HomeMy WebLinkAboutC2009-097 - 2/10/2009 - ApprovedDEPARTMENT OF STATE HEALTH SERVICES
This contract, number 2009-030581 (Contract), is entered into by and between the Department
of State Health Services (DSHS or the Department), an agency of the State of Texas,: and CITY
OF CORPUS CHRISTI (Contractor), a Government Entitv. (collectively, the Parties).
1. Purpose of the Contract. DSHS agrees to purchase, and Contractor agrees to provide,
services or goods to the eligible populations as described in the Program Attachments.
2. Total Amount of the Contract and Payment Method(sl. The total amount of this Contract
is $102,276.00, and the payment method(s) shall be as specified in the Program Attachments.
3. Fundine Oblieation. This Contract is contingent upon the continued availability of funding.
If funds become unavailable through lack of appropriations, budget cuts, transfer of funds
between programs or health and human services agencies, amendment to the Appropriations Act,
health and human services agency consolidation, or any other disruptions of current appropriated
funding for this Contract, DSHS may restrict, reduce, or terminate funding under this Contract.
4. Term of the Contract. This Contract begins on 01/01/2009 and ends on 12/31/2009. DSHS
has the option, in its sole discretion, to renew the Contract as provided in each Program
Attachment. DSHS is not responsible for payment under this Contract before both parties have
signed the Contract or before the start date of the Contract, whichever is later.
5. Authority. DSHS enters into this Contract under the authority of Health and Safety Code,
Chapter 1001.
6. Documents Formine Contract. The Contract consists of the following:
a. Core Contract (this document)
b. Program Attachments:
2009-030581-001 Tuberculosis Prevention and Control -Federal
c. General Provisions (Sub-recipient)
d. Solicitation Document(s), and
e. Contractor's response(s) to the Solicitation Document(s).
£ Exhibits
Any changes made to the Contract, whether by edit or attachment, do not form part of the
Contract unless expressly agreed to in writing by DSHS and Contractor and incorporated herein.
2009-097
Res. 028042
02/10/09
Dept. Of State Health Svcs.
7. Conflicting Terms. In the event of conflicting terms among the documents forming this
Contract, the order of control is first the Core Contract, then the Program Attachment(s), then the
General Provisions, then the Solicitation Document, if any, and then Contractor's response to the
Solicitation Document, if any.
8. Pavee• The Parties agree that the following payee is entitled to receive payment for services
rendered by Contractor or goods received under this Contract:
Name: CITY OF CORPUS CHRISTI
Address: PO BOX 9277
CORPUS CHRISTI, TX 78469-9277
Vendor Identification Number: 17460005741027
9. Entire Aereement. The Parties acknowledge that this Contract is the entire agreement of
the Parties and that there are no agreements or understandings, written or oral, between them
with respect to the subject matter of this Contract, other than as set forth in this Contract.
By signing below, the Parties acknowledge that they have read the Contract and agree to its
terms, and that the persons whose signatures appear below have the requisite authority to execute
this Contract on behalf of the named party.
DEPARTMEN OF STATE HEALTH S E9--~~CITY OF CORPUS CHRISTI
...
By: By: °%~•/
Signature of Authorized Official Sig t re aTiFSr.
Q 1 ARMt1~~DQ CFihPP -~~
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Date DateT\\\
Bob Barnette, C.P.M., CTPM -~~~e (~ .~ c~-~ ~~-y ~ ~ ~ ~~~y
Printed Name and Title
Director, Client Services Contracting Unit ~(~ f~O~C ~~~1
Address
1100 WEST 49TH STREET Cc>r~U~ ~y ~~ ~~ ~~~~~
AUSTIN, TEXAS 78756 City, State, Zip
(512) 458-7470 ~J~ ~ ' ~-~0 -3a-~
Telephone Number
Bob.Burnette@dshs.state.tx.us '('A11~C?~2~~ c%. C'L`~)CCIS , C=4~'fYl
nn ~ ~~ E-mail A dress for Official Correspondence
• VO2 ~.. AUTHURIttr 3 o~j
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CONTRACT N0.2009-030581
PROGRAM ATTACHMENT NO.001
PURCHASE ORDER N0.0000346026
CONTRACTOR: CITY OF CORPUS CHRISTI
DSHS PROGRAM: Tuberculosis Prevention and Control -Federal
TERM: 01/01/2009 THRU: 12/31/2009
SECTION I. STATEMENT OF WORK:
Throughout the Contractor's defined service area of Corpus Christi the Contractor shall develop and
provide: (1) basic services and associated activities for tuberculosis (TB) prevention and control;
and (2) expanded outreach services to individuals of identified special populations who have TB or
who aze at high risk of developing TB.
Contractor shall provide the services outlined above in compliance with the following:
• DSHS Standards of Performance for the Prevention and Control of Tuberculosis,
available at http://www.dshsstate.tx.us/idcu/disease/tb/publications/default.aso;
• DSHS Standards for Public Health Clinic Services, available at
httn://www. dshs.state.tx.us/sdi/docs/section8.pdf;
• American Thoracic Society (ATS) and Centers for Disease Control and Prevention
(CDC) joint statements on diagnosis, treatment and control of TB available at
http://www.cdo.eov/mmwr/preview/mmwrhtml/rr5211 al.htm;
• Diagnostic Standards and Classification of Tuberculosis in Adults and Children,
(American Journal of Respiratory and Critical Care Medicine, Vol. 161, pp. 1376-1395,
2000) http://ajrccm.atsjournals.or /g_cgi/reprint/161/4/1376;
• Treatment of Tuberculosis, (ATS/CDC/IDSA), 2003 available at
httn://www.cdc. og v/tb/pubs/mmwr/Maj_auide/default.htm;
• Tazgeted Tuberculin Testing and Treatment of Latent TB Infection (LTBI), Morbidity and
Mortality Weekly Report, Vol. 49, No. RR-6, 2000, available at
http://www. cdc. gov/mmwr/PDF/rr/rr4906.pdf;
• Updated: Adverse Event Data and Revised American Thoracic Society/CDC
Recommendations Against the Use of Rifampin and Pyrazinamide for Treatment of
Latent Tuberculosis Infection -United States, 2003, MMWR 52 (No. 31)
http://www.cdo.eov/mmwr/preview/mmwrhtml/mm5231a4.htm ;and
• Controlling Tuberculosis in the United States, MMWR, Vol. 54, No. RR-12, 2005
httn://www.cdc. gov/mmwr/preview/mmwrhtmUrr5412a1.htm.
Contractor shall comply with all applicable federal and state regulations and statutes, including, but
not limited to, the following:
• Texas Tuberculosis Code, Health and Safety Code, Chapter 13, Subchapter B,
PROGRAM ATTACHMENT -Page 1
• Communicable Disease Prevention and Control Act, Texas Health and Safety Code,
Chapter 81,
• Screening and Treatment for Tuberculosis in Jails and Other Correctional Facilities,
Health and Safety Code, Chapter 89,
• Texas Administrative Code TAC, Title 25, Part 1, Chapter 97, Subchapter A, Control of
Communicable Diseases, and
• Texas Administrative Code TAC, Title 25, Part 1, Chapter 97, Subchapter H,
Tuberculosis Screening for Jails and Other Correctional Facilities.
Contractor shall perform all activities under this Renewal Program Attachment in accordance with
Contractor's final, approved work plan (attached as Exhibit A), and detailed budget as approved by
DSHS. Contractor must receive written approval from DSHS before varying from applicable
policies, procedures, protocols, and the final approved work plan, and must update its
implementation documentation within forty-eight (48) hours of making approved changes so that
staff working on activities under this contract knows of the change(s).
DSHS reserves the right, where allowed by legal authority, to redirect funds in the event of financial
shortfalls. DSHS will monitor Contractor's expenditures on a quarterly basis. If expenditures are
below that projected in Contractor's total Renewal Program Attachment amount, as shown in
SECTION VI. BUDGET, Contractor's budget maybe subject to a decrease for the remainder of the
Contract term. Vacant positions existing after ninety (90) days may result in a decrease in funds.
Because of the inherent time to complete treatment for tuberculosis disease and latent tuberculosis
infection in relation to the period of this Renewal Program Attachment, required reporting under this
Program Attachment will show results for work performed under previous Program Attachments.
Contractor shall provide a complete and accurate annual narrative report, in the format provided by
DSHS, demonstrating compliance with the requirements ofthis Renewal Program Attachment. That
report shall include, but is not limited to, a detailed analysis of performance related to the
performance measures listed below. A progress report of activities in January through December
shall also be submitted, in a format provided by DSHS. The narrative program report shall be sent to
the Department of State Health Services, Infectious Disease Intervention and Control Branch, Mail
Code 1939, PO Box 149347, Austin, Texas 78714-9347 via regular mail, or by fax to (512)458-
7787), or a-mail to Charles.wallace(a~dshs.sfate.tx.us. Contractor shall maintain the documentation
used to calculate performance measures as required by the General Provisions Article VIII "Records
Retention" and by the Texas Administrative Code Title 22, Part 9 Chapter 165, § 165.1 regarding the
retention of medical records.
Report periods and due dates are as follows:
PERIOD COVERED DUE DATE
Janu 2008 -December 2008 March 2, 2009
Janu 2009 - Ma 2009 Jul 1, 2009
PROGRAM ATTACHMENT -Page 2
Contractor shall send all initial reports of confirmed and suspected TB cases to DSHS within seven
(7) working days of identification or notification. Any updates to initial DSHS Report of Cases and
Patient Services Forms (TB-400) (e.g., diagnosis, medication changes, x-rays, and bacteriology) and
case closures shall be sent to DSHS at PO Box 14937, Mail Code 1939, Austin, Texas 78714-9347.
Contractor shall send an initial report to DSHS of contacts on all Class 3 TB cases and smeaz-
positive Class 5 TB suspects within thirty (30) days of identification using DSHS' Report of
Contacts Fonn (TB-340 and TB-341). Any new follow-up information (not included in the initial
report) related to the evaluation and treatment of contacts shall be sent to DSHS on the TB-340 and
TB-341 at intervals of 90 days, 120 days, and 2 years after the day the Contractor became aware of
the TB case.
Electronic reporting to DSHS for Class 3 TB cases, smeaz positive Class 5 TB suspects, and their
contacts may become available during the term of this Renewal Program Attachment. Once notified
of this option by DSHS, Contractor may avail itself of this option if it adheres to all the electronic
reporting requirements (including system requirements) provided at that time.
Contractor will determine the number of persons which receive at least one TB service, including
but not limited to: tuberculin skin tests; chest radiographs; health care worker services; or
treatment with one or more anti-tuberculosis medications. Contractor must determine these
numbers at the end of each month during the contract term and report these numbers to DSHS
TB Program by the Sa' of each month following the end of the month.
SECTION II. PERFORMANCE MEASURES:
The following performance measures will be used to assess, in part, Contractor's effectiveness in
providing the services described in this Renewal Program Attachment, without waiving the
enforceability of any of the other terms of the contract or any other method of determining
compliance.
Contractor must ensure that:
1. At least 90% of cases and suspected cases under treatment in 2008 aze on directly
observed therapy (DOT);
2. At least 92% of eligible* TB cases reported in 2007 complete a course of curative TB
treatment within twelve (12) months of initiation of treatment;
3. At least 95% of TB patients reported in 2007 with initial positive cultures are tested for
drug susceptibility and have those test results documented in their medical record;
4. At least 93% of smear positive TB cases reported in 2008 have at least one (1) contact
identified;
5. At least 74% of identified contacts to smear-positive TB cases reported in 2007 shall be
evaluated for TB infection or disease;
6. At least 65% of infected contacts (to smear-positive cases reported in 2007) who are
started on treatment for latent tuberculosis infection (LTBI) shall complete therapy;
7. At least 74% of adults (age>14) with TB disease reported in 2008 are tested for HIV;
PROGRAM ATTACHMENT -Page 3
8. At least 84% of adults (age 25-44) with TB disease reported in 2008 aze tested for HIV;
and
9. Report the number of TB cases in US-born non-Hispanic African-Americans reported in
2008.
*Excludes TB cases: 1) diagnosed at death; 2) who die during therapy; 3) who are resistant to
rifampin; 4) who have meningeal disease; and/or 5) who are younger than 15 yeazs with either
miliary disease or a positive blood culture for TB.
If the Contractor fails to meet any of the performance measures, the Contractor shall furnish in the
narrative report due March 2, 2009, a written explanation including a plan (with schedule) to meet
those measures. This requirement does not excuse any violation of this Contract, nor does it limit
DSHS as to any options available under the contract regarding breach.
DSHS shall evaluate compliance with these performance measures based on: information
maintained in databases kept at the Tuberculosis Prevention and Control Program; audits and/or
inspections; scheduled program reviews; reporting requirements under this contract; and using any
other information available to DSHS.
SECTION III. SOLICITATION DOCUMENT:
N/A
SECTION IV. RENEWALS:
None.
SECTION V. PAYMENT METHOD:
Cost Reimbursement
Funding is further detailed in the attached Categorical Budget and if applicable, Equipment List.
SECTION VL BILLING INSTRUCTIONS:
Contractor shall request payment using the State of Texas Purchase Voucher (Form B-13) and
acceptable supporting documentation for reimbursement of the required services/deliverables.
Vouchers and supporting documentation should be mailed or submitted by fax or electronic mail to
the addresses/number below.
Claims Processing Unit, MC1940
Department of State Health Services
1100 West 49"' Street
PO Box 149347
Austin, TX 78714-9347
PROGRAM ATTACHMENT -Page 4
The fax number for submitting State of Texas Purchase Voucher (Form B-13) to the Claims
Processing Unit is (512) 458-7442. The email address is invoices e dshs.state.tx.us.
SECTION VII. BUDGET
SOURCE OF FUNDS: CFDA Funding #93.116
SECTION VIII. SPECIAL PROVISIONS:
General Provisions, aze revised to include the following:
General Provisions, FUNDING Article, is revised to include the following:
Funding from this Renewal Program Attachment shall not be used to supplant (i.e, used in place
of funds dedicated, appropriated or expended for activities funded through this Renewal Program
Attachment) state or local funds, but Contractor shall use such funds to increase state or local
funds currently available for a particular activity. Contractor shall maintain local funding at a
sufficient rate to support the local program. If the total cost of the project is greater than DSHS'
funding set out in SECTION VII. BUDGET, Contractor shall supply funds for the remaining
costs in order to accomplish the objectives set forth in this Program Attachment.
All revenues directly generated by this Renewal Program Attachment or earned as a result ofthis
Renewal Program Attachment during the term of this Renewal Program Attachment are
considered program income; including income generated through Medicaid billings for TB
related clinic services. The Contractor shall use this program income to further the scope of
work detailed in this Renewal Program Attachment, and must keep documentation to
demonstrate such to DSHS's satisfaction. This program income may not be used to take the
place of existing local, state, or federal program funds.
General Provisions, PAYMENT METHODS AND RESTRICTIONS Article, Billing Submission
Section, is hereby revised to add:
Quarterly Financial Status Reports (Form 269A) from Contractor shall be provided to DSHS in
the format provided by the DSHS. These reports shall be mailed to Department of State Health
Services, Attention: Accounting Section, Claims Processing Unit, Mail Code 1940, 1100 West
49a' Street, PO Box 149347, Austin, Texas 78714-9347. One (1) copy of each quarterly financial
status report shall be mailed to the Department of State Health Services, Attention: Infectious
Disease Intervention and Control Branch, Mail Code 1939, PO Box 149347, Austin, Texas
78714-9347. These re orts shall be submitted on a uarterl basis as follows:
PERIOD COVERED DUE DATE
Janu , Febru March Aril 30, 2009
A ril, Ma ,June Jul 31, 2009
Jul , Au ust, Se tember October 30, 2009
October, November December Febru 26, 2010
PROGRAM ATTACHMENT -Page 5
Fiscal Year 2009 Department of State Health Services Contract
General Provisions
(Core/Subrecipient)
TABLE OF CONTENTS
ARTICLE I COMPLIANCE AND REPORTING ......................................................................1
Section 1.01 Compliance with Statutes and Rules ...................................................................1
Section 1.02 Compliance with Requirements of Solicitation Document ...............................1
Section 1.03 Reporting ...............................................................................................................1
Section 1.04 Client Eligibility ....................................................................................................1
Section 1.05 Applicable Contracts Law and Venue for Disputes ...........................................1
Section 1.06 Applicable Laws and Regulations Regarding Funding Sources . .....................1
Section 1.07 Statutes and Standards of General Applicability ..............................................2
Section 1.08 Applicability of General Provisions to Interagency and Interlocal Contracts..
.....4
............................................................................................................................
Section 1.09 Civil Rights Policies and Complaints ..................................................................5
ARTICLE II SERVICES .................................................................................................................5
Section 2.01 Education to Persons in Residential Facilities ....................................................5
Section 2.02 Disaster Services ....................................................................................................5
Section 2.03 Consent to Medical Care of a Minor ...................................................................5
Section 2.04 Telemedicine Medical Services ............................................................................6
Section 2.05 Fees for Personal Health Services .......................................................................6
Section 2.06 Cost Effective Purchasing of Medications ..........................................................6
Section 2.07 Services and Information for Persons with Limited English Proficiency.......6
ARTICLE III FUNDING ...................................................................................:..............................7
Section 3.01 Debt to State and Corporate Status ....................................................................7
Section 3.02 Application of Payment Due ................................................................................7
Section 3.03 Use of Funds ..........................................................................................................7
Section 3.04 Use for Match Prohibited .....................................................................................7
Section 3.05 Program Income ....................................................................................................7
Section 3.06 Nonsupplanting .....................................................................................................8
ARTICLE IV PAYMENT METHODS AND RESTRICTIONS ..................................................8
Section 4.01 Payment Methods ..................................................................................................8
Section 4.02 Billing Submission .................................................................................................8
Section 4.03 Final Billing Submission .......................................................................................8
Section 4.04 Working Capital Advance ....................................................................................8
Section 4.05 Financial Status Reports (FSRs) ..........................................................................9
Section 4.06 Third Party Payors ...............................................................................................9
ARTICLE V TERMS AND CONDITIONS OF PAYMENT ......................................................9
Section 5.01 Prompt Payment ...................................................................................................9
Section 5.02 Withholding Payments .........................................................................................9
Section 5.03 Condition Precedent to Requesting Payment ...................................................10
General Provisions (Core Subrecipient 2009) Table of Contents 6/5/08 Page 1 of 4
Section 12.03 Insurance .............................................................................................................20
Section 12.04 Fidelity Bond .......................................................................................................20
Section 12.05 Liability Coverage ...............................................................................................20
Section 12.06 Overtime Compensation .....................................................................................20
Section 12.07 Program Site ........................................................................................................20
Section 12.08 Cost Allocation Plan ...........................................................................................20
Section 12.09 Reporting for Unit Rate and Fee For Service Contracts .................................21
Section 12.10 Historically Underutilized Businesses (HUBs) .................................................21
Section 12.11 Buy Texas .............................................................................................................21
Section 12.12 Contracts with Subrecipient Subcontractors ...................................................21
Section 12.13 Status of Subcontractors ....................................................................................22
Section 12.14 Incorporation of Terms ......................................................................................22
Section 12.15 Independent Contractor .....................................................................................22
Section 12.16 Authority to Bind ................................................................................................22
Section 12.17 Tax Liability ........................................................................................................22
Section 12.18 Notice of Organizational Change ......................................................................23
Section 12.19 Quality Management ..........................................................................................23
Section 12.20 Equipment (Including Controlled Assets) Purchases ......................................23
Section 12.21 Supplies ................................................................................................................23
Section 12.22 Changes to Equipment List ................................................................................23
Section 12.23 Property Inventory and Protection of Assets ...................................................23
Section 12.24 Bankruptcy ..........................................................................................................24
Section 12.25 Title to Property ..................................................................................................24
Section 12.26 Property Acquisitions .........................................................................................24
Section 12.27 Disposition of Property .......................................................................................24
Section 12.28 Closeout of Equipment .......................................................................................24
Section 12.29 Assets as Collateral Prohibited ..........................................................................24
ARTICLE XIII GENERAL TERMS ............................................................................................25
Section 13.01 Assignment ............................................. ..............................................................25
Section 13
02 Lobbying ............................................... ..............................................................25
.
03
Section 13 Conflict of Interest ................................ ..............................................................25
.
04
Section 13 Transactions Between Related Parties ..............................................................25
.
05
Section 13 Intellectual Property ...........................................................................................26
.
Section 13
06 Other Intangible Property ................... ..............................................................27
.
07
Section 13 Severability and Ambiguity ................. ..............................................................27
.
08
Section 13 Legal Notice ........................................... ..............................................................27
.
Section 13
09 Successors .............................................. ..............................................................27
.
Section 13.10 Headings ................................................. ..............................................................27
Section 13.11 Parties ..................................................... ..............................................................27
Section 13.12 Survivability of Terms .......................... ..............................................................27
Section 13
13 Direct Operation ................................... ..............................................................27
.
14
Section 13 Customer Service Information ............ ..............................................................28
.
Section 13.15 Amendment ........................................... ..............................................................28
Section 13.16 Contractor's Notification of Change to Certain Contract Provisions...........28
Section 13.17 Contractor's Request for Revision of Certain Contract Provisions ..............28
Section 13.18 Immunity Not Waived .......................... ..............................................................29
General Provisions (Core Subrecipient 2009) Table of Contents 6/5/08 Page 3 of 4
Fiscal Year 2009 Department of State Health Services Contract
General Provisions
(Core/Subrecipient)
ARTICLE I COMPLIANCE AND REPORTING
Section 1.01 Compliance with Statutes and Rules. Contractor shall comply, and shall require its
subcontractor(s) to comply, with the requirements of the Department's rules of general applicability
and other applicable state and federal statutes, regulations and rules as such statutes, regulations and
rules currently exist and as they maybe lawfully amended. The Department rules are located in the
Texas Administrative Code, Title 25 (Rules). To the extent this Contract imposes a higher standard,
or additional requirements beyond those required by applicable statutes, regulations or the Rules, the
terms of this Contract shall control.
Section 1.02 Compliance with Requirements of Solicitation Document. Except as specified in
these General Provisions or the Program Attachment(s), Contractor shall comply with the
requirements, eligibility conditions, assurances, certifications and program requirements of the
Solicitation Document, if any, (including any revised or additional terms agreed to in writing by
Contractor and DSHS prior to execution of this Contract) for the duration of this Contract or any
subsequent renewals. The Parties agree that the Department has relied upon the Contractor's
response to the Solicitation Document. The Parties agree that any misrepresentation contained in the
Contractor's response to the Solicitation Document shall constitute a breach of this Contract.
Section 1.03 Reporting. Contractor shall submit reports in accordance with the reporting
requirements established by the Department and shall provide any other information requested by the
Department in the format required by DSHS. Failure to submit a required report or additional
requested information by the due date specified in the Program Attachment(s) or upon request
constitutes a breach of contract, may result in delayed payment and/or the imposition of sanctions and
remedies, and, if appropriate, emergency action; and may adversely affect evaluation of Contractor's
future contracting opportunities with the Department.
Section 1.04 Client Eligibility. Where applicable, Contractor shall use financial eligibility criteria,
fmancial assessment procedures and standazds developed by the Department to determine client
eligibility.
Section 1.05 Applicable Contracts Law and Venue for Disputes. Regazding all issues related to
contract formation, performance, interpretation, and any issues that may azise in any dispute between
the Parties, this Contract shall be governed by, and construed in accordance with, the laws of the
State of Texas. In the event of a dispute between the Parties, venue for any suit shall be Travis
County, Texas.
Section 1.06 Applicable Laws and Regulations Regarding Funding Sources. Where applicable,
federal statutes and regulations, including federal grant requirements applicable to funding sources,
shall apply to this Contract. Contractor agrees to comply with applicable laws, executive orders,
regulations and policies as well as Office of Management and Budget (OMB) Circulazs, the Uniform
Grant and Contract Management Act of 1981 (UGMA), Tex. Gov. Code Chapter 783, as amended,
and Uniform Grant Management Standards (UGMS), as amended, by revised federal circulazs and
incorporated in UGMS by the Governor's Budget, Planning and Policy Division. UGMA is located
on the Internet at httu•//tlo2 tlc state.tx.us/statutes/statutes.html; the UGMS aze located on the
General Provisions (Core Subrecipient 2009) 6/5/08 Page 1 of 38
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Texas Workers' Compensation Act, Tex. Lab. Code, Chapters 401-406 and 28 Tex. Admin.
Code Part 2, regazding compensation for employees' injuries;
The Clinical Laboratory Improvement Amendments of 1988, 42 USC § 263a, regarding the
regulation and certification of clinical laboratories;
The Occupational Safety and Health Administration Regulations on Blood Bome Pathogens,
29 CFR § 1910.1030, or Title 25 Tex. Admin. Code Chapter 96 regazding safety standazds for
handling blood borne pathogens;
Laboratory Animal Welfare Act of 1966, 7 USC §§ 2131 et seq., pertaining to the treatment
of laboratory animals;
environmental standards pursuant to the following: 1) Institution of environmental quality
control measures under the National Environmental Policy Act of 1969, 42 USC §§ 4321-
4347 and Executive Order 11514 (35 Fed. Reg. 4247), "Protection and Enhancement of
Environmental Quality;" 2) Notification of violating facilities pursuant to Executive Order
11738 (40 CFR Part 32), "Providing for Administration of the Clean Air Act and the Federal
Water Pollution Controi Act with respect to Federal Contracts, Grants, or Loans;" 3)
Protection of wetlands pursuant to Executive Order 11990, 42 Fed. Reg. 26961; 4) Evaluation
of flood hazards in floodplains in accordance with Executive Order 11988, 42 Fed. Reg.
26951 and, if applicable, flood insurance purchase requirements of Section 102(a) of the
Flood Disaster Protection Act of 1973 (PL 93-234); 5) Assurance of project consistency with
the approved State Management program developed under the Coastal Zone Management Act
of 1972, 16 USC §§ 1451 et seq.; 6) Federal Water Pollution Control Act, 33 USC §1251 et
seq.; 7) Protection of underground sources of drinking water under the Safe Drinking Water
Act of 1974, 42 USC §§ 300f-300j; 8) Protection of endangered species under the Endangered
Species Act of 1973, 16 USC §§ 1531 et seq.; 9) Conformity of federal actions to state clean
air implementation plans under the Clean Air Act of 1955, 42 USC §7401 et seq.; 10) Wild
and Scenic Rivers Act of 1968 (16 USC §§ 1271 et seq.) related to protecting certain rivers
system; and 11) Lead-Based Paint Poisoning Prevention Act (42 USC §§ 4801 et seq.)
prohibiting the use of lead-based paint in residential construction or rehabilitation;
Intergovernmental Personnel Act of 1970 (42 USC §§4278-4763) regazding personnel merit
systems for programs specified in Appendix A of the federal Office of Program
Management's Standazds for a Merit System of Personnel Administration (5 CFR Part 900,
Subpart F);
Titles II and III of the Uniform Relocation Assistance and Real Property Acquisition Policies
Act of 1970 (PL 91-646), relating to fair treatment of persons displaced or whose property is
acquired as a result of Federal or federally-assisted programs;
Davis-Bacon Act (40 USC §§ 276a to 276a-7), the Copeland Act (40 U.S.C. § 276c and 18
USC § 874), and the Contract Work Hours and Safety Standazds Act (40 USC §§ 327-333),
regazding labor standards for federally-assisted construction subagreements;
National Historic Preservation Act of 1966, §106 (16 USC § 470), Executive Order 11593,
and the Archaeological and Historic Preservation Act of 1974 (16 USC §§ 469a-1 et seq.)
regarding historic property to the extent necessary to assist DSHS in complying with the Acts;
financial and compliance audits in accordance with Single Audit Act Amendments of 1996
and OMB Circulaz No. A-133, "Audits of States, Local Governments, and Non-Profit
Organizations;" and
General Provisions (Core Subrecipient 2009) 6/5/08 Page 3 of 38
Department, whether that date is prior to or after the date of any ratification by Contractor's
governing boazd.
Section 1.09 Civil Rights Policies and Complaints. Upon request, Contactor shall provide the
Health and Human Services Commission (HHSC) Civil Rights Office with copies of all Contractor's
civil rights policies and procedures. Contractor must notify HHSC's Office of Civil Rights of any
civil rights complaints received relating to performance under this Contract no more than ten (10)
calendar days after Contractor's receipt of the claim. Notice must be directed to -
HHSC Civil Rights Office
701 W. 51st St., Mail Code W206
Austin, Texas 78751
Toll-free phone (888) 388-6332
Phone (512) 438-4313
TTY Toll-free (877) 432-7232
Fax (512) 438-5885
ARTICLE II SERVICES
Section 2.01 Education to Persons in Residential Facilities. If applicable, Contractor shall ensure.
that all persons, who aze housed in Department licensed and/or funded residential facilities and who
aze twenty-two (22) yeazs of age or younger, have access to educational services as required by Tex.
Educ. Code § 29.012. Contractor shall notify the local education agency or local early intervention
program as prescribed by Tex. Educ. Code § 29.012 not later than the third calendaz day after the date
a person who is twenty-two (22) yeazs of age or younger is placed in Contractor's residential facility.
Section 2.02 Disaster Services.
In the event of a local, state, or federal emergency, including natural, man-made, criminal, terrorist,
and/or biotenorism events, declared as a state disaster by the Governor, or a federal disaster by the
appropriate federal official, Contractor may be called upon to assist DSHS in providing services, as
appropriate, in the following areas: community evacuation; health and medical assistance; assessment
of health and medical needs; health surveillance; medical caze personnel; health and medical
equipment and supplies; patient evacuation; in-hospital caze and hospital facility status; food, drug,
and medical device safety; worker health and safety; mental health and substance abuse; public health
information; vector control and veterinary services; and victim identification and mortuary services.
Disaster services shall be carried out in the manner most responsive to the needs of the emergency, be
cost effective, and be least intrusive on the primary services of the Contractor.
Section 2.03 Consent to Medical Care of a Minor. If Contractor provides medical, dental,
psychological or surgical treatment to a minor under this Contract, either directly or through contracts
with subcontractors, the treatment of a minor shall be provided only if informed consent to treatment
is obtained pursuant to Tex. Fam. Code, Chapter 32 relating to consent to treatment of a child by a
General Provisions (Core Subrecipient 2009) 6/5/08 Page 5 of 38
any family member or friend of the client as an interpreter for essential communications with a client
with limited English proficiency unless the client has requested that person and the use of such a
person would not compromise the effectiveness of services or violate the client's confidentiality and
the client is advised that a free interpreter is available.
ARTICLE III FUNDING
Section 3.01 Debt to State and Corporate Status. Pursuant to Tex. Gov. Code § 403.055, the
Department will not approve and the State Comptroller will not issue payment to Contractor if
Contractor is indebted to the State for any reason, including a tax delinquency. Contractor, if a
corporation, certifies by execution of this Contract that it is cturent and will remain current in its
payment of franchise taxes to the State of Texas or that it is exempt from payment of franchise taxes
under Texas law (Tex. Tax Code §§ 171.001 et seq., as amended). Contractor, if a corporation,
further certifies that it is and will remain in good standing with the Secretary of State's office. A
false statement regazding franchise tax or corporate status is a material breach of this Contract. If
franchise tax payments become delinquent during the Contract term, all or part of the payments under
this Contract may be withheld until Contractor's delinquent franchise tax is paid in full.
Section 3.02 Application of Payment Due. Contractor agrees that any payments due under this
Contract will be applied towards any debt of Contractor, including but not limited to delinquent taxes
and child support that is owed to the State of Texas.
Section 3.03 Use of Funds. Contractor agrees that it shall expend Department funds only for the
provision of approved services and for reasonable and allowable expenses directly related to those
services.
Section 3.04 Use for Match Prohibited. Contractor agrees funds provided through this Contract
shall not be used for matching purposes in securing other funding unless directed or approved by the
Department in writing.
Section 3.05 Program Income. Gross income directly generated from Department funds through a
project or activity performed under a Program Attachment and/or earned only as a result of a
Program Attachment during the teen of the Program Attachment aze considered program income.
Unless otherwise required under the terms of the grant funding this Contract, the addition alternative,
as provided in UGMS § _.25(g)(2), for the use of program income shall be used by Contractor to
further the program objectives of the state or federal statute under which the Program Attachment
was made, and it shall be spent on the same Program Attachment project in which it was generated.
Contractor shall identify and report this income in accordance with the Compliance and Reporting
Article of these General Provisions and the provisions of the Program Attachment(s). Contractor
shall expend program income during the Program Attachment term and may not carry forward to the
succeeding term. Program income not expended in the term in which it is eazned shall be refunded to
DSHS. DSHS may base future funding levels, in part, upon Contractor's proficiency in identifying,
General Provisions (Core Subrecipient 2009) 6/5/08 Page 7 of 38
assigned to the Program Attachment to justify the need for a working capital advance. The working
capital advance must be liquidated as directed by the Department. The requirements for the
documentation justifying the need for an advance and the directions for liquidating the advance aze
found in the Contractor's Financial Procedures Manual located at
http •//www.dshs.state.tx.us/contracts.
Section 4.05 Financial Status Reports (FSRs). Except as otherwise provided in these General
Provisions or in the terms of the Program Attachment(s), for contracts with categorical budgets,
Contractor shall submit quarterly FSRs to Accounts Payable by the thirtieth calendar day of the
month following the end of each quarter of the Program Attachment term for Department review and
financial assessment. The final FSR must be submitted not later than sixty (60) days following the
end of the applicable term.
Section 4.06 Third Party Payors. A third party payor is any person or entity who has the legal
responsibility for paying for all or part of the services provided, including commercial health or
liability inswance carriers, Medicaid, or other federal, state, local, and private funding sowces.
Except as provided in this Contract, Contractor shall screen all clients and shall not bill the
Department for services eligible for reimbwsement from third party payors. Contractor shall: (a)
enroll as a provider in Children's Health Insurance Plan and Medicaid if providing approved services
authorized under this Contract that may be covered by those programs, and bill those plans for the
covered services; (b) provide assistance to individuals to enroll in such programs when the screening
process indicates possible eligibility for such programs; (c) allow clients that aze otherwise eligible
for Department services, but cannot pay a deductible required by a third party payor, to receive
services up to the amount of the deductible and to bill the Department for the deductible; (d) not bill
the Department for any services eligible for third party reimbwsement until all appeals to third party
payors have been exhausted; (e) maintain appropriate documentation from the third party payor
reflecting attempts to obtain reimbwsement; (f) bill all third party payors for services provided under
this Contract before submitting any request for reimbwsement to Department; and (g) provide third
party billing functions at no cost to the client.
ARTICLE V TERMS AND CONDITIONS OF PAYMENT
Section 5.01 Prompt Payment. Upon receipt of a timely, undisputed invoice pwsuant to this
Contract, Department will pay Contractor. Payments and reimbwsements are contingent upon a
signed Contract and will not exceed the total amount of authorized funds under this Contract.
Contractor is entitled to payment or reimbursement only if the service, work, and/or product has been
authorized by the Department and performed or provided pursuant to this Contract. If those
conditions are met, Department will make payment in accordance with the Texas prompt payment
law (Tex. Gov. Code Chapter 2251). Contractor must comply with Tex. Gov. Code Chapter 2251
regarding its prompt payment obligations to subcontractors. Payment of invoices by the Department
shall not constitute acceptance or approval of Contractor's performance, and all invoices and
Contractor's performance is subject to audit or review by the Department.
Section 5.02 Withholding Payments. Department may withhold all or part of any payments to
Contractor to offset reimbwsement for any ineligible expenditures or overpayments that Contractor
General Provisions (Core Subrecipient 2009) 6/5/08 Page 9 of 38
Non-Profit
Organizations OMB Circular
A-122 OMB Circulaz
A-133 and UGMS UGMS; OMB
Circular A-110 and
applicable Federal
awazding agency
common rule
For-profit 48 CFR Part 31, Program audit UGMS and applicable
Organization other Contract Cost conducted by an Federal awarding
than a hospital and an Principles independent agency common rule
organization named in Procedures, or certified public
OMB Circulaz A-122 uniform cost accountant in
as not subject to that accounting accordance with
circular. standards that Governmental
comply with cost Auditing
principles Standards.
acceptable to the
federal or state
awazdin agency
A chart of applicable common rules is located on the Internet at
httn•//www Whitehouse eov/omb/grants/chart.html. OMB Circulars will be applied with the
modifications prescribed by UGMS with effect given to whichever provision imposes the more
stringent requirement in the event of a conflict.
Section 6.02 Independent Single or Program-Specific Audit. If Contractor within Contractor's
fiscal yeaz expends a total amount of at least $500,000 in state funds awazded or at least $500,000 in
federal funds awazded, Contractor must have a single audit or program-specific audit in accordance
with the Office of Management and Budget (OMB) Circ. No. A-133, the Single Audit Act of 1984, P
L 98-502, 98 Stat. 2327, and the Single Audit Act Amendments of 1996, P L 104-156, 110 Stat.
1396. The $500,000 federal threshold amount includes federal funds passed through by way of state
agency awards. The HHSC Office of Inspector General (OIG) will notify the Contractor to complete
the Single Audit Determination Registration Form. If Contractor fails to complete the Single Audit
Determination Form within thirty (30) days after notification by OIG to do so, Contractor shall be
subject to DSHS sanctions and remedies for non-compliance with this Contract. The audit shall be
conducted by an independent certified public accountant and in accordance with applicable OMB
Circulazs, Government Auditing Standazds, and Uniform Grant Management Standards (UGMS)
located on the Intemet at
httn•//www eovemor state tx us/divisions/stategrants/euidelines/files/UGMS062004.doc. Contractor
shall procure audit services in compliance with this section, state procurement procedures, as well as
with the provisions of UGMS. Contractor, unless Contractor is a governmental entity, shall
competitively re-procure independent single audit services every five (5) yeazs and shall not use the
same lead or coordinating audit partner (having primary responsibility for the audit) to conduct the
independent audit for more than five (5) consecutive years. Procurement of audit services must
comply with the procurement standards of 45 CFR Part 74 or 92, as applicable, including obtaining
General Provisions (Core Subrecipient 2009) 6/5/08 Page 11 of 38
Safety Code § 614.017(a)(2) relating to special needs offenders, to an agency described in Tex.
Health & Safety Code § 614.017(c) upon request of that agency, unless Contractor documents that
the information is not allowed to be disclosed under 45 CFR Part 164 or other applicable law.
Section 7.04 Security of Patient or Client Records. Contractor must maintain patient and client
records in compliance with state and federal law relating to security and retention of medical or
mental health and substance abuse patient records. Department may require Contractor to transfer
original or copies of patient and client records to Department, without the consent or authorization of
the patient or client, upon termination of this Contract or a Program Attachment to this Contract, as
applicable, or if the care and treatment of the individual patient or client is transferred to another
entity. Prior to providing services funded under this Contract to a patient or client, Contractor shall
attempt to obtain consent from the patient or client to transfer copies of patient or client records to
another entity funded by DSHS upon termination of this Contract or a Program Attachment to this
Contract, as applicable, or if caze or treatment is transferred to another DSHS-funded contractor.
Section 7.05 HIV/AIDS Model Workplace Guidelines. if providing direct client Gaze, services,
or programs, Contractor shall implement Department's policies based on the HIV/AIDS (human
immunodeficiency virus/acquired immunodeficiency syndrotne) Model Workplace Guidelines for
Businesses, State Agencies, and State Contractors, Policy No. 090.021, and Contractor shall educate
employees and clients concerning HIV and its related conditions, including AIDS, in accordance with
the Tex. Health & Safety Code § 85.112-114. A link to the Model Workplace Guidelines can be
found at httn•//www dshs state tx us/hivstd/golicy/ydf/090021 ndf.
ARTICLE VIII RECORDS RETENTION
Section 8.01 Retention. Contractor shall retain records in accordance with applicable state and
federal statutes and regulations. At a minimum, Contractor shall retain and preserve all other records,
including fmancial records that are generated or collected by Contractor under the provisions of this
Contract, for a period of four (4) years after the termination of this Contract. If services are funded
through Medicaid, the federal retention period, if more than four (4) yeazs, shall apply. Contractor
shall retain all records pertaining to this Contract that are the subject of litigation or an audit until the
litigation has ended or all questions pertaining to the audit are resolved. Legal requirements for
Contractor may extend beyond the retention schedules established in this section. Contractor shall
retain medical records in accordance with Tex. Admin. Code Title 22, Part 9, § 165.1(6) and (c) or
other applicable statutes and regulations governing medical information. Contractor shall ensure that
this provision concerning records retention is included in any subcontract it awards. If Contractor
ceases business operations, it shall ensure that records relating to this Contract aze securely stored and
aze accessible by the Department upon Department's request for at least four (4) years from the date
Contractor ceases business or from the termination date of this Contract, whichever is sooner.
Contractor shall provide the name and address of the party responsible for storage of records to the
Division Contract Management Unit assigned to the Program Attachment.
General Provisions (Core Subrecipient 2009) 6/5/08 Page 13 of 38
Nutrition Services. Contractor shall make a good faith effort to comply with child abuse reporting
guidelines and requirements in Tex. Faro. Code Chapter 261 relating to investigations of reports of
child abuse and neglect. Contractor shall develop, implement and enforce a written policy that
includes at a minimum the Depaztment's Child Abuse Screening, Documenting, and Reporting Policy
for Contractors/Providers and train all staff on reporting requirements. Contractor shall use the
DSHS Child Abuse Reporting Form as required by the Department located at
www.dshs.state.tx.us/childabusereporting. Contractor shall retain reporting documentation on site
and make it available for inspection by DSHS.
Section 10.02 Signif-cant Incidents. In addition to notifying the appropriate authorities, Contractor
shall report to the Division Contract Management Unit assigned to the Program Attachment
significant incidents involving substantial disruption of program operation or potentially affecting
Department-funded clients or participants within seventy-two (72) hours of discovery.
Section 10.03 Litigation. Contractor shall notify the Division Contract Management Unit assigned
to the Program Attachment of litigation related to or affecting this Contract and to which Contractor
is a party within seven (7) calendaz days of becoming aware of such a proceeding. This includes, but
is not limited to an action, suit or proceeding before any court or governmental body, including
environmental and civil rights matters, professional liability, and employee litigation. Notification
shall include the names of the parties, nature of the litigation and remedy sought, including amount of
damages, if any.
Section 10.04 Action Against the Contractor. Contractor shall notify the Division Contract
Management Unit assigned to the Program Attachment if Contractor has had a contract suspended or
terminated for cause by any local, state or federal department or agency or nonprofit entity within
three (3) working days of the suspension or termination. Such notification shall include the reason
for such action; the name and contact information of the local, state or federal department or agency
or entity; the date of the contract; and the contract or case reference number. If the Contractor, as an
organization, has surrendered its license or has had its license suspended or revoked by any local,
state or federal department or agency or non-profit entity, it shall disclose this information within
three (3) working days of the surrender, suspension or revocation to the Division Contract
Management Unit assigned to the Program Attachment by submitting a one page description that
includes the reason(s) for such action; the name and contact information of the local, state or federal
department or agency or entity; the date of the license action; and a license or case reference number.
Section 10.05 Insolvency. Contractor shall notify in writing the Division Contract Management
Unit assigned to the Program Attachment of Contractor's insolvency, incapacity, or outstanding
unpaid obligations to the Internal Revenue Service (IRS) or Texas Workforce Commission (TWC)
within three (3) working days of the date of determination that Contractor is insolvent or
incapacitated, or the date Contractor discovered an unpaid obligation to the IRS or TWC. Contractor
shall notify in writing the Division Contract Management Unit assigned to the Program Attachment
of its plan to seek bankruptcy protection within three (3) working days of such action by the
Contractor's boazd of directors.
Section 10.06 Misuse of Funds. Contractor shall report to the Division Contract Management Unit
assigned to the Program Attachment and to the SAO, any knowledge of debarment, suspected fraud,
program abuse, possible illegal expenditures, unlawful activity, or violation of financial laws, roles,
General Provisions (Core Subrecipient 2009) 6/5/08 Page 15 of 38
e) it is in good standing with all state and/or federal agencies that have a contracting or
regulatory relationship with Contractor;
f) that no person who has an ownership or controlling interest in Contractor or who is an agent
or managing employee of Contractor has been convicted of a criminal offense related to
involvement in any program established under Medicare, Medicaid, or a federal block grant;
g) neither it, nor its principals have within the three-year period preceding this Contract, has
been convicted of or had a civil judgment rendered against them for commission of fraud or a
criminal offence in connection with obtaining, attempting to obtain, or performing a private or
public (federal, state or local) transaction or contract under a private or public transaction,
violation of federal or state antitrust statutes (including those proscribing price fixing between
competitors, allocation of customers between competitors and bid rigging), or commission of
embezzlement, theft, forgery, bribery, falsification or destruction of records, making false
statements or false claims, tax evasion, obstruction of justice, receiving stolen property or any
other offense indicating a lack of business integrity or business honesty that seriously and
directly affects the present responsibility of Contactor or its principals;
h) neither it, nor its principals is presently indicted or otherwise criminally or civilly charged by
a governmental entity (federal, state or local) with the commission of any of the offenses
enumerated in subsection g) of this section; and
i) neither it, nor its principals within athree-year period preceding this Contract has had one or
more public transaction (federal, state or local) terminated for cause or default.
Contractor shall include the certifications in this section, without modification (except as required to
make applicable to the subcontractor), in all subcontracts and solicitations for subcontracts. Where
Contractor is unable to certify to any of the statements in this Article, Contractor shall submit an
explanation to the Division Contract Management Unit assigned to the Program Attachment. If
Contractor's status with respect to the items certified above changes during the term of this Contract,
Contractor shall immediately notify the Division Contract Management Unit assigned to the Program
Attachment.
Section 11.02 Child Support Delinquencies. As required by Tex. Fam. Code § 231.006, a child
support obligor who is more than thirty (30) calendar days delinquent in paying child support and a
business entity in which the obligor is a sole proprietor, partner, shareholder, or owner with an
ownership interest of at least twenty-five percent (25%) is not eligible to receive payments from state
funds under a contract to provide property, materials, or services or receive astate-funded grant or
loan. If applicable, Contractor agrees to maintain its eligibility to receive payments under this
Contract, certifies that it is not ineligible to receive the payments specified in this Contract, and
acknowledges that this Contract maybe terminated and payment may be withheld if this certification
is inaccurate.
Section 11.03 Authorization. Contractor certifies that it possesses legal authority to contract for the
services set forth in this Contract and that a resolution, motion or similar action has been duly
adopted or passed as an official act of the Contractor's governing body, authorizing the binding of the
organization under this Contract including all understandings and assurances contained in this
Contract, and directing and authorizing the person identified as the authorized representative of the
General Provisions (Core Subrecipient 2009) 9/10/08 Page 17 of 38
and materials received from Department. The responsibility of Contractor's goveming board shall
also include accountability for compliance with Department Rules, policies, procedures, and
applicable federal and state laws and regulations; and correction of fiscal and program deficiencies
identified through self-evaluation and Department's monitoring processes. Further, Contractor's
goveming board shall ensure separation of powers, duties, and functions of board members and staff.
Staff members, including the executive director, shall not serve as voting members of the
Contractor's governing board. No member of Contractor's goveming board, or officer or employee of
Contractor shall vote for, confirm or act to influence the employment, compensation or change in
status of any person related within the second degree of affinity or the third degree of consanguinity
(as defined in Tex.Gov. Code Chapter 573) to the member of the goveming body or the officer or any
employee authorized to employ or supervise such person. This prohibition does not prohibit the
continued employment of a person who has been continuously employed for a period of two (2) years
prior to the election, appointment or employment of the officer, employee, or governing body
member related to such person in the prohibited degree. These restrictions shall also apply to the
governing board, officers and employees of Contractor's subcontractors. Ignorance of any Contract
provisions or other requirements contained or referenced in this Contract shall not constitute a
defense or basis for waiving or appealing such provisions or requirements.
Section 12.02 Management and Control Systems. Contractor shall comply with all the
requirements of the Deparhment's Contractor's Financial Procedures Manual, and any of its
subsequent amendments, which is available at the Deparhnent's web site:
httn'//www dshs state tx.us/contracts. Contractor shall maintain an appropriate contract
administration system to insure that all terms, conditions, and specifications are met. Contractor shall
develop, implement, and maintain financial management and control systems that meet or exceed the
requirements of UGMS and adhere to procedures detailed in Department's Contractor's Financial
Procedures Manual. Those requirements shall include at a minimum:
a) 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;
b) financial management systems that include accurate accounting records that are accessible
and identify the source and application of funds provided under each Program Attachment of
this Contract, original source documentation substantiating that costs are specifically and
solely allocable to the Program Attachment and are traceable from the transaction to the
general ledger; and
c) effective internal and budgetary controls; comparison of actual costs to budget; determination
of reasonableness, allowableness, and allocability of costs; timely and appropriate audits and
resolution of any findings; billing and collection policies; and a mechanism capable of billing
and making reasonable efforts to collect from clients and third parties.
General Provisions (Core Subrecipient 2009) 9/10/08 Page 19 of 38
that its current Cost Allocation Plan for the current year is the same as that submitted to DSHS for the
previous yeaz. In the event that the Cost Allocation Plan changes during the Contract term, Contractor
must submit a new Cost Allocation Plan to the Contract Oversight and Support Section within thirty
(30) calendaz days after the effective date of the change. Cost Allocation Plan must comply with the
guidelines provided in the Department's Contractor's Financial Procedures Manual located at
httn'//www dshs.state.tx.us/contracts.
Section 12.09 Reporting for Unit Rate and Fee For Service Contracts. Contractor shall submit
reports concerning unit rate and fee-for-service contracts to the Department in accordance with the
requirements stated in the Department's Contractor's Financial Procedures Manual located at
httn•//www dshs.state.tx.us/contracts.
Section 12.10 Historically Underutilized Businesses (HUBs). If Contractor was not required to
submit a HUB subcontracting plan and if subcontracting is permitted under this Program Attachment,
Contractor is encouraged to make a good faith effort to consider subcontracting with HUBS as set
forth in Tex. Gov. Code Chapter 2161 and 34 Tex. Admin. Code § 20.14 et seq. Contractors may
obtain a list of HUBs at httn•//www window state tx us/~rocurement/proe/hub. If Contractor has
filed a HUB subcontracting plan, the plan is incorporated by reference in this Contract. If Contractor
desires to make a change in the plan, Contractor must obtain prior approval from the Department's
HUB Coordinator of the revised plan before proposed changes will be effective under this Contract.
Contractor agrees to make a good faith effort to subcontract with HUBS during the performance of
this Contract and shall report HUB subcontract activity to the Department's HUB Coordinator by the
15th day of each month for the prior month's activity, if there was any such activity, in accordance
with 34 Tex. Admin. Code § 20.16(c).
Section 12.11 Buy Texas. Contractor shall ptuchase products and materials produced in Texas when
the products and materials are available at a price and time compazable to products and materials
produced outside of Texas as required by Tex. Gov. Code § 2155.4441.
Section 12.12 Contracts with Subrecipient Subcontractors. Contractor may enter into contracts
with subrecipient subcontractors unless restricted or otherwise prohibited in a specific Program
Attachment(s). Prior to entering into an agreement equaling or exceeding $100,000, Contractor shall
obtain written approval from DSHS. Contracts with subcontractors shall be in writing and include the
following:
a) name and address of ail parties;
b) a detailed description of the services to be provided;
c) measurable method and rate of payment and total amount of contract;
d) cleazly defined and executable termination clause;
e) beginning and ending dates that coincide with the dates of the applicable Program
Attachment(s) or that cover a term within the beginning and ending dates of the applicable
Program Attachment(s);
fl access to inspect the work and the premises on which any work is performed, in accordance
with the Access and Inspection Article in these General Provisions; and
g) a copy of these General Provisions and a copy of the Statement of Work and any other
provisions in the Program Attachment(s) applicable to the subcontract.
Contractor is responsible to DSHS for the performance of any subcontractor. Contractor shall
monitor subcontractors for both financial and programmatic performance and shall maintain pertinent
General Provisions (Core Subrecipient 2009) 6/5/08 Page 21 of 38
Section 12.18 Notice of Organizational Change. Contractor shall submit written notice to the
Division Contract Management Unit assigned to the Program Attachment within ten (10) business
days of any change to the following: Contractor's name; contact information; key personnel, officer,
director or partner; organizational structure; legal standing; or authority to do business in Texas. A
change in Contractor's name requires an amendment to this Contract in accordance with the
Amendments section of these General Provisions.
Section 12.19 Quality Management. Contractor shall comply with quality management
requirements as directed by the Department.
Section 12.20 Equipment (Including Controlled Assets) Purchases. Equipment means an article
of nonexpendable, tangible personal property having a useful lifetime of more than one yeaz and an
acquisition cost of $5,000 or more, and "controlled assets." Controlled assets include firearms
regardless of the acquisition cost, and the following assets with an acquisition cost of $500 or more:
desktop and laptop computers, non-portable printers and copiers, emergency management equipment,
communication devices and systems, medical and laboratory equipment, and media equipment.
Contractors on a cost reimbursement payment method shall inventory all equipment. If the purchase
of equipment is approved in writing by the Department, Contractor is required to initiate the purchase
of that equipment in the fast quarter of the Contract or Program Attachment term, as applicable.
Failure to initiate the purchase of equipment may result in loss of availability of funds for the
purchase of equipment. Requests to purchase previously approved equipment after the fust quarter of
the Program Attachment must be submitted to the Division Contract Management Unit assigned to
the Program Attachment.
Section 12.21 Supplies. Supplies aze defined as consumable items necessazy to carry out the
services under this Contract including medical supplies, drugs, janitorial supplies, office supplies,
patient educational supplies, softwaze, and any items of tangible personal property other than those
defined as equipment above.
Section 12.22 Changes to Equipment List. All items of equipment purchased with funds under this
Contract shall be itemized in Contractor's equipment list as finally approved by the Department in the
executed Contract. Any changes to the approved equipment list in the executed Contract must be
approved in writing by Department prior to purchase of equipment. Contractor shall submit to the
Division Contract Management Unit assigned to the Program Attachment, a written description
including complete product specifications and need justification prior to purchasing any item of
unapproved equipment. If approved, Department will acknowledge its approval by means of a
written amendment or by written acceptance of Contractor's Contract Revision Request, as
appropriate.
Section 12.23 Properly Inventory and Protection of Assets. Contractor shall maintain a
nonexpendable personal property (equipment and controlled assets) inventory and submit an annual
cumulative report to the Department's Contract Oversight and Support Section, Mail Code 1326, P.O.
Box 149347 Austin, Texas 78714-9347, no later than October 15th of each yeaz. The form for this
report (Form GC-11) is located on the DSHS website at
ht+~•//www dshs.state.tx.us/contracts/forms.shtm. Contractor shall administer a program of
General Provisions (Core Subrecipient 2009) 6/5/08 Page 23 of 38
ARTICLE XIII GENERAL TERMS
Section 13.01 Assignment. Contractor shall not transfer, assign, or sell its interest, in whole or in
part, in this Contract, or in any equipment purchased with funds from this Contract, without the prior
written consent of the Department.
Section 13.02 Lobbying. Contractor shall comply with Tex. Gov Code § 556.0055, which prohibits
contractors who receive state funds from using those funds to pay lobbying expenses. Further,
Contractor shall not use funds paid under this Contract to pay any person for influencing or
attempting to influence an officer or employee of any federal or state 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 contract or the extension, continuation, renewal, amendment, or modification of any
contract (31 USCA § 1352, as amended, and UGMS). If at any time this Contract exceeds $100,000
of federal funds, Contractor shall file with the Division Contract Management Unit assigned to the
Program Attachment a declazation containing the name of any registrant under the Lobbying
Disclosure Act of 1995 who has made lobbying contacts on behalf of Contractor in connection with
this Contract, a certification that none of the funds provided by Department have been or will be used
for payment to lobbyists, and disclosure of the names of any and all registered lobbyists with whom
Contractor has an agreement. Contractor shall file the declazation, certification, and disclosure at the
time of application for this Contract; upon execution of this Contract unless Contractor previously
filed a declazation, certification, or disclosure form in connection with the awazd; and at the end of
each calendaz quarter in which there occurs any event that materially affects the accuracy of the
information contained in any declaration, certification, or disclosure previously filed. Contractor shall
require any person who requests or receives a subcontract to file the same declazation, certification,
and disclosure with the Division Contract Management Unit assigned to the Program Attachment.
Contractor shall also comply, as applicable, with the lobbying restrictions and requirements in OMB
Circulars A-122 Attachment B pazagraph 25; A-87 Attachment B section 27; A-110 section_.27 and
A-21 pazagraphs 17 and 24. Contractor shall include this provision in any subcontracts.
Section 13.03 Conflict of Interest. Contractor represents to the Department that it does not have nor
shall it knowingly acquire any financial or other interest that would conflict in any manner with the.
performance of its obligations under this Contract. Potential conflicts of interest include, but aze not
limited to, an existing or potential business or personal relationship between Contractor, its principal
(or a member of the principal's immediate family), or any affiliate or subcontractor and Department
or HHSC, their commissioners, officers or employees, or any other entity or person involved in any
way in any project that is the subject of this Contract. Contractor shall establish safeguards to prohibit
employees from using their positions for a purpose that constitutes or presents the appeazance of
personal or organizational conflict of interest or personal gain.
Section 13.04 Transactions Between Related Parties. Contractor shall identify and report to
DSHS any transactions between Contractor and a related party that is part of the work that the
Department is purchasing under this Contract before entering into the transaction or immediately
upon discovery. Contractor shall submit to the Division Contract Management Unit assigned to the
Program Attachment the name, address and telephone number of the related party, how the party is
related to the Contractor and the work the related party will perform under this Contract. A related
General Provisions (Core Subrecipient 2009) 6/5/08 Page 25 of 38
any rights of copyright, service or trade marks or patents to which a grantee, subgrantee or a
Contractor purchases ownership with contract funds.
e) If the results of the contract performance are subject to copyright law, the Contractor cannot
publish those results without prior review and approval of DSHS. Contractor shall submit
requests for review and approval to the Division Contract Management Unit assigned to the
Program Attaclunent.
Section 13.06 Otber Intangible Property. At the conclusion of the contractual relationship
between Department and the Contractor, for any reason, Department shall have the sole ownership
rights and interest in all non-copyrightable intangible Property that was developed, produced or
obtained by Contractor as a specific requirement under this Contract or under any grant that funds
this Contract, such as domain names, U1tLs, etc. Contractor shall cooperate with Department and
perform all actions necessazy to transfer ownership of such property to the Department or its
designee, or otherwise affirm Department's ownership rights and interest in such property. This
provision shall survive the termination or expiration of this Contract.
Section 13.07 Severability and Ambiguity. If any provision of this Contract is construed to be
illegal or invalid, the illegal or invalid provision will be deemed stricken and deleted to the same
extent and effect as if never incorporated, but all other provisions will continue. Parties represent and
agree that the language contained in this Contract is to be construed as jointly drafted, proposed and
accepted.
Section 13.08 Legal Notice. Any notice required or permitted to be given by the provisions of this
Contract shall be deemed to have been received by a Party on the third business day after the date on
which it was mailed to the Party at the address first given above (or at such other address as the Party
shall specify to the other Pazty in writing) or, if sent by certified mail, on the date of receipt.
Section 13.09 Successors. This Contract shall be binding upon the Parties and their successors and
assignees, except as expressly provided in this Contract.
Section 13.10 Headings. The azticles and section headings used in this Contract aze for convenience
of reference only and shall not be construed in any way to define, limit or describe the scope or intent
of any provisions.
Section 13.1 I Parties. The Parties represent to each other that they aze entities fully familiaz with
transactions of the kind reflected by this document, and aze capable of understanding the terminology
and meaning of its terms and conditions and of obtaining independent legal advice pertaining to this
Contract.
Section 13.12 Survivability of Terms. Termination or expiration of this Contract or a Program
Attachment for any reason shall not release either Party from any liabilities or obligations set forth in
this Contract that (a) the Parties have expressly agreed shall survive any such termination or
expiration, or (b) remain to be performed or (c) by their nature would be intended to be applicable
following any such termination or expiration.
Section 13.13 Direct Operation. The Department may temporarily assume operations of a
Contractor's program or programs funded under this Contract when the continued operation of the
General Provisions (Core Subrecipient 2009) 6/5/08 Page 27 of 38
a) cumulative budget line item transfers among direct cost categories, other than the equipment
category, that exceed 10% of Program Attachments of $100,000 or more, provided that the
total budget amount is unchanged;
b) line item transfer to other categories of funds for direct payment to trainees for training
allowances;
c) change in clinic hours or location;
d) change in equipment list substituting an item of equipment equivalent to an item of equipment
on the approved budget, (For example, purchase of XYZ brand computer instead of approved
ABC brand computer with essentially identical features as the XYZ computer);
e) changes in the equipment category of a previously approved equipment budget (other than
acquisition of additional equipment, which requires an amendment to this Contract);
f) changes specified in applicable OMB Circular cost principles as requiring prior approval,
regazdless of dollaz threshold (e.g., foreign travel expenses, overtime premiums, membership
fees); and
g) changes to community sites, independent school districts or schools, in substance abuse
Program Attachments.
In order to request a revision of any of the enumerated provisions, Contractor shall obtain a Contract
Revision Request form from the DSHS website and complete the form as directed by the Department.
Two copies of the completed form must be signed by Contractor's representative who is authorized to
sign contracts on behalf of Contractor, and both original, signed forms must be submitted to the
Division Contract Management Unit assigned to the Program Attachment. Any approved revision
will not be effective unless signed by the DSHS Director of Client Services Contracting Unit. A
separate Contractor Revision Request is required for each Program Attachment to be revised.
Circumstances of a requested contract revision may indicate the need for an amendment described in
the Amendment section of this Article rather than a contract revision under this section.
Section 13.18 Immunity Not Waived. THE PARTIES EXPRESSLY AGREE THAT NO
PROVISION OF THIS CONTRACT IS IN ANY WAY INTENDED TO CONSTITUTE A
WAIVER BY DEPARTMENT OR THE STATE OF TEXAS OF ANY IMMUNITIES FROM SUIT
OR FROM LIABILITY THAT DEPARTMENT OR THE STATE OF TEXAS MAY HAVE BY
OPERATION OF LAW.
Section 13.19 Hold Harmless and Indemnification. Contractor, as an independent contractor,
agrees to hold Department, the State of Texas, individual state employees and officers, and the
federal government harmless and to indemnify them from any and all liability, suits, claims, losses,
damages and judgments, and to pay all costs, fees, and damages to the extent that such costs, fees,
and damages arise from performance or nonperformance of Contractor, its employees,
subcontractors, joint venture participants or agents under this Contract.
Section 13.20 Waiver. Acceptance by either Party of partial performance or failure to complain of
any action, non-action or default under this Contract shall not constitute a waiver of either Party's
rights under this Contract.
Section 13.21 Technology Accessibility. If performance under this Contract includes the
development, modification or maintenance of a website or other electronic information resources for
General Provisions (Core Subrecipient 2009) 6/5/08 Page 29 of 38
services or goods. HHSC OIG may investigate, audit and impose or recommend imposition of
sanctions to Department for any breach of this Contract and may monitor Contractor for financial
compliance. The Department may impose one or more remedies or sanctions for each item of
noncompliance and will determine sanctions on a case-by-case basis. Contractor is responsible for
complying with all of the terms of this Contract. The listing of or use of one or more of the remedies
or sanctions listed below does not relieve Contractor of any obligations under this Contract. A state
or federal statute, Wile or regulation, or federal guideline will prevail over the provisions of this
Article unless the statute, rule, regulation, or guideline can be read together with the provision(s) of
this Article to give effect to both. If the Contractor breaches this Contract by failing to comply with
one or more of the terms of this Contract, including but not limited to compliance with applicable
statutes, rules or regulations, the Department may take one or more of the actions listed below:
a) terminate this Contract or a Program Attachment of this Contract as it relates to a specific
program type. In the case of termination, the Department will inform Contractor of the
termination no less than thirty-one (31) calendaz days before the effective date of the
termination in a notice of termination. The notice of termination will state the effective date
of the termination, the reasons for the tern~ination, and, if applicable, alert the Contractor of
the opportunity to request a hearing on the termination pursuant to Tex. Gov. Code Chapter
2105 regarding administration of Block Grants. The Contractor agrees that it shall not make
any claim for payment or reimbursement for services provided from the effective date of
temvnation;
b) suspend all or part of this Contract. Suspension is, depending on the context, either (1) the
temporary withdrawal of Contractor's authority to obligate funds pending corrective action by
Contractor or its subcontractor(s) or pending a decision to terminate or amend this Contract,
or (2) an action taken by a suspending official in accordance with Department rules to
immediately exclude a person from participating in contract transactions for a period of time,
pending completion of an investigation and such legal or debarment proceedings as may
ensue. Contractor may not bill DSHS for services performed during suspension, and
Contractor's costs resulting from obligations incurred by Contractor during a suspension aze
not allowable unless expressly authorized by the notice of suspension;
c) deny additional or future contracts or renewals with Contractor;
d) reduce funding if the Contractor fails to provide services or goods consistent with
performance expectations described in this Contract;
e) disallow costs and credit for matching funds, if any, for all or part of the activities or action
not in compliance;
fl temporarily withhold cash payments. Temporarily withholding cash payments means the
temporary withholding of a working capital advance, if applicable, or reimbursements or
payments to Contractor for proper chazges or obligations incurred, pending resolution of
issues of noncompliance with conditions of this Contract or indebtedness to the United States
or to the State of Texas;
g) permanently withhold cash payments. Permanent withholding of cash payment means that
Departrnent retains funds billed by Contractor for (1) unallowable, undocumented, disputed,
inaccurate, improper, or erroneous billings; (2) material failure to comply with Contract
provisions; or (3) indebtedness to the United States or to the State of Texas;
General Provisions (Core Subrecipient 2009) 6/5/08 Page 31 of 38
reconsideration of the remedies and sanctions imposed. Other than in the case of repayment or
recoupment, Contractor is required to file, within fifteen (15) calendaz days of receipt of notice, a
written response to Department acknowledging receipt of such notice. If requested by the
Department, the written response shall state how Contractor shall correct the noncompliance or
demonstrate in writing that the findings on which the remedies or sanction(s) are based are either
invalid or do not warrant the remedies or sanction(s). If Department determines that a remedy or
sanction is warranted, unless the remedy or sanction is subject to review under a federal or state
statute, regulation, rule, or guideline, Department's decision is final. Department shall provide written
notice to Contractor of Department's decision. If required by the Department, Contractor shall take
con•ective action. If DSHS determines that repayment is warranted, DSHS will issue a demand letter
to Contractor for repayment. If full repayment is not received within the time limit stated in the
demand letter, and if recoupment is available, DSHS will recoup the amount due to DSHS from funds
otherwise due to Contractor.
Section 14.04 Emergency Action. In an emergency, Departrnent may immediately terminate or
suspend all or part of this Contract, temporarily or permanently withhold cash payments, deny
contract renewal or future contract awazds, or delay contract execution by delivering written notice to
Contractor, by any verifiable method, stating the reason for the emergency action. An "emergency"
is defined as the following:
a) Contractor is noncompliant and the noncompliance has a direct adverse impact on the public
or client health, welfaze or safety. The direct adverse impact may be programmatic or
financial and may include failing to provide services, providing inadequate services,
providing unnecessary services, or utilizing resources so that the public or clients do not
receive the benefits contemplated by the scope of work or performance measures; or
b) Contractor is expending funds inappropriately.
Whether Contractor's conduct or noncompliance is an emergency will be determined by Department
on a case-by-case basis and will be based upon the nature of the noncompliance or conduct.
ARTICLE XV CLAIMS AGAINST TAE DEPARTMENT
Section 15.01 Breach of Contract Claim. The process for a breach of contract claim against the
Department provided for in Tex. Gov. Code Chapter 2260 and implemented in Department Rules §§
1.431-1.447 shall be used by DSHS and Contractor to attempt to resolve any breach of contract claim
against DSHS.
Section 15.02 Notice. Contractor's claims for breach of this Contract that the Parties cannot resolve
in the ordinazy course of business shall be submitted to the negotiation process provided in Tex. Gov
Code Chapter 2260, subchapter B. To initiate the process, Contractor shall submit written notice, as
required by subchapter B, to DSHS's Office of General Counsel. The notice shall specifically state
that the provisions of Chapter 2260, subchapter B, aze being invoked. A copy of the notice shall also
be given to all other representatives of DSHS and Contractor. Subchapter B is a condition precedent
to the filing of a contested case proceeding under Tex. Gov. Code Chapter 2260, subchapter C.
General Provisions (Core Subrecipient 2009) 6/5/08 Page 33 of 38
competing or noncompeting continuation, renewal, extension, or supplemental award; or (4) voiding
of a contract upon determination that the award was obtained fraudulently, or was otherwise illegal or
invalid from inception.
Section 16.04 Termination Without Cause.
a) Either Party may terminate this Contractor a Program Attachment, as applicable, with at least
thirty (30) calendaz days prior written notice to the other Party, except that if Contractor seeks
to terminate a Contract or Program Attachment that involves residential client services,
Contractor must give the Department at least ninety (90) calendar days prior written notice
and must submit a transition plan to ensure client services are not disrupted.
b) The Parties may terminate this Contract or a Program Attachment by mutual agreement.
c) Either Party may terminate this Contract or a Program Attachment with at least thirty (30)
calendaz days prior written notice to the other Party in the event funds become unavailable
through lack of appropriations, budget cuts, transfer of funds between programs or health and
human services agencies, amendments to the Appropriations Act, health and human services
consolidations, or any disruption of current appropriated funding for this Contract or Program
Attachment.
d) Department may terminate this Contract or a Program Attachment immediately when, in the
sole determination of Department, termination is in the best interest of the State of Texas.
Section 16.05 Termination For Canse. Either Party may terminate for material breach of this
Contract with at least thirty (30) calendar days written notice to the other Party. Department may
terminate this Contract, in whole or in part, for breach of contract or for any other conduct that
jeopardizes the Contract objectives, by giving at least thirty (30) calendaz days written notice to
Contractor. Such conduct may include one or more of the following:
a) a court of competent jurisdiction finds that Contractor has failed to adhere to any laws,
ordinances, rules, regulations or orders of any public authority having jurisdiction;
b) Contractor fails to communicate with Department or fails to allow its employees or those of
its subcontractor to communicate with Department as necessary for the performance of this
Contract;
c) Contractor breaches a standazd of confidentiality with respect to the services provided under
this Contract;
d) Department determines that Contractor is without sufficient personnel or resources to perform
under this Contract or that Contractor is otherwise unable or unwilling to fulfill any of its
requirements under this Contract or exercise adequate control over expenditures or assets;
e) Department determines that Contractor, its agent or another representative offered or gave a
gratuity (e.g., entertainment or gift) to an official or employee of DSHS or HHSC for the
purpose of obtaining a contract or favorable treatment;
f) Department determines that this Contract includes financial participation by a person who
received compensation from DSHS to participate in developing, drafting or preparing the
specifications, requirements or statement(s) of work or Solicitation Document on which this
Contract is based in violation of Tex. Gov. Code § 2155.004;
g) Contractor appeazs to be financially unstable. Indicators of financial instability may include
one or more of the following:
1) Contractor fails to make payments;
2) Contractor makes an assignment for the benefit of its creditors;
General Provisions (Core Subrecipient 2009) 6/5/08 Page 35 of 38
terminated for cause is not eligible for expansion of current contracts, if any, or new contracts or
renewals until the Department has determined that Contractor has satisfactorily resolved the issues
underlying the suspension or termination. Additionally, if this Contract is found to be void, any
amount paid is subject to refund.
Section 17.03 Appeals Rights. Pursuant to Tex. Gov. Code § 2105.302, after receiving notice from
the Department of termination of a contract with DSHS funded by block grant funds, Contractor may
request an administrative hearing under Tex. Gov. Code Chapter 2001.
ARTICLE XVIII CLOSEOUT AND CONTRACT RECONCILIATION
Section 18.01 Cessation of Services At Closeout. Upon expiration of this Contract or Program
Attachment, as applicable, (and any renewals of this Contract or Program Attachment) on its own
terms, Contractor shall cease services under this Contract or Program Attachment and shall cooperate
with DSHS to the fullest extent possible to ensure the orderly and safe transfer of responsibilities
under this Contract to DSHS or other entity designated by DSHS. Upon receiving notice of Contract
or Program Attachment termination or non-renewal, the Contractor agrees to immediately begin to
transition recipients of services to alternative service providers, as needed. Contractor also agrees to
completely cease providing services under this Contract or Program Attachment by the date specified
in the termination or non-renewal notice. Contractor shall not bill DSHS for services performed after
termination or expiration of this Contract or Program Attachment, or incur any additional expenses
once this Contract or Program Attachment is terminated or has expired. Upon termination, expiration
or non-renewal of this Contract or a Program Attachment, Contractor shall immediately initiate
Closeout activities described in this Article.
Section 18.02 Administrative Offset. The Department shall have the right to administratively offset
amounts owed by Contractor against billings.
Section 18.03 Deadline for Closeout. Contractor shall submit all financial, perfonnance, and other
Closeout reports required under this Contract within sixty (60) calendar days after the Contract or
Program Attachment end date. Unless otherwise provided under the Final Billing Submission section
of the Payment Methods and Restrictions Article, the Department is not liable for any claims that are
not received within sixty (60) calendar days after the Contract or Program Attachment end date.
Section 18.04 Payment of Refunds. Any funds paid to the Contractor in excess of the amount to
which the Contractor is finally determined to be entitled under the terms of this Contract constitute a
debt to the Department and will result in a refund due. Contractor shall pay any refund amount due
within the time period established by the Department.
Section 18.05 Disallowances and Adjustments. The Closeout of this Contract or Program
Attachment does not affect the Department's right to disallow costs and recover funds on the basis of
a later audit or other review or the Contractor's obligation to return any funds due as a result of later
refunds, corrections, or other transactions.
Section 18.06 Contract Reconciliation. If Contractor is required to annually reconcile multi-year
contracts, Contractor, within sixty (60) calendar days after the end of each year of this Contract, shall
General Provisions (Core Subrecipient 2009) 6/5/08 Page 37 of 38
- 2009-030581-001
Categorical Budget:
a +r u e ~
~ ~~~~~
R'SHARE
$O ^~'O
$iQ2,276.00.
Total reimbursements will not exceed $102,276.00
504OQ
t $0 ~~7a
Financial status reports are due: 04/30/2009, 07/30/2009, 10/30/2009, 03/01/2010
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
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 awazding of any federal contract, the making of any federal gran[, 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 fedeml 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
Standazd Form LLL, "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 a[ all tiers (including subcontracts, subgrants, and contracts under grants,
loans and cooperative agreements) and [hat 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
transaction imposed by Section 1352, Title 31, U.S. Code. Any person who fails to file the requved
certification shall be subject to a civil penalty of not less that $10,000 and not more than $100,000 for each
such failure.
r NA-ti
Si re
Print Name of Authorized Individual
2009-030581
Application or Contract Number
City of CORPUS CHRISTI
Organization Name
~t d~j
Dat
. aeb a AUTHURIZt~
69 COUNCIL.,~~,~,~~„~
SEC E7ARY ~JyJ•
CSCU # EF29-12374 -Revised 08.10.07
FORM E: WORK PLAN
Applicant shall describe its plan for service delivery to the population in the proposed service area(s) and include timelines for accomplishments.
Address the required elements (see WORK PLAN Requirements) associated with the services proposed in this proposal.
A maximum of five (5) additional pages may be attached if needed.
FORM E: WORK PLAN GUIDELINES
Applicant shall describe its plan for service delivery to the population in the proposed service area(s) and include time lines for accomplishments.
The work plan shall address the needs and the problems identified in the community assessment for improving health status. The plan shall:
1. Summarize the proposed services, service area, population to be served, location (counties to be served), etc.
List subcontractors you will work with in your area. Also, address if and how you will serve individuals from
counties outside your stated service area.
The service area for Corpus Christi-Nueces County Tuberculosis Elimination program covers approximately 836
miles of land and 331 square miles of water bounded by the Gulf of Mexico to the east, San Patricio County to the
north, Jim Wells County to the west, Kleberg County to the south, and approximately 150 miles from the Mexican
border. Corpus Christi Nueces County's population is ranked 12~ among Texas counties. The ethnicity is
divided into 55.8% Hispanics, 37.7% Anglo, 4.1% Black, 1.1% Asian, and 1.3% categorized as "other". Nueces
County ranks 29`h for average annual percent of minority populations with 51%of the population female and 49%
male. This information was published in the "Community Needs Public Health Survey in 2001.
The Corpus Christi-Nueces County Tuberculosis Elimination Program provides basic services fortuberculosis
control and prevention in Corpus Christi and Nueces County and responds to requests for assistance with
contact investigation, DOT, chest x-rays and sputum collection when necessary. Services are provided in
compliance with the Corpus Christi-Nueces County Tuberculosis Elimination Clinic's Protocols, Tezas
Department of Health Tuberculosis Elimination Division Standards of Pertormance, American Thoracic Society,
Center for Disease Control (ATS/CDC) Joint Statements. The Corpus Christi-Nueces County Tuberculosis
Elimination Program identified 15 countable new cases of tuberculosis between January 1, 2007 and December
31, 2007. The case rate is based on the 15 countable cases for the year 2007 and is 5 cases per 100,000. A
decrease of 9 cases per 100,000 is noted forthis time frame. January 1, 2008 thru June 20, 2008 Corpus Christi-
Nueces County Tuberculosis Elimination Program has identified 8 pulmonary TB Cases for Corpus Christi-
Nueces County and one (1) for Bear County that was co-infected. All the Corpus Christi-Nueces County cases
are on DOT, and for these eight cases 1329 contacts have been identified. CCTBC has five (5) full time
employees and a full time temporary LVN. They are dedicated and persistent in working to meet CCTBC
program objectives. We are committed to DOT/DOPY including seven (7) days a week when the Medical
Consultant orders daily medication. The Federal Grant supports 100% of the salary for Barbara Cavazos, R.N.
and (1) outreach worker, Gabriel Duran. Mr. Duran is the primary DOTIDOPT provider.
Clinical and outreach services target identification of Tuberculosis (TB) cases/suspects, contacts, evaluation of
those individuals seeking to immigrate to this country with Bt and Bz waivers. Outreach services target those
individuals in correctional facilities, homeless shelters, alcohol/drug treatment centers, identification of the
homeless living on streets with active tuberculosis and those individuals with latenttuberculosislnfection (LTBI)
and or HIV/AIDS at high risk of developing active tuberculosis.
Corpus Christi-Nueces County Tuberculosis Elimination Program (CCNCTBEP) serves the Corpus Christi Nueces
County area. The populations served are jail inmates and halfway houses forthose released from jail but notyet
ready to go into the community, the homeless on the streets and those in shelters, foster children, dialysis
patients, nursing home patients, clients of the abused women's shelter, individuals with suppressed immune
systems and sexually transmitted diseases, the foreign born applying for citizenship, clients of drug and alcohol
treatment centers, high risk maternity, and health care workers.
Page 1 Tuberculosis Prevention & Control ILA for FY2009 Federal Funds
Revised 11130/07
As previously stated CCNCTBEP works closely with the neighboring counties, hospitals, local physicians, and
the state TB nurse to provide DOT, contact investigation, x-ray services, medications, monitoring, and
transportation to the Texas Center for Infectious Diseases for the surrounding counties when requested.
2. ,Describe delivery systems, workforce (attach organizational chart), policies, support systems (i.e., training,
research, technical assistance, information, financial and administrative systems) and other infrastructure available
to achieve service delivery and policy-making activities. What resources do you have to pertorm the project, who
will deliver services and how will they be delivered?
.The City of Corpus Christi provides the office space, utilities, administrative support, and computer
maintenance forthe Internet based programs, TWICES and PICS, utilized by CCNCTBEP. The Federal Grant
2008 was increased to 106, 806.00. In 2008 the Federal Grant funded one (1) RN ,paid thru the Federal
Grant and works in the field and the office, one (1) outreach CSA that delivers DOTIDOPT, tests eleven (11)
homeless shelters on a monthly and PRN schedule, and one (1) temporary contact investigator. The
Registered Nurse Program Manager is paid by the City of Corpus Christi, two (2) administrative assistants,
one is funded by the State Grant, one by Nueces County. Forthe Grant year of 2007/2008 a temporary LVN
position has been funded by the State Grant. She works both in the field and the office with DOTIDOPT,
contact investigation and assisting with transport of female clients to the office for work-ups or sputum
collection. DOT/DOPY are provided 7 (seven) days a week by CCTBC. All permanent staff participates in
delivery of the week-end services based on client need.
The 106,537.00 has been reduced to 102,276.00. to fund the salaries and fringes for one (1) Registered Nurse
and one (1) Community Service Aide. The program manger is currently paid thru the City of Corpus Christi
and one of the two (2) administrative assistants is currently funded in the general revenue grant and the
other administrative assistant is paid by Nueces County. The Corpus Christi-Nueces County Health
Authority is the Medical Director for CCNCTBEP and is funded by the State Grant . Physician Clinical
Services include all orders for initial medications, medication changes, lab, drug Ievels,DOTIDOPT,
quarantine, hospitalization, and release from isolation and completion oftreatmentforcases and for positive
reactors.
CCNCTBEP owns a van for delivery of directly observed therapy/directly observed preventive therapy
(DOTIDOPT) throughout Corpus Christi-Nueces County. CCNCTBEP policies are based on DSHS
Tuberculosis Elimination Division guidelines and standards of pertormance. CCNCTBEP has historically
made up the shortfalls in the DSHS funding with program income over the last five (5) years to prevent
interruption of services provided by the CCNCTBEP. DOT is delivered to TB suspects and cases seven (7)
days a week by the CCNCEBEP staff. All CCNCTBEP staff is trained to deliver DOT/DOPY.
3. Summarize the proposed services, service area, population to be served, location (counties to be served), etc.
List subcontractors you will work with in your area. Also, address if and how you will serve individuals from
counties outside your stated service area. ,
The service area for Corpus Christi-Nueces County Tuberculosis Elimination program covers approximately
836 miles of land and 331 square miles of water bounded by the Gulf of Mexico to the east, San Patricio
County to the north, Jim Wells County to the west, Kleberg County to the south, and approximately 150 miles
from the Mexican border. Corpus Christi-Nueces County's population is ranked 12`h among Texas
counties. The ethnicity is divided into 55.8% Hispanics, 37.7% Anglo, 4.1% Black, 1.1% Asian, and 1.3%
categorized as "other". Nueces County ranks 29`" for average annual percent of minority populations with
51% of the population female and 49% male. This information was published in the "Community Needs
Public Health Survey in 2001.
The Corpus Christi-Nueces County Tuberculosis Elimination Program provides basic services for
tuberculosis control and prevention in Corpus Christi and Nueces County. Services are provided in
compliance with the Corpus Christi-Nueces County Tuberculosis Elimination Clinic's Protocols, Texas
Page 2 Tuberculosis Prevention & Control ILA for FY2009 Federal Funds
Revised 11/30/07
Department of Health Tuberculosis Elimination Division Standards of Pertormance, American Thoracic
Society, Center for Disease Control (ATS/CDC) Joint Statements. The Corpus Christi-Nueces County
Tuberculosis Elimination Program identified 15 countable new cases of tuberculosis between January 1, 2007
and December 31, 2007. The case rate is based on the 15 countable cases forthe year is 5 cases per 100,000.
A decrease of 9 cases per 100,000 is noted forthis time frame. Corpus Christi-Nueces County Tuberculosis
Elimination Program has five (5) full time employees and one contract LVN. They are dedicated and
persistent in working to meet CCTBC program objectives. We are committed to DOT/DOPY including seven
(7) days a week when the Medical Consultant orders daily medication. The Federal Grant supports 100%of
the salary for Barbara Cavazos, R.N. and (1) outreach worker, Gabriel Duran. Mr. Duran is the primary
DOTIDOPT provider.
Clinical and outreach services target identification ofTuberculosis (TB) cases/suspects, contacts, evaluation
of those individuals seeking to immigrate to this country with Bt and B2 waivers. Outreach services target
'those individuals in correctional facilities, homeless shelters, alcohol/drug treatment centers, identification of
the homeless living on streets with active tuberculosis and those individuals with latent tuberculosis
infection (LTBq and or HIV/AIDS at high risk of developing active tuberculosis.
Corpus Christi-Nueces County Tuberculosis Elimination Program (CCNCTBEP) serves the Corpus Christi
Nueces County area. The populations served arejail inmates and halfway houses forthose released from jail
but not yet ready to go into the community, the homeless on the streets and those in shelters, foster children,
dialysis patients, nursing home patients, clients ofthe abused women's shelter, individuals with suppressed
immune systems and sexually transmitted diseases, the foreign born applying forcitizenship, clients of drug
and alcohol treatment centers, high risk maternity, and health care workers.
CCNCTBEP works closely with the neighboring counties, hospitals, local physicians, and the state TB nurse
to provide DOT, x-ray services, medications, monitoring, and transportation to the Texas Center for
Infectious Diseases for the surrounding counties when requested.
4. Determine the number of persons who received from the CONTRACTOR in 2009 at least one TB service including
but not limited to tuberculin skin tests, chest radiographs, health care worker services, or treatment with one or
more anti-tuberculosis medications
Monthly CCTBC counts the number of PPD's placed both free and paid, the number of homeless tested and
or x-rayed, the number of doses of DOT/DOPY, and the number of alcohol and drug treatment clients that
received either a PPD or CXR in it's own category, the number f missed doses is recorded if any or missed,
all clients sign in when they arrive at the clinic and they specify the service needed. These statics are
available any time a request of number of services is requested.
5. Describe how data is collected and tabulated, who will be responsible for data collection and reporting, and how
often data collection activities will occur. Describe how you will conduct community surveillance, to identify
unreported cases of TB and individuals suspected of having TB infection. Describe how you will maintain a record
of outbreaks, in your area, with a description of the outbreak and how it was managed.
Identify and examine all household, social, occupational and otherclose contacts to the suspected infectious
TB suspects within seven (7) days of notification utilizing the concentric circle and send the preliminary 340
to Austin TB Elimination. All close household contacts to a smear positive TB suspect or TB case will have a
chest x-ray regardless of their TB skin test result. The final TB 3401341 is to be forwarded to Austin TB
Elimination within 90 days. All children with a negative chest x-ray that live in the house with a smear
positive TB suspect or TB case are placed on Directly Observed Preventive Therapy on INH. Those with a
positive PPD are continued for nine (9) months on INH and those that have a negative PPD at three months
may discontinue INH if the PPD is negative and the TB case is no longersmear negative or no longer in the
home. All household contacts five (5) years and under are placed on DOPY. Older household contacts are
placed on DOPY as resources allow.
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All patients on DOT/DOPY are assessed for drug toxicity prior to each dose of medication and must come
into the clinic once a month for a workup that includes a drug toxicity check, age appropriate lab and a
visual acuity.
All positive reactors referred to CCTBC by private physicians are questioned as to who infected them. They
are provided achest x-ray or given a referral for a chest x-ray privately. The x-rays are read by Dr. Burgin and
INH is ordered if the chest x-ray is normal. Positive reactors picking up medication monthly must have a drug
toxicity check, and age appropriate lab with their monthly work-up. Treatment for Latent TB Infection is
provided without cost to the patient.
6. Describe coordination with the other health and human services providers in the service area(s) and delineate how
duplication of services is to be avoided. List other community programs you will be working with in yourjurisdiction
(community based organizations, private providers, hospitals, and service organizations).
CCNCTBP manages all reported tuberculosis suspects and cases in CCNC. CCNCTBP works closely with all
community based organizations and often assists TBTB Programs in other counties with the management of
the TB suspects and cases.
7. Describe ability to provide services to culturally diverse populations (e.g., use of interpreter services, language
translation, compliance with ADA requirements, location, hours of service delivery, and other means to ensure
accessibility for the defined population).
CCNCTBP has two bilingual employees, Brenda Hinojosa and Gabriel Duran. Both speak Spanish and Mr.
Duran is able to translate English to Spanish and Spanish to English form chart forms and for client
instructions.
8. Describe your strategy for the management of TB cases and suspects, with emphasis on provision of directly
observed therapy (DOT).
All Tuberculosis (TB) cases and suspects are placed on four (4) drug therapies given by DOT per the
American Thoracic Society (ATS), Center for Disease Control (CDC) and Infectious Diseases Society of
America (IDSA) guidelines. Private physicians are provided current information related to TB managementto
ensure the correct medication and DOT is ordered. If a private physician does not place a patient on four (4)
drug therapy or DOT, a consultation is requested for that physician with Dr. Burgin, Dr. Barbara Seaworth,
Dr. David Griffith, or Dr. Starke. CCNCTBEP does seven (7) days a week DOT in Nueces County.
TB suspects and cases determined to be infectious by smear are placed on home isolation until they are no
longer able to transmit disease. Control orders are utilized at the start of care to establish parameters and
prevent the need for quarantine. Control orders are given in the patient's language or an interpreter may
read the letter to the patient or the guardian of the patient. Court ordered management would be initiated for
those that are non-compliant.
Education is provided for TB cases and their families that covers TB disease vs. TB infection, INH side
effects, importance of following all the instructions given, the schedule for follow up chest x-rays, having
blood drawn, work-ups, sputum collection, and the phone number of the case manger. All TB cases are
informed that if they need to talkto the TB Elimination Medical Consultantthey can schedule an appointment
on Tuesdays during x-ray clinic to speak to the consultant.
Drug susceptibility is done on all initial specimens, and treatment is adjusted if drug resistance is identified.
Sputum is collected three (3) consecutive days every two weeks until the patient is smear negative then three
consecutive days monthly until the end of treatment. If the patient remains smear and culture positive on
adequate doses of medication, then new susceptibilities are requested. Drug levels are done on an as
needed basis for those patients that continue to be smear and culture positive longer than the guidelines
address. Those patients identified as drug resistant or with low drug levels require a consultation with a
state paid consultant.
A licensed physician certified in pulmonary diseases monitors TB cases. Human Immunodeficiency Virus
(HIV) and syphilis counseling as well as testing are part of the admission lab: Toxicity assessment is done
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prior to each dose of medication. Liver profiles are drawn per DSHS Tuberculosis Elimination Division
protocols throughout treatment. Visual acuity is done monthly while color vision and hearing screening is
done based on the drugs the patient is prescribed. All this is recorded in the patient's record. TB cases and
suspects are treated without consideration to the patient's ability to pay.
9. Describe your strategy for the management of contacts and positive reactors, with emphasis on directly observed
preventive therapy (DOPY).
Identify and examine all household, social, occupational and other close contacts to the suspected infectious
TB suspects within seven (7) days of notification utilizing the concentric circle and send the preliminary 340
to Austin TB Elimination. All close household contacts to a smear positive TB suspect or TB case will have a
chest x-ray regardless of their TB skin test result. The final TB 340/341 is to be fonxarded to Austin TB
Elimination within 90 days. All children with a negative chest x-ray that live in the house with a smear
positive TB suspect or TB case are placed on Directly Observed Preventive Therapy on tNH. Those with a
positive PPD are continued for nine (9) months on INH and those that have a negative PPD at three months
may discontinue INH if the PPD is negative and the TB case is no longer smear negative or no longer in the
home. All household contacts five (5) years and under are placed on DOPY. Older household contacts are
placed on DOPY as resources allow.
All patients on DOT/DOPY are assessed for drug toxicity prior to each dose of medication and must come
into the clinic once a month for a workup that includes a drug toxicity check, age appropriate lab and a visual
acuity.
All positive reactors referred to CCTBC by private physicians are questioned as to who infected them. They
are provided achest x-ray or given a referral for achest x-ray privately. The x-rays are read by Dr. Burgin and
INH is ordered if the chest x-ray is normal. Positive reactors picking up medication monthly must have a drug
toxicity check, and age appropriate lab with their monthly work-up. Treatment for Latent TB Infection is
provided without cost to the patient.
10. Describe your infection control procedures.
All CCNCTBEP staff received education related to personal respirators, when to wear the respirators, and
how to maintain them. Each staff member has been fit tested.
CCNCTBEP has three portable hepa filter units that are used as needed in the patient exam rooms, x-rays or
any other area of the clinic when needed. A mask is placed on anyone in the office that is coughing and the
patient is immediately taken to an exam room with a hepa filter and UV light. Sputum is collected in a
negative pressure chamber. CCNCTBEP has seven (7) UV lights installed including in the clinic areas, the x-
ray room, lobby, and hall over the clinic exit. Skin testing for TB staff is one every six (li) months. To date,
the six (0) employees working in this program remain skin test negative and four have worked in the
department more than ten (11) years.
11. Describe plans to conduct targeted TB screening programs for high-risk populations
All CCNCTBEP staff has excellent working relationships with the homeless shelters, drug and alcohol
treatment centers, jail, and other adult and juvenile correctional facilities. We work closely with the Coastal
Bend Aids Foundation, the Valley Aids Clinic, high-risk maternity clinics, and the indigent health clinic at
Christus Spohn Memorial Hospital. The primary DOT providerspeaks and writes fluent Spanish. Information
is provided to Austin TB Elimination Division through CCNCTBEP related to these targeted populations.
12. Describe your strategy to provide professional education and training programs for new and current TB staff
Professional education consists of the education and training of new employees and the continuing
education of TB staff. Training will be provided to all new employees within 60 days. Each new employee
must receive 40 hours of TB education within the first 60 days of employment and 16 hours of training each
year thereafter. This includes all staff involved in TB activities including physicians, nurses, investigators,
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outreach workers, medical records clerks, receptionists, and other support staff. The TB education will be
utilized when possible to provide workshops with continuing hours of
education being documented. CDC's "Self Study Modules on Tuberculosis" will be used in the initial training,
and the test will be given at the completion of the modules. Initial and follow-up training will
include the suggested reading materials identified in the TDH contract. A written plan will be developed for
each new employee and addressed with the new staff member by the 7B Program Manager on the first day
the employee spent in the TB Clinic after City Orientation. A time frame will be established for completing
the initial education phase and a time frame will be established for acquiring the 16 hours of TB education
needed yearly. The assessment of need will be done by the employee and the program manger, and the plan
-will be written yearly before the annual evaluation and reviewed quarterly with the employee by the Program
Manager. A copy will be placed in their personal record and they will retain a copy for themselves.
Staff will be instructed where the Staff education Notebook is kept and that they are responsible for recording
each educational event and notifying the Program Manager if a workshop is canceled and rescheduling is
needed. A copy of TDH Pertormance Standards for professional education will be given to each new
employee at time of hire and to all other staff. A copy of TDH Pertormance Standards will be placed in the TB
Education Notebook for reference.
Describe the internal program evaluation process utilized to monitor services, identify staff that utilize them and who is
responsible for ensuring they are updated. The description shall include the following
1) role of a program evaluation committee;
DSHS TB Elimination staff review the program approximately every three (3) years. We workto correctany
problems they identified in the reviews. We have a CtA Committee inside the Corpus Christi-Nueces County
Public Health District that meets quarterly. The committee addresses problems identified bythe members
or other staff, possible solutions, and the innovative things being done in all the clinics. Problems
addressed at the prior meeting are revisited to evaluate the solutions proposed.
2) Medical Director's involvement in the program evaluation activities;
Dr. William W. Burgin, Jr., M.D., is the medical director for CCTBC (Corpus Christi-Nueces County
Tuberculosis Elimination Clinic). He or his associate writes all orders for medications for preventive, TB
cases, or suspects. He is involved in problem solving when patients are having difficulties with
medications to problem solving forthe homeless. Dr. Burgin worked forseveral years at Texas Centerfor
Infectious Diseases when he left the Army. We are very fortunate to have a physician as involved as Dr.
Burgin is with our clinic.
Activities are utilized to identify trends of needed improvement and the frequency of those activities
3) activities utilized are used identify trends of needed improvement and the frequency of those activities;
CCTBC staff and PRN meetweekly to address any problems encountered with clients. Solutions are proposed and
progress or lack of progress to the desired outcome is addressed at the next meeting.
4) activities to ensure correction and follow-up to findings identified;
After assessing situation, we develop a plan of action and assign each person a particular activity to perform within a
limited time frame. We schedule a meeting for each person to report findings on assigned activity, and atthattime an
assessment is made to determine if the matter was satisfactorily resolved or to determine if further action is required.
5) utilization and frequency of client satisfaction surveys;
CCTBC uses client surveys to monitor our effectiveness at meeting client needs in a timely manner during office
visits. The survey is provided in both English and Spanish twice a year. Over the coming months we will be looking
at utilizing other languages based on our increasing diverse population. All staff is involved as we each provide
multiple services.
6) system utilized to identify and monitor adverse outcomes;
Monitor labs, DOT, drug levels, and consultations from the TB experts
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7) process for identifying performance and outcome measures; and 8) process utilized to develop protocols and
standing delegation orders.
Ongoing monitoring of each client from the 1s` day of admission to service. CCTBC monitors lab, Drug
levels, DOT, and when/if problems arise consultations with the TB experts is requested.
13. Describe your strategy to document the evaluation of immigrants and refugees with the following notifications:
Class A (Applicants who have tuberculosis disease diagnosed [sputum smear positive or culture positive] and
require treatment overseas but who have been granted a waiver to travel prior to the completion of therapy.); Class
61-Pulmonary (No treatment: -Applicants who have medical history, physical exam, or CXR findings suggestive
of pulmonary tuberculosis but have negative AFB sputum smears and cultures and are not diagnosed with
tuberculosis or can wait to have tuberculosis treatment started after immigration. Completed treatment: -
Applicants who were diagnosed with pulmonary tuberculosis and successfully completed directly observed therapy
prior to immigration.); Class 61 -Extra-pulmonary (evidence of extra-pulmonary tuberculosis); Class B2 (LTBI
Evaluation -Applicants who have a tuberculin skin test z 10 mm but who othervuise have a negative evaluation for
tuberculosis.); Class 63 (Contact Evaluation -applicants who are a contact of a known tuberculosis case.)
When a B1 or B2 notification is received the client is contacted and they are scheduled for the specified or
indicated examination. CCTBC tracked one client to New York State and arranged for the chest x-ray prior to her
leaving the United States to go back to her country of origin. Her brother was a physician in Corpus Christi and
was able to provide the information necessary to clear her. After the work-ups are completed the information is
forwarded to Sam Householder at TDH/TB in Austin and if the individual is not located the tracking that was done
is documented and the original papers are mailed to Mr. Householder. A copy will be retained for CCTBCs
records.
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