HomeMy WebLinkAboutResolution - 4988 - 3 Contract Amendments - TDOH - Health Programs, Etc. - 10_12_1995Resolution No. 4988
W October 12, 1995
Item #25
BE IT RESOLVED BY THE CITY COUNCIL OF THE CITY OF LUBBOCK:
THAT the Mayor of the City of Lubbock BE and is hereby authorized and directed to
execute for and on behalf of the City of Lubbock three (3) Contract Amendments (TDH
Document No. 06000126) and all related documents by and between the City of Lubbock and the
Texas Department of Health for programs in TB Elimination and Immunizations, HIV, milk
testing and the Office of Regional Administrative Services and a new attachment for Bureau of
Chronic Disease Prevention and Control to fund services to reduce premature morbidity and
mortality associated with breast and cervical cancer, which contracts are 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 esolution 'f fully copied herein in detail.
Passed by the City Council this 12t
VID R.
ATTEST:
Betty M. Johnson, ity Secretary
APPROVED AS TO CONTENT:
Doug Goodm anaging Director of
Health and Co 'ty Services
APPROVED AS TO FORM:
&a n %?&
Clarence Walker, Assistant City Attorney
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October 2,1995
TEXAS DEPARTMENT OF HEALTH
STATE OF TEXAS
COUNTY OF TRAVIS
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 2
Resolution No. 4988
October 12, 1995
Item #25
TDH Document No. C6000126
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. 02A — Amendment for Bureau of HIV and STD Prevention (CTRPN) — GHC
Amendment to add Revised General Provisions and the following new Attachments:;
Att. No. 03 — Milk and Dairy Products Division ;
Att. No. 04 — Office of Regional Administrative Services ;
All terms and conditions not hereby amended remain in full force and effect. ;
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN. ;
Authorized Contracting Entity (type above ;
if different from PERFORMING AGENCY) ;
' or and i alf of: ;
LUBBOCK LT EPARTM TEXAS DEPARTMENT OF HEALTH ;
;\ PER MIN EN RECEIVi AGENCY ;
By:
(Sign ture of _person au horized (Sign' .of person authorized
to sign contracts) _ to sign contracts) ;
Linda Farrow, Chief ;
DAVID R. LANGSTON, MAYOR Bureau of Financial. Services
(Name and itle) (Name and Title) ;
Attest:
Date: getty Y4 4hon& it�r_ Date: ,
Secretary ;
RECOMMENDED: APPROVED AS TO FORM:
By: _ By:(�
(PERFORMING AGENCY D' tor, Office of General Counsel ;
if different from pe n ;
authorized to sign contract) ;
�APPR D AS TO FORM: �
By109
nce-Walker, Asst. City Attorney
Cover - Page t
DOCUMENT NO. C6000126
ATTACHMENT NO. 01
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 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. All revisions to said
documents will be approved by RECEIVING AGENCY and transmitted in writing to
RECEIVING AGENCY.
The activities required to carry out these projects are outlined in the
Centers for Disease Control and Prevention (CDC) and RECEIVING AGENCY'S
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 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 workin4
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 RECEIVING AGENCY for the design,
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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
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 within PERFORMING AGENCY'S geo-
graphic jurisdiction.
b. Collect reports of AIDS cases diagnosed and/or treated within
PERFORMING AGENCY'S geographic jurisdiction.
c. Report cases to RECEIVING AGENCY'S 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 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 eighty percent
(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 (5) days of receipt of case report through contact with
appropriate health care provider or the review of medical records.
b. Assist RECEIVING AGENCY with other epidemiologic investigations
as deemed necessary by RECEIVING AGENCY or the 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
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information in a locking file cabinet when not in use. The locking
file cabinet and surveillance computer must be kept in a locked room,
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
arouos/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 RECEIVING AGENCY HIVAIDS Surveillance
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 150 clients with
services/units of service in or benefiting the county( ies)/area defined as:
UBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, 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, RECEIVING AGENCY (TEXAS DEPARTMENT OF HEALTH) may require
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f
r
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.
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 submit quarterly activity reports within twenty (20)
days after the end of each quarter, that are prepared 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.
SECTION IV. BUDGET:
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Total Direct Costs
Indirect
TOTAL
$25,500.00
6,758.00
1,000.00
.00
750.00
.00
.00
$34,008.00
1,390.00
$35,398.00
Financial status reports (FSRs) are due the 30th of April, July,
October, January and the 15th of February.
Total reimbursements will not exceed $35,398.00.
* Indirect cost is based on UGCMA, Table 1.
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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 oartner
elicitation/notification (CTRPN) activities to help reduce the spread of human
immunodeficiency virus/acauired immunodeficiency syndrome (HIV/AIDS3. 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, injecting drug use, or other risk behaviors.
All information and educational materials developed and provided by PERFORMING
AGENCY will be accurate. comorehensive. 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 reouest for proposal (RFP) and assurances. and PER-
FORMING AGENCY'S oblectives, 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 aooroved by RECEIVING AGENCY and transmitted in writing_
to PERFORMING AGENCY.
PERFORMING AGENCY will provide CTRPN services to the target population defined
as:
1. Males who routinely have sex with other males.
2. Males who occasionally have sex with other males.
3. Males who have sex with males and females.
4. Males and females with multiple sex partners.
5. Persons with a history of sexually transmitted diseases.
6. Persons with a history of high risk behavior.
PERFORMING AGENCY will perform the following Counseling and Testing Services:
1. Offer voluntary 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 cost -test coun-
seling based on TDH approved guidelines.
3. Publicize HIV counseling and testing services so that ootential 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 aoproved instrument to collect demographic information and unlinked
test result data. This includes the accurate completion and timely
submission of scannable forms according_ to the guidelines in the HIV
Counseling and Testing Reoort Manual.
6. Utilize RECEIVING AGENCY'S laboratory. for all ELISA and Western Blot
testing unless otherwise aoproved in writing by RECEIVING AGENCY.
7. PERFORMING AGENCY will develoD and maintain a referral plan by which
reciprocal linkages are established with other service providers
(especially other RECEIVING AGENCY funded Droviders) for the Duroose of:
a. Case management
b. Extended HIV prevention counseling
c. C04 testing
d. TB skin tasting
e. Immunizations
f. STD screening
G. Family planning
h. Gynecological exam
i. Substance abuse treatment
J. Medical evaluation for HIV illness
k. Medical follow-uo
1. Antiviral therapy
m. PCP oroohvlaxis
n. Psychosocial needs assessment
o. Professional psychosocial counseling_
p. Emotional support groups
a.Financial eligibility assistance
r. Legal assistance
PERFORMING AGENCY will perform the following Partner Elicitation/Notification
Services:
1. All partner elicitation/notification services must be consistent with
RECEIVING AGENCY'S pre -test and post-test counseling guidelines and the
TDH Ser000sitive and Partner Notification Guidelines which are incoroorated
by reference and made part 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 partner(s) but is not sure whether they
will be able to do so, a verbal agreement/contract will be established. In
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the contract. the client aa_rees to notify oartner(s) by a specific date. The
client provides full names and locating information with the knowledge that
this information will be relayed to the local Health Department/regional
STD oroaram who will confidentially notify the partner(s) if the referral
is not completed as agreed.
5. If the client does not want to notify partners) or in the counselor's
Opinion is incapable, elicit adeauate information for `STD personnel to make
the notification. Elicited information will be referred to the local health
deoartment/rea_ional STD orogram 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 pre -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. Through use of Quality Assurance
Systems (OAS) PERFORMING AGENCY'S program manager will possess current
information and will monitor counselor performance (at least monthly for
months 1-6 of employment, bimonthly for months 7-12, and auarterly for
experienced counselors whether directly suoervised or on independent
assignment). A written record (TDH skills assessment form or other TDH
aporoved model) of the monitored session is to be kept on file.
3. PERFORMING AGENCY agrees to facilitate RECEIVING AGENCY review of
scheduled counseling_, testing, referral, and partner notification
sessions.
PERFORMING AGENCY agrees to comply with Chapters 81 and 85 of the Health and
Safety Code 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 county (ies) /area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
RECEIVING AGENCY will supply PERFORMING AGENCY with the most current version
of the document entitled "Content of AIDS -Related Written Materials,
Pictorials. Audiovisuals, Questionnaires, Survey Instruments, and Educational
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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
compliancewith these Guidelines. All of the above -referenced documents are
incoroorated 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 comply
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 oatient 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 reouire
PERFORMING AGENCY: or anv subcontractor, to transfer a client or Datient
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 oossession 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 Datient 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 quarter._ that are prepared 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 bv:RECEIVING AGENCY.
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SECTION IV. BUDGET:
Personnel
Fringe Benefits
Travel
Eauioment
Suoolies
Contractual
Other
Total Direct Costs
Indirect
TOTAL
513.198.00
3.220.00
200.00
.00
165.00
.00
22.00
116.805.00
695.00*
$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 negotiated amount is less than UGCMA. Table 1.
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TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: HIV -GENERAL HEALTH CARE-LHS
Performing Agency: LUBBOCK CITY HEALTH DEPARTMENT
TDH Document No. C6000126 Change # 2 Term: January 1. 1995 -_December 31, 1995
Attachment/Amendment No 02A IAC No. ( - )
REVISED CONTRACT BUDGET
/--- ----------------------------------------------------------------------------------- \
FINANCIAL ASSISTANCE
'--------------------------------------------------------------------------------------'
Current Approved
;Change
Requested
; New or Revised ;
;Object Class Categories
;
Budget (a)
(b)
Budget (c)
'-------------------------------------------------------------------------------------
:a.
Personnel
$13,198.00
;
$13,198.00
; $26,396.00-;
'-------------------------------------------------------------------
------------------ '
b.
Fringe Benefits
$3,220.00
;
$3,219.00
; $6,439.00
'------------------------------------------------------------------------------------
'
;c.
Travel
$200.00
;
$200.00
; $400.00 ;
'------------------------------------------------------------------------------------
'
;d.
Equipment
;
.00
;
.00
; .00
'------------------------------------------------------------------------------------- '
;e.
Supplies
;
$165.00
;
$165.00
; $330.00 ;
' ---
---------------------------------------------------------------------------------'
;f.
Contractual
;
.00
;
.00
; .00
'--------------------------------------------------------------------------------------- '
:9.
Other
$22.00
;
$23.00
; $45.00
'--------------------------------------------------------------------------------------'
:h.
Total Direct Charges
$16,805.00
;
$16,805.00
; $33,610.00 ;
'-------------------------------------------------------------------------------------
;i.
Indirect Charges
$695.00
;
$695.00
'
; $1,390.00*
I ,
j. TOTAL $17,500.00 ; $17,500.00 ; $35,000.00
'-----------------------------------------------------------------------------------'
'k. RECEIVING AGENCY share $17,500.00 $17,500.00 $35,000.00 ;
'--------------------------------------------------------------------------------------'
1. PERFORMING AGENCY share; .00 .00 .00
(Includes m. PI) ;
'--------------------------------------------------------------------------------------'
;m. Program Income .00 ; .00 ; .00 ;
'------------------------------------------------------------------------------------- '
,Detail on Indirect Charges:
Type of Rate (Mark one Box) _ Provisional _ Predetermined
_ Final _ Fixed ;
Rate 0.00 Base .00 Total Indirect Charges .00
,
-------------------------------------------------------------
'EXPLANATION OF CHANGE: ;
'Increase in funds due to a twelve-month budget; initial funding was for six
;months. ;
!Revised number of clients served: 1600 '
*Indirect cost is based on UGCMA, Table 1. ;
,
,
Form No. GC-9
Rev. 03/91
DOCUMENT NO. C6000126
ATTACHMENT NO. 03
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: MILK AND DAIRY PRODUCTS DIVISION
TERM: September 1, 1995 THROUGH August 31, 1996
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.
—1—
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. C6000126
ATTACHMENT NO. 04
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: OFFICE OF REGIONAL ADMINISTRATIVE SERVICES
TERM: September 1, 1995
SECTION I. SCOPE OF WORK:
THROUGH August 31, 1996
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, for any of the
following program areas for which it provides direct or sub -contracted
services:
HIV/AIDS
Immunization
Food Protection
Women and Children
Chronic Disease Prevention and Control
Nutrition Services
Milk and Dairy
Injury Prevention and Control
(Bicycle Helmet Project)
Public Health Promotion
Refugee Health
Sexually Transmitted Disease
Tuberculosis Elimination
Dental Health Services
Hansen's Disease
Asbestos Programs Branch
(Enforcement Section)
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 this 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 Administrative Services. The format for performance -based monitoring
reports will be agreed upon by both parties prior to the due date of the first
Quarterly report.
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PERFORMING AGENCY will provide an estimated 6,500 clients; with
services/units of service in or benefiting the county(ies)/area defined as:
LUBBOCK.
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
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
$59,382.00
Fringe Benefits
9,800.00
Travel
.00
Equipment
.00
Supplies
.00
Contractual
.00
Other
.00
Total Direct Costs $69,182.00
Indirect .00
TOTAL $69,182.00
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RECEIVING AGENCY financial assistance will not exceed $69,182.00.
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 $112,622.00.
—3—
LUBBOCK CITY HEALTH DEPARTMENT PAGE 881
TEXAS DEPARTMENT OF HEALTH PHR 1
OPERATING BUDGET FOR YEAR ENDING AUGUST 31. 1996
AS OF APRIL 28 1995 BUDGET NO. L0000
H21311/K1i028
CATE• DESCRIPTION OR TITLE FUND END ITEM JOB PAY PAY EFFECTIVE MONTHLY
GORY OESC. MONTH NO. CLASS GP STP DATE RATE
1 LIC VOCATIONAL NURSE II STATE AUG 083 4412 10 04 SEP 95 1.839.00
ADMINISTRATIVE TECH I STATE AUG 104 1501 08 07 SEP 95 1.781.00
BUDGETED AMT
22,068.00
21,372.00
43,440.00
INSTRUCTIONS FOR COMPLETION OF SF LI.I., DISCLOSURE OF LOBBYING ACID MISS
Tbis disclosure form shall be completed by the reporting entity, whether subawardee or prime Federal recipient, at the initiation or receipt
of a covered Federal action, or a material change to a previous fling, pursuant to title 31 U.S.C. section 1352. The filing of a form is
reg4ired for each payment or agreement to make payment to any lobbying entity for influencing or attempting to influence an officer
or employee of any agency, a Member of Congress, an officer or employee of Congress, or an employee of a Member of Congress in connec-
tion wwith a covered Federal action. Use the SF-LLL-A Continuation Sheet for additional information if the space on the form is inadequate.
Complete all items that apply for both the initial fling and material change report- Refer to the implementing guidance published by the
Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity is and/or has been secured to influence the outcome of a covered
Federal action.
2. Identify the status of the covered Federal action.
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previ-
ously reported, enter the year and quarter m which the change occurred. Enter the date of the last previously submitted report by
this repotting entity for this covered Federal action.
4. Enter the full name, address, city, state and rip code of the repotting entity. Include Congressional District, if known. Check the
appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify
the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcon-
tracts, subgrants and contract awards under grants.
5. If the organization filing the report in item 4 checks "subawardee", then enter the full name, address, city, state and zip code of
the prime Federal recipie—t. Include Congressional District, if known.
6. Eater the name of the F Aaral agency making the award or loan commitment. Include at least one organizational level below agency
name, if known. For ex-.mple, Department of Transportation, United States Coast Guard.
i. Enter the Federal program name or description for the covered Federal action (item 1). If knows, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commitments.
8. Eater tiie most appropriate Federal identifying number available for the Federal action identified in item 1 [e.g., Request for Proposal
(BFP) number, Invitation for Bid (IFB) mmmben grant announcement number, the contract, grant, or loan award number, the appli-
cation/proposal control mrmber assigned by the Federal agency]. Include prefixes, e.g., "RFP-DE90-00l. '
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount
of the awardlloaa commitment for the prime entity identified in item 4 or S.
10. (a) Enter the full name, address, city,, state and zip cock of the lobbying entity engaged by the reporting entity identified in item
4 to influence the covered Federal action.
(b) Enter the fan names of the individual(s) performing services, and include full address if different from 10(a). Enter Last Name,
Fist Name, and Middle Initial (MI).
11. Eater the amount of compensation paid or reasonably expected to be paid by the reporting 'entny (item. 4) to the lobbying entity
Chem 10). Indicate whether the payment has been made (actual) or will be made (planned). Check all boxes that apply. If this is
a material change report, enter the cumulative amount of payment made or planned to be made.
12 Check the appropriate box(es). Check all boxes that apply. If payment is made through an in -land contribution, specify the nature
and value of the in -kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If "other," specify nature.
14. Provide a specific and detailed description of the services that the Iobbyist has performed, or will be expected to perform, and the
date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal offi-
cials. Identify the Federal official(s) or employee(s) contacted or the officer(s), employee(s), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLL-A Continuation Sheet(s) is attached.
16. The certifying official shall sign and date the form, print his/her name, title, and telephone number.
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including time for reviewing instruc-
tions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the colk►wmarr of information.
Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Management and Budget.. Paperwork Reduction Project (0348-0046), Washington. D.C. 20503.
DISCLOSURE OF LOBBYING ACTIVITIES
Complete this form to disclose lobbying activities pursuant to 31 U.S.C. 1352
(See reverse for public burden disclosure.)
Approved by OMB
0348-0046
V Type of Federal Action:
2. Status of Federal Action
3. Report Types
�aa. contract
a a. bid/offedapplicadon
a a. initial filing
b. grant
b. initial award
b. material change
c cooperative agreement
c. post -award
d. loan
For Material Change Only:
e. loan guarantee
year Quarter
f. loan insurance
date of last report
4. Name and Address of Reporting Entity:
S. If Reporting Entity in No. 4 is; Subawardee, Enter Name and
❑ Prime ❑ Subawardee
Address of Prime:
Tier , if known:
Congressional District, if known:
Congressional District, if known:
6. Federal DepartmerWAgency:
7. Federal Program Name/Description:
CFDA Number, if applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
S
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address of different
(if individual, last name, first name, Mlh from No. 10a.)
(last name, tint name, Mi .
(a=ch Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply):
13. Type of Payment (check all that apply):
$ d actual ❑ planned
❑ a. retainer
❑ b. one-time fee
❑ c. commission
12. Form of Payment (check all that apply):
❑ a. cash
❑ d. contingent tee
❑ b. in -kind; specify: nature
❑ e. deferred
value
❑ f. other, specify:
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s)
contacted, for Payment indicated in Item 11.:
(arach Continuation Sheet(s) SF-LLLvt, if necessary)
1S. Continuation Sheet(s) SF-LLL-A attached: ❑ Yes ❑ No
16. Information requested through this form is authorized by tale 31 U.S.0
section 13S2. This disclosure of lobbying activities is a material represen-
tation of fact upon which reliance was placed by the tier above when
Print Name:
this transaction was made or entered into. This disclosure is required pur-
suant to 31 U.S.C. 13S2. This information will be reported to the Con-
Title:
V�en sermi4nnually and will be available for public inspectiom Any person
who fails to file the required disclosure shall be subject to a civil penalty
Telephone No.: Date:
of not less than 310,000 and not more than $100,000 for each such failure.
Federal Use Only:
Authorized for Local Reproduction
Standard Form . LLL
DISCLOSURE OF LOBBYING ACTIVITIES Approved by OM8
CONTINUATION SHEET 0348-0046
Repord8
Page of
*U.S. Gowrnaene lrinainq Office , 1992 - 33s-044r0sii SwWard Form - u'L
FY 1996
EXHIBIT A
PERFORMANCE -BASED OBJECTIVES
OFFICE OF REGIONAL ADMINISTRATIVE SERVICES
ATTACHMENT FOR
LUBBOCK CITY HEALTH DEPARTMENT
DEC 2 7 1994
FEB 15
PERFORMANCE -BASED OBJECTIVES
FOR FY 1996
191�1• :1�1
List programs you DO NOT provide. If there is more than one program, use: a separate disclaimer
sheet for each one. .
LOCAL HEALTH DEPART IFNT• City of Lubbock Health Department
PROGRAM NOT PROVIDED: Chronic Disease
SIGNATURE: _
TITLE: Viihli c Neal th Services Manager _
PHONE NLJJIMER: (806)767-2899
No Funding.
4
From: "Dale Drennan" <TDHR01/DDRENNAN>
To: TDHCOPC/KSHIELDS
Date: Thu, 6 Apr 1995 08:51:09 -0600 (CST)
Subject: LUBBOCK CITY HEALTH DEPARTMENT/DENTAL
CC: ' TDHR0.1/TSNELL
X-Confirm-Reading-To: "Dale Drennan" <TDHR01/DDRENNAN>
X-pmrgc: 1
X-mailer: Pegasus Mail v3.22
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT: LUBBOCK CITY
PROGRAM: DENTAL
--------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
X- No comments, suggestions, or revisions.
-----------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each
program.
j
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
SURROGATE OUTCOME
0-1
y 2000, gi e ubbock Countychildren will
have received services at the LCHD Dental Clinic,
Note: Program qualification Is determined by family
size, income and lack of health care resources
(Insurance, Medicaid)
umu a e # of new(annual unduplicated
count) eligible county children seen in the
Dental clinic from FY 95-99
PROCESS
P-1.1
During FY 96, LCHD staff will:
provide dental services to 520 new eligible children
at the LCHD.
# of first time eiligible children receiving dental
health services during FY 96.
P-1.2
Provide 90% of requested emergency dental services
for eligible children within 48 hours.
EmergeIlgy services provided within 48 hours
# of requests for emergency services
Provide an appointment within 60 days for all e +9il) a
children requesting services.
of eligible children j-e-e
# of eiligible children requesting appointments
A-1.2
Counsel all children seen at LCHD regarding
reventive dental care.
# of eilioible children counseled
# of eligible children seen
A-1.3
Contact all dental no shows for follow-up
appointments.
follow --up contacts for "no show" app�
# "no-show" appointments
A-1.4
Provide an inservice clinical rotation for school nurses
about LCHD Dental clinic services.
# school nurses attending inservice
A-1.5
LCHD will provide dental services to 40 or more
school age children per 5 day work week,
# children receiving dental services per 5 day
work week
DEC 2 7 1964
FED is
PERFORMANC�BASM OBJECTIVES
FOR FY 1996
IZ I :1an*
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: Hansen's Disease _
SIGNATURE: _
1=: P11h1ir. Health Services Manager
PHONE NiJAr1BER: (806)767-2899 .
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding, and _practically no Hansen's Disease in this part of Texas (onlyboc
one case in Lubk in the IS years I have been with -the Health Department).
From: "Billie Ray" <TDHROI/BRAY>
To: TDHCOPC/KSHIELDS
Date: Thu, 26 Jan 1995 14:26:15 -0600
Subject: LHD AND PROGRAM INITIAL HERE
CC: TDHROI/TSnell, TDHR01/DWILSON
X-pmrgc: 1
X-mailer: Pegasus Mail v3.1 (Rla)
(CST)
PERFORMANCE -BASED OBJECTIVES
COMMENT/ VERIFICATION FORM
FOR FY 1996
(CORRECTION TO PREVIOUS DOCUMENT)
LOCAL HEALTH DEPARTMENT: Lubbock City Health Department
PROGRAM: HIV Prevention
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME: Tammy Foskey
TITLE: HIV Counselor
DATE: Jan 24, 1995
- Comments only. No revisions necessary.
X - Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
- No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each
program.
The state has identified the following as priorities for HIV
prevention related activities. These should be condidered for future
planning:
Men who have sex with Men (MSM)
Men who have sex with Men of Color (MSM of color)
Men who have sex with men who are also injecting drug users (MSM/IDU)
Injecting drug users and substance abusers (IDU/SA)
Individuals with HIV
Individuals who trade sex for money, drugs and other goods
Women of color
Female partners of MSMs, IDUs, and MSM/IDUs
Women of reproductive age
Individuals in correctional and detention facilities
Adolescents
These are listed by top priority first and down.
REGION: PHR 1
PROGRAM: HIV
CONTACT: NANCY HANEY
FY 1996
PAGE 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
MINIMENNImm
SURROGATE OUTCOME
0-1
By 2000, 25% of all Lubbock citizens receiving HIV education will
Total # of citizens tested for HIV
seek counseling and testing for HIV from any of the certified HIV
Total # of citizens receiving HIV education
counselors in Lubbock.
PROCESS
P-1.1
During FY 95-96, the LCHD certified HIV educator will distribute
# persons given referral cards
referral cards for HIV testing and counseling to 100% of individuals
# of persons educated by LCHD HIV educator
educated.
P-1.2
During FY 95-96, LCHD staff will schedule 100% of those
# of persons scheduled in 1 month
individuals requesting HIV Counseling and Testing within one month
# of persons requesting HIV C&T
of the request.
ACTIVITIES
MONITORING COMPLETED DATE:
A-1.1
During FY 95-96, the HIV educator will actively seek new
opportunities for educating citizens about HIV.
A-1.2
During FY 95-96, the LCHD HIV Counselor will ask 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 positive for HIV
# HIV positive clients attending 1 session
infection and who receive post-test counseling at LCHD will
# of LCHD clients testing HIV positive &
attend one appointment for HIV Early Intervention Services.
receiving post-test counseling
PROCESS
P-2.1
During FY 95-96, LCHD HIV Counselor will schedule 100% of
# of persons sceduled for post-test within
individuals testing for HIV infection a post-test counseling
3 weeks of test.
appointment within three weeks of initial appointment.
# of Individuals testing for HIV at LCHD
P-2.2
During FY 95-96, LCHD HIV Counselor will refer for early
# of LCHD patients referred
intervention services 100% of all LCHD patients testing positive
# of LCHD clients testing HIV positive
for HIV & receiving post-test counseling.
ACTIVITIES
A-2.1
During FY 95-96, the HIV Counselor will record all referrals and
follow-up of those testing positive for early intervention services.
From: TDHR01/DWILSON
To: TDHCOPC/KSHIELDS
Date: wed, 18 Jan 1995 16:06:45 -0600 (CST)
Subject: lubbock city health department
CC: TDHR01/TSNELL
X-pmrgc: 1
X-mailer: Pegasus Mail v3.1 (Rla)
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT:lubbock city health department
PROGRAM:immunization
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
X- No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each
program.
REGION: PHR 1
PROGRAM: IMMUN TIONS
CONTACT: MARILYN MITCHI. LL
EY 996
PAGE 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
OUTCOME I
0-1
y 2000, 90% of children years of age in Lub ck
will have received adequate vaccine for age.
# of childrene e
# of children 2 years and under
PROCESS
y the end of FY 95-96, 97% of children years of age
or under seen in the Immunization clinic will be sent
reminder notices of vaccines due or past due.
# of childern 2 years of age or under sent due
or past due reminders
# of children 2 years of age or under seen in
immunization clinic
P-1.2
P-1.3
Survey Immunization records of 2 year olds
attending Health Department immunization clinic
for :vaccines due or past due.
A-1.2
Mail reminders to 97% of children under 2 years of age.
A-1.3
Operate immunization clinic 37 hours each 5 day work
week.
A-1.4
Serve on the Steering Committee for Shots Across
Texas Lubbock Style.
A-1.5
DEC 2 7 11194
FEB 15
PERFORMANCE -BASED OBJECTIVES
FOR FY 1996
Oil 00WAi31MZ
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: ini ury Prevention/Bicycle Helmet Program
SIGNATURE:
IME: P,ih1 i c Heal rh services Manager ,
PHONE NUMBER: (806)767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding.
y
MAR 6 1995
*Ri,0 11
PERFORMANC&BASED OBJECTIVE'S
FOR FY 1996
E13i IZARX;
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: Milk s Dairy
PHONE NUMBER: (806)767-2899 _
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
Program provided by Texas Department of Health, Region 1, out of Canyon (Skip Moore).
Local Health Department provides laboratory support, as one function of being a
designated Regional Laboratory.
i
DEC 2 7 1994
FES 15
PERFORMANC&BASED OBJECTIVES
FOR FY 1996
1Mz :IM
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: Occupational Health/Asbestos Abatement
SIGNATURE: _
TTTLE: Ptihl i c Health Services Manager .
PHONE NUMBER: (806)767-2899 .
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding. _.
From:
To
Date:
Subject:
CC
X-pmrgc.
X-mailer:
"Kaye Shields" <TDHCOPC/KSHIELDS>
TDHCOPC/KSHIELDS
Wed, 31 May 1995 16:13:31 -0600 (CST)
Lubbock/PHP
tdhr0l/tsnell
1
Pegasus Mail v3.1 (Rla)
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT: City of Lubbock Health Department
PROGRAM: Public Health Promotion
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
— Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
X - No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each program.
Per Tommy Snell, PHR 1 PBO Coordinator: No comments at this time.
ilON: PHR 1
)GRAM: HEALTH PROMOTION
VTACT: NANCY HANEY
1996
3E 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
SURROGATE OUTCOME
0-1 By 2000, the number of Lubbock citizens attending # of citizens attending in FY 9495
Health Education Events sponsored by LCHD # of citizens attending in FY 99-2000
will increase by 10% as compared to FY 9495.
PROCESS
During FY 95-96, LCHD Health Educator will:
P-1.1
schedule 5% more health education events
# of events in FY 9495
then in FY 9495.
# of events in FY 95-98
P-1.2
Include a review of LCHD services in 100% of
# events with LCHD services description
educational events.
1# of events in FY 95-96
ACTIVITIES MONITORING COMPLETED DATE:
A-1.1 During FY 95-95, the LCHD Health Educator will
actively seek new opportunities for educating citizens
about health care issues.
A-1.2 During FY 95-96, the LCHD Health Educator will
record the number of attendees present at each event.
1011D
PERFORMANCE -BASED OBJECTIVES
FOR FY 1996
lkvj Ia• :tom
List programs you DO NOT provide. If there is more than one program, use a separate disclaimer
sheet for each one.
LOCAL EEALT$ DEPARIIAENT. City of Lubbock Health Department
PROGRAM NOT PROVIDED: Refj,gee Health
SIGNATURE:
TULE: P,,hi i c, Health Services Manaeer
PHONE NUMBER: (806)767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
No funding.
[J
From:
To:
Date:
Subject:
CC:
X-pmrgc:
X-mailer:
"Kaye Shields" <TDHCOPC/KSHIELDS>
TDHCOPC/KSHIELDS
Wed, 31 May 1995 16:12:04 -0600 (CST)
Lubbock/retail food
tdhr0l/tsnell
1
Pegasus Mail v3.1 (Rla)
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT: City of Lubbock Health Department
PROGRAM: Retail food
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
X - No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each program.
Per Tommy Snell, PHR 1 PBO coordinator: No comments at this time.
PROGRAM: Retail Food
- —CONTACT: a Keefer
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES - 1995
Tf
OUTCOME
0-1
By 2000, the incidence of reported foodbome
# reported foodborne illnesses
illnesses confirmed and associated with
confirmed and associated with
commercial food establishments will not
commercial food establishments
exceed one (1) outbreak per 100,000 population.
in given year
population in given year
PROCESS
P-1.1
Ensure that a minimum of 10% of the food service
# of foodservice managers state cerfified
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
P-1.2
Rate 100% of the commercial food establishments
#of food establishments rated
based on epiderniologic risk and their
# of food establishments
compliance records.
Note: Documentation of risk factors and inspecti
n
records (Risk factors based an those factors
ACTIVITIES
known to contribute to foodbome disease outbrei
,ks)
A-1.1
Staff will develop and implement a
food manager cerfification course
approved by TDH.
council all foodservice operators/managers about
food manager cerfification program.
A-1.3
During FY 94-95, staff will research, develop
and implement a risked -based approach
From:
"David L. Hoehns, Region 1 STD Program Manage" <TDHROI/DHOEi
To: TDHCOPC/KSHIELDS
Date: Fri, 20 Jan 1995 10:23:07 -0600 (CST)
Subject: LHD AND PROGRAM INITIAL HERE(Lubbock HD)
CC: TDHROI/TSNELL, TDHR01/DWILSON, TDHSTD/Hramsey
X-pmrgc: 1
X-mailer: Pegasus Mail v3.1 (Rla)
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT: Lubbock City Health Department
PROGRAM: STD Control
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time..
X - No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each
program.
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
SURROGATE OUTCOME
0-1
y 2000, 20% of CLHD STD patients with a reportable
sexually transmitted disease seen in the CLHD STD
clinic will consent to be tested for HN.
# of patients repoitable STDs having HIV
test'
# of patients with reportable STDs
During FY 95 - 96, 100% of persons with a agnosis-
of a reportable STD within the last year will be
counseled by the STD staff regarding STDs and HIV.
#pafients counseled
# patients seen In last year with positive STD
P-1.2
During FY 95 - 96, STD staff will provide information
on the prevention of STD and HIV to 100% of persons
treated or examined in STD clinic.
# of patients provided information
# of patients seen in STD clinic
ACTIVITIES
G COMPLETED DATE:
A-1.1
During pamphlets on STDs and HIV will
available to all clients.
A-1.2
During FY 95 - 96 video tapes on STDs and HIV will
be played in the STD waiting area during clinic hours.
R _ • \ ■
• i.=1 •
CQNTACTo ARILYNul ■
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
OUTCOME
0-2
y the year 2000 fFe—re—p-o-ffiain—ciaince of syp i is
less than one year will not exceed 12 cases per
hundred thousand population city of Lubbock.
Number of cases reported at meet case
definition for syphils than one year.
Population of city of Lubbock in 2000
During reported incidence of syphilis less
than one year will not exceed 25 cases per hundred
thousand of population.
Number o cases reported during
that meet definition of syphilis less than one
Year,
Population of city of Lubbock
ACTIVITIES
IMONITORING
COMPLETED DATE:
Ensure that 100% of STD clients requesting minatlonclientsee
for STDs receive a syphilis serology unless they have
been tested in previous 30 days.
syphTils, serglQgy
Number of clients requesting examination
(excluding those tested previous 30 days).
A-2.2
Ensure that 100°% of syphilis contacts who come for
service to the clinic are prophylactically treated if
exposure Is In the last year.
fiber of contacts prophylacticallytreated
Number of contacts with one year exposure
examined
REGION: PHR1
PROGRAM: STD
CONTACT: MARILYN MITCHELL
FY 996
PAGE 3
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
OUTCOME
0-3
y 2000 reduce e n ence o gonorrhea
to fewer than 200 cases per 100,000 population in the
city of Lubbock.
N-U 6 Thea cases
Population of city of Lubbock in 2000
PROCESS
During r uce a rate of gnonorrhea
infection to 271 cases per 100,000 population In the
c' of Lubbock.
NUmber of gonorrheaes
Population of city of Lubbock
ACTIVITIES
of persons treated or examined in the STD
clinic will receive education regarding prevention of STDs
Number rsons
Number persons educated recorded In chart
A-3.2
Pamphlets on STDs will be available to all clients.
A-3.3
Video tapes on STDs will be played In the lobby during
clinic hours.
r � 3
PERFORMANCE -BASED OBJECTIVES
FOR FY 1996
1 to IMZ :IM
DEC 2 7 064
List programs you DO NOT provide. If there is more than one program, = a separate disclaimer
sheet for each one. .
LOCAL HEALTH DEPARTlb=: City of Lubbock Health Department
PROGRAM NOT PROVIDED: TR _
SIGNATURE: _
TTME: P„blic Health services Manaszer
PHONE NUMBER: (806)767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
Provided by Region 1. Local Health Department supports this program through
a state -funded Community Service Aide outreach worker.
r 'w J
Resent -from: "Tommy Snell" <TDHROI/TSNELL>
Resent -to: TDHCOPC/KSHIELDS
Resent -date: Fri, 2 Jun 1995 09:15:07 -0600 (CST)
From: "Tommy Snell" <TDHROI/TSNELL>
To: TDHCOPC/KSHIELDS
Date: Fri, 2 Jun 1995 08:43:30 -0600 (CST)
Subject: LCHD/WOMEN HAEALTH
CC: TSNELL
X-mailer: Pegasus Mail v3.22
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT:LCHD
PROGRAM:WOMEN HEALTH
-----------------------------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
x- No comments, suggestions, or revisions. -
Please list below any comments, suggestions, or NEGOTIATED revisions.
Revisions must be agreed upon by the LHD. Use a new form for each
program.
V dA y
From: °Sheila Rhodes" <TDHR01/SRHODES>
To:
TDHCOPC/KSHIELDS
Date:
Wed, 5 Apr 1995 13:10:15 -0600 (CST)
Subject:
lubbock/womens
CC:
TDHR01/TSNELL
X-mailer:
Pegasus Mail v3.22
PERFORMANCE -BASED OBJECTIVES
COMMENT / VERIFICATION FORM
FOR FY 1996
LOCAL HEALTH DEPARTMENT:lubbock
PROGRAM:womens health
---------------------------------------------
Please place an "X" in front of one of the following items:
- The revisions listed below were negotiated with:
NAME:
TITLE:
DATE:
- Comments only. No revisions necessary.
- Suggestions for FY 1997 PBOs. No revisions necessary at this
time.
x -No comments, suggestions, or revisions.
-----------------------------------------------------------------
Please list below any comments, suggestions, or NEGOTIATED revisions.
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 996
PAGE 1
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
TIMES
SURROGATEOUTCOME
0-1
y 2000, o of patients initially enrolled n the Lubbock
City Health Department (LCHD) prenatal care clinic will
exhibit adequate prenatal care by having a minimum
of nine prenatal care visits.
# of enrolled patients having 9 or more visits
PROCESS
P-1.1
During FY 95-96,a will:
Counsel 100% of pregnant women enrolled In LCHD
prenatal clinic about the importance of regular, on -going
prenatal care visits.
# gf pregnant women enrolled in cfinlc
# of pregnant women counseled
P-1.2
Provide an appointment within two weeks of diagnosis
of pregnancy to 95% of women requesting LCHD
prenatal care.
# men requesting LCHD prenatal care
# women given appointment in 2 wks.
ACTIVITIES
IMONITORING
COMPLETED DATE:
- .
unng , a licensed nurse will counsel
of patients obtaining a positive pregnancy test result
at LCHD about the value of early and on -going
prenatal care.
A-1.2
Clients will have access to pamphlets regarding the
value of early and on -going prenatal care.
A-1.3
Staff will contact pregnant women who fail to keep their
clinic appointments within no more than five working
days; and will take appropriate action.
.................. DUT
0-2
Y of Health Department e a men female clients
will exhibit preventive health care practices by
returning for annual or postpartum examinations.
a e eturnina for
# of LCHD female clients
PROCESS
P-2.1
During FY 94-95:
LCHD staff will counsel 100% of women receiving
prenatal or women's health care about the importance
of annual preventive health care exams.
# LCHD female Glients counseled
# of LCHD female clients
REGION: PHR 1
' : uA'i'IIu _ ►K3:L3I51:
O► MARMARY 5TRANGE
,PAGE 2
CITY OF LUBBOCK HEALTH DEPARTMENT
PERFORMANCE BASED OBJECTIVES
y 2000, 70% of HealthDepartment ema e clients
will exhibit preventive health care practices by
returnin for annual or post parturn examinations.
a e clients rele a
# of LCHD female clients
PROCESS
T-
P-2.1
unng FY 95-96:
LCHD staff will counsel 100% of women receiving
prenatal or women's health care about the importance
of annual preventive health care exams.
# LCHD female clients counseled
# of LCHD female clients
P-2.2
DURING FY 95-96:
Staff assigned to LCHD outreach clinics will counsel
100°% of women seen about the importance of annual
preventive health care exams.
#of women counseled in outreach clinics
# of women seen in LCHD outreach clinics
P-2.3
Of qualified women screened at the LCHD outreach
clinics 50% of those 50 or older needing clinical breast
exam, and Pap smear will receive an appointment
with LCHD.
#qualified women_ receiving aopOnttment
# qualified women seen In outreach clinics
ACTIVITIES
IMONITORING COMPLETED DATE:
A-2.1
During .
LCHD staff will contact, by phone or In person, 90°%
of women who receive prenatal care at the Health
Department to make a - artum appointment
DEC 2 7 1994
FEB 15
PERFORMANCE -BASED OBJECTIVES
FOR FY 1996
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: wTr.
SIGNAITIM-
TULE: p„m i r, H a1 th services Manager
PHONE NZTMBER: (806)767-2899
REASON THE ABOVE PROGRAM IS NOT PROVIDED:
Provided by another agency - works with Health Department, and has a' WIC
team located in the Health Dept. facility.
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief
that:
(1) No federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or an employee of any agency,
a member of congress, an officer or employee of congress, or an
employee of a member of congress in connection with the awarding
of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a
member of congress in connection with this federal contract,
grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-111, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans and cooperative agreements) and
that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance
was placed when this transaction was made or entered into. Submission of
certification is a prerequisite for making or entering into this
transa ion impose Section 1352, Title 31, U.S. Code. Any person who
fails/ t filz� a quired certification shall be subject to a civil
than $lq GeO—agd not more than $100,000 for each such
DAVID R. LANGSTON MAYOR
Name of uthorize Individua
Name and Address of Organization
Attest:
Be ty W. Johnson City Secretary
October 12, 1995
Date
C t, oo0102L=,- (:)
App ication or Contract Number
Appraved as to Conte awed as to Form
larence Walker, As . City Attorney
DETAILS OF ATTACHMENTS
Att/; �r; ;� Financial Assistance ;
Am. ; TON ; Term ; Source of ; ; Direct ; Total Assistance ;
No. ; Program Begirt ; End ; Funds* ; Amount ; Assistance ,; Amount (TDH Share) ;
01 HIY/SURY-LHS 1/ 1/95;12/31195; STATE ; 35,398.00: .00; 35,396,00:
02A ; HIY/GHC-LHS ; 1/ 1/95;12/31/95; 93.940 35,000.00; .00; 35,000.00:
03 MID-LHS ; 9/ 1/95; 8/31/96; STATE .00: .00; .00;
04 ; ORAS-LHS ; 9/ 1/95: 8/31/96: STATE 69,182.00; 43,440.00: 112,622.00:
--, ------------------------------------------------------------------------------------------------------------------
TOH Document No. C6000126 TOTALS ; E 139,580.00; f 43,440.00; = 183,020.00;
Change No. 02
0ederal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO ANOUNT ATTACHMENT FOR DETAILS.
COVER - Page 2
GENERAL PROVISIONS FOR
TEXAS DEPARTMENT OF EEALTH CONTRACTS
PERFORMING AGENCY and RECEIVING AGENCY agree this contract, assurances, general
and/or special provisions, and Attachments) with detailed scopes) of work and
budget (s), as applicable, incorporate all covenants and agreements pertaining
hereto. No prior agreement or understanding, oral or otherwise, of the parties
or their agents will be valid or enforceable unless embodied in this contract..
The person or persons signing and executing this contract on behalf of PERFORMING
AGENCY, or representing themselves as signing and executing this contract on
behalf of PERFORMING AGENCY, do hereby warrant and guarantee that he, she, or
they have been duly authorized by PERFORMING AGENCY to execute this contract on
behalf of PERFORMING AGENCY and to validly and legally bind PERFORMING AGENCY to
all terms, performances, and provisions herein set forth.
PERFORMING AGENCY hereby assures compliance with the following terms and
conditions unless otherwise specified in the Attachment(s) hereto:
ARTICLE 1. Scone of Work
PERFORMING AGENCY will perform the work outlined in the Scope(s) of Work
contained in the Attachments) hereto which is/are referenced in the Details of
Attachments and hereby incorporated and made a part of this contract, plus
amendments which may be added by additional Attachment(s) from time to time as
hereinafter provided.
Satisfactory performance of this contract will be measured in part by:
(1) adherence to the contract; (2) results of CPA or State Auditor reports; and,
3) timeliness, completeness, and accuracy of required reports.
ARTICLE 2. Term
The time period of this contract will be governed by the term(s) on the
Attachment(s). No commitment of contract funds is permitted prior to the first
day or 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(s) and PERFORMINGAGENCYwill 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
This contract and any Attachments) hereto represent the entire understanding and
agreement between the parties and each party agrees to faithfully perform and
uphold each of the provisions hereof. No modification, alteration, or waiver of
any term, covenant, or condition of this contract and any Attachment(s) shall be
valid unless in writing, subscribed 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
(LEIS) 1996 GENERAL PROVISIONS - Page 1 (5/95)
hereof. The illegal or invalid provision will be deemed stricken and deleted
herefrom to the same extent and effect as if never incorporated herein, but all
other provisions will continue.
ARTICLE 6.
Applicable Laws and Standards'
This contract will -be governed by the laws of the State of Texas and enabling
state/federal regulations, including federal grant requirements applicable to
funding sources as set out in Attachment(s) hereto. 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 the Uniform Grant and Contract Management Act (UGCMA),
Chapter 783, Texas Government Code Annotated, and the Uniform Grant and Contract
Management Standards (UGCMS) as amended by revised federal circulars to be
incorporated in UGCMA by the Governor's Budget and Planning Office, apply 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,
UGCMA and UGCMS, the provisions of UGCMA and UGCMS 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 writtenapproval 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, 31 U.S.C.S. 51352,
effective December 22, 1989, PERFORMING AGENCY is prohibited from using funds
granted under this contract for lobbying Congress or any agency in connection
with a particular contract. In addition, if at any time a contract exceeds
$100,000, the law requires certification that none of the funds provided by
RECEIVING AGENCY to PERFORMING AGENCY have been used for payment to lobbyists.
Regardless of funding source, and if a contract exceeds $100,000, a disclosure
form must be completed if PERFORMING AGENCY has any agreement with a lobbyist.
This certification and/or form is available upon request and must be forwarded
to RECEIVING AGENCY within 90 days of receipt.
PERFORMING AGENCY certifies by execution of this contract that its payment of
franchise taxes is current or, if PERFORMING AGENCY is exempt from payment of
franchise taxes, that it is not subject to the State of Texas franchise tax. A
false statement regarding franchise tax status will be treated as a material
breach of this contract and may be grounds for termination at,the option of
RECEIVING AGENCY. If franchise tax payments become delinquent during the
Attachment term, payments under this contract will be held until PERFORMING
AGENCY's delinquent franchise tax is paid in full.
PERFORMING AGENCY agrees to comply with the requirements of the Immigration
Reform and Control Act of 1986 and Immigration Act of 1990 regarding employment
verification and retention of verification forms for any individual(s) hired on
or after November 6, 1986, who will perform any labor or services under this
contract.
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
(LEIS) 1996 GENERAL PROVISIONS- Page 2 (5/95)
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.
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.
To the extent such provisions are applicable to PERFORMING AGENCY, PERFORMING
AGENCY agrees to fully comply with the following: Title VI of the Civil Rights
Act of 1964 (Public Law 88-352); Section 504 of the Rehabilitation Act of 1973
(Public Law 93-112); The Americans with Disabilities Act of 1990 (Public Law 101-
336) ; and all amendments to each, and all requirements imposed by the regulations
issued pursuant to these acts, especially 45 CFR Part 80 (relating to race, color
and national origin), 45 CFR Part 84 (relating to handicap), 45 CFR Part 86
(relating to sex), and 45 CFR Part 91 (relating to age).
Collectively, such requirements obligate RECEIVING AGENCY to provide services
without discrimination on the basis of race, color, national origin, age, sex,
disability, or political or religious beliefs; PERFORMING AGENCY agrees that in
carrying out the terms of this contract, it will do so in a manner which will
assist RECEIVING AGENCY to comply with such obligations to the fullest extent of
PERFORMING AGENCY's ability. PERFORMING AGENCY will use its best efforts to make
available employment opportunities for qualified disabled individuals.
PERFORMING AGENCY agrees to comply with the non-discriminatory requirements of
Texas Labor Code, Chapter 21, which requires that certain employers not
discriminate on the basis of race, color, disability, religion, sex, national
origin, or age.
PERFORMING AGENCY will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification of violating facilities
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 agrees to comply with the Pro -Children Act of 1994, Public Law
103-227; 108 Stat 271 §104; U.S.C.A. Title 20 §§ 6080-6081, regarding the
provision of a smoke -free workplace and promoting the non-use of all tobacco
products.
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.
(LHS) 1996 GENERAL PROVISIONS - Page 3 (5/95)
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 and Programmatic Management
PERFORMING AGENCY will develop, implement, and maintain financial management and
control systems that meet or exceed the requirements of UGCMA. Those
requirements include at a minimum:
1. Financial planning,°including the development of budgets that adequately
reflect all functions and resources necessary to carry out authorized
activities and the adequate determination of costs;
2. Financial management system including accurate, correct, and complete
payroll, accounting, and financial reporting records, cost source
documentation, effective internal and budgetary controls, determination of
reasonableness, allowability, and allocability of costs, and timely and
appropriate audits and resolution of any findings; and,
3. Billing and collection policies, including a charge schedule, a system for
discounting or adjusting charges based on a person's income and family
size, and a mechanism capable of billing and making reasonable efforts to
collect from patients and third parties.
In addition, PERFORMING AGENCY agrees to bill third party payors, at no cost to
the client, for services provided under the Attachment(s). - 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.
PERFORMING AGENCY, if designated a ;501(c)(3) organization- as defined in the
Internal Revenue Code or a for -profit organization, and its governing board shall
bear full responsibility for the integrity of the fiscal 'and programmatic
management of the organization. Such management shall include accountability for
all funds and materials received from the RECEIVING AGENCY, compliance with
RECEIVING AGENCY rules, policies, and procedures, and applicable federal and
state laws and regulations, and correction,of fiscal and program deficiencies
identified through self -evaluation and the RECEIVING AGENCY's monitoring
processes. Ignorance of any contract provisions or other requirements contained
or referenced in the contract or contract Attachment(s) shall not constitute a
defense or basis for waiving or appealing such provisions or requirements.
Further," PERFORMING AGENCY'S governing board shall ensure separation of powers,
duties, and functions of board members and.staff.
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 and paid by PERFORMING AGENCY within the Attachment term prior to
(LUS) 1996 GENERAL PROVISIONS - Page 4 (5/95)
claiming reimbursement from RECEIVING AGENCY. Costs encumbered by the last day
of the Attachment term must be 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 a 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 Attachments) will be used to pay overtime.
PERFORMING AGENCY will be responsible for any obligations of overtime pay due
employees.
ARTICLE 12. Terms and Conditions of Payment
For services satisfactorily performed pursuant to the Scope(s) of Work,
PERFORMING AGENCY will receive reimbursement for allowable costs. Reimbursements
will not exceed the total of each Attachment(s) hereto and are contingent on a
signed contract.
Claims for reimbursement will be made on a State of Texas Purchase Voucher (TDH
Form B-13). Vouchers for reimbursement of actual expenses will be submitted
monthly within 20 days following the end of the month covered by the bill. A
make-up claim may be submitted as a final close-out bill not later than 45 days
following the end of Attachment term(s). Advance payment may be requested in
accordance with the applicable provisions of this contract.
Payments made for approved claims or notice of denial of claims submitted against
Attachment(s) to this contract will be mailed not later than 60 days after
receipt of monthly vouchers. Payment is considered made on the date postmarked.
Any reimbursements made by PERFORMING AGENCY to subcontractors will be made in
accordance with Article 601f, V.T.C.S.
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. Repayment may be taken from -this contract or other active
contracts between the parties in amounts necessary to fulfill PERFORMING AGENCY
repayment obligations.
(LHS) 1996 GENERAL PROVISIONS - Page 5 (5/95)
Payment may be denied for noncompliance if required financial reports are not on
file for previous quarters or for the final period, for failure to respond to
financial compliance monitoring reports, failure to submit independent audit
reports as required by applicable OMB Circulars, or if program requirements are
not met as specified in the Scope(s) of Work.
ARTICLE 13. Advance Payments
PERFORMING AGENCY may request, in writing, a one time advance with written
justification and the concurrence of RECEIVING AGENCY. Amount of advance will be
determined by the amount and term of the Attachment(s); however, for each
Attachment, the amount of the advance will not exceed one -sixth (1/6th) of a
twelve-month Attachment. Advance will be requested on a State of Texas
Purchase Voucher at the beginning of Attachment period or at a single later time
in the Attachment period if circumstances so warrant and the request is approved.
Advance funds will be liquidated during the Attachment term so that, after final
monthly billing, PERFORMING AGENCY will not have advance funds on hand. Advance
funds may be drawn only to meet immediate cash needs for disbursement (UGCMA and
federal circulars).
Amendments to this Attachment (s) may require upward or downward adjustment to the
allowable advance until it equates 1/6th of a twelve-month Attachment. In the
case of a downward adjustment, PERFORMING AGENCY and RECEIVING AGENCY will agree
on the amount of adjustment to the advance. RECEIVING AGENCY retains the option
to reduce future claims by the required amount. In the case of an upward
adjustment and PERFORMING AGENCY needs additional funds to meet immediate
operating expenses, PERFORMING AGENCY may submit to RECEIVING AGENCY a written
justification and State of Texas Purchase Voucher in the amount necessary to
correct the ratio.
ARTICLE 14. Program Income
PERFORMING AGENCY will develop a fee for service system and a schedule of fees
for 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. PERFORMING AGENCY agrees
program income 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 and must be spent in the same project where it was generated.
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.
(LEIS) 1996 GENERAL PROVISIONS - Page 6 (5/95)
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 by
PERFORMING AGENCY regardless of whether or not expenses have; been incurred.
A Financial Status Report, State of Texas Supplemental Form 269a - (TDH Form
GC-4a), will be submitted within 30 days following the end of each of the first
three quarters. A final financial report, State of Texas Supplemental Form 269a
(TDH Form GC-4a), will be submitted not later than 45 days following the end of
Attachment term(s). If necessary, a State of Texas Purchase Voucher will be
submitted if all costs have not been recovered or a refund will be made of excess
monies if costs incurred were less than funds received.
ARTICLE 16. Reports and Inspections
PERFORMING AGENCY will submit financial, program, progress, and other reports as
requested by RECEIVING AGENCY in the format agreed to by the parties hereto.
RECEIVING AGENCY and, when federal funds are involved, any authorized
representative(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 Is findings. A determination
by RECEIVING AGENCY of either an inadequate or inappropriate resolution of the
findings may result in the withholding of funds, as provided in Terms and
Conditions of Payment Article. 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.
(L1US) 1996 GENERAL PROVISIONS Page 7 (5/95)
ARTICLE 17. Client Records
PERFORMING AGENCY, or any subcontractor, shall not transfer an identifiable
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 may require the PERFORMING AGENCY,
or any subcontractor, to transfer a client or patient record to another agency
or to the RECEIVING AGENCY if the transfer is necessary to protect either the
confidentiality of the record or the health and welfare of -the client or patient.
At the end of the Attachment term, all client or 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 or patient records upon written notice to PERFORMING AGENCY,
either to another entity that agrees to continue the service or to RECEIVING
AGENCY.
Notwithstanding any other provision herein, if requested by RECEIVING AGENCY, the
PERFORMING AGENCY shall, share all patient information with the RECEIVING AGENCY
when the contract involves patient care by the PERFORMING AGENCY. The PERFORMING
AGENCY shall attempt to obtain a release of medical information from the client
or patient or someone authorized to act on his or her behalf permitting the
transfer of information outside the PERFORMING AGENCY on forms supplied by the
RECEIVING AGENCY. If the patient refuses to sign the release of information
form, the information will be shared with the RECEIVING AGENCY devoid of all
identifiers of a personal nature, as specified by RECEIVING AGENCY.
ARTICLE 18. 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 connection 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
immunodeficiency syndrome (AIDS). PERFORMING AGENCYagrees 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
(LHS) 1996 GENERAL"PROVISIONS - Page 8 (5/95)
equipment if their unit cost is over $500. In accordance with Health & Safety
Code, Section 12,053, title to all equipment and supplies 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 Attachments) 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 and supplies 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. Subcontractin
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. Such contractual agreements must be executed on an annual basis
and include, at minimum, the following information: 1) name and address of all
parties, 2) well defined scope of work, 3) measurable method and rate of payment,
and 4) clearly defined and executable termination clause. It is recommended that
subcontracts have beginning and ending dates coinciding with the dates of the
applicable contract Attachment(s).
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. Coovriahts, Publications, and Patents
PERFORMING AGENCY understands and agrees that where activities supported by the
contract Attachment(s) produce original books, manuals, films, or other original
material, PERFORMING AGENCY may copyright such material subject to any rights
'to same reserved by or vested in the federal or state government or any agency
thereof; however, PERFORMING AGENCY may grant to RECEIVING AGENCY limited rights
to produce, publish, and use such materials as appropriate. The rights reserved
by or vested in the federal or state government or any agency thereof consist of
the following: The federal or state government or any agency thereof reserves
a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or
otherwise use, and to authorize others to use, for government purposes (a) the
copyright in any work developed under a grant, subgrant, or contract under a
grant or subgrant, and (b) any rights of copyright to which a grantee, subgrantee
or a contractor purchases ownership with grant support.
(LHS) 1996 GENERAL PROVISIONS - Page 9 (5/95)
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 Seca 401.14 or FAR 52.227.11.
ARTICLE 22. Hold Harmless
PERFORMING AGENCY, as an independent contractor, agrees to hold RECEIVING AGENCY
and/or federal government harmless and to indemnify them. from any and all
liability, suits, claims, losses, damages and judgments, and shall pay all costs,
fees and damages to the extent that such costs, fees and damages arise from
performance or non-performance of PERFORMING AGENCY under this contract.
Likewise, RECEIVING AGENCY, as a state governmental agency, agrees to hold
PERFORMING AGENCY harmless and to indemnify it against any and all liability,
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 a fidelity bond or insurance coverage
equal to the amount of funding provided under the contract'Attachment(s) up to
$100,000 that protects each employee of the PERFORMING AGENCY handling funds
under this contract, including persons) authorizing payment of such funds. 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. Historically Underutilized Businesses
PERFORMING AGENCY agrees to take affirmative steps to ensure that Historically
Underutilized Businesses (HUBS) are utilized whenever possible. A HUB includes:
(a) A corporation formed for the purpose of making a profit in which at
least 51t of all classes of the shares of stock or other equitable
securities are owned by one or more persons who are socially
disadvantaged because of, their identification as members of certain
.groups, including Black Americans, Hispanic Americans, Asian
Americans, or Native Americans, and have suffered the effects of
discriminatory practices or similar insidious circumstances over
which they have no control; and have a proportionate interest .and
demonstrate active participation in the control, operation, and
management of the corporation's affairs;
(b) A sole proprietorship created for the purpose of making a profit
that is 10096 owned, operated or controlledby such person(s)
described in (a);
(LHS) 1996 GENERAL PROVISIONS - Page 10 (5/95)
(c) A partnership formed for the purpose of making a profit in which 51k
of the assets and interest in the partnership is owned by one or
more persons who are described in (a) above and have a proportionate
interest and demonstrate active participation in the control,
operation, and management of the partnership's Eiffairs;
(d) A joint venture in which each entity in the joint venture is a
historically underutilized business; or
(e) A supplier contract between a HUB as defined in (a) above and a
prime contractor under which the HUB is directly involved in the
manufacture or distribution of the supplies or materials or
otherwise warehouses and ships the supplies.
ARTICLE 25. Termination
If PERFORMING AGENCY fails to comply with RECEIVING AGENCY's reporting
requirements, the program objectives, or the contract award conditions, RECEIVING
AGENCY may withhold payments. RECEIVING AGENCY will provide advance written
notice to PERFORMING AGENCY which will identify the deficiency and RECEIVING
AGENCY's intent to withhold payments if the deficiency is not corrected within
a specific number of days. When the.deficiency is corrected, RECEIVING AGENCY
will release any withheld payments with no further action. If: PERFORMING AGENCY
fails to comply with the terms, conditions, or standards of this contract,
RECEIVING AGENCY may 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. 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 Attachments) 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 Attachments) budget period, and RECEIVING AGENCY is unable to obtain
additional funds for such purposes. RECEIVING AGENCY will immediately provide
written notification to PERFORMING AGENCY of such fact and such Attachment(s) to
this contract is/are terminated upon receipt of that notification. PERFORMING
AGENCY will not incur new obligations after the effective date of termination and
will cancel as many outstanding obligations as possible. RECEIVING AGENCY will
allow full credit to PERFORMING AGENCY for noncancelable obligations which were
properly incurred prior to the termination date.
This contract or any Attachment(s) hereto may be terminated in the event that
federal or state laws or other requirements should be amended or judicially
interpreted so as to render continued fulfillment of this contract, on the part
of either party, unreasonable or impossible. If the parties should be unable to
(LEIS) 1996 GENERAL PROVISIONS - Page 11 (5/95)
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 26. 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 out above. The only
distinction between state budgeted and local paid employees is that employees on
state budgeted positions receive state benefits and are subject to certain
duties, obligations, and restrictions as state employees as contained in state
law. One such restriction, as contained in the State Appropriations Act, is that
no employee paid on a state budgeted position may receive a salary supplement
from any source unless specifically authorized in the Appropriations Act or other
state law. This prohibition includes, but is not limited to, the payment to such
employee of a so-called "flat rate" car allowance or travel allowance Any such
travel or per ahem 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
Attachments) to this contract. Qualifications of any individuals filling these
positions will be subject to approval of RECEIVING AGENCY's Bureau .of Personnel
Management. The purpose of the approval is to ensure that individuals occupying
these positions meet minimum educational and experience requirements.
PERFORMING AGENCY will maintain required records and submit documents necessary
to process personnel, payroll, leave and time records, and travel claims on state
budgeted positions. PERFORMING AGENCY will be furnished by RECEIVING AGENCY
state warrants for salary compensation or travel reimbursement for issuance to
employees on state budgeted positions.
An independent audit is not required as a condition of this contract if the
Attachment provides assistance through assignment of state budgeted positions and
no funds are budgeted for local costs.
PERFORMING AGENCY may be reimbursed for local personnel costs or other categories
of expense used to fulfill the scope of work of Attachment(s) in lieu of being
furnished state payroll warrants after a state budgeted position becomes vacant.
Reimbursement will not exceed the balance of funds on the state budgeted position
after all benefits, obligations, and/or other entitlements are met. PERFORMING
AGENCY's Director, or other person(s) authorized elsewhere in this contract, may
submit a request for conversion. RECEIVING AGENCY will transmit formal approval
and a revised budget to PERFORMING AGENCY to complete the conversion.
(LHS) 1996 GENERAL PROVISIONS - Page 12 (5/95)
ARTICLE 27. 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 28. 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;
- 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
Public Health Promotion
Immunization Initiative
women & Children
Chronic Disease Prevention & Control
HIV/AIDS
Refugee Health
Sexually Transmitted Diseases
Tuberculosis Elimination
Dental Health Services
Nutrition Services
These objectives are appended to the Office of Regional Administrative Services
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
(LUS) 1996 GENERAL PROVISIONS - Page 13 (5/95)
objectives for the following pilot program areas:
Milk & Dairy
Hansen's Disease
Injury Prevention & Control (Bicycle Helmet Project)
Asbestos Program Branch (Enforcement Section)
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.
RECEIVING AGENCY contact for matters pertaining to the performance -based public
health services project is the Office of Regional Administrative Services.
(LHS) 1996 GENERAL PROVISIONS - Page 14 (5/95)
TEXAS DEPARTMENT OF HEALTH Resolution No.•4988
1100 WEST 49TH STREET October''12, 1995
AUSTIN, TEXAS 78756-3199 Item #25
CONTRACT CHANGE NOTICE NO. 3
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: ;
- � s
Revision to public health services contract. ;
Att. No. 05 - Amendment to add a new Attachment for Tuberculosis Elimination ;
Division to fund expanded outreach services to individuals of ;
identified sub -groups who have tuberculosis or are at high risk ;
of developing tuberculosis. ;
Att. No. 06 - Amendment to add a new Attachment for Immunization Division to ;
fund investigation, control measures, and immunization services.;
All terms and conditions not hereby amended remain in full force and effect. ;
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCX
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY) ;
behalf of: ;
, LUBBOCX CITY H T OEPARTME TEXAS DEPARTMENT OF HEALTH
ERFOR ENCY RECEIVING AGENCY
(Sign of person auth ize --(-S'igbture of person authorized
to si contracts) to sign contracts)
Linda Farrow, Chief
DAVID R. LANGS'I'ON, MAYOR _ Bureau of Financial Services
(Name and Title) IName and Title) '
Date: October 12, 1995 Date:
RECOMMENDE11 APPROVED AS TO FORK:
+ By: By:
(PERFORMING AGENCY Direct - Office of Genera Counsel
if different from pens ;
authorized to sign contract) '
,
Attest:
Betty M. Johns n, City Secretar
CXer - Page i
3ved as to F
A 6AI7 P9 &61 A
Clarence Walker, Asst. City Attorney
DETAILS- OF ATTACHNENTS
Att/I
I
I
Financial
Assistance 'I;
;
As. ; TDH
;
Term ;
Source
of ;
;
Direct ;
Total Assistance
Na. ; Program
; Begin
; End ;
Funds*
;
Amount ;
Assistance _;
Amount (TOH Share) ;
01 ; HIV/SURV-LHS
; 1/
1/16:12/31/95:
STATE
;
35,398.00;
.00;
35,398.00:
02A ; HIV/GHC-LHS
; 1/
1/95:12/31/95;
93.940
;
35,000.00;
.00:
35,000.00;
t 1
I 1
1
1
i
1
1
1
1
!
I
I
1
1
03 ; KID-LHS
; 9/
1/95; 8/31/951
STATE
....00;
.001,
.001,
1 1
1
t
1
I
1
l
04 ; ORAS-LHS
9/
1/95: 8/31/96:
STATE
;
69,182.00:
43,440.00;
112,622.00
1 1
1 I
!
1
(
!
t
(
1
1
1
1
I
1
05 ; TB/OR/ST-LHS
; 9/
1/95; 8/31/96:
STATE
;
20,073.00:
.00;
20,073.00:
1 1
1
1
1
1
i
1
06 ; INN/OPTS-LHS
; 9/
1/95: 8/31/96:
STATE
58,366.00:
140,011.00:
2081.367.00
1 i
t l
1
I
1
1
i
t
I
I
1
I
1
1
1 1
1
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--------------------------------------------------------------------------------.--------------------------------------�
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TDH Document No. COCOO126
TOTALS ;
t 228,009.00:
t 183,451,0+D;
t 411,460.00
Change No. 03
0ederal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
COVER - Page 2
DOCUMENT NO. C6000126
ATTACHMENT NO. 05
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: TUBERCULOSIS ELIMINATION DIVISION
TERM: September 1, 1995 THROUGH August 31, 1996
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.
A tuberculosis program nurse, physician, or other health professional for the
PERFORMING AGENCY must be assigned to review the medical management of each
tuberculosis case diagnosed. PERFORMING AGENCY assures that an expert medical
consultation will be obtained if this medical management does not meet the
standards of care for tuberculosis patients set by the Centers for Disease
Control and Prevention (CDC).
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:
-1-
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).
- 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
Total reimbursements will not exceed $20,073.00.
*Indirect cost is based on UGCMA, Table 1.
-2-
DOCUMENT NO. C6000126
ATTACHMENT NO. 06
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
TERM: September 1, 1995 THROUGH August 31, 1996
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 preschool 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 will produce reminders of upcoming immunizations as well as
recalls for children who are due/overdue for doses of vaccine. The notifica-
tions may be automated or manual and may include mailed or telephone messages.
Extra effort should be made to notify parents/guardians of children at high -
risk of failure to complete the series on schedule (e.g. children who start
their series late).
PERFORMING AGENCY agrees to conduct at least one seminar or training session
concerning immunization requirements in conjunction with the Licensing
Division of tte Texas Department of Protective and Regulatory Services (TDPRS)
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
-1-
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.
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, C33,
C33A). PERFORMING AGENCY will obtain monthly biological reports from private
physician offices and others who receive state supplied biologicals.
Effective 1/1/96, PERFORMING AGENCY agrees to provide to RECEIVING AGENCY,
Immunization Division, weekly reports of all immunizations given, detailed by
client demographic and dose information. The report will be submitted in a
format provided by RECEIVING AGENCY, Immunization Division.
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(ImmTrac). 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; Human Resources Code, Chapter 42; 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.
-2-
SECTION II. LEGAL AUTHORITY TO CONTRACT:
Chapters 12 and 121, 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.
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 schedules 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
-3-
authorization or approval for any work performed by exempt
or non-exempt employees in excess of 40 hours in a workweek.
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
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-
CERTIFICATION REGARDING LOBBYING
CERTIFICATION FOR CONTRACTS, GRANTS, LOANS AND COOPERATIVE AGREEMENTS
The undersigned certifies, to the best of his or her knowledge and belief
that:
(1) No federal appropriated funds have been paid or will be paid, by
or on behalf of the undersigned, to any person for influencing or
attempting to influence an officer or an employee of any agency,
a member of congress, an officer or employee of congress, or an
employee of a member of congress in connection with the awarding
of any federal contract, the making of any federal grant, the
making of any federal loan, the entering into of any cooperative
agreement, and the extension, continuation, renewal, amendment,
or modification of any federal contract, grant, loan, or
cooperative agreement.
(2) If any funds other than federal appropriated funds have been paid
or will be paid to any person for influencing or attempting to
influence an officer or employee of any agency, a member of
congress, an officer or employee of congress, or an employee of a
member of congress in connection with this federal contract,
grant, loan, or cooperative agreement, the undersigned shall
complete and submit Standard Form-111, "Disclosure Form to Report
Lobbying," in accordance with its instructions.
(3) The undersigned shall require that the language of this
certification be included in the award documents for all
subawards at all tiers (including subcontracts, subgrants, and
contracts under grants, loans and cooperative agreements) and
that all subrecipients shall certify and disclose accordingly.
This certification is a material representation of fact upon which reliance
was placed when this transaction was made or entered into. Submission of
this certification is a prerequisite for making or entering into this
traniab imposed ection 1352, Title 31, U.S. Code. Any person who
fail tbb fil e r it ification shall be subject to a civil
n ty lof not les 1 gsand not more than $100,000 for each such
re
DAVID R. LMGSMN
Name of Authorized Individual
CITY -OF LUBBOC(
October 12, 1995
ate
C 1 �2 0001---� L,--,-D(o
Application or Contract Nu er
Name and Address of Organization;.
Attest:
Betty lk.,-JohnsorV, City secretary
roved as to Content: ed as to Fo
3
C ce W , Asst. City Attorney
DISCLOSURE OF LOBBYING ACTIVITIES Appioved by OMB
Complete this form to disclose lobbying activities pursuant to 31 U.S.0 1352 0348.0046
(See reverse for public burden disclosure.)
1. Type of Federal Action:
2. Staurs of Federal Action
3. Report Type:
a. contract
a. bid/offer/application
a. initial filing
b. grant
b. initial award
b. material change
c- cooperative agreement
c. post -award
d. loan
For Material Change Only:
e. loam guarantee
Year Quarter
f. loan insurance
dare of last report
4. Name and Address of Reporting Entity:
S. If Repotting Entity in No. 4 is Subawardee, Enter Name and
❑ Prime ❑ Subawardee
Address of Prime:
Tier , if known:
Congressional District, if known:
Congressional District, if known:
6. Federal 0epartmentJAgency.
7. Federal Program Name/Descriooru
CFDA Number, if applicable:
8. Federal Action Number, if known:
9. Award Amount, if known:
$
10. a. Name and Address of Lobbying Entity b. Individuals Performing Services (including address of different
(if individual, last name, first name, MI): from No. 10a.)
(last name, first name, MI):
(attach Continuation Sheet(s) SF-LLL-A, if necessary)
11. Amount of Payment (check all that apply):
13. Type of Payment (check all that apply):
S b actual C planned
D a. retainer
❑ b. one-time fee
D c. commission
12. Form of Payment (check all that apply).
❑ a. cash
❑ d. contingent fee
❑ b. in -kind; specify: nature
D e. deferred
value
❑ f. other. specify:
14. Brief Description of Services Performed or to be Performed and Date(s) of Service, including officer(s), employee(s), or Member(s)
contacted, for Payment indicated in Item 11.:
(attach Continuation Sheet(s) SF-LLL-A, if necessary)
15. Continuation Sheet(s) SF-LLL-A attached: ❑ Yes ❑ No
16. Information requested through this form is authorized by title 31 U.S.C.
section 1352. This disclosure of lobbying activities is a material represen-
tation of fact upon which reliance was placed by the tier above when
Print Name:
this transaction was made or entered into. This disclosure is required pun
suanrt to 31 U.S.C- 1332. This information will be reported to the Con-
Title-
gtss semiannually and will be available for public inspection. Any person
who fails to file the required disclosure shall be subject to a civil penalty
Telephone No.: Date:
of not less than $10,000 and riot more than $100,000 for each such failure.
Federal Use Only:
Authcrized for Local Reproduction
Standard form - LLL
DISCLOSURE OF LOBBYING ACTIVITIES
CONTINUATION SHEET
Approved by OM6
0348-0046
Reporfig Eftitr
Page of
*U.S. Goverment Printing offtce : L992 - 733-044/70511
Standard forth - LLL
D(STRUCTIONS FOR COMPLETION OF SF-LLL, DISCLOSURE OF LOBBYING ACTIVITIES
This disclosure form shall he completed by the reporting entity, whether subawardee or prime Federal dear, at the initiation or receipt
of'a covered Federal action, or a material change to & previous filing, pursuant to title 31 U.S.C. aection 13M The filing of a form is
required for each payment or agreement to make payment to any lobbying entity for intiuencing or attempting to influence an officer
or employee of any agency, a Dumber of Congress, an officer or employee of Congress, or an employee of a Member of Congress in count•
tiou with a covered Federal action. Use the SF-L.LI.A Continuation Sheet for additional information if the space on the form is inadequate.
Complete all items that apply for both the initial filing and material change report. Refer to the implementing guidance published by the
Office of Management and Budget for additional information.
1. Identify the type of covered Federal action for which lobbying activity a and/or has been secured to infhue = the outcome of a covered
Federal action.
Z. Identify the status of the covered Federal action
3. Identify the appropriate classification of this report. If this is a followup report caused by a material change to the information previ-
ously reported, enter the year and quarter in which the change occurred. Enter the date of the last previously submitted report by
this reporting entity for this covered Federal action.
4. Enter the full name, address. city, state and zip code of the reporting entity. Include Congressional District, if known. Check the
appropriate classification of the reporting entity that designates if it is, or expects to be, a prime or subaward recipient. Identify
the tier of the subawardee, e.g., the first subawardee of the prime is the 1st tier. Subawards include but are not limited to subcon-
tracts, subgrants and contract awards under pmm-
5. If the organization filing the report in item 4 checks "subawardee", then enter the full name, address, city, state and zip code of
the prime Federal recipiew. include Congressional District, if known.
6. Enter the name of the F,..leral agency making the award or loan commitment. Include at least one! organizational level below agency
name, if known. For exfmple, Department of Transportation, United States Coast Guard.
7. Enter the Federal program name or description for the covered Federal action (tem 1). If knows, enter the full Catalog of Federal
Domestic Assistance (CFDA) number for grants, cooperative agreements, loans, and loan commizatents.
8. Eater the most appropriate Federal identifying number available for the Federal action identified in item 1 [e.g., Request for Proposal
(REP) number, cavitation for Bid (IFB) number, grant announcement number; the contract, grant, or loan award number, the appli-
cation/proposal control number assigned by the Federal agency]. Include prefixes, e.g., "RFP-DEA0-001."
9. For a covered Federal action where there has been an award or loan commitment by the Federal agency, enter the Federal amount
of the award4oan commitment for the prime entity identified in item 4 or S.
10. (a) Enter the full name, address, city, state and zip code of the lobbying entity engaged by the reporting entity identified in item
4 to influence the covered Federal action
(b) Enter the full names of the individuals) perforating services, and include fall address if different from 10(a). Entu Last Name,
First Name, and Middle Initial (BQ.
11. Enter the amount of compensation paid or reasonably expected to he paid by the reporting entry (item 4) to the lobbying entity
(item, 10). Indicate whether the payment bas been made (actual) or will be made (planned). Check all boxes that apply. If this is
a material change report, enter the cumulative amount of payment made or planned to be made»
M Check the appropriate box(es). Cbeck all boxes that apply. If payment is made through an hAdnc'I contribution, specify the nature
and value of the in -kind payment.
13. Check the appropriate box(es). Check all boxes that apply. If `other," specify nature.
14. Provide a specific and detailed description of the services that the lobbyist has performed, or will he expected to perform, and the
date(s) of any services rendered. Include all preparatory and related activity, not just time spent in actual contact with Federal offi
dais. Identify the Federal official(:) or employee(,) contacted or the officer(s), employee(:), or Member(s) of Congress that were contacted.
15. Check whether or not a SF-LLT--A Continuation Sheet(s) is attached. -
16. The certifying official shall sign and date the forma, print his/her name, title, and telephone number.
Public reporting burden for this collection of information is estimated aced to average 30 minutes per response, including time for reviewing instruc-
tions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the eoII.xtion of information.
Send comments regsrdiag the burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Office of Management and Budget,. Paperwork Reduction Project (03484*46), Washington, D.G 20503.
TEXAS DEPARTMENT OF HEALTH
•`_' 1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 4
Resolution No. 4988 '
October 12, 1995
Item #25
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. C6000126
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. 07 — Amendment to add a new Attachment for Bureau of Chronic Disease
Prevention and Control to fund services to reduce premature morbidity
and mortality associated with breast and cervical cancer.
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)
or an ehalf of:
MI
By ; —v 1 _
(Si a of person author
to sign ontracts)
�._110.1M F-A►, `'AAA.► u s e
Date: October 12, 1995
RECd
By:
(PERFOR NG AGENCY liLector,
if different fr son
authorized to sign contract)
Attest: A
City Secretary
Cover - Page t
RECEIVING AGENCY
Z�riure of person authorized
o sign contracts)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date: 41 -1 s - A,,.5
APPROVED AS TO FORM:
By: 4u
Office of General Counsel
DETAILS
OF
ATTACHMENTS
Att/;
11
;
Financial
Assistance1.
Am.
;
TDH ;
Term ;
Source of
; ;
Direct ;
Total Assistance ;
No.
; Program ;
Begin
; End ;
Funds*
; Amount ;
Assistance ;:
Amount (TDH Share)
01
;
HIV/SURV-LHS ;
1/
1/95:12/31/95:
STATE
; 35,398.00;
00;
35,398.00
02A
;
HIV/GHC-LHS ;
1/
1/95:12/31/95:
93.940
; 35,000.00:
.00;
35,000.00:
1
I
1
I
I I
1
1
03
;
MID-LHS ;
9/
1/95,1 8/31/96:
STATE
; .00:
.00;
.00
1
I
1
i
1 I
1
1
04
;
ORAS-LHS ;
9/
1/95: 8/31/96:
STATE
; 69,182.00;
43,440.00:
112,622.00:
05
;
TB/OR/ST-LHS ;
9/
1/95: 8/31/96;
STATE
; 20,073.00:
,00:
20,073.00:
I
1
I
I
1 1
1
1
06
;
INN/OPTS-LHS ;
9/
1/95; 8/31195:
STATE
; 68,356.00:
140,011.00:
208,367.00
Ol
;
CHRON/BC-LHS ;
7/
1/95: 6/30/96:
93.919
; 70,694,00;
.00:
70,694.00:
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TDH
Document No. C6000125
TOTALS
; $ 299,703.001
S 183,451.00:
S 492,154.00
Change
No. 04
;
1
I 1
1
1
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable.
REFER TO BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
COVER - Page 2
S
DOCUMENT NO. C6000126
ATTACHMENT NO. OT
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF CHRONIC DISEASE PREVENTION AND CONTROL
TERM: July 1, 1995
SECTION I. SCOPE OF WORK:
THROUGH June 30, 1996
PERFORMING AGENCY will provide services to reduce premature morbidity and
mortality associated with breast and cervical cancer. These services will
include eligibility determination, risk assessment, screening, client
education, referral to other resources, tracking, case management, follow-up
and outreach activities as described in the attached Exhibit "A".
PERFORMING AGENCY will conduct activities in accordance with RECEIVING
AGENCY policies, procedures, program rules, standards, program manual of
operations and award letter, as specified and issued by RECEIVING AGENCY.
All activities will conform with PERFORMING AGENCY'S application, assurances,
Thd ctivities work plan as agreed to and approved by RECEIVING AGENCY.
ee foregoing are adopted by reference as part of this Attachment.
PERFORMING AGENCY will investigate and apply for all other sources of third
party funding available to or identified by recipients, including any avail-
able resources existing for women to receive essential diagnostic services in
a timely manner, before submitting claims for services rendered under this
program. No payment will be made by RECEIVING AGENCY for services provided to
a Texas Breast and Cervical Cancer Control Program (TBCCCP) recipient who is
eligible to receive reimbursement for the same services from a third party
source. PERFORMING AGENCY agrees to participate in the development of on-
going, local resources in order to make diagnostic and treatment services
available in the community.
PERFORMING AGENCY agrees to comply with the Texas Breast and Cervical Cancer
Control Program Rules, Standards and Guidelines and the Breast and Cervical
Cancer Mortality Prevention Act of 1990, Title XV, Section 1501, et seq.,
PHS Act, as amended.
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, Health and Safety Code.
SECTION III. SPECIAL PROVISIONS:
General Provisions, APPLICABLE LAWS AND STANDARDS Article, is amended to
include the following:
PERFORMING AGENCY will respond in writing to all review and audit
-1-
exceptions and recommendations within thirty (30) calendar days of
their receipt.
General Provisions, ASSURANCES Article, is revised to include the following:
PERFORMING AGENCY will submit Pap Smear specimens to the Texas Center for
Infectious Diseases (TCID) and/or any Program -approved laboratory and
complete and submit the Cytology Services follow-up report form for
each recipient of abnormal cytology test results within sixty (60) days
of receipt.
PERFORMING AGENCY assures the quality of any screening procedures for
breast and cervical cancer and, in the case of mammography, will sub-
contract with mammography facilities that meet all of the following:
1. Possess a current Certificate of Mammography Systems from the
Texas Department of Health (TDH) Bureau of Radiation Control
for each mammography system.
2. Use the American College of Radiology (ACR) Breast Image Reporting
system for reporting mammography results (or any system adopted by
Centers for Disease Control and Prevention (CDC)).
3. Follow guidelines for mammography quality assurance issued by the
Public Health Service Centers for Disease Control pertaining to
Public Law 101-354, the Breast and Cervical Cancer Mortality
Prevention Act of 1990.
4. Possess a full certificate from the U.S. Food and Drug Administration
certifying compliance with the Federal Mammography Quality Standards
Act of 1992.
Cytology Providers Must:
5. Possess a current Clinical Laboratory Improvement Registration
certificate issued by the U.S. Health Care Finance Administration
(HCFA).
6. Use the 1988 Bethesda System for Reporting Cervical/Vaginal
Cytological Diagnosis (or any system adopted by CDC).
T. Possess a current copy of the HCFA Clinical Application (HCFA-116)
indicating that the cytology provider has applied for certification
In cytology services.
8. Be accredited by the College of American Pathologists.
9. Be accredited by a HCFA-approved accrediting organization, or be
certified by the RECEIVING AGENCY as in compliance with the Clinical
Laboratory Improvement Amendments, 1986.
10. Use State forms, supplies, and follow the Texas Department of
-2-
Health Pap protocol for routine screening and follow-up (unless
written approval is obtained from the Program).
(It is expressly understood that continued funding for these services is
contingent upon PERFORMING AGENCY'S compliance with the above -listed
assurances. If PERFORMING AGENCY is not in compliance with these assurances,
reimbursement for these services will be disallowed.)
PERFORMING AGENCY agrees that any of the terms "Texas Department of Health",
"Department of Health", "Health Department", or similar words, in any con-
text other than to aid in publicizing the availability of the contract
services to the intended beneficiaries is prohibited. Especially prohibited
is any use of these terms or mention of RECEIVING AGENCY'S relationship in any
promotional or advertising materials to promote other commercial or profit
making activities.
General Provisions, TERMS AND CONDITIONS OF PAYMENT Article, paragraph two
(2), is revised to read as follows:
Claims for reimbursement will be made on a State of Texas Purchase
Voucher (TDH Form B-13). Vouchers for reimbursement will be sub-
mitted monthly within 20 days following the end of the month covered
by the bill. A make-up claim may be submitted as a final close-out
bill not later than 45 days following the end of the Attachment term.
The Program Summary form for billing must accompany each claim for
reimbursement.
General Provisions, TERMS AND CONDITIONS OF PAYMENT Article, paragraph four
(4) is modified to include the following:
PERFORMING AGENCY is required to maintain breast and cervical cancer
activities at a level that is at least equal to and not less than the
two (2) base years as specified in RECEIVING AGENCY'S request. for
proposals.
General Provisions, TERMS AND CONDITIONS OF PAYMENT Article, is hereby
modified to include the following paragraphs:
PERFORMING AGENCY agrees to submit completed CD forms (CD-19, 23 & 24)
and summary billing forms as requested by RECEIVING AGENCY. Any delay
in the submission of these forms could result in the withholding of
reimbursements to PERFORMING AGENCY.
RECEIVING AGENCY will reimburse PERFORMING AGENCY for breast and
cervical cancer screening and, if applicable, diagnostic services
and related costs which include determination of client eligibility,
data collection, general support, outreach activities, referral of
client for treatment and follow-up services.
Cost of screening and diagnostic services will be reimbursed not
to exceed the procedure cost for the service as specified in the
1995 Breast and Cervical Cancer Control Program (BCCCP) Medicare-
-3-
Based Reimbursement Rates for Texas, which is incorporated herein
by reference. The parties hereto will be bound by the schedule
shown in Exhibit "B" and, if applicable, Exhibit "C". (Performing
Agencies approved for Texas Cancer Council (TCC) funding will only
be reimbursed for approved procedures listed in the BCCCP Medicare -
Based Reimbursement Rates for Texas.)
General Provisions, FINANCIAL REPORTS Article, is not applicable to this
Attachment.
General Provisions, REPORTS AND INSPECTIONS Article, Paragraph one (1), is
modified to include the following:
A Program Narrative Report and a Quarterly Program Indicator Report
(Exhibit 0) are due within 20 days following the end of each quarter -
October 20th, January 20th, April 20th and July 20th.
General Provisions, SUBCONTRACTING Article, is modified to read as follows:
PERFORMING AGENCY may enter into agreements with subcontractors.
Subcontracts, if any, entered into by PERFORMING AGENCY will be
in writing and subject to the requirements of this Attachment,
including adherence to all quality assurance guidelines specified
and issued by RECEIVING AGENCY, Bureau of Chronic Disease Prevention
and Control (BCDPC). The subcontractor may not impose a charge for
the provisions of services funded under this Attachment and will
accept the reimbursement amount as payment in full for services
rendered. 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.
Prior written approval is required from the RECEIVING AGENCY, BCDPC, for
travel costs when PERFORMING AGENCY employees working on this project attend
conference(s), meeting(s), or other events directly benefiting the project.
SECTION IV. BUDGET:
Total reimbursements will not exceed $70,694.00.
-4-
Base years
Breast biopsy
EXHIBIT "A"
DEFIlNMONS AND DISTINC17IONS
The two years prior to the first funded year.
Escisianal - Removal and examination (usually
microscopic) of an entire lesion from the breast.
Incisianal - A small portion of the breast is removed.
Includes interpretation.
Needle Biopsy - A needle is - used to obtain. a core or
plug of tissue from a breast lesion: Includes
interpretation. .
Breast Screening for an asymptomatic woman 40 years or older
screening which includes education, a clinical breast exam and
a screening mammogram with interpretation.
Breast Diagnostic procedure used to differentiate between solid
ultrasound and cystic breast masses. Includes interpretation.
Also referred to as "Echogram".
CPT code Current Procedural Terminology. List of codes for all
procedures a physician might do.
Cervical Screening for an asymptomatic woman 40 years or older.
screening Includes a clinical breast exam, a pelvic exam, and a Pap
smear.
Client case Individual client recall and referral to insure periodic
management re -screening and initiation of diagnostic and treatment
services. Activities include comprehensive needs
assessment planning, monitoring and evaluation, and data
management.
Client Individual client counseling and education relating to
counseling screening or diagnostic services.
and education
Client
(Must
meet all
three criteria)
eligibility for
1.
At
or below
200% of Federal poverty level
breast and
2.
No
other third
party payment source
comprehensive
3.
At
least 40
years old for cervical screening and
screening
50
years or
older for breast screening (new clients).
,Client
(Must
meet all
four criteria)
eligibility
1.
At
or below
200% of Federal poverty level
for cervical
2.
No
other third party payment source
screening
3.
At
least 40
years old
4.
Intact cervix, or hysterectomy for cancer
Client intake Individual client eligibility determination such as age
and financial status; completion of demographic
information.
Client Transportation to assist individual clients in keeping
transportation their appointments. Requires prior approval.
Clinical breast A physical examination of the breast performed by
examination a physician, nurse practitioner, nurse, or physician's
assistant.
Colpeseope A magnifying, lighted optical instrument which allows
for the direct observation and study of vaginal and
cervical wells.
Colpescopy A diagnostic procedure performed using a colposcope
which examines the cervix following an abnormal Pap
smear result. Cervical biopsies are usually done under
colposcopic examination.
Comprehensive: Screening for an asymptomatic woman 40 years or older
screening which includes education, a clinical breast exam, a
screening mammogram with interpretation, a pelvic exam,
and a Pap smear.
Fine needle A method for obtaining cell samples from internal body
aspiration sites through the use of a long needle and syringe. This
procedure is used to remove fluid from a breast.
Includes pathology (interpretation).
Follow-up Efforts to assure diagnosis for women with abnormal
screening results, treatment for women with confirmed
diagnoses of cancer, repeat screening at recommended
intervals and collection of staging information.
Mammogram A radiographic image produced through mammography.
Diagnostic mammogram - A mammogram with interpretation
for women over 40 years of age with one of the following:
- breast symptoms such as a palpable mass, pain or
discharge
- breast augmentation (implants) for women over age 40
- breast reconstruction as a result of a previous cancer
- questionable or abnormal mammogram.
(This normally includes multiple views and
interpretation. It may also include micromagnification
and compression).
Screening mammogram - A mammogram (normally consisting of
two views of each breast) with interpretation, for an
asymptomatic woman.
Mammography Radiography of the breast which uses ionizing radiation.
(i.e., x-rays) for the purpose of evaluating the presence
or absence of cancerous or potentially cancerous breast
tissue. Includes interpretation.
outreach Public awareness activities to seek out targeted
population groups, and assist them to access the service
delivery system.
Pap smear Examination of cervical scrapings under a microscope
with interpretation for the purpose of evaluating the
presence or absence of cancerous or potentially cancerous
cervical tissue. (If a Pap smear is "Unsatisfactory", it
should be -done again, but not billed again. %,A "follow-
up" Pap smear may need to be done at an interval shorter
than one year for following up an abnormal Pap smear
result, and can be billed separately).
Professional Training to enhance skills of professionals, including
education allied health professionals, in the early detection and
control of breast and cervical cancer.
Procedure cost The local prevailing Medicare rate by CPT code.
Public Activities to develop and disseminate: public information
information and and education programs for the early detection and
education control of breast and cervical cancer.
Quality A system of standards, policies, rules, etc., for
assurance breast and cervical screening and diagnostic procedures
designed to assure accurate and early detection of
disease or its precursors.
Tracking system Keeps track of the following:
- client data
- screening, diagnostic and treatment services and
results received by client
- staging information at time of cancer diagnosis
- when the client needs next screening
3l�:11:
ho • 011 l 1514 DI 10 1: 811 " :lug Q0 QMIN i
m.
CPT CODE PROCEDURE
57452 Colposcopy
57454
Colposcopy with Biopsy
76090
Diagnostic Mammogram/unilateral
76091
Diagnostic Mammogram/bilateral
76092
Screening Mammogram
88170
Fine needle aspiration of breast,
including pathology
88305
Pathology
99203
Office/Outpatient Visit, New
99212
Office/Outpatient Visit, Est. (10 min)
99213
Office/Outpatient Visit, Est. (15 min)
99214
Office/Outpatient Visit, Est. (25 min)
99244
Office Consultation
N/A
Supportive service (comprehensive)
N/A
Supportive service (breast)
N/A
Supportive Service (cervical)
* Use activity code 274 when billing
EXHIBIT "C"
PROCEDURES REIMBURSED Wn TEXAS CANCER COUNCIL FUNDS*
CPT CODE PROCEDURE
00400 Anesthesia (per point)
19100 Needle (core) biopsy of breast
19120
Excisional breast biopsy of cyst, fibroadenoma, or
other benign or malignant tumor aberrant breast
tissue, duct lesion or nipple lesion, one or•more
lesions
19125
Excisional breast biopsy of lesion identified
by pre -operative placement of radiological marker
19126
Each additional lesion separately identified by a
radiological marker
76090
** Diagnostic Mammogram/unilateral
76091
** Diagnostic Mammogram/bilateral
76095
Stereotactic localization for breast biopsy, each
lesion, radiological supervision
76096
Peri-operative placement of localization wise (breast)
radiological supervision (with 19125)
76645
Echogram breast/unilateral or bilateral B-scan
and/or real time with image documentation
88170
** Fine needle aspiration of breast,
including pathology
88305 Pathology
99203 Office/Outpatient Visit, New
99212 Office/Outpatient Visit, Est. (10 min)
99213 office/Outpatient Visit, Est. (15 min)
99214 Office/Outpatient Visit, Est. (25 min)
99244 office Consultation
* All procedures noted above are •'breast only"
Use activity code 273 when billing
* Only for women under 40
EXHIBIT D: BCCCP PERFORMANCE INDICATORS
SCREENING/FOLLOW-UP
1. No. of women screened for breast cancer
2. No. of breast cancer screenings
3. No. of women screened for cervical cancer
4. No. of cervical cancer screenings
5. No. and percent of women screened for breast cancer for the first time who are
age 50 or older
6. No. and percent of women screened for cervical cancer who are age 40 or
older -
7. Percentage of women whose clinical breast examination was conducted more
than 60 days before the screening mammogram
S. Percentage of women with abnormal breast screening results completing
diagnostic evaluations'
S. Percentage of women with abnormal cervical screening results completing
diagnostic evaluations2
10. Percentage of women needing breast diagnostic procedures who get
procedures within 60 days
11. Percentage of women needing cervical diagnostic procedures who get
procedures within 60 days
12. Number and percent of women requiring treatment for breast cancer who
Initiated treatment within 30 days
13. Number and percent of women requiring treatment for cervical cancer who
Initiated treatment within 30 days
14. Number and percent of women with abnormal breast screening results lost to
follow-up
15. Number and percent of women with abnormal cervical screening results lost to
follow-up
QUALITY ASSURANCEICERVICAL SERVICES
1. No. and percent of cervical cancers
2. No. and percent of cervical biopsies
3. No. of cervical cancers/No. of cervical biopsies (Positive Predictive Value)
QUALITY ASSURANCEIBREAST SERVICES
1. No. and percent of breast cancers
2. No. and percent of completed diagnostic evaluations
3. No. breast cancers/No. of completed diagnostic evaluations (Positive Predictive
Value)
r PUBLIC EDUCATION
1. Evidence of outreach activities
2. Evidence of staff for public education activities
3. Client education protocols
PROFESSIONAL EDUCATION
1. No. of trained coiposcopists and other biopsy resources
2. No. of staff with credentials or training for screening
3. No. of staff participating in professional education events
DATA MANAGEMENT
1. Proportion of screening forms submitted within 30 days of date screening
results are received ' -
2. Proportion of cases with staging Information submitted within 60 days of the
final diagnosis of cancer
3. Proportion of breast cases pending for closure of cycle
4. Proportion of cervical cases pending for closure of cycle
Performance thresholds are to be negotiated with each provider. Most indicators can
be monitored with the BCCCP databases.
1. A response of '1' (yes) to Question 14, form D-19
2. A response of 01' (yes) to Question 28, form 0-19
3. The number of '1' responses to Question 9 on form D-23
Z
STATE OF TEXAS
COUNTY OF TRAVIS
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH-STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 6
TDH Document No. C6000126
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. 07A — Amendment for Bureau of Chronic Disease Prevention and Control ;
to fund services to reduce premature morbidity and mortality ;
associated with breast and cervical cancer. ;
Total reimbursement Will not exceed $75,918.00.
All terms and conditions not hereby amended remain in full force and effect. ;
EXECUTED INDUPLICATEORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK
Authorized Contracting Entityj(type above '
if different from PERFORMINOGENCY)
fo in behalf of:
COSOCK CITY HEAIAEPARTNENT TEXAS DEPARTMENT OF HEALTH' ;
PERFORM NCY RECEIVING AGENCY
BY: B
(Signat f person authorWed (S' at a of person au horized
to signcontracts) to sign contracts)
Linda Farrow, Chief ;
David R. Langston, Mayor Bureau of Financial Services
` (Name and Title)
(Name and Title)
Date: —/ S Otte:
RECOMMENDED: APPROVED AS TO FORK:
By: �_._ By:
(PERFORMING AdWYTrector, Ofice of General Counsel
if differert om person _
authorized to sign contract) ;
r _ i
Cover - Page t
M
DETAILS
-
OF
ATTACHMENTS
•
.
'
Att/'
'
Financial
Assistance
'
Am.
;
TDH
Term
Source of
Direct
Total Assistance
No.
; Program ;
Begin
' End
Funds$
;
Amount
Assistance _;
Amount (TDH Share) ;
01
HIY/SURV-LHS
; 1/
1/95:12/31195:
STATE
35,398.00:
.00:
35,398.00:
1
1
I
l
1
1
1
1
02A
;
HIY/GHC-LHS
1/
1/95:12131/95:
93.940
35,000.00:
.00:
35,000.00
03
910-LHS
9/
1/95; 8131156:
STATE
.001,
.00;
.00
1
1
1
1
1
1
I
i
04
ORAS-LHS
9/
1/95: 8/31/96:
STATE
;
69,182.00:
43,440.00:
112,622.00
1
1
1
1
1
1
!
1
1
1
1
I
I
1
1
1
05
;
TB/OR/ST-LHS
; 9/
1/95: 8/31/96:
STATE
;
20,013.00',
.00:
20,OT3.00',
I
1
1
1
1
1
I
1
05
;
INN/OPTS-LHS
; 9/
1/95: 8131/96:
STATE
68,356.00:
140,011.00;
208,367.00
t
1-
07A
;
CHRON/BC-LHS
; 1/
1/95: 6/30/96:
93.919 STATE
;
75,918.00:
.00;
75,918.00;
1
1
1
1
1
1
1
1
08
;
HIY/EIP-LHS
; 9/
1/95: 8/31/96:
STATE
;
20,226.00',
.00:
20,226.00:
!
1
I
1
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'----------
,
---------------------
-------
------- '4'------
--
----- ------------
-- --------------------------------«---_I
1
TON
Document No. C6000125
TOTALS
;
;- 324,153.00;
S 183,451.00;
; 501,604.00
Change
No. 06
1
$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
No Text
CONTRACT FOR PUBLIC HEALTH SERVICES
TDH DOCUMENT NO. 7560005906 97
Contract Issued by: TEXAS DEPARTMENT OF HEALTH CT
(RECEIVING AGENCY) 1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
Legal Authority to Contract: Chapters 12 and 121, Health and Safety Code.
Venue: The provisions of this Contract shall be interpreted in accordance with Texas law. Venue for any court disputes shall be in
Travis County, Texas.
PERFORMING AGENCY NAME: LUBBOCK CITY HEALTH DEPARTMENT
MAILING ADDRESS: P. O. BOX 2548 LUBBOCK TX 79408-2548
(City, State, Zip)
STREET ADDRESS: 1902 TEXAS AVENUE LUBBOCK TX 79405-1117
(City, State, Zip)
NAME OF AUTHORIZED
CONTRACTING ENTITY: CITY OF LUBBOCK
(If differem from PERFORMING AGENCY)
PAYEE DATA (If not the same as PERFORMING AGENCY or AUTHORIZED CONTRACTING ENTITY; must be on file with the Texas State
Comptroller's Office.):
NAME: CITY OF LUBBOCK HEALTH DEPARTMENT
ADDRESS: P. O. BOX 2000 LUBBOCK TX 79457-M
(City, State, Zip)
State of Texas Vendor Identification No. (14 digits)
PAYEE AGENCY Fiscal
1
17560005906037
Year Ending Month: September
PAYEE BUSINESS INFORMATION FOR STATISTICAL REPORTING: Please check the categories that apply to your business.
_ Small Business - A corporation, sole proprietorship, or other legal entity formed for the purpose of making a profit which is independently
owned and operated and has fewer than 100 employees or has less than $1,000,000 in annual gross receipts.
_ Historically Underutilized Business (HUB) - A corporation, sole proprietorship, or joint venture formed for the purpose of making a profit
in which at least 51 % of all classes of the shares of stock or other equitable securities are owned by one or more persons who have been
historically underutilized (socially disadvantaged) because of their identification as members of certain groups: Black American, Hispanic
American, Asian Pacific American, Native American, and Women. The HUB must be certified by General Services Commission or
another entity.
For Profit Organization
SUNMLARY OF CONTRACT DOCUMENTATION:
COVER PAGE 1 - Receiving and Performing Agency Data GENERAL PROVISIONS
COVER PAGE 2 - Details of Attachment(s) A1TACHMENT(S)
COVER PAGE 3 - Authorized Signatures EXHIBITS, IF APPLICABLE
Cover Page 1
DETAILS OF ATTACHMENTS
Att/
ANmod
TDH
Progr
Term
Financial Assistance
Direct
Assistance
Total Amount
(TDH Share)
Begin
End
Source of
Funds*
Amount
01
1 HIV/GHC
01/01/96
1 12/31/96
93.940
35,000.00
0.00
35,000.00
TDH Document No.7560005906 97 Totals
$35,000.00
$0.00
$35,000.00
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
RECEIVED
JAN 3 01996
COMPLIA,WRING
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF LUBBOCK
Authorized Contracting Entity for or on behalf
of PERFORMING AGENCY listed below:
L-2
AGENCY NAME:
DEP,
a
of person authorized to
DAVID R. LANGSTON, MAYOR
(Name and Title)
Date: 03/07/96
RECOMMENDED:
By:
(?ERqffifZNG AGENCY Director, if different
from 13bdon authorized to sign contract)
APPROVED AS TO CONTENT:
Mary" .QStrankje, Medical QPrograms
Coordinator
APPROVED AS TO FORM:
(1619A
Clarence . Walker, Assistant City
Attorney
RECEIVING AGENCY NAME:
TEXAS DEPARTMENT OF HEALTH
By:al
re of person authorized to sign contracts)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date: 1 " 3 O - 5 tO
APPROVED AS TO FORM:
By-AL4ajL—TQ SK 28 IM
Office of General Counsel
Cover Page 3
i / • t f - e I • ���1� • �i ��A
GENERAL PROVISIONS FOR
TEXAS DEPARTbIENT OF HEALTH CONTRACTS
PERFORMING AGENCY and RECEIVING AGENCY agree this contract, assurances, general
and/or special provisions, and Attachment(s) with detailed scopes) of work and
budget (s), as applicable, incorporate all covenants and agreements pertaining
hereto. No prior agreement or understanding, oral or otherwise, of the parties
or their agents will be valid or enforceable unless embodied in this contract.
The person or persons signing and executing this contract on behalf of PERFORMING
AGENCY, or representing themselves as signing and executing this contract on
behalf of PERFORMING AGENCY, do hereby warrant and guarantee! that he, she, or
they have been duly authorized by PERFORMING AGENCY to execute this contract on
behalf of PERFORMING AGENCY and to validly and legally bind PERFORMING AGENCY to
all terms, performances, and provisions herein set forth.
PERFORMING AGENCY hereby assures compliance with the following terms and
conditions unless otherwise specified in the Attachment(s) hereto:
ARTICLE 1. Scope of Work
PERFORMING AGENCY will perform the work outlined in the Scope(s) of Work
contained in the Attachment(s) hereto which is/are referenced in the Details of
Attachments and hereby incorporated and made a part of this contract, plus
amendments which may be added by additional Attachment(s) from time to time as
hereinafter provided.
Satisfactory performance of this contract will be measured in part by:
(1) adherence to the contract; (2) results of CPA or State Auditor reports; and,
3) timeliness, completeness, and accuracy of required reports.
ARTICLE 2. Term
The time period of this contract will
Attachment(s). No commitment of contract
day or subsequent to the last day of the
shortened by amendment(s).
ARTICLE 3. Funding
be governed by the term (s ) on the
funds is permitted prior to the first
term. The term may be extended or.
This contract is contingent upon funding being available for the term of the
Attachment(s) and PERFORMING AGENCY will have no right of action against
RECEIVING AGENCY in the 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
This contract and any Attachment(s) hereto represent the entire understanding and
agreement between the parties and each party agrees to faithfully perform and
uphold each of the provisions hereof. No modification, alteration, or waiver of
any term, covenant, or condition of this contract and any Attachments) shall be
valid unless in writing, subscribed 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
(LNS) 1996 GENERAL PROVISIONS - Page 1 (5/95)
hereof. The illegal or invalid provision will be deemed stricken and deleted
herefrom to the same extent and effect as if never incorporated herein, but all
other provisions will continue.
ARTICLE 6. Applicable Laws and Standards
This contract will be governed by the laws of the State of Texas and enabling
state/federal regulations, including federal grant requirements applicable to
funding sources as set out in Attachment(s) hereto. 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 the Uniform Grant and Contract Management Act (UGCMA),
Chapter 783, Texas Government Code Annotated, .and the Uniform Grant and Contract
Management Standards (UGCMS) as amended by revised federal circulars to be
incorporated in UGCMA by the Governor's Budget and Planning Office, apply 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,
UGCMA and UGCMS, the provisions of UGCMA and UGCMS 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, 31 U.S.C.S. 51352,
effective December 22, 1989, PERFORMING AGENCY is prohibited from using funds
granted under this contract for lobbying Congress or any agency in connection
with a particular contract. In addition, if at any time a contract exceeds
$100,000, the law requires certification that none of the funds provided by
RECEIVING AGENCY to PERFORMING AGENCY have been used for payment to lobbyists.
Regardless of funding source, and if a contract exceeds $100,000, a disclosure
form must be completed if PERFORMING AGENCY has any agreement with a lobbyist.
This certification and/or form is available upon request and must be forwarded
to RECEIVING AGENCY within 90 days of receipt.
PERFORMING AGENCY certifies by execution of this contract that its payment of
franchise taxes is current or, if PERFORMING AGENCY is exempt from payment of
franchise taxes, that it is not subject to the State of Texas franchise tax. A
false statement regarding franchise tax status will be treated -as a material
breach of this contract and may be grounds for termination at the option of
RECEIVING AGENCY. If franchise tax payments become delinquent during the
Attachment term, payments under this contract will be held until PERFORMING
AGENCY's delinquent franchise tax is paid in full.
PERFORMING AGENCY agrees to comply with the requirements of the Immigration
Reform and Control Act of 1986 and Immigration Act of 1990 regarding -employment
verification and retention of verification forms for any individual(s) hired on
or after November 6, 1986, who will perform any labor or services under this
contract.
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
(LEIS) 1996 GENERAL PROVISIONS —Page 2 (5/95)
s a
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.
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.
To the extent such provisions are applicable to PERFORMING AGENCY, PERFORMING
AGENCY agrees to fully comply with the following: Title VI of the Civil Rights
Act of 1964 (Public Law 88-352); Section 504 of the Rehabilitation Act of 1973
(Public Law 93-112); The Americans with Disabilities Act of 1990 (Public Law 101-
336); and all amendments to each, and all requirements imposed by the regulations
issued pursuant to these acts, especially 45 CFR Part 80 (relating to race, color
and national origin), 45 CFR Part 84 (relating to handicap), 45 CFR Part 86
(relating to sex), and 45 CFR Part 91 (relating to age).
Collectively, such requirements obligate RECEIVING AGENCY to provide services
without discrimination on the basis of race, color, national origin, age, sex,
disability, or political or religious beliefs; PERFORMING AGENCY agrees that in
carrying out the terms of this contract, it will do so in a manner which will
assist RECEIVING AGENCY to comply with such obligations to the fullest extent of
PERFORMING AGENCY's ability. PERFORMING AGENCY will use its best efforts to make
available employment opportunities for qualified disabled individuals.
PERFORMING AGENCY agrees to comply with the non-discriminatory requirements of
Texas Labor Code, Chapter 21, which requires that certain employers not
discriminate on the basis of race, color, disability, religion, sex, national
origin, or age.
PERFORMING AGENCY will comply with environmental standards which may be
prescribed pursuant to the following: (a) institution of environmental quality
control measures under the National Environmental Policy Act of 1969 (P.L. 91-
190) and Executive Order (EO) 11514; (b) notification of violating facilities
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 agrees to comply with the Pro -Children Act of 1994, Public Law
103-227; 108 Stat 271 §104; U.S.C.A. Title 20 §§ 6080-6081, regarding the
provision of a smoke -free workplace and promoting the non-use of all tobacco
products.
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.
(LEIS) 1996 GENERAL PROVISIONS - Page 3 (5/95)
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_ and Programmatic Management
PERFORMING AGENCY will develop, implement, and maintain financial management and
control systems that meet or exceed the requirements of UGCMA. Those
requirements include at a minimum:
1. Financial planning, including the development of budgets that adequately
reflect all functions and resources necessary to carry out authorized
activities and the adequate determination of costs;
2. Financial management system including accurate, correct, and complete
payroll, accounting, and financial reporting records, cost source
documentation, effective internal and budgetary controls, determination of
reasonableness, allowability, and allocability of costs, and timely and
appropriate audits and resolution of any findings; and,
3. Billing and collection policies, including a charge schedule, a system for
discounting or adjusting charges based on a person's income and family
size, and a mechanism capable of billing and making reasonable efforts to
collect from patients and third parties.
In addition, PERFORMING AGENCY, agrees to bill third party payors,:at no cost to
the client, for services provided under the Attachment(s). 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.
PERFORMING AGENCY, if designated a 501(c)(3) organization as defined in the
Internal Revenue Code or a for -profit organization, and its governing board shall
bear full responsibility for the integrity of the fiscal and programmatic
management of the organization. Such management shall include accountability for
all funds and materials received from the RECEIVING AGENCY, compliance with
RECEIVING AGENCY rules, policies, and procedures, and applicable federal and
state laws and regulations, and correction of fiscal and program deficiencies
identified through self -evaluation and the RECEIVING AGENCY's monitoring
processes. Ignorance of any contract provisions or other requirements contained
or referenced in the contract or contract Attachment(s) shall not constitute a
defense or basis for waiving or appealing such provisions or requirements.
Further, PERFORMING AGENCY'S governing board shall ensure separation of powers,
duties, and functions of board members and staff.
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 and paid by PERFORMING AGENCY within the Attachment term prior to
(LUS) 1996 GENERAL PROVISIONS - Page 4 (5195)
f
claiming reimbursement from RECEIVING AGENCY. Costs encumbered by the last day
of the Attachment term must be 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 a 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
Form B-13). Vouchers for reimbursement of actual expenses will be submitted
monthly within 20 days following the end of the month covered by the bill. A
make-up claim may be submitted as a final close-out bill not later than 45 days
following the end of Attachment term(s). Advance payment may be requested in
accordance with the applicable provisions of this contract.
Payments made for approved claims or notice of denial of claims submitted against
Attachment(s) to this contract will be mailed not later than 60 days after
receipt of monthly vouchers. Payment is considered made on the date postmarked.
Any reimbursements made by PERFORMING AGENCY to subcontractors will be made in
accordance with Article 601f, V.T.C.S.
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. Repayment may be taken from this contract or other active
contracts between the parties in amounts necessary to fulfill PERFORMING AGENCY
repayment obligations.
(LHS) 1996 GENERAL PROVISIONS - Page 5 (5/95)
Payment may be denied for noncompliance if required financial reports are not on
file for previous quarters or for the final period, for failure to respond to
financial compliance monitoring reports, failure to submit independent audit
reports as required by applicable OMB Circulars, or if program requirements are
not met as specified in the Scope(s) of Work.
ARTICLE 13. Advance Payments
PERFORMING AGENCY may request, in writing, a one time advance with written
justification and the concurrence of RECEIVING AGENCY. Amount of advance will be
determined by the amount and term of the Attachment (s) ; however, for each
Attachment, the amount of the advance will not exceed one -sixth (1/6th) of a
twelve-month Attachment. Advance will be requested on a -State of Texas
Purchase Voucher at the beginning of Attachment period or at a single later time
in the Attachment period if circumstances so warrant and the request is approved.
Advance funds will be liquidated during the Attachment term so that, after final
monthly billing, PERFORMING AGENCY will not have advance funds on hand. Advance
funds may be drawn only to meet immediate cash needs fordisbursement(UGCMA and
federal circulars).
Amendments to this Attachments) may require upward or downward adjustment to the
allowable advance until it equates 1/6th of a twelve-month Attachment. In the
case of a downward adjustment, PERFORMING AGENCY and RECEIVING AGENCY will agree
on the amount of adjustment to the advance. RECEIVING AGENCY retains the option
to reduce future claims by the required amount. In the case of an upward
adjustment and PERFORMING AGENCY needs additional funds to meet immediate
operating expenses, PERFORMING AGENCY may submit to RECEIVING AGENCY a written
justification and State of Texas Purchase Voucher in the amount necessary to
correct the ratio.
ARTICLE 14. Program Income
PERFORMING AGENCY will develop a fee for service system and a schedule of fees
for 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
Attachments) 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. PERFORMING AGENCY agrees
program income 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 and must be spent in the same project where it was generated.
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.
(LIPS) 1996 GENERAL PROVISIONS - Page 6 (5/95)
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 by
PERFORMING AGENCY regardless of whether or not expenses have been incurred.
A Financial Status Report, State of Texas Supplemental Form 269a (TDH Form
GC-4a), will be submitted within 30 days following the end of each of the first
three quarters. A final financial report, State of Texas Supplemental Form 269a
(TDH Form GC-4a), will be submitted not later than 45 days following the end of
Attachment term(s). If necessary, a State of Texas Purchase Voucher will be
submitted if all costs have not been recovered or a refund will be made of excess
monies if costs incurred were less than funds received.
ARTICLE 16. Reports and Inspections
PERFORMING AGENCY will submit financial, program, progress, and other reports as
requested by RECEIVING AGENCY in the format agreed to by the parties hereto.
RECEIVING AGENCY and, when federal funds are involved, any authorized
representatives) 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 AGENCYYIs findings. A determination
by RECEIVING AGENCY of either an inadequate or inappropriate resolution of the
findings may result in the withholding of funds, as provided in Terms and
Conditions of Payment Article. 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.
aRs) 1996 GENERAL PROVISIONS - Page 7 (5/95)
ARTICLE 17. Client Records
PERFORMING AGENCY, or any subcontractor, shall not transfer an identifiable
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 may require the PERFORMING AGENCY,
or any subcontractor, to transfer a client or patient record to another agency
or to the RECEIVING AGENCY if the transfer is necessary to protect either the
confidentiality of the record or the health and welfare of the client or patient.
At the end of the Attachment term, all client or 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 or patient records upon written notice to PERFORMING AGENCY,
either to another entity that agrees to continue the service or to RECEIVING
AGENCY.
Notwithstanding any other provision herein, if requested by RECEIVING AGENCY, the
PERFORMING AGENCY shall share all patient information with the RECEIVING AGENCY
when the contract involves patient care by the PERFORMING AGENCY. The PERFORMING
AGENCY shall attempt to obtain a release of medical information from the client
or patient or someone authorized to act on his or her behalf permitting the
transfer of information outside the PERFORMING AGENCY on forms supplied by the
RECEIVING AGENCY. If the patient refuses to sign the release of information
form, the information will be shared with the RECEIVING AGENCY devoid of all
identifiers of a personal nature, as specified by RECEIVING AGENCY.
ARTICLE 18. 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 connection 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
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 notlegally
eligible to receive state funds until the policy is developed and implemented.
ARTICLE 19. Ecqui=ent 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
(LHS) 1996 GENERAL PROVISIONS - Page 8 (5/95)
equipment if their unit cost is over $500. In accordance with Health & Safety
Code, Section 12.053, title to all equipment and supplies 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 Attachments) 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 and supplies 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. Subcontractinct
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. Such contractual agreements must be executed on an annual basis
and include, at minimum, the following information: 1) name and address of all
parties, 2) well defined scope of work, 3) measurable method and rate of payment,
and 4) clearly defined and executable termination clause. It is recommended that
subcontracts have beginning and ending dates coinciding with the dates of the
applicable contract Attachment(s).
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. CopMiahte, Publications, and Patents
PERFORMING AGENCY understands and agrees that where activities supported by the
contract Attachment(s) produce original books, manuals, films, or other original
material, PERFORMING AGENCY may copyright such material subject to any rights
to same reserved by or vested in the federal or state government or any agency
thereof; however, PERFORMING AGENCY may grant to RECEIVING AGENCY limited rights
to produce, publish, and use such materials as appropriate. The rights reserved
by or.vested in the federal or state government or any agency thereof consist of
the following: The federal or state government or any agency thereof reserves
a royalty -free, nonexclusive, and irrevocable license to reproduce, publish or
otherwise use, and to authorize others to use, for government purposes (a) the
copyright in any work developed under a grant, subgrant, or contract under a
grant or subgrant, and (b) any rights of copyright to which a grantee, subgrantee
or a contractor purchases ownership with grant support.
(LKS) 1996 GENERAL PROVISIONS - Page 9 (5195)
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 supportreceived 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 CPR Sec. 401.14 or FAR 52.227.11.
ARTICLE 22. Hold Harmless ---
PERFORMING AGENCY, as an independent contractor, agrees to hold RECEIVING AGENCY
and/or federal government harmless and to indemnify them from any and all
liability, suits, claims, losses, damages and judgments, and shall pay all costs,
fees and damages to the extent that such costs, fees and damages arise from
performance or non-performance of PERFORMING AGENCY under this contract.
Likewise, RECEIVING AGENCY, as a state governmental agency, agrees to hold
PERFORMING AGENCY harmless and to indemnify it against any and all liability,.
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 a fidelity bond or insurance coverage
equal to the amount of funding provided under the contract Attachment(s) up to
$100,000 that protects each employee of the PERFORMING AGENCY handling funds
under this contract, including person(s) authorizing payment of such funds. 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. Historically Underutilized Businesses
PERFORMING AGENCY agrees to take affirmative steps to ensure that Historically
Underutilized Businesses (HUBs) are utilized whenever possible. A HQB includes:
(a) A corporation formed for the purpose of making a profit in which at
least Sisk of all classes of the shares of stock or other equitable
securities are owned by one or more persons who are socially
disadvantaged because of their identification as members of certain
groups, including Black Americans, Hispanic Americans, Asian
Americans, or Native Americans, and have suffered the effects of
discriminatory practices or similar insidious circumstances over
which they have no control; and have a proportionate interest and
demonstrate active participation in the control, operation, and
management of the corporation's affairs;
(b) A sole proprietorship created for the purpose of making a profit
that is 100% owned, operated or controlled by such person(s)
described in (a);
fWS) 1996 GENERAL PROVISIONS - Page 10 (5/95)
i
i
(c) A partnership formed for the purpose of making a profit in which sit
of the .assets and interest in the partnership is owned by one or
more persons who are described in (a) above and have a proportionate
interest and demonstrate active participation in the control,
operation, and management of the partnership's affairs;
(d) A joint venture in which each entity in the joint venture is a
historically underutilized business; or
(e) A supplier contract between a RUB as defined in (a) above and a
prime contractor under which the HUB is directly involved in the
manufacture or distribution of the supplies or materials or
otherwise warehouses and ships the supplies.
ARTICLE 25. Termination
If PERFORMING AGENCY fails to comply with RECEIVING AGENCY's reporting
requirements, the program objectives, or the contract award conditions, RECEIVING
AGENCY may withhold payments. RECEIVING AGENCY will provide advance written
notice to PERFORMING AGENCY which will identify the deficiency and RECEIVING,
AGENCY's intent to withhold payments if the deficiency is not corrected within
a specific number of days. When the deficiency is corrected, RECEIVING AGENCY
will release any withheld payments with no further action. If PERFORMING AGENCY
fails to comply with the terms, conditions, or standards of this contract,
RECEIVING AGENCY may terminate the contract Attachment(s) for non-compliance.
This contract or any Attachments) 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. 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 Attachments) 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 Attachments) hereto may be terminated if funds allocated
for any Attachments) hereto should become reduced, depleted, or unavailable
during any Attachments) 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 Attachments) to
this contract is/are terminated upon receipt of that notification. PERFORMING
AGENCY will not incur new obligations after the effective date of termination and
will cancel as many outstanding obligations as possible. RECEIVING AGENCY will
allow full credit to PERFORMING AGENCY for noncancelable obligations which were
properly incurred prior to the termination date.
This contract or any Attachment(s) hereto may be terminated in the event that
federal or state laws or other requirements should be amended or judicially
interpreted so as to render continued fulfillment of this contract, on the part
of either party, unreasonable or impossible. If the parties should be unable to
(LUS) 1996 GENERAL PROVISIONS - Page 11 (5/95)
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 26. 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 Attachments) to this contract provided, however, that any
demotion, suspension, or discharge of such state budgeted employees will be in
accordance with the Due Process Hearing Procedures as set out above. The only
distinction between state budgeted and local paid employees is that employees on
state budgeted positions receive state benefits and are subject to certain
duties, obligations, and restrictions as state employees as contained in state
law. One such restriction, as contained in the'State Appropriations Act, is that
no employee paid on a state budgeted position may receive a salary supplement
from any source unless specifically authorized in the Appropriations Act or other
state law. This prohibition -includes, but is not limited to, the payment to such
employee of a so-called "flat rate" car allowance or travel allowance. Any such
travel or per diem to these employees must be on a reimbursement basis, supported
by appropriate records, and may not exceed the reimbursement for mileage and/or
per diem allowed under the Appropriations Act and current state travel
regulations. This restriction will apply whether travel funds are provided in
Attachment(s) under this contract or from any other source.
PERFORMING AGENCY will utilize RECEIVING AGENCY's policies and procedures for
hiring and promoting individuals into state budgeted positions funded by
Attachments) to this contract. Qualifications of any individuals filling these
positions will be subject to approval of RECEIVING AGENCY's Bureau of Personnel
Management. The purpose of the approval is to ensure that individuals occupying
these positions meet minimum educational and experience requirements.
PERFORMING AGENCY will maintain required records and submit documents necessary
to process personnel, payroll, leave and time records, and travel claims on state
budgeted positions. PERFORMING AGENCY will be furnished by RECEIVING AGENCY
state warrants for salary compensation or travel reimbursement for issuance to
employees on state budgeted positions.
An independent audit is not required as a condition of this contract if the
Attachment provides assistance through assignment of state budgeted positions and
no funds are budgeted for local costs.
PERFORMING AGENCY may be reimbursed for local personnel costs or other categories
of expense used to fulfill the scope of work of Attachment(s) in lieu of being
furnished state payroll warrants after a state budgeted position becomes vacant.
Reimbursement will not exceed the balance of funds on the state budgeted position
after all benefits, obligations, and/or other entitlements are met. PERFORMING
AGENCY's Director, or other person(s) authorized elsewhere in this contract, may
submit a request for conversion'. RECEIVING AGENCY will transmit formal approval
and a revised budget to PERFORMING AGENCY to complete the conversion.
(I.NS) 1996 GENERAL PROVISIONS - Page 12 (5/95)
ARTICLE 27. Funding Particiration 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 28. 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;
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
Public Health Promotion
Immunization Initiative
Women & Children
Chronic Disease Prevention & Control
HIV/AIDS
Refugee Health
Sexually Transmitted Diseases
Tuberculosis Elimination
Dental Health Services
Nutrition Services
These objectives are appended to the Office of Regional Administrative Services
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
(LHS) 1996 GENERAL PROVISIONS - Page 13 (5/95)
objectives for the following pilot program areas:
Milk & Dairy
Hansen's Disease
Injury Prevention & Control (Bicycle Helmet Project)
Asbestos Program Branch (Enforcement Section)
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.
RECEIVING AGENCY contact for matters pertaining to the performance -based public
health services project is the Office of Regional Administrative Services.
DOCUMENT NO. 7560005906-97
ATTACHMENT NO. 01
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
RECEIVING AGENCY PROGRAM: BUREAU OF HIV AND STD PREVENTION
TERM: January 01, 1996 THRU: December 31, 1996
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/acquired immunodeficiency syndrome (HIV/AIDS). CTRPN activities include establishing
and maintaining anonymous and/or confidential HIV testing programs for persons at risk of HIV
infection due to individual sexual behavior, injecting 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 PERFORMING
AGENCY'S objectives, activities work plan, and detailed budget as approved by RECEIVING
AGENCY. All of the above -named documents are incorporated 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 perform 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 TDH guidelines.
ATTACHMENT - Page 1
a
2. Provide culturally sensitive and effective pre -test and post-test counseling based on
Texas Department of Health (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 convenient for the
majority of the target population and during hours established to reach these
clients.
S. Use optically scannable forms supplied by RECEIVING AGENCY or a similar
TDH approved instrument to collect demographic information and unlinked test
result data. This includes the accurate completion and timely submission of
scannable forms according 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 approved in writing by RECEIVING AGENCY.
7. PERFORMING AGENCY will develop and maintain a referral plan by which
reciprocal linkages are established with other service providers (especially other
RECEIVING AGENCY funded providers) for the purpose of:
a. Case management
b. Extended HIV prevention counseling
C. CD4 testing
d. TB skin testing
e. Immunizations
f. STD screening
g. Family planning
h. Gynecological exam
i. Substance abuse treatment
j. Medical evaluation for HIV illness
k. Medical follow-up
1. Antiviral therapy
In. PCP prophylaxis
n. Psychosocial needs assessment
o. Professional psychosocial counseling
P. Emotional support groups
q. Financial eligibility assistance
r. Legal assistance
PERFORMING AGENCY will perform the following Partner Elicitation/Notification Services:
ATTACHMENT - Page 2
1. All partner elicitation/notification services must be consistent with RECEIVING
AGENCY'S pre -test and post-test counseling guidelines and the TDH Seropositive
and Partner Notification Guidelines which are incorporated by reference and made
part hereof.
2. Partner notification must be mentioned in every pre -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 post-test counseling
session.
4. If the client would like to inform partner(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 agrees to notify partner(s) by a specific date. The client provides full names
and locating 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 partner(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 pre -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. Through the use of Quality Assurance Systems
(QAS), PERFORMING AGENCY'S program manager will possess current
information and will monitor counselor performance (at least monthly for months
1-6 of employment, bimonthly for months 7-12, and quarterly for experienced
counselors whether directly supervised or on independent assignment). A written
record (TDH skills assessment form or other TDH approved model) of the
monitored session is to be kept on file.
ATTACHMENT - Page 3
3. PERFORMING AGENCY agrees to facilitate RECEIVING AGENCY review of
scheduled counseling, testing, referral, and partner notification sessions.
PERFORMING AGENCY agrees to comply with Chapters 81 and 85 of the Health and Safety
Code 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 L,ffl clients with services/units of service
in or benefiting the county(ies)/area defined as: Lubbock.
SECTION II. 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 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 information, strict adherence
to the General Provisions, CONFIDENTLALITY Article is required. In addition to these
conditions, PERFORMING AGENCY will comply with TDH Bureau of HIV and STD
Prevention's HIV Serologic Testing and Documentation Guidelines. All of the above -referenced
documents are incorporated herein and made a part 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 may require
PERFORMING AGENCY, or any subcontractor, .to transfer a client or patient record to
RECEIVING AGENCY (THE 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 (THE 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 (THE 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.
ATTACHMENT - Page 4
PERFORMING AGENCY will submit quarterly activity reports within twenty (20) days after the
end of each quarter, that are prepared 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.
ATTACHMENT - Page 5
SECTION M. BUDGET:
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
TOTAL DIRECT CHARGES
INDIRECT CHARGES
TOTAL
Total reimbursements will not exceed $ 35,000.00.
$26,396.00
6,439.00
460.00
0.00
85.00
0.00
230.00
$33,610.00
1,390.00
$35,000.00
Financial status reports are due the 30th of April, 30th of July, 30th of October, and the 15th of
February.
Indirect cost is based on UGCMA, Table 1. Indirect charges to this contract may not exceed the
amount shown above, except by prior written approval of RECEIVING AGENCY.
ATTACHMENT - Page 6
STATE OF TEXAS
COUNTY OF TRAVIS
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
CONTRACT CHANGE NOTICE NO. 7
TDH Document No. C6000126
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY, did
heretofore enter into a contract in writing with
LUBBOCK CITY HEALTH DEPARTMENT
hereinafter referred to as PERFORMING AGENCY. The parties thereto now desire to
amend such contract as follows:
-------------------------------------------------------------------------------
SUMMARY OF TRANSACTION:
1 - 1
Revision to public health services contract. ;
i
Att. No. 04A - Amendment for Office of Regional Administrative Services to ;
fund public health services including personal and environ-
mental health services.
1 1
1 1
1
1 �
i
All terms and conditions not hereby amended remain in full force and effect. ;
1 ,
1 1
E$EC<1TED IE DUPLICATE ORIGINALS ON SHE DATES SHOWN.
CITY of LnBOCB 1
Authorized Contracting Entity (type above
if different from PERFORMING AGENCY)
for and in behalf of:
�LSBBOCIf
CITY ITN DEPiRTIi?9?
TEIAS DEPIIRTHEHT OF H UTH 1!
PtZGW
RECEIVING AGENCY /
1By
1
(Shorized
re of personaXhorMl ;
;-
to sign contracts)
to sign contracts)
Linda Farrow, Chief
David R. Langston, Mayor
Bureau of Financial Services ,
(Name and Title)
(lame and Title) ;
Date: 03/22/96
Date:
RECOMME QED:
R
APPROVED AS TO PORN:
11:
By:
(PERFORMING AGENCY Director,
Office of General Counsel
if different from person
;
authorized to sign contract)
1
1
1
,
1
1
1
1
Cover - Page 1
DETAILS
OF
ATTACHMENTS
-
�Ittll
Financial
Assistance
At
; TDH
Term ;
Source of
;
Direct ;
Total Assistance ;
No.
Program ;
Begin
1 End ;
Fundsx
;
Amount ;
Assistance ;
Amount (TOH Share)
01
; HIV/SURV-LHS
; 1/
1/55112131/951
STATE
;
35,398.001
.001
35,398.001
02A
1 HIV/GRC-LHS
1 1/
1/95112131/951
93.910
;
35,000.001
.001
35,000.001
03
; MAD-LHS
1 9/
1/951 8/311961
STATE
;
.001
.001
.001
CIA
; ORAS-LHS
1 91
1/951 8/31/961
STATE
;
120,200.00:
13,110.001
163,640.00:
05
; TB/OR/ST-LHS
1 91
1/951 8/31/961
STATE
;
20,073.001
.001
20,013.00:
t
,
�
1
06
1 IMM/OPTS-LHS
1 91
1/951 81311961
STATE
1
68,355.001,
110,011.001,
208,361.00
+
,
+
t
+
t
t
t
+
+
,
1
07A
1 CHRON/BC-LRS
1 T/
1/951 6/30/96:
93.919 STATE
1
15,918.001
.001
15,918.001
t
t+
++
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08
1 HIV/EIP-LHS
1 9/
1/95111/30/951
STATE
1
20,226.00:
.001
20,226.001
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----------------------------------------------------------------------------------------------------------------------1
1
TDH
Document Ia. C6000125
TOTALS
1
1 375,111.001
$ 183,151.001
$ 558,622.00:
1
Cbange
No. 01
1
1
1
#Federal
funds are indicated
bq a number
from the Catalog
of Federal Domestic
Assistance (CFDA),
if applicable.
REFER
TO BUDGET SECTION OF
ANY ZERO AMOUNT
ATTACHMENT
FOR
DETAILS.
COVER - Page 2
TEXAS DEPARTMENT OF HEALTH
Receiving Agency/Program: REGIONAL ADMIN. S
Performing Agency: LUBBOCK
TDH Document No. C60UUIZ6 Change7 Term:
REVISED CONTRACT BUDGET
1--------------------------------
DIRECT
i
----
-ASSISTANCE---------------------------
--- -
;Change
Requested
------
- -
New or Revised
BudgeCurrett-Appro(a�
Budget
--------------------------
(Personnel (No. Pos. 2) '
(Travel {
--------------------------------------------------
$43,440.00 '
1
.00 '
1
$43,440.00 I
1
.00
.00
.00
(Laboratory Support {
.00 {
.00 {
.00 1
ISTD Drugs I
I*TB I
.00 1
1
.00 1
1
.00 1
1
Drugs
IV'accines 1
.00 1
.00 1
.00 1
.0
.00
.00
(Other I
00 I
.00 1
.00 1
irec ssis ance
1 TDH Financial Assist. 1
�8�i36
69 182.00 1
$51.018.00 I
,
1120,200.00 1
t--------TDH-Share---------------------------- ---- 3-i�i$:6i1-, - ib3_ Q�4
--------------------------------------------------------------------------------------
(---------------------------
----FINANCIAL-ASSISTANCE-------------------------
CurrenApproved ;Change
Reques
-------I
New or Revised
10bject Class Categories___
----------------------
-Budgett
----------------------------------------------------------
------�b) 1
Budget
la:_ Personnel
--------------,--------$59,382_00_,_00-,--------$59,382_00-I
1b.- Fringe - Benefits
,---------$9,800_00-,
---------------
00-,------_--$9,800_00-1
IC-- Travel
----
--------------00--------------00-�
---------------00-{
---------
id. Equipment - -- -
----------------00-;
.00 ;
.00-I
Ie. Supplies
.00 i--------------
.00-i---------------.00
I
---------------1
I------------�----------------00_!--------------
f. Contractual
.00-i---------------
.00 1
Ig:_Other------------------;
.00;--------$51,018.00-;--------$51_018
00 1
1h.- Total -Direct Charges
$69,182 00 ;
$51,018 00 ;
$120,200.00.1
I- Indirect
1-
-Charges
-----------------------00
1�_-Total------------------,-------
---------------00-----------------00-I
$69,182_00-,------_-$51,018_00_,-------$120,200_---I
00
1k RECEIVING AGENCY share ;
$69,182.00 ;
$51,018.00 ;
$120,200.00 I
11 PERFORMING AGENCY share----------------oo-i----------------oo-i
-------------------
.00
1 m. PI)--
=
1
--(Includes
- -----
1m. Program Income -- --�
--------
----------.00-;-
----
---- .00 -1-
- - ---- -
--------- .00I
----------------(----------------------------------------------------------------
(Detail on Indirect Charges:
-
I
1----
Type of Rate Mark one Box) Provisional
Predetermined
Final
_ Fixed
1
1 Rate 0.00 Base
.DO Total Indirect Changes
.00 1
I--------------------------------------------------------------------------------
IERPLANATION OF CHANGE:
(Increase
------I
I
I
in Financial Assistance for expansion of services currently
performed
}due to withdrawal of Attachments 08 and 09, Bureau of
1
Women and Children.
1
- 1
I
form No. GC - a
Rev. 03/91
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
TDH Document No. 7560005906 96
Contract Change Notice No. Q$
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 attachment(s) as follows:
UN04ARY OF
S ATT. N0�04BS REGIONAL ADMINISTRATIVE SERVICES II
RECEIVING AGENCY:
TEXAS DEPARTMENT OF HEALTH
By: /
lure of person authorized to sign)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date: cj b
Cover Page 1
• DETAILS OF ATTACHMENTS '
Att/
ANmod
TDH
ProID
Term
Financial Assistance
Direct
Assistance
Total Amount
(TDH Share)
Begin
End
Source of
Funds*
Amount
01
HIV/SURV
01/01/95
12/31/95
State
35,398.00
0.00
35,398.00
02A
HIV/GHC
01/01/95
12/31/95
93.940
35,000.00
0.00
35,000.00
03
M&D
09/01/95
08/31/96
State
0.00
0.00
0.00
04B
ORAS
09/01/95
08/31/96
State
120,200.00
43,440.00
163,640.00
05
TB/OR/ST
09/01/95
08/31/96
State
20,073.00
0.00
20,073.00
06
DAM/OPTS
09/01/95
08/31/96
State
68,356.00
140,011.00
208,367.00
07A
CHRONIC/BC
07/01/95
06/30/96
State 93.919
75,918.00
0.00
75,918.00
08
HIV/EIP
09/Ol/95
11/30/95
State
20,226.00
0.00
20,226.00
TDH Document No.7560005906 96 Totals
Change No. 08
$375,171.00
$183,451.00
$558,622.00
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAII.S.
Cover Page 2
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY PROGRAM: OFFICE OF REGIONAL ADMINISTRATIVE SERVIDI3SDOC. NO.7560005906 9604B
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT CHG. 08
CONTRACT TERM: 09/01/95 THRU: 08/31/96 BUDGET PERIOD: 09/01/95 THRU: 08/31/96
REVISED CONTRACT BUDGET
DIRECT ASSISTANCE
CURRENT APPROVED
BUDGET
CHANGES
REQUESTED
NEW OR REVISED
BUDGET
PERSONNEL
TRAVEL
VACCINE
OTHER:
TDH DIRECT ASSISTANCE
TDH FINANCIAL ASSISTANCE
TOTAL TDH SHARE
TOTAL CONTRACT AMOUNT
$43,440.00
$0.00
$43,440.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
43,440.00
120,200.00
163,640.00
0.00
0.00
0.00
43,440.00
120,200.00
163,640.00
$163 640.00
$0.00
$163,640.00
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES JCURRENT
APPROVED
BUDGET
CHANGES
REQUESTED
NEW OR REVISED
BUDGET
PERSONNEL
FRINGE BENEFITS
TRAVEL
EQUIPMENT
SUPPLIES
CONTRACTUAL
OTHER
TOTAL DIRECT CHARGES
INDIRECT CHARGES
TOTAL
PERFORMING AGENCY SHARE:
Program Income (Carryover)
Program Income (Projected)
Other Match
RECEIVING AGENCY SHARE:
PERFORMING AGENCY SHARE:
$59,382.00
$38,774.00
$98,156.00
9,800.00
12,244.00
22,044.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
51,018.00
(51,018.00)
0.00
120,200.00
0.00
120,200.00
0.00
0.00
0.00
$120,200.00
$0.00
$120,200.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$120,200.00
$0.00
$120,200.00
$0.00
$0.00
$0.00
Detail on Indirect Cost Rate Type:
Rate. 0.00% Base $0.00 Total
Budget Justification: Reallocation of funds to reflect actual expenditures.
Form No. GC-9a
a
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS TDH Document No.7560005906 96-08-A
COUNTY OF TRAVIS CONTRACT CHANGE NOTICE NO. QQ
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 amens such contract attactnnent(s) as ronows:
SUMMARY OF TRANSACTION: ATT. NO. 08A HIV - EARLY INTERVENTION
Revised Number to be Served: 100
Revised Service Area: Bailey, Cochran, Crosby, Dickens, Floyd, Garza, Hale, Hockley, King, Lamb, Lubbock, Lynn, Motley,
Terry, Yoakum.
All terms and conditions not hereby amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
David R. Langston, Mayor
(Name and Title)
Date: 06/07/96
RECOMMENDED:
RECEIVING AGENCY:
TEXAS DEPARTMENT OF HEALTH
By:4j6;0'41
�Z/5)
i tore of person authorized to sign contracts)
Linda Farrow, Chief
Bureau of Financial Services
(Name and Title)
Date:
APPROVED AS TO FORM:
By: By: — MAY 17 IS
(PERFORMfNG AG erector, if different Office oTowerid 1
from person authorizeda sign contract)
Rev.
Cover Page 1
DETAILS OF ATTACHMENTS -
Att/
Amd
No.
TDH
Program/
ID
Term
Financial Assistance
Direct
Assistance
Total Amount
(TDH Share)
Begin
End
Source of
Funds*
Amount
01
HIV/SURV
01/01/95 '
12/31/95
State
35,398.00
0.00
35,398.00
02A
HIV/GHC
01/01/95
12/31/95
93.940
35,000.00
0.00
35,000.00
03
M&D
09/01/95
08/31/96
State
0.00
0.00
0.00
04B
ORAS
09/01/95
08/31/96
State
120,200.00
43,440.00
163,640.00
05
TB/OR/ST
09/01/95
08/31/96
State
20,073.00
0.00
20,073.00
06
IMM/OPTS
09/01/95
08/31/96
State
68,356.00
140,011.00
208,367.00
07A
CHRONIC/BC
07/01/95
06/30/96
State 93.919
75,918.00
0.00
75,918.00
08A
HIV/EIF
1 09/01/95
08/31/96
1 State
53,178.001
0.00
53,178.00
TDH Document No.7560005906 96 Totals
Change No. 09
$408,123.00
$183,451.00
$591,574.00
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
0
TEXAS DEPARTMENT OF HEALTH '
RECEIVING AGENCY PROGRAM: BUREAU OF HIV AND STD PREVENTION
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
CONTRACT TERM: 09/01/1995 THRU: 08/31/1996 BUDGET PERIOD: 09/01/1995 THRU 08/31/1996
TDH DOC. NO. 7560005906 9608A CHG. 09
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES
CURRENT APPROVED
BUDGET (A)
CHANGE
REQUESTED (B)
NEW OR REVISED
BUDGET (C)
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Total Direct Charges
Indirect Charges
TOTAL
PERFORMING AGENCY SHARE:
Program Income (Carryover)
Program Income (Projected)
Other Match
RECEIVING AGENCY SHARE
PERFORMING AGENCY SHARE
$0.00
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
300.00
(300.00)
0.00
19,926.00
33,252.00
53,178.00
0.00
0.00
0.00
20,226.00
32,952.00
53,178.00
0.00
0.00
0.00
$20,226.00
$32,952.00
$53,178.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$20,226.00
$32,952.00
$53,178.00
$0.001
$0.00
$0.00
Detail on Indirect Cost Rate Type:
Rate 0.00% Base $0.00 Total $0.00
Budget Justification: Amendment to increase contract, increase service area and extend term to 8/31/96.
Revised Number to be Served: 100
Form No. GC-9
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 15th of October.
• M
a
y
TEXAS DEPARTMENT OF HEALTH
1100 WEST 49TH STREET
AUSTIN, TEXAS 78756-3199
STATE OF TEXAS
COUNTY OF TRAVIS
The Texas Department of Health, hereinafter referred to as RECEIVING AGENCY
LUBBOCK CITY HEALTH DEPARTMENT hereinafter referred to as PERFOR
to amend such contract attachment(s) as follows:
SUMMARY OF TRANSACTION:
ATT. NO.08B: HIV - EARLY INTERVENTION
All terms and conditions not hereb
amended remain in full force and effect.
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
David R. Langston, Mayor
(Name and Title)
Date:
RECOMMENDED:
By:
(PERFORMIN GENCY Director. if different
from person a orized to sign contract)
CEIVING
CONTRACT CHANGE NOTICE NO.14
AUG 3 01996
L U 8 b 0C K, IE ^.v;
KAS DEPARIIAENT OF 9FMTH
G
0ture
of pe on authorized to sign contracts)
Linda Farrow0 Chief
Bureau of Financial Services
(Name and Title)
Date:
APPROVED AS TO FORM:
By AM 14 IN
Office of General Counsel
Cover Page 1
DETAILS .OF ATTACHMENTS
Att/
Amd
No.
TDH
Program/
IDBegin
Term
Financial Assistance
Direct
Assistance
Total Amount
(TDH Share)
End
Source of
Funds*
Amount
01
1 HIV/SURV
01/01/95
12/31/95
State
35,398.00
0.00
35.398.00
02A
H1V/GHC
01/01/95
12/31/95
93.940
35,000.00
0.00
35,000.00
03
M&D
09/01/95
08/31/96
State
0.00
0.00
0.00
04B
ORAS
09/01/95
08/31/96
State
120,200.00
43,440.00
163,640.00
05
TB/OR/ST
09/01/95
08/31/96
State
20,073.00
0.00
20,073.00
06
i1VIM/OPTS
09/01/95
08/31/96
State
68,356.00
140,011.00
208,367.00
07A
CHRONIC/BC
07/01/95
06/30/96
State 93.919
75,918.00
0.00
75,918.00
08B
HIV/EIP
09/01/95
1 08/31/96
1 State
71,532.00
0.00
71,532.00
TDH Document No.7560005906 96 Totals
Change No. 10
$426,477.00
$183,451.00
$609,928.00
*Federal funds are indicated by a number from the Catalog of Federal Domestic Assistance (CFDA), if applicable. REFER TO
BUDGET SECTION OF ANY ZERO AMOUNT ATTACHMENT FOR DETAILS.
Cover Page 2
■
TEXAS DEPARTMENT OF HEALTH
RECEIVING AGENCY PROGRAM: BUREAU OF HIV AND STD PREVENTION
PERFORMING AGENCY: LUBBOCK CITY HEALTH DEPARTMENT
CONTRACT TERM: 09/01/1995 THRU: 08/31/1996 BUDGET PERIOD: 09/01/1995 THRU 08/31/1996
TDH DOC. NO. 7560005906 9608B CHG. 10
REVISED CONTRACT BUDGET
FINANCIAL ASSISTANCE
OBJECT CLASS CATEGORIES
CURRENT APPROVED
BUDGET (A)
CHANGE
REQUESTED (B)
NEW OR REVISED
BUDGET (C)
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Contractual
Other
Total Direct Charges
Indirect Charges
TOTAL
PERFORMING AGENCY SHARE:
Program Income (Carryover)
Program Income (Projected)
Other Match
RECEIVING AGENCY SHARE
PERFORMING AGENCY SHARE
$0.00
$0.00
$0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
53,178.00
18,354.00
71,532.00
0.00
0.00
0.00
53,178.00
18,354.00
71,532.00
0.00
0.00
0.00
$53,178.00
$18,354.00
$71,532.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
$53,178.00
$18,354.00
$71,532.00
$0.00
$0.00
$0.00
Detail on Indirect Cost Rate Type:
Rate 0.00 % Base $0.00 Total $0.00
Budget Justification: Attachment 08A was in error. The additional funding reflects the amount needed to serve existing
clients. --Jl
Form No. GC-9
Financial status reports are due the 30th of December, 30th of March, 30th of June, and the 15th of October.