Backup Documents 02/24/2009 Item #16D1016D10
MEMORANDUM
Date: July 1, 2009
To: Terri Daniels, Grants Supervisor
Human Services Department
From: Martha Vergara, Deputy Clerk
Minutes & Records Department
Re: Agreement
Contractor: Health Planning Council of SW FL, Inc.
Attached, please find one (1) originals as referenced above (Agenda
Item #16D10), approved by the Board of County Commissioners on
Tuesday, February 24, 2009.
Please return any fully executed original documents back to the
Minutes & Records Department for the Board's Record.
If you should have any questions, please call 252 -7240.
Thank you.
AM AW
ORIGINAL DOCUMENTS CHECKLIST & ROUTING SLIPU 10
TO ACCOMPANY ALL ORIGINAL DOCUMENTS SENT TO
THE BOARD OF COUNTY COMMISSIONERS OFFICE FOR SIGNATURE
Print on pink paper. Attach to original document. Original documents should be hand delivered to the Board Office. The completed routing slip and original
documents are to be forwarded to the Board Office only after the Board has taken action on the item.)
ROUTING SLIP
Complete routing lines #1 through #4 as appropriate for additional signatures, dates, and /or information needed. If the document is already complete with the
exception of the Chairman's sienature, draw a line through routing lines #1 through #4, complete the checklist, and forward to Sue Filson (line #5).
Route to Addressee(s)
(List in routing order
Office
Initials
Date
1. Terri Daniels
Housing and Human Services
Dept.
(Initial)
06/30/09
2.
February 24, 2009
Agenda Item Number
16D10
3.
signed by the Chairman, with the exception of most letters, must be reviewed and signed
4. Sue Filson, Executive Manager
Board of County Commissioners
Number of Original
2
5. Minutes and Records
Clerk of Court's Office
Documents Attached
PRIMARY CONTACT INFORMATION
(The primary contact is the holder of the original document pending BCC approval. Normally the primary contact is the person who created /prepared the executive
summary. Primary contact information is needed in the event one of the addressees above, including Sue Filson, need to contact staff for additional or missing
information. All original documents needing the BCC Chairman's signature are to he delivered to the BCC office only after the BCC has acted to approve the
item.)
Name of Primary Staff
Terri Daniels
Phone Number
252 -2689
Contact
appropriate
(Initial)
Applicable)
Agenda Date Item was
February 24, 2009
Agenda Item Number
16D10
Approved by the BCC
signed by the Chairman, with the exception of most letters, must be reviewed and signed
Type of Document
Agreement
Number of Original
2
Attached
resolutions, etc. signed by the County Attorney's Office and signature pages from
Documents Attached
INSTRUCTIONS & CHECKLIST
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
Initial the Yes column or mark "N /A" in the Not Applicable column, whichever is
Yes
N/A (Not
appropriate
(Initial)
Applicable)
1.
Original document has been signed/initialed for legal sufficiency. (All documents to be
signed by the Chairman, with the exception of most letters, must be reviewed and signed
by the Office of the County Attorney. This includes signature pages from ordinances,
resolutions, etc. signed by the County Attorney's Office and signature pages from
contracts, agreements, etc. that have been fully executed by all parties except the BCC
Chairman and Clerk to the Board and possibly State Officials.)
2.
All handwritten strike- through and revisions have been initialed by the County Attorney's
Office and all other parties except the BCC Chairman and the Clerk to the Board
3.
The Chairman's signature line date has been entered as the date of BCC approval of the
document or the final negotiated contract date whichever is applicable.
4.
"Sign here" tabs are placed on the appropriate pages indicating where the Chairman's
signature and initials are required.
5.
In most cases (some contracts are an exception), the original document and this routing slip
should be provided to Sue Filson in the BCC office within 24 hours of BCC approval.
Some documents are time sensitive and require forwarding to Tallahassee within a certain
time frame or the BCC's actions are nullified. Be.#War q 9kyour deadlines!
67
The document was approved by the BCC on (enter date) and all changes
made during the meeting have been incorporat d i h Fattached document. The
EL
County Attorney's Office has reviewed the changes, if applicable.
I: Forms/ County Forms/ BCC Forms/ Original Documents Routing Slip W WS Original 9.03.04, Revised 1.26.05, Revised 2.24.05
16010
AGREEMENT
THIS AGREEMENT, made and entered into on this 24th day of February, 2009, by and
between the Health Planning Council of Southwest Florida, Inc. authorized to do
business in the State of Florida whose business address is 8961 Daniels Center Drive,
Suite 401, Fort Myers, FL 33912, ( "Contractor" or "Consultant ") and Collier County, a
political subdivision of the State of Florida, Collier County, Naples, ( "County "):
WITNESSETH:
1. COMMENCEMENT. The contract shall be for a one (1) year period,
commencing on February 24, 2009, and terminating on February 23, 2010. In the
event that additional grant funding becomes available or the grantor extends the
grant award, the County may, at its discretion and with the consent of the
Consultant, extend the Agreement under all of the terms and conditions
contained in this Agreement for two (2) additional one (1) year periods. The
County shall give the Consultant written notice of the County's intention to
extend the Agreement term not less than ten (10) days prior to the end of the
Agreement term then in effect.
2. STATEMENT OF WORK: The Contractor shall provide services in accordance
with the scope of services of Attachment B, hereto attached and made an integral
part of this agreement. Additional related services may be provided by the
Contractor subject to the issuance of Change Orders as approved in advance by
the County. Services provided under this contract may include, but not be
limited to, the following:
a. Establish a Project Committee to guide the development of the project with
representatives from Collier County, PLAN, CHSI, Senior Friendship and
the Hospitals.
b. Create a Technical Advisory Panel (TAP) consisting of IT /data /information
practitioners who will be the working group.
Working with the TAP, the Health Planning staff will:
c. Identify the patient level data to be transferred from the provider to PLAN.
d. Develop a procedure as to how the data will be collected and a data
collection schedule.
e. Identify the technical needs of the project, i.e. hardware and software.
f. Determine the methodology to transfer the data from the providers to
PLAN.
g. Develop the format for data analysis and reporting.
16D 10
3. COMPENSATION. The County shall pay for contracted services performed on
behalf of the Health Planning Council of SW FL, Inc. for the performance of this
Agreement a total amount of One Hundred and Sixty thousand dollars,
($160,000) based on allowable expenses incurred. Payment will be made upon
receipt of a proper invoice and in compliance with Section 218.70 Florida
Statutes, otherwise known as the "Local Government Prompt Payment Act" and
a signed affidavit from the Health Planning Council of SW FL, Inc. Chief
Executive Officer, attesting that the work has been completed. Collier County
reserves the right to withhold and/or reduce an appropriate amount of any
payments for work not performed or for unsatisfactory performance of
Contractual requirements. Payments for eligible work tasks and /or activities
may be made directly to the provider of the service(s), as approved by the
Housing and Human Services Department, at the Contractor's request.
Deliverables are included in Attachment B and Budget is included in Attachment
C. Following are the dollar amounts to be paid for each deliverable:
Deliverables:
1. Creation of a Project Committee who will govern the work activities of the project.
Provide names of committee members and first meeting date in writing to Collier
County and PLAN. ($4,000.)
2. Creation of a Technical Advisory Panel (TAP). Provide names of committee
members and first meeting date in writing to Collier County and PLAN. ($4,000.)
3. Conduct a national survey of the status of HIT data sharing projects for the
underinsured/ uninsured regarding patient data transfer and provide a written
report to Collier County and PLAN. ($19,000.)
4. Provide a comprehensive written report to the Project Committee, Collier County,
and PLAN identifying at least two similar projects that have been implemented.
($24,000.)
5. Provide a comprehensive written report which identifies the types of patient level
data to be transferred from the providers to Collier County and PLAN. ($24,000.)
6. Determine the technical needs of the project including the hardware and software to
implement the data transfer and provide appropriate documentation to support
conclusions. ($25,000.)
7. Develop and provide written privacy protocols and a methodology regarding data
collection and reporting to Collier County and PLAN. ($18,000.)
8. Coordinate and provide written documentation for the implementation aspects of
the data transfer contingent upon the capabilities and /or development of the
software acceptable to the providers, PLAN and approved by Collier County.
($30,000.)
9. Final payment in the amount of $10,000 will be withheld pending completion of all
deliverables. ($10,000.)
2
16D10
Total is not to exceed $160,000.00.
4. The County and U.S. Department of Health and Human Services, Health
Resources and Services Administration have agreed that these funds will only be
used to fund projects that demonstrate expertise in the area of Health
Information Technology.
5. NOTICES. All notices from the County to the Contractor shall be deemed duly
served if mailed or faxed to the Contractor at the following address:
Health Planning Council of SW FL, Inc.
8961 Daniels Center Drive, Suite 401
Fort Myers, Florida 33912
Dr. Edward Houck, Chief Executive Officer
Phone: 239 - 433 -6700
Fax: 239 - 433 -6706
All notices from the Contractor to the County shall be deemed duly served if mailed or
faxed to the County to:
Collier County Government Center
Housing and Human Services Department
3301 Tamiami Trail East Bldg. H/211
Naples, Florida 34112
Attn: Marcy Krumbine, Director
Phone: 239 - 252 -2273
Fax: 239 - 252 -2638
The Contractor and the County may change the above mailing address at any time
upon giving the other party written notification. All notices under this Agreement must
be in writing.
6. NO PARTNERSHIP. Nothing herein contained shall create or be construed as
creating a partnership between the County and the Contractor or to constitute
the Contractor as an agent of the County.
7. CONDITIONS.
a. Special Conditions: The Contractor agrees to comply with the
requirements set for in the Notice of Grant Award Special Conditions
(Attachment A).
3
16010
b. Compliance with Local and Federal Rules, Regulations and Laws: During
the performance of this agreement, the Contractor agrees to comply with
any applicable laws, regulations and orders listed below by reference and
incorporated and made a part hereof. The Contractor further agrees to
abide by all other applicable laws as outlined in the Notice of Grant Award,
Attachment A.
8. SUBCONTRACTS. Any work or services subcontracts by the Contractor shall
be specifically by written contract or agreements, and such subcontracts shall be
subject to each provision of this Agreement and applicable County, State, and
Federal guidelines and regulations. Prior to execution by the Contractor of any
subcontract hereunder, such subcontracts must be submitted by the Contractor
to Housing and Human Services for its review and approval. None of the work
or services covered by the Agreement, including but not limited to consultant
work or services, shall be subcontracted by the Contractor or reimbursed by the
County without prior written approval of the Housing and Human Services
Director or his designee.
9. AMENDMENTS. The County may, at its discretion, amend this Agreement to
conform to changes required by Federal, State, County or Department of Health
and Human Services,) guidelines, directives, and objectives. Such amendments
shall be incorporated by written amendment as a part of this Agreement and
shall be subject to approval of Collier County. Except as otherwise provided
herein, no amendment to this Agreement shall be binding on either party unless
in writing, approved by the County and signed by each Party's designee.
10. PERMITS: LICENSE TAXES. In compliance with Section 218.80, F.S., all
permits necessary for the prosecution of the Work shall be obtained by the
Contractor. Payment for all such permits issued by the County shall be
processed internally by the County. All non - County permits necessary for the
prosecution of the Work shall be procured and paid for by the Contractor. The
Contractor shall also be solely responsible for payment of any and all taxes
levied on the Contractor. In addition, the Contractor shall comply with all rules,
regulations and laws of Collier County, the State of Florida, or the U. S.
Government now in force or hereafter adopted. The Contractor agrees to comply
with all laws governing the responsibility of an employer with respect to persons
employed by the Contractor.
11. NO IMPROPER USE. The Contractor will not use, nor suffer or permit any
person to use in any manner whatsoever, County facilities for any improper,
immoral or offensive purpose, or for any purpose in violation of any federal,
state, county or municipal ordinance, rule, order or regulation, or of any
governmental rule or regulation now in effect or hereafter enacted or adopted.
4
16D10
In the event of such violation by the Contractor or if the County or its authorized
representative shall deem any conduct on the part of the Contractor to be
objectionable or improper, the County shall have the right to suspend the
contract of the Contractor. Should the Contractor fail to correct any such
violation, conduct, or practice to the satisfaction of the County within
twenty -four (24) hours after receiving notice of such violation, conduct, or
practice, such suspension to continue until the violation is cured. The Contractor
further agrees not to commence operation during the suspension period until the
violation has been corrected to the satisfaction of the County.
12. PROHIBITION OF GIFTS TO COUNTY EMPLOYEES: No organization or
individual shall offer or give, either directly or indirectly, any favor, gift, loan,
fee, service or other item of value to any County employee, as set forth in
Chapter 112, Part III, Florida Statutes, Collier County Ethics Ordinance No. 2004-
53, and County Administrative Procedure 5311. Violation of this provision may
result in one or more of the following consequences: a. Prohibition by the
individual, firm, and/or any employee of the firm from contact with County staff
for a specified period of time; b. Prohibition by the individual and /or firm from
doing business with the County for a specified period of time, including but not
limited to: submitting bids, RFP, and/or quotes; and, c. immediate termination of
any contract held by the individual and/or firm for cause.
13. TERMINATION. Should the Contractor be found to have failed to perform his
services in a manner satisfactory to the County as per this Agreement, the
County may terminate said agreement immediately for cause; further the County
may terminate this Agreement for convenience with a seven (7) day written
notice. The County shall be sole judge of non - performance.
14. NO DISCRIMINATION. The Contractor agrees that there shall be no
discrimination as to race, sex, color, creed or national origin.
15. INSURANCE. The Contractor shall provide insurance as follows:
A. Commercial General Liability: Coverage shall have minimum limits of
$1,000,000 Per Occurrence, Combined Single Limit for Bodily Injury Liability
and Property Damage Liability. This shall include Premises and Operations;
Independent Contractors; Products and Completed Operations and
Contractual Liability.
B. Business Auto Liability: Coverage shall have minimum limits of $500,000
Per Occurrence, Combined Single Limit for Bodily Injury Liability and
Property Damage Liability. This shall include: Owned Vehicles, Hired and
Non -Owned Vehicles and Employee Non - Ownership.
5
16010
C. Workers' Compensation: Insurance covering all employees meeting
Statutory Limits in compliance with the applicable state and federal laws.
The coverage must include Employers' Liability with a minimum limit of
$1,000,000 for each accident.
Special Requirements: Collier County shall be listed as the Certificate
Holder and included as an Additional Insured on the Comprehensive
General Liability Policy.
Current, valid insurance policies meeting the requirement herein identified
shall be maintained by Contractor during the duration of this Agreement.
Renewal certificates shall be sent to the County 30 days prior to any
expiration date. There shall be a 30 day notification to the County in the
event of cancellation or modification of any stipulated insurance coverage.
Contractor shall insure that all subcontractors comply with the same
insurance requirements that he is required to meet. The same Contractor
shall provide County with certificates of insurance meeting the required
insurance provisions.
12. INDEMNIFICATION. To the maximum extent permitted by Florida law,
the Contractor or Consultant shall indemnify and hold harmless Collier
County, its officers and employees from any and all liabilities, damages,
losses and costs, including, but not limited to, reasonable attorneys' fees and
paralegals' fees, to the extent caused by the negligence, recklessness, or
intentionally wrongful conduct of Contractor or Consultant or anyone
employed or utilized by the Contractor or Consultant in the performance of
this Agreement. This indemnification obligation shall not be construed to
negate, abridge or reduce any other rights or remedies which otherwise may
be available to an indemnified party or person described in this paragraph.
This section does not pertain to any incident arising from the sole negligence of
Collier County.
13. CONTRACT ADMINISTRATION. This Agreement shall be administered on
behalf of the County by the Housing and Human Services Department.
14. CONFLICT OF INTEREST: Contractor represents that it presently has no interest
and shall acquire no interest, either direct or indirect, which would conflict in any
manner with the performance of services required hereunder. Contractor further
16p10
represents that no persons having any such interest shall be employed to perform
those services.
15. COMPONENT PARTS OF THIS CONTRACT. This Contract consists of the
attached component parts, all of which are as fully a part of the contract as if
herein set out verbatim: Notice of Grant Award Terms and Conditions
(Attachment A)
16. SUBTECT TO APPROPRIATION. It is further understood and agreed by and
between the parties herein that this agreement is subject to appropriation by the
Board of County Commissioners.
VA
16010
IN WITNESS WHEREOF, the Contractor and the County, have each, respectively, by an
authorized person or agent, hereunder set their hands and seals on the date and year first
above written.
ATTEST:
Dwight E. Brock, Clerk of Courts
By.
A�
" SEA)
9, hl�j
First Witness
4 t4 1,.,/\ k-Tc- a e7
TType/ print witness nameT
Second Witness
TType/ print witness nameT
Approved as to form and
legal sufficiency:
Colleen M. Greene
Assistant County Attorney
BOARD OF COUNTY COMMISSIONERS
COLLIER COUNTY, FLORIDA
1
By:
Donnt Fiala, Chairman
February 24, 2009
jZ
Dr. Edward Houck
Chief Executive Officer
February 24, 2009
1Anin
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ff=
ACORD. CERTIFICATE OF LIABILITY INSURANCE
DATE IMM=IYYYY)
PRODUCER
Marsh Commercial Business Center
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
a service of Seabury & Smith
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
9830 Colonnade Blvd. #400
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
PO Box 659520
LIABILITY
54SBAKKO154
San Antonio, TX 78265 -9520
INSURERS AFFORDING COVERAGE
NAIC;I�
INSURED
INSURER A. HARTFORD CASUALTY INS CO
INSURER B:
COMMERCIAL GENERAL LIABILITY
Health Planning Cncl of SW FL
8961 Daniels Center Drive Suite 401
INSURER C:
PREMISES DAMAGE TO RENTEff
a
Fort Myers, FL 33912
INSURER D:
MED EXP IAny am song'
INSURER E:
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ff=
ADD1
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
GENERAL
LIABILITY
54SBAKKO154
4/15/2009
4/15/2010
EACH OCCURRENCE
S
COMMERCIAL GENERAL LIABILITY
PREMISES DAMAGE TO RENTEff
a
$
MED EXP IAny am song'
S
CLAIMSMADE OCCUR
PERSONAL 6 ADV INJURY
S
GENERAL AGGREGATE
$
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO LOC
PRODUCTS - COMP/OP AGG
0
A
AUTOMOBILE
LIABILITY
ANYAUTO
54SBAKKO154
04/15/2009
4/15/2010
COMBINED SINGLE LIMIT
Me accident
S 1,000,000
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY
(Per person)
S
HIRED AUTOS
NON -OWNED AUTOS
BODILY INJURY
(Per accident)
S
PROPERTY DAMAGE
(Per accident)
S
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT
$
ANY AUTO
OTHER THAN EA ACC
S
$
AUTO ONLY: AGG
EXCESS/UMBRELLA UANUTY
EACH OCCURRENCE
$
AGGREGATE
S
OCCUR FI CLAIMSMADE
S
DEDUCTIBLE
S
RETENTION S
S
WORKERS COMPENSATION AND
WC STATU- OTH-
EMPLOYERS' LIABILITY
I ER
E.L. EACH ACCIDENT
S
--
ANY PROPRIEIORMARTNERIEXECUTIVE
OFFlC_ MEMBER EXCLUDEDT - -
- -- - - - -_ -
- -
I Yes, describe under
— —
E- rtprENPLDY£E
E.L. DISEASE - POLICY LIMIT
S
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT / SPECIAL PROVISIONS
Collier County is recognized as an Additional Insured on General Liability as required by written contract.
AG�Trt•In ATL� „�, w��
Collier County Government Center
Housing and Human Services Department
ATTN: Marcy Krumbine
3310 Tamiami Trail East Bldg. H/221
Naples, FL 34112
ACORD 2542001/081
DS #8823786
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MALI 34-_ DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL
IMPOSE NO OBUOATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
AUTHOIIZED
ACORD CORPORATION 1988
ATTACHMENT A 16010
I. DATE ISSUED: PROGRAM CFDA: 93.888
Papa t
12.
08/26/2008
DEPARTMENT OF HEALTH AND HUMAN SERVICES
3. SUPERCEDES AWARD NOTICE dated
HEALTH RESOURCES AND SERVICES ADMINISTRATION
asap Ihat arty addaiona a raMdPdana P--IY inpoaad ramaln In W@0 u W" $Padfioai V r kWed.
4a. AWARD NO.: 4b. GRANT NO,: 5. FORMER GRANT NO.:
1 DIBIT10769 -01 -00 DlBIT10769
RSA
6. PROJECT PERIOD:
FROM: 09/01/2008 THROUGH: 08/31/2010
NOTICE OF GRANT AWARD
AUTHORIZATION (Legislation /Regulation)
7. BUDGET PERIOD:
Public Health Service Act, Title III, Section 330(A) as Amended
FROM: 09/01/2008 THROUGH: 08/31!2010
Act,
A107
Public Health Service Act, Title II, Section 330(1), P.L. -251
S. TITLE OF PROJECT (OR PROGRAM): Congressionally- Mandated Health Information Technology Grants
GRANTEE NAME AND ADDRESS:
Collier
C ollier County
10. DIRECTOR: (PROGRAM DIRECTOR/PRINCIPAL INVESTIGATOR)
3301 Trail E
Marcy Krumbine
Naples,
Napl es, FL 34112 -3969
Collier County
3301 Tamiami Trail East
Naples, FL 34112 -3969
11. APPROVED BUDGET: (Excludes Direct Assistance)
12. AWARD COMPUTATION FOR FINANCIAL ASSISTANCE
[X] Grant Funds Only
[ ] Total project costs including
g grant funds
a. Authorized Financial Assistance This Period 323,911.00
and all other financial
Participation
b. Lass Unobligated Balance from Prior Budget Periods
i. Additional Authority $ 000
a. Salaries and Wages: $ 26,250.00
ii. Offset $ 0.00
b. Fringe Benefits: $ 8,061.00
c. Unawarded Balance of Current Year's Funds $ 0.00
c. Total Personnel Costs: $ 34,311.00
d. Less Cumulative Prior Award(s) This Budget $0.00
Period
d. Consultant Costs:
$ 0.00
e. AMOUNT OF FINANCIAL ASSISTANCE THIS
e. Equipment: $ 0.00
ACTION $ 323,911.00
f. Supplies: $ 41,300.00
g. Travel:
13. RECOMMENDED FUTURE SUPPORT: (Subject to the availability of
$ 4,400.00
funds and satisfactory progress of project)
h. Construction/Alteration and Renovation: $ Q.00
,^°
s ',
I. Other:
$ 82,400.00
+rs `
FM Not Applicable
j. ConsortiumlContractual Costs: $ 161,500.00
k. Trainee Related Expenses: $ 0.00
14. APPROVED DIRECT ASSISTANCE BUDGET: (in lieu of cash)
I. Trainee Stipends: $0.00
a. Amount of Direct Assistance $ 0.00
m. Trainee Tuition and Fees: $0.00
b. Less Unawarded Balance of Current Year's $ 0.00
n. Trainee Travel: $ 0.00
Funds
o. TOTAL DIRECT COSTS: $ 323,911.00
c. Less Cumulative Prior Awards(s) This Budget $ 0.00
Period
p. INDIRECT COSTS: (Rate: % of S &W/TADC) $ 0.00
d. AMOUNT OF DIRECT ASSISTANCE THIS
q. TOTAL APPROVED BUDGET: $ 323,911.00
ACTION $ 0.00
i. Less Non - Federal Resources: $ 0.00
ii. Federal Share: $ 323,911.00
15. PROGRAM INCOME SUBJECT TO 45 CFR Part 74.24 OR 45 CFR 92.25 SHALL BE USED IN ACCORD WITH ONE OF THE
ALTERNATIVES:
A- Addition B.Deduction C -Cost Sharing or Matching D -Other
FOLLOWING
Estimated Program Income: $ 0.00
[A]
16. THIS AWARD IS BASED ON AN APPLICATION SUBMITTED TO, AND AS APPROVED BY HRSA, IS ON THE ABOVE TITLED PROJECT
AND IS SUBJECT TO THE TERMS AND CONDITIONS INCORPORATED EITHER DIRECTLY OR BY REFERENCE IN THE FOLLOWING:
a. 71" 9- nopmrn IaO"b- cited -b-. b. Tlw pnud pngm,n ngolabon tlad abo a. a TMa _&W nodes Indudkq arms and oonOMkna, p a roi.d
awlnl tMm am oordlPdrp or aManwa Incors4UM Pdidw aPOk-"- m dN pmnt, dr aba order tl ^Y. below undv REMARKS. d. 46 CFR Pan 74 a 45 CFR Pan Y2"
oMainad Irwn dr pram Paymanl ayWm. Praoadano ahYl pmwLl, Asaplano d Ma pmM mrrm and aordidona 4 acknowbopp by 1" Omni" whin Arnds am dnwn� -q »,��y,y
REMARKS: (Other Terms and Conditions Attached M Yes [ ] No )
Electronically signed by Dorothy M. Kelley, Grants Managwnant Offlcwr on: 08/26/2008
17. OBJ. CLASS: 41.51 16. CRS -EIN: 1596000558A1 19. FUTURE RECOMMENDED FUNDING:
08- 3706311 93.888 D161T10769A0 $ 323 911 00�
$ O DO N/A
16D10
NOTICE OF GRANT AWARD (Continuation Sheet) _ e 2 �1DIBIT1067E6�9-01-00 te Issued
[Aiwad r Nu
HRSA Electronic Handbooks (EHBs) Registration Requirements
The Project Director of the grant (listed on this NGA) and the Authorizing Official of the grantee organization are
required to register (if not already registered) within HRSA's Electronic Handbooks (EHBs). Registration within
HRSA EHBs is required only once for each user for each organization they represent. To complete the
registration quickly and efficiently we recommend that you note the 10 -digit grant number from box 4b of this
NGA. After you have completed the Initial registration steps (i.e., created an individual account and associated it
with the correct grantee organization record), be sure to add this grant to your portfolio. This registration in
HRSA EHBs is required for submission of noncompeting continuation applications. In addition, you can also use
HRSA EHBs to perform other activities such as updating addresses, updating email addresses and submitting
certain deliverables electronically. Visit https: // grants .hrsa.gov /webexternal /login.asp to use the system.
Additional help is available online and /or from the HRSA Call Center at 1- 877 - 464.4772.
Terms and Conditions
Failure to comply with the special remarks and condition(s) may result In a draw down restriction being placed
on your Payment Management System account or denial of future funding.
Program Terms:
1. Telemedicine Projects: Whenever a third -party payer can be billed for a consult, the grantee may not provide the
involved clinician(s) with a grant- funded clinician incentive payment. This remains the rule even when the clinician
incentive payment is more than what the third -party payer will reimburse. This also applies when a State Medicaid
agency will reimburse for a consult, but the grantee has not yet established its own internal procedure to bill Medicaid.
2. The Universal Service Provisions of the Telecommunications Act of 1996 should make telecommunication rates for
eligible rural health providers comparable with rates for urban providers and in many cases thereby reduce
transmission costs to rural providers. All eligible applicants and their eligible grant - funded network members must
apply for a Universal Service subsidy as soon as possible or demonstrate to CHIT that applying would not provide any
financial advantage. Further information on Universal Service is available at: ( http: / /www.ncc.universalservice.org).
3. It is the policy of HRSA to make available to the public the results and accomplishments of the activities that it funds.
Therefore, it is incumbent upon project directors, program directors, and principal investigators to make results and
accomplishments of their activities available to the public. Prior approval is not required for publishing the results of an
activity under a grant. Recipients shall place an acknowledgement of HRSA grant support and a disclaimer, as
appropriate, on any publication, briefing paper, report, or other document that is written, published, or otherwise
produced (e.g., website, electronic work products) with such support and, if feasible, on any document (electronic or
paper) reporting the results of or describing a grant- supported activity. The acknowledgement shall read:
"This publication (report, briefing paper, document, website, etc.) was made possible by grant number from the
Office of Health Information Technology, Health Resources and Services Administration, DHHS" or "The project
described was supported by grant number from the Office of Health Information Technology, Health
Resources and Services Administration, DH—HS."
THREE copies of documents or reports (electronic or paper), resulting from work performed under a HRSA
grant- supported project or activity MUST be submitted to CHIT, no matter what the media by which they are
disseminated (e.g., publications in journals, reports, CD -Rom, web). In addition, copies of presentations to major
organizations should acknowledge HRSA support and be submitted to the CHIT project officer.
THREE reprints of publications or work products resulting from work performed under a HRSA grant supported project
or activity MUST be submitted to the CHIT project officer.
4. In the event the grantee organization anticipates that Federal funding available through this award will not be
expended by the project period end date, the grantee is required to submit to the grants management representative
and project officer indicated in the "contacts" section of this document a request for a no -cost extension to complete
goals and objectives. This request, under an original signature of an authorized grant official should be submitted at
least 60 days prior to the expiration of the project period and include: (a) the grant number, (b) the additional time
desired, (c) the grant project goals and objectives to be completed and (d) the Federal funds available to complete the
goals and objectives with categorical budget and justification.
16-010
NOTICE OF GRANT AWARD (Continuation Sheet)
sued: 08/26/2008
AD
5. The grantee institution may retain the entire right, title and interest throughout the world to any invention (as defined in
45 CFR, Section 74.36) it conceives, develops, or implements in the performance of work under this grant, subject to
the provisions of the Department of Commerce's regulation 37 CFR Part 401 and 35 U.S.C. 203. The Federal
government, however, shall have a nonexclusive, nontransferable, irrevocable, paid -up license to obtain and use the
invention for or on behalf of the United States throughout the world.
6. Data Collection and Evaluation: Applicants accepting this award must, if requested, participate in the Office for the
Advancement of Telehealth (OAT) data collection and evaluation of telemedicine activities.
7. Telehealth Inventory Assessment: Applicants accepting this award must complete, if requested, a "HRSA Telehealth
Inventory." This inventory collects data about the Telehealth capabilities of the grantee's institution and those of the
network members. OHIT will provide information regarding this inventory at the time of request.
8. OAT Grantee Directory: Applicants accepting this award must provide information for OHIT's Grantee
Directory/Profiles. Further instructions will be provided by OHIT. The current Telehealth directory Is available online at:
http://telehealth.hrsa-gov/grants/grantee.htm.
9. Grantees are requested to attend and participate in the OHIT grantee meetings. Programmatic and logistical details
will be provided later,
10. When responding to reporting requirements, conditions, and requests for post award amendments to the Division of
Grants Management Operations, please send a courtesy copy of your correspondence to the designated project
officer.
Standard Terms:
I. All discretionary awards issued by HRSA on or after October 1, 2006, are subject to the HHS Grants Policy Statement
(HHS GPS) unless otherwise noted in the Notice of Award (NoA). Parts I through III of the HHS GPS are currently
available at ftp: / /ftp.hrsa.gov/ grants /hhsgrantspolicystatement.pdf and it is anticipated that Part IV, HRSA
program - specific guidance will be available at the website in the near future. In addition, HRSA - specific contacts will
be appended to Part III of the GPS which identifies Department -wide points of contact.
Please note that the Terms and Conditions explicitly noted in the award and the HHS GPS are in effect. Once
available, Part IV, HRSA program - specific guidance will take precedence over Parts I and II in situations where there
are conflicting or otherwise inconsistent policies.
2. The HHS Appropriations Act requires that when issuing statements, press releases, requests for proposals, bid
solicitations, and other documents describing projects or programs funded in whole or in part with Federal money, all
grantees receiving Federal funds, including but not limited to State and local governments, shall clearly state the
percentage of the total costs of the program or project which will be financed with Federal money, the dollar amount of
Federal funds for the project or program, and percentage and a dollar amount of the total costs of the project or
program that will be financed by nongovernmental sources.
3. Recipients and sub- recipients of Federal funds are subject to the strictures of the Medicare and Medicaid anti- kickback
statute (42 U.S.C. 1320a - 7b(b) and should be cognizant of the risk of criminal and administrative liability under this
statute, specifically under 42 U.S.C. 1320 7b(b) Illegal remunerations which states, in part, that whoever knowingly
and willfully:
(A) Solicits or receives (or offers or pays) any remuneration (including kickback, bribe, or rebate) directly or indirectly,
overtly or covertly, in cash or in kind, in return for referring (or to induce such person to refer) an individual to a person
for the furnishing or arranging for the furnishing of any item or service, OR
(B) In return for purchasing, leasing, ordering, or recommending purchasing, leasing, or ordering, or to purchase,
lease, or order, any goods, facility, services, or item
....For which payment may be made in whole or in part under subchapter XIII of this chapter or a State health care
program, shall be guilty of a felony and upon conviction thereof, shall be fined not more than $25,000 or imprisoned for
not more than five years, or both.
4. The HHS Appropriations Act requires that to the greatest extent practicable, all equipment and products purchased
with funds made available under this award should be American -made.
• f �
NOTICE OF GRANT AWARD (Continuation Sheet)
Page 4 Date Issued: 08!26/2008
Award Number. 1 DIBIT10769 -01 -o0 =:�]
5. Items that require prior approval from the awarding office as indicated in 45 CFR Part 74.25 [Note: 74.25 (d) HRSA
has not waived cost - related or administrative prior approvals for recipients unless specifically stated on this Notice of
Grant Award] or 45 CFR Part 92.30 must be submitted in writing to the Grants Management Officer (GMO). Only
responses to prior approval requests signed by the GMO are considered valid. Grantees who take action on the basis
of responses from other officials do so at their own risk. Such responses will not be considered binding by or upon the
HRSA.
In addition to the prior approval requirements identified in Part 74.25, HRSA requires grantees to seek prior approval
for significant rebudgeting of project costs. Significant rebudgeting occurs when, under a grant where the Federal
share exceeds $100,000, cumulative transfers among direct cost budget categories for the current budget period
exceed 25 percent of the total approved budget (inclusive of direct and indirect costs and Federal funds and required
matching or cost sharing) for that budget period or $250,000, whichever is less. For example, under a grant in which
the Federal share for a budget period is $200,000, if the total approved budget is $300,000, cumulative changes within
that budget period exceeding $75,000 would require prior approval). For recipients subject to 45 CFR Part 92, this
requirement is in lieu of that in 45 CFR 92.30(c)(1)(ii) which permits an agency to require prior approval for specified
cumulative transfers within a grantee's approved budget. [Note, even if a grantee's proposed rebudgeting of costs falls
below the significant rebudgeting threshold identified above, grantees are still required to request prior approval, if
some or all of the rebudgeting reflects either a change in scope, a proposed purchase of a unit of equipment
exceeding $25,000 (if not included in the approved application) or other prior approval action identified in Parts 74.25
and 92.30 unless HRSA has specifically exempted the grantee from the requirement(s).]
6. Payments under this award will be made available through the DHHS Payment Management System (PMS). PMS is
administered by the Division of Payment Management, Financial Management Services, Program Support Center,
which will forward instructions for obtaining payments. Inquiries regarding payment should be directed to: Payment
Management, DHHS, P.O. Box 6021, Rockville, MD 20852, http: / /www.dpm.psc.gov/ or Telephone Number:
1- 877 - 614 -5533.
7, The DHHS Inspector General maintains a toll -free hotline for receiving information concerning fraud, waste, or abuse
under grants and cooperative agreements. Such reports are kept confidential and callers may decline to give their
names if they choose to remain anonymous. Contact: Office of Inspector General, Department of Health and Human
Services, Attention: HOTLINE, 330 Independence Avenue Southwest, Cohen Building, Room 5140, Washington, D. C.
20201, Email: Htips @os.dhhs.gov or Telephone: 1 -800 -447 -8477 (1- 800 -HHS- TIPS).
8. Submit audits, if required, in accordance with OMB Circular A -133, to: Federal Audit Clearinghouse Bureau of the
Census 1201 East 10th Street Jefferson, IN 47132 PHONE: (310) 457 -1551, (800)253 -0696 toll free
http: / /harvester.census. gov /sac /facconta.htm
9. EO 13166, August 11, 2000, requires recipients receiving Federal financial assistance to take steps to ensure that
people with limited English proficiency can meaningfully access health and social services. A program of language
assistance should provide for effective communication between the service provider and the person with limited
English proficiency to facilitate participation in, and meaningful access to, services. The obligations of recipients are
explained on the OCR website at http: //www.hhs .gov /ocr /lep /revisedlep.html.
10. This award is subject to the requirements of Section 106 (g) of the Trafficking Victims Protection Act of 2000,as
amended (22 U.S.C. 7104). For the full text of the award term, go to http : / /www.hrsa.gov /grants /trafficking.htm. If you
are unable to access this link, please contact the Grants Management Specialist identified in this Notice of Grant
Award to obtain a copy of the Term.
Reporting Requirements:
1. Due Date: Within 90 days of Budget End Date
The grantee must submit a Financial Status Report SF- 269A/Short Form (http: / /www.Psc.gov /forms /sf) within 90 days
after the budget period end date. This report should NOT reflect cumulative reporting from budget period to budget
period and must be submitted to the HRSA, Division of Grants Management Operations, 5600 Fishers Lane, Room
11A -02, Rockville, MD 20857 -0001.
2. Due Date: Within 365 days of Award Issue Date
Technical progress reports are required at annual intervals, when the due date coincides with the conclusion of the
16D 10
NOTICE OF GRANT AWARD (Continuation Sheet)
Page 5 Date Issued: 08/2612008
Award Number. 1 DIBIT10769 -01 -00
project, the final report will also serve as the progress report. Reports should include a summary of what has been
accomplished during the reporting period and what has been learned, as well as basic information required by CHIT to
measure the progress of the program. A copy of the format to be used, as well as instructions for submitting the
report, will be provided by OHIT.
Failure to comply with these reporting requirements will result In deferral or additional restrictions of future
funding decisions.
Contacts:
Program Contact: For assistance on programmatic issues, please contact Makeda Clement at:
CHIT
5600 Fishers Ln RM 7C -26
Rockville, MD 20857 -0001
Phone: (301 )443 -6977
Email: MClement@hrsa.gov
Division of Grants Management Operations
Booker at:
HRSA/DGMO /GSFB
5600 Fishers Ln RM 11A -02
Rockville, MD 20857 -0001
Phone: (301)443-4236
Email: nbooker @hrsa.gov
Fax: (301)443 -6686
For assistance on grants administration issues, please contact Hazel N.
Responses to reporting requirements, conditions, and requests for post award amendments must be mailed to the
attention of the Office of Grants Management contact indicated above. All correspondence should include the Federal
grant number (item 4 on the award document) and program title (item 8 on the award document). Failure to follow this
guidance will result in a delay in responding to your request.
Goals:
16010
Attachment B
SCOPE OF SERVICES
PLAN HRSA HIT Project
1. Patient -level information transfer from Providers to the Physician Led Access Plan Network
(PLAN) into a database with reporting capabilities to allow for trend analysis, segment
targeting and potentially coordinated case - management while ensuring HIPA compliance.
2. Increase the penetration of PLAN into the uninsured and underinsured community in Collier
County.
3. Decrease the number of ER admissions in area hospitals by persons who are eligible for
PLAN while also increasing the health of that population.
Methodology:
1. Create two groups including a representative from each of the following:
a. PLAN
b. Health Planning Council
c. Collier County Government
d. NCH Healthcare System
e. Physicians Regional Medical Center
f. Collier Health Services Inc
g. Senior Friendship Centers
One will be an HIT Project Committee of senior leaders similar to the group who signed the
original Memorandum of Understanding. The other will be a Technical Advisory Panel (TAP)
consisting of IT /data /information practitioners who will be the working group and reporting
back to the Project Committee.
2. The TAP will determine the answers to the following questions:
a. What data can and should be transferred? What is currently gathered? What can
be shared with PLAN? What would be most useful?
b. What is the best method to transfer the information? How is the data gathered?
Who is involved? When and how often is data transferred? What will the ongoing
process be?
c. What information should be reported back to the providers after aggregation?
What data can be aggregated for the area? What needs to be reported by provider?
What should be reported regularly? What can be used for PLAN strategic planning?
d. What are the technical needs of the project (including software and hardware)?
This piece will require an investigation into software currently in use in Collier
County (ClientTrack) and best and worst practices/ lessons learned/ software and
16n10
hardware in use from similar groups across the country (ex. Project Access in
Ashville, Wichita, Dallas etc).
e. What is the recommended implementation plan?
The TAP will be lead by the Project Manager and will report back to the Project
Committee monthly. They will interview and include insights from staff members at
hospitals, clinics, County Government and PLAN including nurses, registration staff,
administrators, case managers and others who would potentially be involved in the final
process or have any necessary practical knowledge. In addition interviews with other
PLAN -like agencies will be conducted. Many of these agencies have attempted similar
data - transfer plans with various degrees of success.
3. The actual implementation plan the will be approved by the HIT Project Committee will
include the following elements and may require a budget revision:
a. Equipment for providers who do not meet all the technical needs of the project (i.e.
a computer with web access) for a clinic.
b. Some preparation/ customization of the software. Development of the necessary
forms and reports.
c. Training for Provider staff and PLAN staff on the software selected and the process
in general.
d. Payment to the providers for the staff time needed to begin data transfer (after the
two -year implementation phase these payments will be replaced by proven cost
savings).
4. Running concurrently with the HIT Project Plan, the Project Committee will oversee the
development of a Marketing Plan. Implementation of this Marketing plan will be a
larger focus for Year -Two.
Deliverables:
1. Creation of a Project Committee who will govern the work activities of the project. $4,000
2. Creation of a Technical Advisory Panel (TAP). $6,000
3. Conduct a national survey of the status of HIT data sharing projects for the
underinsured /uninsured regarding patient data transfer and provide a written
report. $19,000
16D 10
4. Written report to the Project Committee at least two similar projects that have been
implemented. $24,000
5. Identify the types of patient level data to be transferred from the providers
to PLAN. $24,000
6. Determine the technical needs of the project including the hardware and software
to implement the data transfer. $25,000
7. Develop privacy protocols and a methodology regarding data collection and reporting. $18,000
8. Coordinate the implementation aspects of the data transfer contingent upon the
capabilities and /or development of the software acceptable to the providers,
PLAN and approved by the Grantor (Collier County). $ 30,000
9. Final payment in the amount of $10,000 will be withheld pending completion
of all deliverables. $10,000
TOTAL $160,000
A.
B.
C.
D.
E.
F.
G.
H.
I.
Budget Categ_M
Personnel
Fringe Benefits
Travel
Equipment
Supplies
Construction
Consultants / Contracts
Other
Total Direct Costs
Indirect Costs
TOTAL PROJECT COSTS
Budget Summary
E
16010
ATTACHMENT C
Amount
$160,000
$160,000
0
$160,000