
Staff assigned to LCHD outreach clinics anal counsel
# of women counseled in outreach clinics
100% of women seen about the Importance of annual
# of women seen in LCHD outreach clinics
reventhm health care exams.
P-2.3
Of qualified women sceened at the LCHD outreach
# qualfffed women receiving appointment
clinics 50% of those 40 or older needing clinical breast
# qualified women seen In outreach clinics
exam and Pap smearwill receive an appointment
with LCHD
ACTIVITIES
MONITORING COMPLETED DATE:
During FY 94-95:
A-2.1
LCHD staff will contact hone or In person, 90%
of women who receive prenatal care at the Health
Depadnvent to make apost— artum appointment
A-2.2
Designated appointments wilt be available for women
referred from the LCHD screening clinics and from
the S.T.D. clinic for women needing clinical breast
exam and Pap smears.
To: 5� "CRH/KSHIELDS k
From: TDHR01/SKOHOUT
Date: 14 Feb 94 10:07:15
Subject: LHD NAME AND PROGRAM INITIALS
CC: TSNELL
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT:Lubbock City Health Dept.
PROGRAM:Health Promotion
TDH REVIEWER:Sharon Kohout
TDH REVIEWER'S PHONE NUMBER:744-3577
DATE:2/14/94
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
X No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
REGION: PHR I
PROGRAM; HEALTH PROMOTION
CONTACT: NANCY HANEY
FY 1994
PAGE I
CITY OF LUBBOCK HEALTH DEPARTMENT (LCHD)
PERFORMANCE BASED OBJECTIVES — 1994
OBJECTIVES T-1
............... . ...
INIZ
IOW
N
SURROGATE OUTCOME
0-1
By 2000, the number of Lubbock citizens attending
# of citizens attending In FY 93-94
Health Education Events sponsored LCHD
# of citizens attending In FY 99-2000
win Increase by 10% as compared to FY 93-94.
PROCESS
During FY 94-95, LCHD Health Educator will:
P-1.1
schedule 6% more health education events
# of events In FY 93 —94
then In FY 93-94.
# of events In FY 94-95
P-1.2
include a review of LCHD services In 100% of
# ewft with LCHD services descgl?gon
educational events.
# of events In FY 94-95
ACTIVITIES
MONITORING COMPLETED DATE:
A-1.1
During FY 94-95, the LCHD Health Educator VWH
actively seek new opportunities for educating citizens
about health care Issues.
A-1.2
During FY 94-95, the LCHD Health Educator win
record the number of attendees present at each went.
t
PERFORMANCE -BASED CONTRACT O ' ,mit—
FOR FY 1995
DISCLAFgM SHEET
List programs you DO NOT provide. If there is more than one program, use a separate
disclaimer sheet for each one.
LOCAL HEALTH DEPARTMENT: city of Lubbock xPa1 rh napartment
PROGRAM NOT PROVIDED: -Refugee Health
SIGNA
TIT.
PHONE NUIvMER: (806)767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding to provide services; no demand for services
To: C�H/KSHIELDS
From: "Bob Badger" <TDHR01/BBADGER> '
Date: 20 Jan 94 14:46:45
Subject: Performance Based Objectives Comments - Lubbock Health Dept.
CC: tsnell
COMMENT/VERIFICATION FORM
PBCOs FOR FY 1994
LOCAL HEALTH DEPARTMENT: City of Lubbock
PROGRAM: Retail Food
CONTACT: Mark Keefer
REVIEWER: Robert M. Badger, R. S.
REVIEWER'S PHONE NUMBER: TxAN 842-5235, L. D. (806) 744-3577 x 235
DATE: January 20, 1994
Please place an "X" in front of one of the following items and fill
in any pertinent blanks:
- Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestion for FY 95. No revisions necessary at this time.
X - No comments, suggestions and/or revisions. Objectives stand
as written.
Please list below any revisions, comments, and/or suggestions. Use
a new form for each program.
The document was discussed with Mark Keefer on January 20, 1994.
l***THANKS***
{Bob Badger
REGION: PHR 1
PROGRAM: Retail Food
CONTACT: Mark Keefer
FY 1994
PAGE 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
::OBJECTIVES ACTIVITIES
INDICATORS
: ..MONITORING/COMMENTS
OUTCOME
0-1
By 2000, the incidence of reported foodborne
# reported foodbome illnesses
illnesses confirmed and associated with
confirmed and associated with
i
commercial food establishments will not
commercial food establishments
exceed one 1 outbreak per 100,000 population.
in given year
X100 000
population in given year
PROCESS
During FY 94-95 LCHD Staff will:
P-1.1
Ensure that a minimum of 10% of the food service
# of foodservice mana rs state certified
managers in the City of Lubbock will
# of food service managers
have been certified through the State of Texas
in proper food management and food protection
methods.
P_-1.2
Rate 100% of the commercial food establishments
# of food establishments rated
r
( based one idemiolo is risk and their
# of food establishments
compliance records.
Note: Documentation of risk factors and ins ec
ion
records Risk factors based on those factors
ACTIVITIES
known to contribute to foodbome disease outb
eaks
A-1.1
Staff will develop and implement a
food manager certification course
approved by TDH.
A-1.2
Duringroutine inspections, sanitarian will
council all foodservice operators/managers about
food manager certification program.
I
A-1.3
Durinq FY 94-95 staff will research develop
and implement a risked —based approach
to food inspections.
To: CRH/KSHIELDS
From: "David L. Hoehns" <TDHR01/DHOEHNS>
Date: 4 Feb 94 17:16:39
Subject: LHD NAME AND PROGRAM INITIALS
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT: Lubbock City Health Department
PROGRAM: STD
TDH REVIEWER: David L. Hoehns
TDH REVIEWER'S PHONE NUMBER: (806) 744-3577
DATE: February 4, 1994
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
x Listed revisions were negotiated with:
NAME: Marilyn Mitchell, R.N.
TITLE: STD Clinic Supervisor
DATE: January 20, 1994 through February 4, 1994
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
Two new objectives were negotiated with Lubbock City Health
Department. The first of these was the gonorrhea objective with its
three activities. The second new objectives is the syphilis
objective. Ms. Mitchell submitted these through Region 1 channels,
and I received a copy on February 4.
I discussed a revision in the Syphilis Activity - 2,2 from:
"Ensure that 100% of syphilis contacts who come for service to the
clinic are prophylactically treated if exposure is in the the last
year."
to read:
"Ensure the 100% of syphilis contacts who present in the STD clinic
with exposure in the previous ninty days are prophylactically
treated."
Ms. Mitchell agreed to this revision in a meeting conducted this
morning.David L. Hoehns
Region 1 STD Program
REGION: 1 HR 1
PROGRAM: STD
CONTACT: MARILYN MITCHELL .
FY 1994
PAP,F 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
,?< OBJECTIVES ACTIVITIES :,..
INDICATORS-.::'::'MONITORING/COMMENTS
.:
SURRIGATE OUTCOME
0-1
B 2000 20% cf CLHD STD patients with a reportable
# of patients with 2 or more reportable STDs
sexually transmitted disease two or more times seen
havinq HIV test
in the CLHD STD clinic will consent to be tested for HIV
# of patients with 2 or more reportable STDs
PROCESS
P-1.1
During FY 94 — 95 100% of persons with a previous
# patients counseled regarding STD and HIV
diagnosis of a reportable STD within the last yearwiil Ix
# patients seen in last year with positive STD
counseled by the STD staff regarding STDs and HIV.
P-1.2
During FY 94 — 95 STD staff will provide information
# of patients provided information
on the prevention of STD and HIV to 100% of persons
# of patients seen In STD clinic
treated or examined in STD clinic.
ACTIVITIES
MONITORING COMPLETED DATE:
A-1.1
During FY 94 — 95 pamphlets on STDs and HIV will be
available to all clients.
A-1.2
During FY 94 — 95 vedeo tapes on STDs and HIV will
be played in the STD wafting area during clinic hours.
REGION: PHR 1
PROGRAM: STD
CONTACT: MARILYN MITCHELL
FY 1994
PAr:9 9
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
`OBJECTIVES ACTiVII'IES :':.... >......:
INDICATORS ::: ;; .
>MONITORING MMENTS .
OUTCOME
0-2
By the year 2000 the reported incidence of syphilis
Number of cases reported that meet case
less than one year will not exceed 12 cases per
definition for syphilis than one year.
hundred thousand p2pulation city of Lubbock.
Population of _cityof Lubbock in 2000
PROCESS
P-2.1
During FY 94-95 reported incidence of nThills less
Number of cases reported during FY 94-95
than one year wilt not exceed 27 cases per hundred
that meet definition of syphilis less than one
thousand of population.
year.
Po ulation of c'y of Lubbock
ACTIVITIES
MONITORING COMPLETED DATE:
A-2.1
Ensure that 100% of STD clients requesting examinatiot
Number STD clients receiving hills serology
for STDs receive a syphilis serology unless they have
Number of clients requesting examination
been tested in previous 30 da(excluding
those tested previous 30 d
A-22
Ensurotlifttl00% of syphilis con who come for
Number of cntact prophylactically treated
r ' c ' t t
Number of contact with one year a osure
exposure is i the o
examined
C,vsu�� Tlaf /0095 of Sy p
e + 5 WkD P is a vtt wi
e are ru -1-1%,preu(CUS
opt-60vixaf-ically
-rpevjed'.
REGION: PHR I
PROGRAM; STO
CONTACT: MARILYN MITCHELL
FY 1994
PAGE 3
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
;OBJECTIVES�
ITORING/QOM MENM:.`,�
OUTCOME
0-3
By 2000 reduce the incidence of gonorrhea
Number of gonorrhea cases
to fewer than 200 cases per hundred population in the
Population of city of Lubbock In 2000
citv of Lubbock.
PROCESS
P-3
During FY 94-95 reduce the rate of Snonorrhea
Number of gonorrhea cases
infection to 286 cases per hundred p2pulation In the
Population of city of Lubbock
cftv of Lubbock.
ACTIVITIES
A-3.1
100% of persons treated or examined in the STD
Number persons treated or examined
clinic will receive education regarding prevention of ST[
Number persons educated recorded in chart
A-32
Pamphlets on STDs will be available to all clients.
A-3.3
Viedo tapes on STDs will be played in the lobby during
clinic hours.
u
PERFORMANCE -BASED CONTRACT OBJECTIVES
FOR FY 1995
DISCLAIMER SHEET
List programs you DO NOT provide. If there is more than one program, use a separate
disclaimer sheet for each one.
LOCAL HEALTH DEPARTMENT. Lubbock City Health Department
PROGRAM NOT PROVIDED: TB
PHONE NUMBER: (806) 767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
LCHD is in process of acquiring this program from TDH Region 1.
Process is currently dependent upon sufficient staff to perform
necessary duties.
To: CRH/KSHIELDS '
From: "FRANNIE NUTTALL" <TDHR01CA/FNUTTALL>
Date: 3 Feb 94 15:21:10
Subject: LHD NAME AND PROGRAM INITIALS
CC: TDHR01/TSNELL
COMMENT / VERIFICATION FORM
PBCOs FOR FY 1995
LOCAL HEALTH DEPARTMENT:CITY OF LUBBOCK HEALTH DEPARTMENT
PROGRAM:WIC
TDH REVIEWER:FRANCES A. NUTTALL
TDH REVIEWER'S PHONE NUMBER:(806) 655-7151
DATE: 02-03-94
----------------------------------------------------------------
Please place an "X" in front of one of the following items and
fill in any pertinent blanks:
Listed revisions were negotiated with:
NAME:
TITLE:
DATE:
Comments only. No revisions necessary.
Suggestions for FY 1996. No revisions necessary at this time.
x No comments, suggestions, or revisions.
----------------------------------------------------------------
Please list below any NEGOTIATED revisions, comments or
suggestions. Revisions must be agreed upon by the LHD. Use a
new form for each program.
FRANNIE NUTTALL, WIC SECTION DIRECTOR
PUBLIC HEALTH REGION 2
REGION: PHR 1
PROGRAM: WC Program
CONTACT: Stephanie Steger —Doyle
FY 1994
PAGE I
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES — 1994
... iWet 9mo""01
a
N
...... .... 0. (NOW W
OUTCOME
0-1
By 2000,60% of ell ibis pregnant women
# of women enrolled in WIC Project #75
In VAC Project #75 will be enrolled dude g
#of eligbie pregnant women In WIC
their first trimester.
Project #75
PROCESS
P-1.1
During FY 94-95, the staff In WIC Project #75 will
# of opportunftles to enroll In FY 93-94
target outreach to elfflible pregnant women to
# of opportunfties to enroll In FY 94-95
Increase opportunftles to enroll by 25% from FY 93.
ACTIVITIES
During FY 94-95, LCHD Staff vAn:
A-1.1
Conduct a needs assessment to Idently barriers
to participation.
A-12
Implement outreach opportunftles to Idenly e%fble
populations.
A-1.3
Provide" appointment slats per week for
pmgWant clients.
DOCUMENT NO. C5000255
ATTACHMENT NO. 07
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will use direct assistance and/or financial assistance
from RECEIVING AGENCY for the implementation of an immunization program
with special emphasis on children two years old or younger. The goal of
the immunization program is to prevent, control, and eradicate vaccine -
preventable disease in all populations by providing/administering biologicals,
promoting immunizations, and applying epidemiologic/outbreak controls within
budgetary constraints. PERFORMING AGENCY will endeavor to achieve and main-
tain 90% immunity levels for pre-school children.
PERFORMING AGENCY will assess immunization levels in the clinical records of
preschool (two-year) children. Immunization records will be randomly selected
and assessed using the CDC Clinic Assessment Software Application (CASA)
available from the RECEIVING AGENCY, Immunization Division. An initial
assessment must be completed no later than six months after the begin date of
this Attachment. Periodic follow-up assessments must be conducted at least
every six months thereafter. Assessment results must be reported to RECEIVING
AGENCY, Director, Immunization Division not more than two weeks after the
assessments are completed.
PERFORMING AGENCY agrees to conduct at least one seminar or training session
concerning immunization requirements in conjunction with the Licensing Branch
of the Texas Department of Human Services and the RECEIVING AGENCY Program.
INVESTIGATIONS/CONTROL MEASURES
PERFORMING AGENCY will investigate 100% of suspected cases of measles, rubella,
pertussis, poliomyelitis, and diphtheria within 24 hours after a 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, Immunization
Division, within 48 hours after an investigation is initiated.
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, which may then require reimbursement
or replacement of the lost vaccines.
-1-
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 methods to monitor and record daily vaccine
storage temperatures. The report will 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 days after the end
of each month, on forms provided by RECEIVING AGENCY (forms C5, C5A, C33,
C33A). PERFORMING AGENCY will obtain monthly biological reports from private
physician offices and others who receive state supplied biologicals.
Status reports of program activities must be submitted to the RECEIVING AGENCY
using the most current "Immunization Program Performance Indicators Report."
Immunization data (doses administered by age, schedule, and patient demographics)
must be provided in a format that may be loaded directly into the electronic
Immunization Tracking System. PERFORMING AGENCY will be evaluated on both the
number of doses administered and the number of DTP 4 administered to children
who are two years old or younger.
PERFORMING AGENCY agrees to comply with the following: Texas Immunization
Laws, Rules, and Regulations; Chapter 42, Human Resources Code; Sections 2.09
and 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 USPHS, and endorsed by
the American Academy of Pediatrics. PERFORMING AGENCY agrees to provide
immunization services outside usual clinics hours (8am to 5pm) or on weekends
at least once each month or as needed to insure barrier free access to immuni-
zation clinics. PERFORMING AGENCY residency requirements are not applicable
under this Attachment. PERFORMING AGENCY cannot deny vaccinations to recip-
ients because they do not reside within PERFORMING AGENCY'S jurisdiction.
PERFORMING AGENCY will provide an estimated 13413 doses of
vaccine to clients in or benefiting the county(ies)/area defined as:
LUBBOCK AND SURROUNDING COUNTIES.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121 of the Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
PERFORMING AGENCY understands that federal law guarantees access to immuniza-
tion services in public clinics regardless of ability to pay. PERFORMING
AGENCY further understands that the bilingual poster "Fees for Vaccine Admin-
istration," (Form 6-36, available from the Immunization Division) must be
posted where it may be easily seen by patients in each immunization waiting
room.
CPA
. ' .
PERFORMING AGENCY understands that Early and Periodic Screening, Diagnosis,
and Treatment (EPSDT) physicians and other private physicians, authorized by
the RECEIVING AGENCY's vaccine distribution plan to administer state -supplied
vaccines in their practices, are vital members of the Texas Immunization
Initiative. Accordingly, PERFORMING AGENCY agrees to assist in distributing
state -supplied vaccines to EPSDT providers, medicaid providers, physicians,
and other providers and organizations within PERFORMING AGENCY'S local area.
PERFORMING AGENCY agrees that fees collected will be kept within guidelines
established by RECEIVING AGENCY and that no one may be denied immunization
services because of inability to pay the fee. Fee schedule:; will not be based
on per dose charges.
PERFORMING AGENCY understands that if travel funds are provided, they are
restricted for use by persons assigned to the immunization project only.
All out-of-state travel funded by the Immunization Division requires prior
approval by the RECEIVING AGENCY, Immunization Division Director.
For immunization activities performed under this Attachment, General
Provisions, OVERTIME COMPENSATION Article, is not applicable and PERFORMING
AGENCY agrees to comply with the following paragraphs:
PERFORMING AGENCY is authorized to pay employees who are not
exempt under the Fair Labor Standards Act (FLSA), 29 U.S.C.,
Section 20 et. seq., for overtime or compensatory time at the
rate of time and one-half per FLSA.
PERFORMING AGENCY is authorized to pay employees who are
exempt under FLSA on a straight time basis for work performed
on a holiday or for regular compensatory time hours when the
taking of regular compensatory time off would be disruptive
to normal business operations.
Authorization for payment under this provision is limited to
work directly related to immunization activities and has to
be in accordance with the amount budgeted in this contract
Attachment.
PERFORMING AGENCY is responsible for documenting proper
authorization or approval for any work performed by exempt
or non-exempt employees in excess of 40 hours in a workweek.
CleD
SECTION IV. BUDGET:
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to PERFORMING AGENCY for costs
Incurred in carrying out approved activities.
Personnel $51,236.00
Fringe Benefits 17,120.00
Travel .00
Equipment .00
Supplies .00
Contractual .00
Other .00
Total Direct Costs $68,356.00
Indirect .00
TOTAL $68,356.00
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 $68,356.00.
-4-
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the
provision of supplies such as vaccines in lieu of cash.
Vaccine 140,011.00
TOTAL $140,011.00
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 $140,011.00.
Total RECEIVING AGENCY assistance will not exceed $208,367.00.
-5-
DOCUMENT NO. C5O00255
ATTACHMENT NO. 08
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF WOMEN AND CHILDREN
TERM: September 1, 1994 THROUGH August 31, 1995
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will provide at a minimum the following health services to
women and children: prenatal care, family planning services (especially during
the 18 months postpartum), and/or preventive child health services and case
management, as stated in "Exhibit A" which is incorporated herein and made a
part of this Attachment. If PERFORMING AGENCY is not a provider of one or
more of the above -mentioned clinical services, it will assure the provision
of the services by establishing formal referral and tracking systems with
other community -based health care.
In addition, PERFORMING AGENCY will bill Medicaid for all Medicaid billable
services. PERFORMING AGENCY will ensure that all income generated through
Medicaid is used to expand or enhance women and children's health services.
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 Women and Children. The Women and Children's
Service Plan is incorporated herein and made a part of this Attachment.
Maternity, family planning, child health, and case management services reports
will be submitted to RECEIVING AGENCY, Bureau of Women and Children.
PERFORMING AGENCY will participate in the coordination of women and children's
services under the leadership of RECEIVING AGENCY'S Public Health Regional
Director. PERFORMING AGENCY will work with the Public Health Region (PHR) in
order to coordinate services, avoid duplication, report unmet needs of the
community, and help to develop "One Stop Shopping Care Centers" where possi-
ble.
If applicable, PERFORMING AGENCY agrees to comply with the Community Oriented
Primary Care (COPC) Letter of Intent and accompanying COPC Basic Standards
which are adopted by reference.
PERFORMING AGENCY will provide services/units of service in or benefiting the
county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121 of the Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
General Provisions, PROGRAM INCOME Article, is modified for the purposes of
this Attachment to comply with Title 42, United States Code, Title V,
-1-
� y s
"Maternal and Child Health Services Block Grant", which does not allow low
income pregnant women, 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 non -farm income official poverty line defined by
the Office of Management and Budget and revised annually in accordance with
Section 624 of 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:
The PERFORMING AGENCY will provide reports on clients receiving
maternity, child health, family planning and case management
services that include the number of (unduplicated) clients seen
and number of visits by specified race and age groups and time
periods (quarterly and yearly), within 15 days from the end of the
month for the quarterly reports (December, March, June, September)
and within 30 days from the end of the Attachment term for the annual
report. In addition, if the PERFORMING AGENCY receives funds to provide
special tests and services (e.g. sonograms, diagnostic lab tests,
colposcopy, etc.), the agency will submit detailed quarterly reports,
within 15 days from the end of the month for the quarterly reports
and within 30 days from the end of the Attachment term for the annual
report, regarding the expenditure of these funds.
In addition, where applicable, PERFORMING AGENCY will work toward a compre-
hensive health care delivery model as outlined in the COPC Basic Standards
and will report on the progress made in the Women and Children's quarterly
and annual reports.
-2-
SECTION IV. BUDGET:
FINANCIAL ASSISTANCE
Financial assistance involves payment of funds to PERFORMING AGENCY for costs
incurred in carrying out approved activities.
Personnel $276,315.00
Fringe Benefits 50,733.00
Travel .00
Equipment .00
Supplies 16,733.00
Contractual 21,200.00
Other .00
Total Direct Costs $364,981.00
Indirect .00
TOTAL $364,981.00
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 $364,981.00.
-3-
DIRECT ASSISTANCE
Direct assistance involves the assignment of state funded positions or the
provision of supplies such as vaccines in lieu of cash.
Personnel [ 2 position(s)] $32,616.00
TOTAL $32,616.00
Direct assistance for personnel in the amount of $32,616.00 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 $32,616.00.
Total RECEIVING AGENCY assistance will not exceed $397,597.00.
-4-
r
✓
r
►
PERFORMING AGENCY NAME: Lubbock City Health Department
TYPE OF HEALTH SERVICES UNDUPLICATED TOTAL
COUNT VISITS
Maternity 700 5,600
Family Planning 900 2,700
Child Health 200 600
Case Management Maternity 300 1,500
Case Management Children 70 420
c
LUBBOCX CITY / FAMILY HEALTH SERV PAGE 935 '
TEXAS DEPARTMENT OF HEALTH PHR 1
OPERATING BUDGET FOR YEAR ENDING AUGUST 31, 1995
%S.CF APRIL 30, 1994 BUDGET NO. LC301
H21311^13028
CATE- DESCRIPTION OR TITLE FUND ENO ITEM JOB PAY PAY EFFECTIVE MONTHLY
GORY DESC. MONTH NO. CLASS GP STP DATE RATE
1 CLERICAL SUPERVISOR II STATE AUG 088 0063 07 01 SEP 94 1,397.00
COMMUNITY SERV AIDE III STATE AUG 131 5503 06 01 SEP 94 1,321.00
BUDGETED AMT
16,764.00
15,852.00
32,616.00
-C G T 45
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-wis mv,�MT. 0 IV 1510,' A
iw
JUL - 6
A S
i L it'i S E R ',A C E S
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 1
STATE OF TEXAS TDH Document No. C6000126
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.
Att. No. 02 — Amendment to add a new Attachment for Bureau of HIV and STD
Prevention to fund counseling, testing, referral and partner
elicitation/notification (CTRPN) for persons at risk of HIV
due to sexual behavior. in.iecting_ drug_ use. or other risk
behaviors.
All terms and conditions not herebv amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity itvoe above
if different from PERFORMING AGENCY)
for and in behalf of:
�' IUBBOCK CI HE�thi ARTK �._
PERFOUI9 MENCY
A
By : __
(Sig ture of De on authorized
to sign contracts)
David R. Langston, Mayor
(Name and Titlel
Date:-----------
RECONNENDED:
(PERFORKING AG irector,
if different f oerson
authorized to sign contractl.
Cover - Pace 1
TEXAS DEPARTNENT OF HEALTH
RECEIVING AGENCY,
cc,
iSianature of person authorized ;
to sic_n contracts)
Linda Farrow. Chief '
Bureau of Financial Services _
(Name and Title)
Date: T��J
APPROVED AS TO FORK:
By:
Office of General Counsel ;
DETAILS OF ATTACHMENTS
Att/: ; _ _ Financial Assistance
Am. TCH : Term :MSource of : r ; Direct ; Total Assistance
No. : Program Begin End : Funds$ : Amount Assistance ; Amount iTCH Shares
01 HIV/SURV-LHS : 1/ 1/95:12/31/95! STATE 35.398.00! .00: 35.398.00:
t 1
02 : HIV/GHC-LHS ; 1/ 1/95:12/31/95! 93.940 ; 17.500.00; .00: 17.500,00:
. 1
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1 - ------------------------------------------------------------------------------------------------------ I.
TDH Document No. C6000126 TOTALS : 1 52.898.00: 1 .00: f 52.898.00:
Chanoe No: 01
0ederal funds are indicated by a number from the Catalua of Federal.Domestic Assistance (CFDAi, if aoolicable..
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
COVER - Paae 2
DOCUMENT NO. C6000126
ATTACHMENT NO. 02
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF HIV AND STD PREVENTION
TERM: January 1. 1995 THROUGH December 31, 1995
SECTION I. SCOPE OF WORK:'
PERFORMING AGENCY agrees to conduct counseling. testing, referral, and partner
elicitation/notification (CTRPN) activities to help reduce the spread of human
immunodeficiency virus/acauired 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, in-iecting drug use, or other risk behaviors.
All information and educational 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 RECEIVING AGENCY'S request for proposal (RFP) and assurances, and PER-
FORMING AGENCY'S objectives, activities work plan, and detailed budget as
approved by RECEIVING AGENCY. All of the above -named documents are incorpora-
ted herein by reference and made a part of this Attachment. All 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 Derform the following Counseling and Testing Services:
1.. Offer voluntary HIV testing to clients with the option of receiving
services'either anonymously or confidentially_ according_ to Texas
Department of Health (TDH) guidelines.
2. Provide culturally sensitive and effective pre -test and post-test coun-
seling based on TDH approved guidelines.
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 conven-
ient for the majority of the target population and during hours
-1-
established to reach these clients.
5. Use optically scannable forms supplied by RECEIVING AGENCY or a similiar
TDH aaoroved instrument to collect demographic information and unlinked
test result data. This includes the accurate completion and timely
submission of scannable forms accordina to the Guidelines in the HIV
Counseling and Testing Report Manual.
6. Utilize RECEIVING AGENCY'S laboratory, for all ELISA and Western Blot
testing unless otherwise aooroved in writing by RECEIVING AGENCY.
7. PERFORMING AGENCY will develop and maintain a•referral Dlan by which
reciprocal linkages are established with other service providers
(especially other RECEIVING AGENCY funded providers) for the purpose of:
a. Case management
b. Extended HIV prevention counseling
c. C04 testing
d. T6 skin testing_
e. Immunizations
f. STD screening
g. Family Dlanning
h. Gvnecological exam
I. Substance abuse treatment
.1. Medical evaluation for HIV illness
k. Medical follow-up
1. Antiviral therapy_
m. PCP prophylaxis
n. Psvchosocial needs assessment
o. Professional Dsychosocial counseling_
D. Emotional support groups
o. Financial eligibility assistance
r. Legal assistance
PERFORMING AGENCY will perform the following Partner Elicitation/Notification
Services:
1. All Dartner elicitation/notification services must be consistent with
RECEIVING AGENCY'S ore -test and Dost-test counseling guidelines and the
TDH Ser000sitive and Partner Notification Guidelines which are incorporated
by reference and made Dart hereof.
2. Partner notification must be mentioned in every ore -test session and
encouraged and discussed with every HIV positive client during_ the post-test
counseling session.
3. If the client prefers to make the partner notification personally. provide
guidance/coaching in making the notification during_ the posttest counseling_
session.
4. If the client would like to inform Dartner(s) but is not sure whether they
will be able to do so, a verbal agreement/contract will be established. In
the contract. the client aq_rees to notifv Dartner(s) by a specific date. The
client provides full names and iocatinq information with the knowledge that
this information will be relayed to the local Health Department/regional
STD program who will confidentially notify the partner(s) if the referral
is not completed as agreed.
5. If the client does not want to notify Dartner(s) or in the counselor's
opinion is incapable. 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.
6. PERFORMING AGENCY agrees to report HIV partner elicitation data using_ the
RECEIVING AGENCY'S Partner Elicitation Report Form.
PERFORMING AGENCY agrees to comply with the following_ CTRPN Quality Assurance
Guidelines:
1. PERFORMING AGENCY assures that ore -test and post-test counseling sessions
are performed by staff who have successfully completed counseling
training from a course and instructor approved by RECEIVING AGENCY.
2. PERFORMING AGENCY will conduct monitoring of counseling, testing, referral
and partner notification sessions. Throuq_h use of Quality Assurance
Systems (QAS) PERFORMING AGENCY'S program manager will Dossess 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
Safetv Code and relevant portions of Chapter 6A (Public Health Service) of
Title 42 (The Public Health & Welfare) of the U.S. Code, as amended.
PERFORMING AGENCY will provide an estimated 800 clients with
services/units of service in or benefiting_ the countv_(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
-3
Sessions in Centers for Disease Control Assistance Programs." and its preface
which is written by RECEIVING AGENCY. PERFORMING AGENCY has Drovided
RECEIVING AGENCY with written acknowledgement of receipt and assurance of
compliance with these guidelines. All of the above -referenced documents are
incorporated herein and made a _part of this Attachment as though written
herein verbatim.
Due to the sensitive and highly personal nature of HIV/AIDS-related infor-
mation, strict adherence to the General Provisions. CONFIDENTIALITY Article
is required. In addition to these conditions. PERFORMING AGENCY will comDly
with TDH Bureau of HIV and STD Prevention's HIV Serologic Testing and Docu-
mentation Guidelines. All of the above -referenced documents are incorporated
herein and made a Dart of this Attachment as though written herein verbatim.
PERFORMING AGENCY, or any subcontractor, shall not transfer a client record
(including a patient record) to another entity or person without written
consent from the client or patient, or someone authorized to act on his or her
behalf: however. RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) may require
PERFORMING AGENCY. or any subcontractor. to transfer a client or patient
record to RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) if the transfer
is necessary_ to protect either the confidentiality of the record or the health
and welfare of the client or patient.
RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) shall have access to a client
record (including a patient record) in the possession of PERFORMING
AGENCY, or any subcontractor, under authority of the Health and Safety Code,
Chapters 81 and 85, and the Texas Revised Civil Statutes, Article 4495b
(Medical Practice Act). In such cases. RECEIVING AGENCY (TEXAS DEPARTMENT
OF HEALTH) shall keep confidential any information obtained from the client
or patient record, as required by the Health and Safety_ Code, Chapter 81, and
the Texas Revised Civil Statutes, Article 4495b.
PERFORMING AGENCY will submit quarterly activity reports within twenty (20)
days after the end of each ouarter. that are Drepared in the format provided
by RECEIVING.AGENCY.
PERFORMING AGENCY will authorize their staff to attend training, conferences,
and meetings for which funds were budgeted and approved by RECEIVING AGENCY.
-4-
9 1
SECTION IV. BUDGET:
Personnel 113,198.00
Fringe Benefits 3.220.00
Travel 200.00
Equipment .00
Supplies 165.00
Contractual .00
Other 22.00
Total Direct Costs 116,805.00
Indirect 695.00*
TOTAL $17,500.00
Financial status reports (FSRs) are due the 30th of April. July_,
October. January and the 15th of February.
Total reimbursements will not exceed $17,500.00.
*The neaatiated amount is less.than UGCMA. Table 1.