HomeMy WebLinkAboutRES 85-403 R E S O L U T I O N
BE IT RESOLVED BY THE CITY COUNCIL OF THE
CITY OF B EAUMO NT:
THAT the City Manager be, and he is hereby, authorized to approve
the 1986 contract with the Texas Department of Health, a copy of
which is attached as Exhibit "A" .
PASSED BY THE CITY COUNCIL of the City of Beaumont this
the /letX day of � e �� 1985.
- Mayor -
9, C747'
' F
,ny
r PEl6•P9�6 -texas Department of Health
Robert Bernstein, M.D., f.A.0 P. 1100 West 49th Street Robert A. MacLean, M.D.
Commissioner Austin, Texas 78756 Deputy Commissioner
(512) 458-7111 Professional Services
Hermas L. Miller
Deputy Commissioner
Management and Administration
Date November 7 , 1985
From C. C. ave .
Assoc 1 ei si re TDH Doc. No. C 6000507
Community and Rural Health Attachments
To Maurine Gray (Acting ) , Director
Beaumont Citv Health Department
Subject 1985 Contract for Local Health Services
Enclosed are three copies of the 1986 contract between your agency and
the Texas Department of Health. The individual attachments identify
the program and amount of funds allocated for each activity. After
these are signed, all three copies should be returned for final
processing. A fully executed copy will be returned to you after that
action.
The base contract is very similar to the 1985 contract; however , it
has been simplified and clarified. These changes have been discussed
in the meetings held during the summer with representatives of local
health agencies and accounting offices . Hopefully, these discussions
have resulted in all involved parties being familiar with the major
changes and improvements.
There are several blanks to be completed prior to these contract
copies being signed and returned. These are on the first , third,
fourth, and signature pages .
The blanks for authorized contracting entity and the name and title of
the person authorized to sign are to be completed with the name of the
city or county office , or in the event your agency serves more than
one entity, both offices may be listed with the names and titles of
the individuals signing the contract . If the authority to sign has
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been given to a single office or to you as director of the Performing
Agency , a copy of this authorization must be returned with the
contracts . If this has been filed previously please note this
information in the return transmittal . The person indicated on page
one should sign the signature page , fill in the title and date . This
year there is a section on the signature page for Performing Agency
recommendation signature and blanks to be completed with the address .
The information to be completed in Article 4 on page three is very
important . The individual listed will be the one recognized as
authorized to initiate requests for transfer of funds from an
attachment with state budgeted positions to the attachment which
provides funds for local administration. This procedure should
eliminate or reduce the number of amending attachments which have been
done in the past and create a much more efficient and timely process
for handling conversions of state vacancies . It is hoped that you
will be the person so designated by the contracting entities .
In Article 8 , the ending month and year of your local current
operating budget is to be entered. As stated, this will be the fiscal
data to be included in the annual health services and operating budget
report which will be requested later .
Financial requirements are given in Article 15. These have been
simplified and the number of required reports has been reduced. The
method for advance payments and billing procedures is explained in the
article and all of these procedures were covered in the recent
training meetings . Please note that reimbursements cannot be made
after November unless the financial reports have been received. The
due dates for these are given in this article .
For your information, when requesting conversion of funds from a state
budgeted position to local costs and administration , the local
personnel level and pay rate is used. This department ' s job
classification titles and salary schedules do not apply. Also , you
have the option of requesting that funds be set up in categories other
than personnel .
The terms of attachments are being realigned in some cases to keep
within the fiscal period of September 1985 through August 1986. Some
attachments may cover only eleven months in the 1986 contract to allow
this change to occur . The twelfth month, September 1986 , will be
included in the 1987 contract cycle . A few 1985 attachments were
amended to drop September 1985 so that that period could be included
in the 1986 attachment . If this occurred in a 1985 contract
attachment which was amended within the past few months , a transmittal
notice would have indicated this . This new procedure does not apply
to all programs because of the source of funding, etc. , so you may not
have this reflected in any of your department ' s attachments .
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The local categories of expense include all UGCMS authorized direct
cost items; however , funds may not be budgeted in all of the
categories . Institutional prior approval is required on transfers
between categories when the total amount transferred is 5p or more of
the approved budget amount . Also, equipment purchases , items with a
unit cost of $250 . 00 or more , require special approval and a list is
to be filed. All equipment must be ordered prior to the end of the
state fiscal year (August 31 , 1986 ) . When claims are submitted which
include costs for equipment , a list is be be attached to the voucher .
The monitor can advise you regarding specific guidelines if you have
any questions .
A schedule of dates for major contract documents is enclosed. There
will be a grace period of September , October , and November during
which we will honor vouchers even though the base contract has not
been signed. We will need to receive your signed contract during this
period to complete the agreement and continue to process your
vouchers . If there are any questions , please contact me or the
monitor for your department who will be happy to assist you.
7'W:gd
Enclosures
3
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1986 CONTRACTS, FORMS AND REPORTS SCHEDULE
CONTRACTS PERIODICITY DUE, DATE
Contract (base ) with Annually 8-31-85'-mailed to
initial attachments PERFORMING AGENCY
*11-30-85 signed/returned
to RECEIVING AGENCY
FORMS AND REPORTS
Annual Local Health Services Annually Stated in transmittal
and Operating Budget Summary cover letter
Application for Assistance As needed to In advance of changes
Budget Data ( Short Form) (GC-9 ) revise budget
Financial Status Report Quarterly 20th of month following
( SF 269a; GC-4 ) end of each quarter;
90 days after end of
attachment term
Indirect Cost Rate Record As needed Within 6 months
(negotiated between Per- of expiration date
forming Agency and federal/
State Cognizant Agency)
Request for Advance or Annually 90 days after end
Reimbursement ( SF 270; of attachment term
GC-10 )
Request/Approval to Transfer As needed As vacancy or—urs
State Budgeted Funds to Local ( initiate in advance
Funds of actual vacancy,
when possible )
Request for Funds Annually Mid 86 contract cycle
(approx . Feb. 1986 )
State of Texas Purchase Voucher Monthly, or Not later than 90
(AG-37 ) as needed days after end of the
attachment term
*Must be on file in RECEIVING AGENCY by November 30 , 1985 , in order for
billings to be processed after this date .
Submit all forms and reports to:
Texas Department of Health, Community
and Rural Health, 1100 West 49th Street , Austin , Texas 78756 .
NOTE 1 : Individual programs may require other program reports not listed.
NOTE 2 : Most forms may be ordered from TDH/Literature and Forms. Contact
Community and Rural Health for information on others .
1
Document No. C6aa05o7
STATE OF TEXAS LOCAL HEALTH SERVICES
COUNTY OF TRAVIS C O N T R A C T
The Texas Department of Health , hereinafter referred to as RECEIVING AGENCY,
acting through its Deputy Commissioner for Management. and Administration ,
and
_._ (Authorized Contracting Entity)
acting through BEAUMONT CITY HEALTH DEPARTMENT _
(Name of PERFORMING AGENCY )
hereinafter referred to as PERFORMING AGENCY , acting through
C. A. Shelton
(Name of Person Authorized to Sign Contracts )
its Interim City Manager _
(Title of Person Authorized to Sign Contracts )
mutually agree as follows :
ARTICLE 1 . Scope of 'Fork
PERFORMING AGENCY shall perform the work outlined in the Scope ( s ) of Work
which is/are hereby incorporated and made a part of this contract as
Attachment (s ) 1-5 plus amendments which may be added by
additional Attachments ) from time to time as hereinafter provided.
ARTICLE L . Terms
The term of this contract shall be governed by the time period on the
Attachment (s ) . No commitment of contract funds is permitted prior to the
first day of the Attachment term nor subsequent to the last day of the
Attachment term. The term may be extended by amendment ( s ) .
ARTICLE 3 Applicable Laws and Standards
This contract shall be governed by the laws of the State of Texas .
PERFORMING AGENCY agrees that the Uniform Grant and Contract Management
Standards (UGCMS) , Article 4413 , Section 32g, V. A . C . S. , will apply as terms
and conditions of this contract , and the standards are adopted by reference
in their entirety. If there is a conflict between the provisions of this
contract and UGCMS, the provisions of UGCMS will prevail unless expressly
stated otherwise . A copy of this manual and its references are provided to
PERFORMING AGENCY by RECEIVING AGENCY upon request .
UGCMS contains requircaents in OMB Circulars No. A-102 and A-87 that pass-
through with State and Federal monies including but not limited to :
I . allowable costs in applicable Cost Principles , A-87 ;
2. financial management standards , A-102, Attachment G;
3 . procurement , A-102, Attachment U; and
4 . audit requirements , A-102 , Attachment P .
In addition , A-102, Attachment 0,' sets out provisions that must be in all
contracts . Those provisions are hereby adopted when applicable , and
include but are not limited to: audit and record access and retention;
Equal Employment Opportunity; environmental and energy protection laws and
regulations .
PERFORMING AGENCY will comply with the requirements set forth in the
enabling Federal legislation , as set out in the Attachment (s ) hereto,
Treasury Circular 1075 ( 31 CFR Part 205 ) and all other Federal laws and
regulations applicable to Federal funding source (s ) in this contract .
PERFORMING AGENCY will utilize RECEIVING AGENCY policies and procedures for
hiring and promoting individuals into state budgeted positions funded by
this contract . Qualifications of any individuals filling these positions
will be subject to approval of RECEIVING AGENCY Bureau of Personnel
Management . The purpose of the approval is to insure that individuals
occupying these state budgeted positions meet minimum educational and
experience requirements .
PERFORMING AGENCY shall have in place legally sufficient Due Process
Hearing Procedures for all of its state budgeted employees .
The Director of PERFORMING AGENCY shall have full authority to employ,
promote , suspend, demote , discharge , and transfer any and all state
budgeted personnel funded by Attachment (s ) to this contract; provided,
however , that any demotions , suspension , or discharge of such state
Pitt y ..
budgeted to ees shall be in accordance with the Due Process Hearing
g p
Procedures as set out above . All personnel Funded by Att.ac: ment (s ) to this
contract are employees of PERFORMING AGENCY which shall be responsible for
their direction and control and liable for any of their acts or o��iss�v4is .
The only distinction between state budgeted and local paid employees is
that employees on state budgeted positions receive state benefits , and are
subject to certain obligations as state employees , as contained in state
law. These obligations include provisions that no employee paid on a State
budgeted position may receive a salary supplement from any other source .
PERFORMING AGENCY agrees to defend and indemnify RECEIVING AGENCY for any
and all claims and/or judgements taken against any employees , state or
local , or against said RECEIVING AGENCY, arising out of any claims or cause
of action against any such employees .
ARTICLE 4 . Compensation and Payment
For services satisfactorily performed pursuant to the Scope (s ) of Work ,
PERFORMING AGENCY shall have furnished or be reimbursed by RECEIVING AGENCY
an amount not to exceed the total of all Attachment (s ) which are attached
hereto. Allowable costs shall be only as outlined in the Attachment (s ) .
2
PERFORMING AGENCY w- I not bill RECEIVING AGEN' for any costs under this
contract which have also been billed or shoula have been billed to any
other funding source . _
Costs claimed for reimbursement must -be substantiated. With proper
justification, and concurrence of RECEIVING AGENCY, PERFORMING AGENCY may
request advance payment under this contract in accordance with the
applicable provisions of this contract .
PERFORMING AGENCY may be reimbursed for local personnel costs or other
categories of expense used to fulfill the scope of work of an Attachment in
lieu of being furnished state payroll warrants after a state budgeted
position becomes vacant . Reimbursement shall not exceed the balance of
funds on the state budgeted position after all benefits , obligations ,
and/or other entitlements are met . Maurine Gray Acting HPAIth
Director , (title and name of person) is authorized
to request such transfer for PERFORMING AGENCY , the method and format of
which shall be prescribed by RECEIVING AGENCY.
PERFORMING AGENCY shall submit certified vouchers according to the
procedures set out in this contract . At the close of each quarter , a signed
financial report , the format of which is in the UGCMS, must be submitted.
ARTICLE 5 . Funding
PERFORMING AGENCY shall use funds from this contract to supplement its
budget . These funds will in no event supplant existing funds currently
available to PERFORMING AGENCY.
PERFORMING AGENCY agrees to assign to RECEIVING AGENCY expenditures of
local funds for public health services as matching for Federal funds . Such
assigned local matching funds shall be reported to RECEIVING AGENCY on the
annual final report (Form 270 ) . In the event such assigned funds are
required by PERFORMING AGENCY to match other Federal funds , prior written
approval must be obtained from RECEIVING AGENCY to withdraw the assigned
funds from RECEIVING AGENCY.
This contract is contingent upon funding being available for the term of
the Attachment (s ) and PERFORMING AGENCY shall have no right of action
against RECEIVING AGENCY in the event that RECEIVING AGENCY is unable to
perform its obligations under this contract as a result of the suspension,
termination , withdrawal , or failure of funding to RECEIVING AGENCY or lack
of sufficient funding of RECEIVING AGENCY for any Attachment (s ) to this
contract . If funds become unavailable , provisions of the Termination
Article in this contract shall apply.
ARTICLE 6 . Program Income
All revenues received from the delivery of contract services shall be
identified and reported and shall be utilized as provided in this article .
Such program income shall be retained by PERFORMING AGENCY and; ( 1 ) be
used by PERFORMING AGENCY for any purposes which further the objectives of
legislation under which the contract was made and be deducted from total
project costs , or ( 2) be deducted from total project costs , according to
3
4s-
RECEIVING AGENCY pol interpreting UGCMS, a c-oy of which is provided as
supplementary material to the UGCMS manual .
PERFORMING AGENCY shall -develop a fee For service system and a schedule of
fees for personal health services in accordance with the provisions of
Article 4414c, V.C. S. , and the Texas Board of Health rules covering Fees
for Clinical Health Services ( 25 TAC, Sec. 1 . 19 ) and other applicable laws;
provided, however , that a patient may not be denied a service due to
inability to pay.
ARTICLE 7 . Records
PERFORMING AGENCY will have a system in effect to protect from
inappropriate disclosure of patient records maintained in connection with
the activities funded under this contract .
ARTICLE 8 . Reports and Inspections
PERFORMING AGENCY shall make financial , program, progress , and other
reports as requested by RECEIVING AGENCY in the format agreed to by the
parties hereto and will arrange for onsite inspections by RECEIVING AGENCY .
PERFORMING AGENCY shall participate fully in any required evaluation study.
PERFORMING AGENCY will furnish RECEIVING AGENCY an annual budget of
PERFORMING AGENCY on forms provided by RECEIVING AGENCY. The budget shall
be for PERFORMING AGENCY current fiscal year ending September 30. 1986
The budget shall be shown by object of expense category and include all
funding sources . The personnel category shall include position
classification and gross salary for all employees.
ARTICLE 9 . Amendments
This contract may be amended as provided in Article 4 , or by the addition
of Attachments (s ) containing additional Scope (s ) of Work and Budget (s )
related to same , or by revision of existing Attachment (s ) and the Scope (s )
of Work and/or Budget (s ) ; such Attachment (s ) to be duly executed by the
parties as hereinabove provided.
Thar-- contract shall not be altered, changed, or amended except by
instrument in writing executed by authorized officials of the parties
hereto .
ARTICLE 10 . Property and Supplies
Subject to the obligations and conditions set forth in this contract and
UGCMS, title to all property purchased from funds provided herein shall
vest upon acquisition with PERFORMING AGENCY. PERFORMING AGENCY shall
maintain a property and supplies inventory and administer a program of
maintenance , repair , and protection of assets provided under this contract
so as to assure their full availability and usefulness for performance
under this contract .
4
- RECEIVING AGENCY retains the option to recover .ill unused supplies and
useable equipment furnished under this contract upon the termination of
relationship of the parties hereto. This also includes acquisitions
through lease-purchase agreements with funds provided under this contract
or with funds provided by program income attributable to the programs
provided for under this contract .
In the event PERFORMING AGENCY is indemnified, reimbursed, or otherwise
compensated for any loss of , destruction o£ , or damage to, the assets
provided under this contract during the period of this contract , it shall
use the proceeds to repair or replace said assets .
ARTICLE 11 . Discrimination Prohibited
No person in the United States shall on the grounds of race , creed, color ,
handicap, age , ability to pay , sex , or national origin be excluded from
participation in, be denied the proceeds of, or be subject to
discrimination in the performance of this contract . The parties will comply
with the regulations promulgated by the Secretary of DHHS, with the
approval of the President of the United States , pursuant to Title VI of the
Civil Rights Act of 1964 (45 CFR Part 80 ) .
In addition , PERFORMING AGENCY shall comply with the provisions of the
Rehabilitation Act of 1973 , Public Law 93-112, Section 504 , which ensures
that no individual "shall , solely by reason of handicap, be excluded from
the participation in, be denied the benefits of, or be subject to
discrimination in this program. "
ARTICLE 12. Severability
If any provision(s ) of this contract shall be construed to be illegal or
invalid, it shall not affect the legality or validity of any of the other
prt?v sions hereof , and the illegal or invalid provision(s )shall be deemed
stricken and deleted herefrom to the same extent and effect as if never
incorporated herein, but all other provisions shall continue .
ARTICLE 13 . Scope of Agreement
This contract incorporates all of the agreements , convenants , and
understandings between the parties hereto concerning the Attachment (s ) and
all such covenants , agreements , and understandings have been merged into
this written contract . No prior agreement or understanding, oral or
otherwise , of the parties or their agents shall be valid or enforceable
unless embodied in this contract .
ARTICLE 14 . Termination
This contract or any Attachment (s ) hereto may be terminated by either of
the parties hereto for noncompliance by the other party. A party intending
to terminate for noncompliance by the other party shall provide written
notice to the other party at least thirty ( 30 ) days prior to the intended
date of termination. Such notice shall include the reasons for the
5
termination and shams provide the other party r opportunity to rebut the
reasons in writing. A hearing may be requested vii the proposed termination
if such request is made in writing within ten ( 10 ) days from any final
notification of termination. By such termination, neither party may
nullify obligations already incurred for performance or failure to perform
prior to the date of termination. Such termination shall not be an
exclusive remedy but shall be in addition to any other rights and remedies
provided by law or under this contract .
This contract or any Attachment (s ) hereto may be terminated in whole , or in
part , when both parties agree that continuation would not produce results
commensurate with further expenditure of funds . Both parties shall agree
on the effective date and, in the case of partial termination, the portion
to be terminated. RECEIVING AGENCY shall immediately send PERFORMING
AGENCY written notice of the terms agreed to and such notice shall become a
part of the contract . PERFORMING AGENCY shall not incur new obligations
for the terminated portion after the effective date and shall cancel as
many outstanding obligations as possible . RECEIVING AGENCY shall allow
full credit to PERFORMING AGENCY for noncancelable obligations which were
properly incurred prior to the termination date .
This contract or any Attachment (s ) hereto may be terminated if funds
allocated for any Attachment (s ) hereto should become reduced, depleted, or
unavailable during any Attachment (s ) budget period, and RECEIVING AGENCY is
unable to obtain additional funds for such purposes . RECEIVING AGENCY
shall immediately provide written notification to PERFORMING AGENCY of such
fact and such Attachment (s ) to this contract is/are terminated upon receipt
of that notification. PERFORMING AGENCY shall not incur new obligations
after the effective date and shall cancel as many outstanding obligations
as possible . RECEIVING AGENCY shall allow full credit to PERFORMING AGENCY
for noncancelable obligations which were properly incurred prior to the
termination date .
This contract or any Attachment (s ) hereto may be terminated in the event
that Federal or state laws or other requirements should be amended or
judicially interpreted so as Go render continued fulfillment of this
contract , on the part of either party, unreasonable or impossible . If the
parties should be unable to agree upon amendment which would therefore be
needed to enable the substantial contcn services
AGENCY to PERFORMING contemplated
herein, then, upon written notification by RECEIVING
AGENCY, the parties shall be discharged from any further obligations
created under the terms of this contract , except for the equitable
settlement of the respective accrued interests or obligations incurred up
to the date of termination.
ARTICLE 15 Financial Reporting Requirements
The following prescribes uniform procedures and the standard forms for_
PERFORMING AGENCY to:
1 . request reimbursements and/or advance payment , and
2. summarize and report expenditures and unexpended funds.
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Reimbursements
Monthly , or as needed, PERFORMING AGENCY shall submit a State of Texas
Purchase Voucher (TDH Form #AG-37 ) .
Advance Payment
PERFORMING AGENCY may request an advance with proper justification and
concurrence of RECEIVING AGENCY. Amount of the advance shall be
determined by the amount and term of the Attachment (s ) ; however , for
eech Attachment , the amount of the advance shall not exceed one-sixth
( 1/6th) of the Attachment amount . The advance will be requested on a
State of Texas Purchase Voucher at the beginning of the Attachment
period or at a single later time in the Attachment period if
circumstances so warrant and the request is approved. Advance funds
will be liquidated in the final months of the Attachment period so
that , after final monthly billing, PERFORMING AGENCY will- not have
advance funds on hand. Advance funds may be drawn only to meet
immediate cash needs for disbursement (UGCMS and Federal Circulars ) .
Reports
Quarterly - PERFORMING AGENCY shall submit a Financial Status Report State
Supplemental Form 269a (TDH Form #GC-4 ) by the twentieth
( 20th) of the month following a quarter . Reporting
requirements apply regardless of whether or not costs have
been incurred.
Annual/Final-PERFORMING AGENCY shall submit no later than 90 days after the
end of the Attachment period final quarterly Financial Status
Report State Supplemental Form 269a and Request for Advance or
Reimbursement Form 270 . If necessary, a State of Texas
Purchase Voucher will also be submitted if all costs have not
been recovered or a refund will be made of excess monies if
costs incurred were less than funds received.
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EXECUTED IN TRIPLICATE 01--,,IG1NA1T_S ON 711.1'_'
CONTRACTING ENTITY
FOR AND IN BEHALF OF - RECEIVING AGENCY
PERFORMING AGENCY
By By-------
( Signature of Person Authorized Hermas L. Miller
to Sign Contracts ) Deputy Commissioner
Management and Administration
Title
Date- Date---
Recommended: Recommended:
By R-w"W"z By C
(PERFORMING AGENCY Dire or ,
if- different from above Associate Commissioner
Community and Rural Health
Print or Type B'y
PERFORMING AGENCY Address : ice , M.
Beaumont :Iaalth Department ift Pr
-P r� Associate Commissioner
(Mailing Address )
_ L_
PersoQ A
A17-, e aPlt
h
S
e r
vic
es
(Street Address , if different ) J�!r e H . Greenberg, M. D.
.
Beaumont, Teas 77704 ss ciate Commissi r
(city , Zip Code ) r 'rentable Dis ea
A,—
Approved as to Form:
Office of General Counsel
8
ATTACHMENT 'NO . 1
PERFORMING AGENCY: BEAUMONT CI`T'Y HEALTH DEPARTMENT
PROGRAM WITHIN RECEIVING AGENCY (TDH ) : COMMUNITY AND RURAL HEAL'T'H
TERM: September 1 , 1985 through August. 31 ,__ 1986
SCOPE OF WORK:
The state direct assistance and other funds to health departments are
intended to supplement in the delivery of comprehensive public health
services to protect the health of all citizens in the department ' s
jurisdiction. Personal health services may include , but are not limited to,
immunizations , maternal and child health, crippled children, adult health,
tuberculosis control , chronic disease , dental health , public health
education, and venereal disease control . Environmental health services may
include , but are not limited to , food inspections , wastewater control ,
vector control , premise inspections , swimming pool inspections , and other
services as related to the particular problems of the jurisdiction.
Required personnel , payroll , and time records on state budgeted personnel
as the basis for issuance of state ;payroll warrants shall be submitted to
RECEIVING AGENCY .
Reports of services performed under this attachment shall be submitted to
the Office of Community and Rural Health. Also , evidence that a public
hearing was held on expenditure of health block grant funds and an annual
audit report shall be submitted.
LEGAL AUTHORITY :
Current Appropriations Bill .
BUDGET:
The attached list of positions and budgetary amounts , exclusive of category
41 if applicable , is an integral part of Attachment I . A state warrant
will be issued for each filled position in the amount of monthly net salary
earnings .
Total amount of this Attachment shall not exceed $52 . 176 . 00 .
1
AS OF
F U N D ( S A ?I E S O N L Y
GORY DESCRIPTION OR TITLE ENDING ITEM � JOT B 7 PAY TP— EFFECTIVE ( MONTHLY BUDGETED AMOUNT
DESC. I ' ,
MONTH NO. i CLASS Gr STEP; DATE RATE
1 11+P.s IV aTATE � ;r:] �; <' i1 � -t^ 7`- pal , r r
I ..I.. � le. tb G .0 a : f414 .
I i
I ? CT ".T� ur�i �c�U3r 7 2 6.. ^r
i
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r
I
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�T 1
i
_ I III
ATTACHMENT NO. 2
PERFORMING AGENCY: BEAUMONT CITY HEALTH DEPARTMENT
PROGRAM WITHIN RECEIVING AGENCY (TDH) : COMMUNITY AND RURAL HEALTH
TERM: September 1 , 1985 through August 31 , 1986
SCOPE OF WORK:
This allocates funds in support of the scope of work in Attachment No. 1 .
LEGAL AUTHORITY:
Current Appropriations Bill and Title XIX, Public Health Services Act ,
Omnibus Budget Reconciliation Act of 1981 , DHHS final regulations on block
grants .
BUDGET: Personnel $73 , 801 . 00*
Fringe Benefits 4 , 297 . 00
Travel -0-
Equipment -0-
Supplies -0-
Contractual -0-
Other -0-
Total 578 , 098 . 00
*Includes $20 , 801 ( $1 , 891 x 11 month; October 1985 - August 1986 ) and
$53, 000 ( 12 month funding) .
Total amount of this Attachment shall not exceed $78 , 098 . 00 , except as
adjusted under provisions of Article 4 of the contract .
1
ATTACHMENT 3
PERFORMING AGENCY: Beaumont City Health Department
PROGRAM WITHIN RECEIVING AGENCY (TDH) : Bureau of Maternal and Child Health
TERM: October 1, 1985 through September 30, 1986
SCOPE OF WORK: To provide clinical services to meet the needs of low income
women and children with particular reference to prenatal care
for pregnant women, family planning services, and preventive
child health services. These services shall be provided in
accordance with the standards for maternity, family planning,
and child health services as promulgated by the Bureau of
Maternal and Child Health, Texas Department of Health.
Services performed under this Attachment shall be reported
monthly by submission of Maternity/Family Planning and
Child Health Clinic Reports.
If fees for services are imposed as provided in Article 6 of
this contract., charges will not be imposed for the provision
of health services to low income mothers or children. The
term "low income" refe,-s to an individual or family with an
income determined to be below the nonfarm income official
poverty line defined by the Office of Management and Budget
and revised annually in accordance with Section 624 of the
Economic Opportunity Act of 1964,
LEGAL AUTHORITY: Title V, Social Security Act, :omnibus Budget Reconciliation
Act of 1981; DHHS regulations on block grant.
BUDGET: Personnel $71,205 _
Fringe Benefits -0-
Travel • - -0__
Equipment _0-
Supplies -0-
Contractual 2,200
Other -0-
Total Direct Cost $73,405
Total amount of this Attachment shall not exceed $. 73,405.00
'��=��3
4
PEP RMING Beaumont City Health Department
pROMRpM WITHIN DIVING AG&NCY (TOH) : Bureau of Dental Health
TEPM. Deoarber 1, 1985 through August 31, 1986
SOOPE OF WJRK:
Dental treatment services are Ito be ;provided to indigent children through
a
age 18. Indigency is to be defined by Bureau of Dental Health guidelines
(see AddendLun 1) .
A minimum of 225 patients well be treated! and a minimum of 450
dental procedures performed during the contract period. Funds are provided
at $ 20.00 per clinic hoar for _ 225 hour`; and a total of $4,500.00
Ptusua.t to this agreement, the Pei- or<ming Agency shall:
1. Submit a State of Texas Puiatose vouches- (AG-37) monthly, which
shall include the number of clinic hour: involved.
2. With the AG-37, sufinit patient treat Ment record forms (N-19) to
be for-warded to the Bureau of Dental Health.
3. Submit upon request a formal request for continuation of financial
assistance for the subsequent state fiscal year. Tl':e request
shall include an exhibit of information (see Ardde_ndtsn 2) , which
will be used to help to evaluate the request.
IGAL AUytiORITy: S.B. 894, 69th '.texas Legislature.
BUDGET: Personnel $ 0
Fringe Benefits 0
Travel 0
Eicui psrrf:n e
0
Supplies 0
Contractual 4,500.00
Other 0
Total $ 4,500.00
Total amount of this attacfurent shall not exceed $ 4,500-00
BUREAU OF DENTAL HEALTH
GUIDELINES FOR ELIGIBILITY FOR DECAL SERVICES
FY 86
(September 1, 1985 - August 31, 1986
Family Size Annual Incase
1 $0 - 6,825
2 $0 - 9,165
3 $0 - 11,505
4 $0 - 13,845
5 $0 - 16,185
6 $0 - 18,525
7 $0 - 20,865
8 $0 - 23,205
Each additional
family mcziTber - $2,340
LxJlibit OF ln: )t'maC1On
Identificatiull (name, address , & telephone number of clinic) :,
Name & telephone number of person in charge of dental program:
Approximate prorated in-kind costs based on amount of actual
contributed time:
ANNUAL, PRO-RATA:.
EStimale(i cost of clinical space (rent)
Estimated cost of utilities for clinical space
Estimated cost of dental equipment & maintenance
Estimated cost of dental supplies
Estimated cost of office supplies
-- * Estimated cost to the clinic for the time devoted to this program.
!low are patients referred to the clinic for dental care?' School Nurse
Welfare Dept.
Health Dept .
Other (list)
What services are provided: Diagnostic Preventive Restorative
Endodontics Periodontics
Prosthodontics Ora Surgery
Orthodontics
What ' s the priority of care? First Priority
Second Priority
Third Priority
Other
E
f
Estimated number of patients to be treated annually by this program with
the funds requested.
Age: `
( 1 - 4) (5 - 14) ( 15 - 13)
(19 & over) .-
Describe criteria for eligibility for dental care (explain and attach
forms):
Comments:
r
ATTACHMENT 5
PERFORMING AGENCY: Beaumont City Health De artment
PROGRAM WITHIN RECEIVING AGENCY (TDH): _ Bureau of Epidemiology
TERM: October 23, 1985 through April 22, 1986.
SCOPE OF WORK* During the 365—day period of the award the Beaumont City Health
Department will publicize in high risk communities the availability of the HTLV—III
antibody testing through its clinics as an alternative to obtaining the test results
via donation of a unit of blood or plasma; provide written and verbal information,
precounseling about the test and its interpretation to individuals requesting the
test; collect blood on those who elect testing after precounseling; ship it to the
Houston City Health Department laboratory; and communicate results and provide
additional specific counseling to the patient.
The following data must be collected and reported to the Texas Department of Health
in a manner and form approved by the Texas Department of Health (Bureau of
Epidemiology): number of patients tested; number tested without charge; number
(each) of negative. positive, borderline test results; number of pre— and post—test
counseling sessions; and personnel hours devoted to the program. A report and budget
will be required within 90 days of the end of the grant period.
Where permitted, fees will be charged in accordance with the policy of the Beaumont
City Health Department. The following section applies to all fees collected under
this grant.
The Beaumont. City Health Department hereby gives assurances that: 1) Resources
required are only to defray costs for services to those who could not otherwise
afford them except in those situations where the requirement conflicts with state- or
local law or other established policies; 2) it has reduced its request by taking into
consideration funds expected to be collected from patients, wr-iere such collections
are permissible; 3) the resources requested are limited to those required for a 365—
day period from the date of the budget period; and 4) local resources are
insufficient to provide for HTLV—III testing without charge at alternate sites.
LEGAL AUTHORITY: This contract is funded from the Federal Notice of Cooperative
Agreement Award No. U62/CCU600903-01; Section 311, PHS Act.
BUDGET:
Personnel
Fringe Benefits $ 10,202.00
Travel $ 2,551.00
Equipment $ 0
Supplies $ 0
Contractual $ 0
-Other $ 0
$ 301.00
Total $ 13,054.00
This attachment permits continuance of the activities previously funded
through Attachment No. 5B of the Fiscal Year 85 Local Health Department
Contract (TDH Document No. 05000507 ) . The total funding level for
this activitiy for the time period April 26, 1985 through April 22, 1986
shall not exceed $ 13,054.00