HomeMy WebLinkAboutContract 29435 CITY CYsa CONTRACT NO
CONTRACT FOR PUBLIC HEALTH SERVICES TDH DOCUMENT NO.7560005286 2005
Contract Issued by: TEXAS DEPARTMENT OF HEALTH TP
(RECEIVING AGENCY) 1100 WEST 49�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: FORT WORTH DEPARTMENT OF PUBLIC HEALTH
MAILING ADDRESS: 1800 UNIVERSITY DR FORT WORTH TX 76107-3405
STREET ADDRESS: 1800 UNIVERSITY DR FORT WORTH TX 76107-3405
NAME OF AUTHORIZED
CONTRACTING ENTITY: CITY OF FORT WORTH
(If different 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 FORT WORTH
ADDRESS: 1000 THROCKMORTON ST FORT WORTH TX 76102-6311
(City,State,Zip)
State of Texas Vendor Identification No.(14 digits) PAYEE AGENCY Fiscal
17560005286051 Year Ending Month: December
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
SUMMARY OF CONTRACT DOCUMENTATION:
COVER PAGE 1 -Receiving and Performing Agency Data GENERAL PROVISIONS—11/2003
COVER PAGE 2-Details of Attachment(s) ATTACHMENT(S)
COVER PAGE 3-Authorized Signatures EXHIBITS,IF APPLICABLE
J
Cover Page 1 �
DETAILS OF ATTACHMENTS
Att/ TDH Program ID/ Term Financial Assistance Direct Total Amount
Amd TDH Purchase Order Assistance (TDH Share)
No. Number Begin End Source of Amount
Funds*
01 IMM/LOCALS 01/01/04 12/31/04 State 93.268 30,677.00 0.00 30,677.00
000000176411
TDH Document No.7560005286 2005 Totals
$ 30,677.00 $ 0.00 $ 30 In-010 30,677.00
*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
EXECUTED IN DUPLICATE ORIGINALS ON THE DATES SHOWN.
CITY OF FORT WORTH
Authorized Contracting Entity (type above if different
from PERFORMING AGENCY) for and in behalf of:
PERFORMING AGENCY NAME: RECEIVING AGENCY NAME:
FORTsSignature
EPARTMENT OF PUBLIC TEXAS DEPARTMENT OF HEALTH
HEAL
By: By:
son authorized to sign contracts) (Signature of person authorized to sign contracts)
Bob Burnette,Director
Libby Watson, Assistant City Manager Procurement and Contracting_Services Division
(Name and Title) (Name and Title)
Date: Date:
RECOMMENDED:
By
(PERFORMING AGENCY Director,if different
from person authorized to sign contract)
TDH Document No: 7560005286 2005
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Contract Authorization
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Date
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Cover Page 3 �, ."J�:� o � (,,
DOCUMENT NO. 7560005286-2005
ATTACHMENT NO. 01
PURCHASE ORDER NO. 0000001764
PERFORMING AGENCY: FORT WORTH DEPARTMENT OF PUBLIC HEALTH
RECEIVING AGENCY PROGRAM: IMMUNIZATION DIVISION
TERM: January 01, 2004 THRU: December 31, 2004
SECTION I. SCOPE OF WORK:
PERFORMING AGENCY will provide essential public health services as specified in
PERFORMING AGENCY'S approved 2004 Interlocal Application for Immunization Services,
dated June 16, 2003, incorporated herein, and made part of this contract Attachment.
Immunization public health services include one or more of the following eight immunization
core component areas:
1. Program management activities to include program planning, staffing and training, and
partnerships and collaborations.
2. Vaccine management activities to include ordering, storage, and vaccine accountability.
3. Immunization registry activities to include provider participation and training.
4. Provider quality assurance activities to include provider education, site visits, and access
to information on perinatal hepatitis B prevention.
5. Service delivery activities to include targeting under-served populations and promoting a
medical home.
6. Consumer information to include information development and dissemination and
vaccine benefit and risk education.
7. Surveillance activities of vaccine preventable diseases to include surveillance, response,
and reporting, screening for perinatal hepatitis B, and vaccine safety.
8. Population assessment activities to include assessment of communities, child-care
facilities, Head Start Programs, Kindergarten, and 7`h grade entrants.
PERFORMING AGENCY shall perform the following activities to comply with the National
Childhood Vaccine Injury Act of 1986, and the Omnibus Budget Reconciliation Act of 1993 and
Section 1928 of the Social Security Act:
1. Distribute Vaccine Information Statements (VIS) to clients.
2. Record required information regarding vaccine administration in permanent medical
record.
3. Report adverse events relating to vaccine administration.
4. Recruit and enroll providers into the Texas Vaccines For Children (TVFC) program.
5. Obtain a signed provider enrollment form from each provider participating in the TVFC
program that includes name, medical license number and Medicaid provider number (if
applicable) of each provider practicing at an enrolled site.
6. Maintain TVFC provider enrollment records and provider profiles for at least three (3)
years.
pp, 0 �
ATTACHMENT - Page 1 ��CIQIP.I( RVIA 2
PERFORMING AGENCY agrees that alterations, variations or additions to the important
vaccine information statements may not be made without the prior written approval of
RECEIVING AGENCY Program.
PERFORMANCE MEASURES
All activities shall be performed in accordance with PERFORMING AGENCY'S Annual Plan
and detailed budget as approved by RECEIVING AGENCY Program based on the Interlocal
Application for Immunization Services, dated June 16, 2003. PERFORMING AGENCY will
perform the following applicable required activities:
1. By December 31, 2004, PERFORMING AGENCY will implement a plan to improve
vaccine coverage levels.
2. During FY 2004, PERFORMING AGENCY will work with the local WIC program
to implement documentation criteria for referral of under-vaccinated WIC enrollees.
3. By December 31, 2004, PERFORMING AGENCY will ensure that expired, wasted,
and unaccounted for vaccines do not exceed 5% for DTaP, Hib, hepatitis B, IPV,
MMR, PCV7, and varicella vaccines.
4. By December 31, 2004, PERFORMING AGENCY will decrease the proportion of
duplicate records or questionable matches in ImmTrac by a minimum of 5%.
5. By December 31, 2004, PERFORMING AGENCY will increase the percentage of
children less than six years of age participating in ImmTrac by a minimum of 5%.
6. By December 31, 2004, PERFORMING AGENCY will increase the number of
registered provider sites for ImmTrac by a minimum of 5%.
7. By December 31, 2004, PERFORMING AGENCY will increase TVFC provider
enrollment by a minimum of 5%.
8. By December 31, 2004, PERFORMING AGENCY will increase the educational
opportunities on vaccine-preventable diseases to public and private providers.
9. By December 31, 2004, PERFORMING AGENCY will complete 100% of assigned
TVFC follow-up site visits.
10. During FY 2004, PERFORMING AGENCY will promote and ensure immunization
services are provided for all age groups with emphasis on pockets of need.
11. By December 31, 2004, PERFORMING AGENCY will increase the reporting of
varicella cases by a minimum of 10%.
12. During FY 2004, PERFORMING AGENCY will complete 90% of vaccine-
preventable disease investigations within 30 days from date reported.
, 11 lir!1 ��
ATTACHMENT- Page 2 �
13. By December 31, 2004, PERFORMING AGENCY will identify all infants born to
hepatitis B surface antigen-positive pregnant women.
14. By June 30, 2004, PERFORMING AGENCY will ensure all reported infants born to
HBsAg positive women receive hepatitis B vaccine and HBIG within seven (7) days
of birth.
15. By December 31, 2004, PERFORMING AGENCY will complete 100% of assigned
childcare facility assessments.
16. By December 31, 2004, PERFORMING AGENCY'will complete 100% of assigned
private school assessments.
Activities may be subsequently amended as directed by the Centers for Disease Control and
Prevention and RECEIVING AGENCY Program. RECEIVING AGENCY Program must
approve, in writing, any revisions to the PERFORMING AGENCY'S Annual Plan.
SECTION II. SPECIAL PROVISIONS:
PERFORMING AGENCY shall comply with Texas Health and Safety Code, Chapters 81 and
161.
Funds shall not be used for administering vaccines, inpatient care, construction of facilities, or
debt retirement in accordance with RECEIVING AGENCY Interlocal Application for
Immunization Services, dated June 16, 2003.
Travel expenses shall be reimbursed according to State of Texas travel regulations.
Monthly billings must be submitted on a State of Texas Voucher Request form no later than the
close of the following month.
Programmatic reports shall be completed in the format provided by RECEIVING AGENCY
Program and submitted within thirty (30) days from the end of each quarter of the contract
Attachment term. A final summary report detailing all programmatic activity that occurred
during the contract term shall be submitted to RECEIVING AGENCY Program within sixty (60)
days from the end date of the contract Attachment.
ATTACHMENT - Page 3
MR1
SECTION III. BUDGET:
PERSONNEL $20,954.00
FRINGE BENEFITS 5,134.00
TRAVEL 1,260.00
EQUIPMENT 0.00
SUPPLIES 1,750.00
CONTRACTUAL 0.00
OTHER 1,579.00
TOTAL $30,677.00
Total reimbursements will not exceed $30,677.00.
Financial status reports are due the 30th of April, 30th of July, 30th of October, and the 30th of
March.
ATTACHMENT - Page 4 v il
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City of Fort Worth, Texas
I 011jor And COUP"'[ Communication
DATE REFERENCE NUMBER LOG NAMEPAGE
8/7/03 **C-19693 50IMMUNIZATIONS 1 of 2
SUBJECT ADOPTION OF APPROPRIATION ORDINANCE AND AUTHORIZATION TO EXECUTE
A CONTRACT WITH THE TEXAS DEPARTMENT OF HEALTH TO PROVIDE
IMMUNIZATION OUTREACH TO THE COMMUNITY
RECOMMENDATION:
It is recommended that the City Council:
1. Authorize the City Manager to apply for and accept and execute a grant contract with the Texas
Department of Health for $100,000 to be used to increase immunization levels in pre-school aged
children and provide awareness and education at the community level; and
2. Adopt the attached appropriation ordinance increasing appropriations and estimated receipts by
$100,000 in the Grants Fund; and
3. Waive indirect costs of 36.32% of related salary and fringe benefits which are the most recent rates
as indicated by the Finance Department.
DISCUSSION:
• Texas immunization levels in 2000 for children aged 3-24 months who are up-to-date on immunizations
is 70.3%.
• The percentage of Tarrant County children aged 3-24 months who are up-to-date is 72.6%.
(Source: 2000 Texas Immunization Survey, Texas Department of Health).
• This is compared to national levels in 2000 of 75.3% (Source: National Immunization Survey,
Center for Disease Control).
The fundamental reason for under-immunization are factors related to poverty. These factors can be
overcome by removing financial and access barriers. Texas parents overwhelmingly believe in the
importance of immunizations for their children, yet may not consider the importance of timing, or may
not know when immunizations are due. Various focus groups revealed parental confusion about the
schedule, the need for numerous shots, and the low awareness about immunization services.
The goal of this proposal is to utilize immunization funds to achieve and maintain 90% vaccine
coverage for DtaP (pertussis or acellular pertussis), DT (diphtheria, tetanus), IVP (polio), MMR
(measles, mumps and rubella), HepB (hepatitis B), Varicella (chickenpox) and Hib (Haemophilus
influenzae type b) vaccines in pre-school age children.
The City's Public Health Department, Outreach Division is proposing a continued partnership with the
Fire Department to immunize more pre-school age children. This partnership with emergency
personnel makes sense for our community. The personnel are medically trained, know their
neighborhoods, and the stations are "safe havens" in the community. The fire stations are easily
accessible, Americans with Disabilities Act compliant, and appealing to young children. Enlisting
firefighters and paramedics to become immunization partners creates an innovative collaboration in
providing needed services to the community. There will be no charge for the immunizations.
City of Fort Worth, Texas
4"FAIJor And Council Communication
DATE REFERENCE NUMBER LOG NAME PAGE
8/7/03 **C-19693 1 50IMMUNIZATIONS 2 of 2
SUBJECT ADOPTION OF APPROPRIATION ORDINANCE AND AUTHORIZATION TO EXECUTE
A CONTRACT WITH THE TEXAS DEPARTMENT OF HEALTH TO PROVIDE
IMMUNIZATION OUTREACH TO THE COMMUNITY
As part of the advocacy role, outreach staff is extremely aware of the lack of access to health services.
This is especially acute in the area of immunization. The target group of infants and pre-schoolers in
the City is caught in this lack of access. The immunization program provided 2,207 vaccines to 755
children from January 2002, through June 2003. There were 433 (57.4%) children not insured, 32
(4.2%) underinsured, 203 (26.9%) on Medicaid, and 31 (4.1%) on Children's Health Insurance Program
(CHIP).
The current locations for these immunizations.are Station 15 (3100 Azle Avenue), Station 17 (212 East
Felix Street), with Station 3 (4700 Ramey) scheduled to open August 11, 2003. Protocol and standing
delegation orders are in place and quality assurance will come through a collaborative effort between
the Health Department and the Fire Department.
The Outreach staff distributes information about the availability of services to recreation centers,
apartments, neighborhood day-care centers, and faith-based organizations to assure the public is
informed of the immunization services. Data collection is done using the Statistical Package for the
Social Sciences (SPSS) Version 11.0. Data is entered in the Tarrant County Immunization registry and
downloaded to the Texas Department of Health's "ImmTrac" computer system.
Staff recommends the waiver of indirect costs to maximize the funds toward the grant objective.
FISCAL INFORMATION/CERTIFICATION:
The Finance Director certifies that upon adoption of the attached appropriation ordinance, funds will be
available in the current operating budget, as appropriated, of the Grants Fund.
LW:k
Submitted for City Manager's FUND TACCOUNT I CENTER AMOUNT CITY SECRETARY
Office by: (to)
GR76 451923 050301880000 $100,000.00
Libby Watson 6183 GR76 5(various) 050301881010 $100,000.00
Originating Department Head:
APPROVED 8/7/03
Daniel Reimer 7201 (from) ORDINANCE#15635
Additional Information Contact:
Barbara Murph 6213