DalCo 2013-02-26 RyanWhiteFunds

7/29/2019 DalCo 2013-02-26 RyanWhiteFunds

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ORDERNO, ___________DATE: FEBRUARY 26,2013STATE OF TEXASCOUNTY OF DALLAS

COURT ORDER

BE IT REMEMBERED, at a regular meeting of Commissioners' Court of Dallas County, Texas held onthe 26TH day of__ '-Fe""b""r."u"'arv'-1-____________ 2013, on motion made by____________________________________ and seconded by____________________________ the following Order was adopted:WHEREAS, the award of FY 2012 Ryan White Part A Formula funds was discussed in CommissionersCourt on February 19, 2013; andWHEREAS, FY 2012 Ryan Whi te Part A Formula funds in the amount of $356,500, are recommendedfor award approval to service providers reflected in Attachment A; andWHEREAS, the Ryan White Part A Formula grant directly supports a regional indigent medical andmental healthcare network for those impacted by HIV/AIDS and is consistent with theDallas County Strategic Plan, Vision 2: Dallas County is a healthy community; andWHEREAS, the Commissioner Court must approve the contract amendment with the service providersand authorize the County Judge to sign the amendments on behalf of Dallas County,IT IS THEREFORE ORDERED, ADJUDGED AND DECREED that the Dallas County CommissionersCourt does hereby approve the award of FY 2012 Ryan White Part A Formula funds in the amount of$356,500, to service providers as reflected in Attachment A, and authorizes the County Judge to sign the


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ATTACHMENT A

FV 2012-2013 Ryan White Part A Formul a Award

AGENe, INITlAL O""MGL TOTAL. ~ . ~ .....ms ,. I 26iJ i11 ".378

604.182 "".182AIDS Arms, Inc. 374. 374.""i ,. ' .... 46.'"AIDS Interfaith Network, Inc. M,di,,,1 I 354."8 354,8(,8, 42.'" 42';47C"" M ~ ' i " " " ' " I,m, lloh", ," M,, ' . 155.,,;7 "'.657AIDS Services of Dallas M,d",1 C", 133.'"'' 133.'09, " ~ h , " ' , 63.170 63.170

IDS29'i,J65 299.:;(,:;c," 89.458 89.458row" P o " ~ " ~ 67.364 67.3


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DALLAS COUNTYHEALTH AND HUMAN SERVICESGRANTS MANAGEMENTZACHARY THOMPSONDIRECTOR

TO: Zachary ThompsonFROM: Aurelio RodriguezDATE: February 8, 2013SUB.IECT: 2012-2013 Ryan White Part A Formula Contract Amendment is ready.CONTRACTOR NAME: AIDS Arms, Inc.,GRANT PROGRAM: FY 2012-2013 Ryan White Part A FormulaThe attached budget was reviewed by Grants Management staff and is ready for signature. Thefollowing items were verified:ITEM1.2.3.

Amount corresponds with Briefing and Court Order documents.All five originals signed by appropriate agent of organization.Budget Exhibits A are calculated conectly.


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CONTRACT AMENDMENT NO.3

CONTRACT FO R HIV/AIDS SERVICES DELIVERYFUNDED UNDER THE FY 2012 TITLE XXVI OF TH E PH S ACT,AS AMENDED BY THE RYAN WHITE HIV/AIDS TREATMENT

EXTENSION ACT OF 2009: PART A FORMULA FUNDING GRANTCATALOG OF FEDERAL DOMESTIC ASSISTANCE (CDFA) NO. 93.914

BetweenDALLAS COUNTY HEALTH & HUMAN SERVICES

(Contractor)

I. PURPOSE:

andAIDS Arms, Inc.(Snb-Contractor)

Contract Amendment No.3 amends the HIV AIDS Services Delivery Funded under the FY 2012Title XXVI of the PHS Act, as amended by the Ryan White HIV / AIDS Treatment Extension Actof2009: Part A Formula grant agreement executed between Dallas County Health & HumanServices and AIDS Arms, Inc., effective March 1,2012.II. AMENDED PROVISIONS:

Contract Amendment No.3 shall not change any contractual provisions agreed upon in the RyanWhite HIV/AIDS Treatment Extension Act Part A Formula funded agreement; each provision


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For:

B: AMENDED PROVISIONS:

The revised Exhibit A-I (detailed for the line item service budget), A-3 (budgetjustification), B-I(perfonnance objectives), and CI and C2 (multiple funding sources)reflect increased funding in the AIDS Phannaceutical Assistance service category.

C. TERM:Contract Amendment No.3 shall not affect the original term of the contact that is ineffect through February 28, 2013.

AIDS Arms, Inc.

(Signat

(Print or type name)

For: Dallas County

Health and Human Services

Date


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AIDS ARMS, INC.351 WEST JEFFERSON BLVD SUITE 300DALLAS TX 75208-4599FEIN: 75-2306145EXHIBIT A1 (a): DETAILED LINE ITEM BUDGET FOR DIRECT COSTAGENCY: AIDS ARMS, INC, GRANT:Ryan White Part A FormulaSERVICE CATEGORY: Local AIDS Pharmaceutical Assistance GRANT PERIOD: March 1, 2012 to February 28, 2013

A1 ~ a r l e l l ; SimpsonJlsnomasIAnole Ibarra

8

11:114111116111

,rURE ITEMSI I TITLE

enefits i'ene"ts I>ala Suppenlirector of I ::Iinic , i i

I 1& Dala

B

DOC

20%2>

1>

D',120,12C,23C,34C.068

'. _. - ' -< ............. " . . 2 ~ : ~ ~ ~ IC;2"'11i::in:. ,:':ii.: L ~ i C c ~ e S T ! : : = = = = = = = = = = = = = = = = t : = = = = : ; ~ " ' ~ " f U ~ I ' .... ." ;ce. '., ' . ~ ; - - - - - - - - - - - - - - ~ ' - - - - - - - - l I DITURE 11OTHERE F

267255, 72


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AIDS ARMS, INC,351 WEST JEFFERSON BLVD SUITE 300DALLAS TX 75208-4599F { ) ( t I l S i f : ; . l ; ~ 1 ( h DETAILED LINE ITEM BUDGET FOR INDIRECT COSTAGENCY: AIDS ARMS, INC, GRANT:Ryan White Part A FormulaSERVICE CATEGORY: Local AIDS Pharmaceutical Assistance GRANT PERIOD: March 1, 2012 to February 28, 2013

A1 ;Sherrie,2 I Warren- i ~ L a f f i t t e 5 ,John Carlo6 i Moreno7 'Vickie8789

ITURE ITEMSPOSITION TITLE

Lead AStaffStaff ,; ..0ChiefOfficeHuman

I ,OfficerIi

TOTALANNUALSALARYB

66332000098,536

140,0002 ~ ' , 3 7 3 63,000

% ,Bdgtd,

C554'3%2%10%4%

D1,000

7807802,670

2,6702,6702,670

10

! 11_ ""', >


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AIDS ARMS, INC.351 WEST JEFFERSON BLVD SUITE 300DALLAS TX 75208-4599FEIN: 75-2306145

AIDS Arms, Inc.EXHIBIT A-3 (a)FY 2012- 2013 Ryan White Part A Formula Grant

Service Category -Local AIDS Pharmaceutical AssistanceI. P E R s ' P N I ) i ~ L ABenefits Coordinator - Carletta Simpson. Peabody Health Center'. Assesses all patients for eligibility ofthird party payors and the PHC drug reimbursement program. Completes and maintains all necessarydocumentation for application and ongoing reassessment of eligibility.Annual SalaryB 36,504 20% 7,120Benefits Coordinator - Krist! Thomas Trinity Health & Well ness Center: Assesses all patients of PHC for ellgibility of

third party payers and the THWC drug reimbursement program. Completes and maintains all necessarydocumentation for application and ongoing reassessment of eligibility.Annual SalaryC

35,090Director of Clinic Administration Nicole Wilbur:

20% 7,120

Supervises and provides guidance to benefits coordinator. Reviews eligibility documentation periodicallyto ensure procedures are consistently followed.Annual SalaryDData Support Speclallst Angle Ibarra:

55,000 10% 5,340

Ensures functionality of source document flow through out the agency. Enters programmatic and clientinformation into ARIES from the common intake form. Enters service delivery information into ARIES fromdaily drug log sheets from Bioscrip.Annual SalaryE

29,390Technology and Data Manager - Rick Funches:

21%

Ensures and manages functionality of information technology systems, includingnew user set up, e-mai! set up and configuration, and hardware and software

6,230

2.;87:8


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AIDS Arms, Inc.EXHIBIT A-3 (a)FY 2012 2013 Ryan White Part A Formula Grant

Service Category -Local AI DS Pharmaceutical Assistance

1 i ! . i : o N r ~ l < t I i J J l . l . i I. Pharmacy: Contract for the dispensing of medications.Name of Subcontractor: Avita Drugs, LLC.Amount of Contract: 629,464 41% 255,672Method of Selection: Sole SourcePeriod of Performance: March 1, 2012- February 28, 2013Description of Services: Dispensing of all medically necessary

prescriptions for patients who meetprogram guidelines. Payer of last resortafter compassionate care, Medicaid and ADAP.

Name of Subcontractor: 0.67%Amount of Contrac t: Bid / InterviewMethod of Selection: March 1, 2012-February 28, 2013Period of Performance:Description of Services:

Consulting, network support, and programming needs beyondthe competence of current IT staff.~ i l , ( l ) m l j i E ! f i ( l j t s ' E p m ; t . i s : r s ACommunicationsTelephone and internet access to provide cllent service.BInsuranceGenera! liability insurance, including insurance coverage for property and equipmen t andprofessional liability insurance coverage for service staff.CEquipment Lease/RentalPortion of copier and telephone lease

100

89

67

80

255,7,1.2'

592'


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AIDS Arms, Inc.EXHIBIT A-3 (b)FY 2012- 2013 Ryan White Part A Formula Grant

Service Category -Local AIDS Pharmaceutical AssistanceI. INDIRECT PERSONNELALead Accountant - Sherrie Jackson:Reviews payroll before it is submitted for processing. Prepares financial statements andbillings for all grant funded activities. Assists CFO with other accounting and reportingactivities.Annual Salary 59,663 5%BStaff Accountant - Chakara Warren

3,000

Prepares payroll documents for processing, including benefits and deductions. Assists Lead Accountantwith other accounting duties.Annual SalaryC

34,320Staff Accountant- General Laffitte:

5%

Processes AlP and AIR. Assists Lead Accountant with other accounting duties.Annual SalaryD 40,000 4%

1,780

1,780Chief Financial Officer - Gilbert Kouame: Ensures accurate and timely financial reporting and auditactivities. Insures compliance with all financial requirements of funders, government andthe Board. Supervises staff accountant and IT staff. Provides financial strategic planning.Annual SalaryE

98,536 3% 2,670Chief Executive Officer-John Carlo: Responsible for all administrative and programmatic

17,240


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AIDS Arms, Inc.EXHIBIT A-3 (b)FY 2012- 2013 Ryan White Part A Formula Grant

Service Category -Local AIDS Pharmaceutical AssistanceRetirement 1.27% 219Disability Insurance 0.71% 122Life Insurance Expense 0.55% 95Workers' Compensation 0.48% 8321.18% 3,652

III. STAFF TRAVELIV. EQUIPMENTV. SUPPLIESVI. CONTRACTUALA

None RequestedNone RequestedNone Requested

Name of Subcontractor: Srosowske, Mares, Smothermon & Co., P.CAmount of Contract: 16,000 4%Method of Selection:Period of Performance:Description of Services:B

Bid / InterviewMarch 1, 2012 - February 28, 2013Performs Single Audit

Name of Subcontractor: Avior InnovationsAmount of Contract: 2,000Method of Selection: Bid / InterviewPeriod of Performance: March 1, 2012 - February 28, 2013

3%

Description of Services: Provides support for the accounting software (MIP)CName of Subcontractor: Custom Payroll Assoicates, CPA

623

57

725


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AIDS ARMS, INC,351 W. JEFFERSON BLVD SUITE 300DALLAS TX 75208-4599FEIN: 752306145

EXHIBIT B1: PERFORMANCE OBJECTIVE FORM

I I AIDS, 1BLVD. S,ite 300.y," W h i t ~ Progcam Part AIIPHONE

II OBJEC

,

~ ; ~ ~ y , ~ ~ ~ : ~ , ' o q vouc' I , If thece .ce problem "eas. descc'be youc pia" 10 , , 'veate.Service Category and Performance Amount Unttof Annual Target Completion Dates and

M"suce Goal clthec PI,"s,0, ,Total 'E Peeso" ,

Wome" Pmo"

" Pecso", I ,T o t a l i ~ Pees" ,

, Seeved'"'a"ts Peeso"

Pecso,

I i Medical Care 1$ 1 DotesU,it Cost I 1,396.74

II 2128/2013


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AIDS ARMS, INC.351 W. JEFFERSON BLVD SUITE 300DALLAS TX 75208-4599FEIN: 75-2306145FY 2012-2013 Ryan White Title Part A, B, & DSHS

AGENCY:AIDS Arms, Inc.351 W. Jefferson BLVD, Suite 300Dallas, Texas 75208-4599EIN: 75-2306145

I # I!OTAl LINE IrEM COS

68

172

L1

119120

124~ . 5 . I1ll

PI (Direct)

Fringe (Direct)Travel (Direct)(Direct)

Direct)_([)irecJlOther (Direct)Total DirectTotal Indirect- - - - -_ _---------

Part AFormula

454783014--046,07:

47,0881,446,97:148,21:

EXHIBIT C1: MULTIPLE FUNDING SOURCE FORM% OF TOTAL BUDGET FUNDED BY RYAN WHITE PART A, B & DSHS:% OF TOTAL BUDGET FUNDED BY Ryan White Part A Formula:% OF TOTAL BUDGET FUNDED BY Ryan White Part A Supplemental:% OF TOTAL BUDGET FUNDED BY Ryan White Part B :% OF TOTAL BUDGET FUNDED BY Ryan White Part A MAl:% OF TOTAL BUDGET FUNDED BY DSHS:

DALLAS COUNTY PASS TIPart A Part B

Supplemental FormulaC IDE329,978 3'69,888 67

4,920 5,4o -27,087 12,120.0(260,526 202,129.0(14,237 17,357.0(706,636 621,509,0(70,636 64,1 OO.O(

Part AMAl

352,9344,7534,435o8,625360,69211,748813,18770,345

DSHSG121,25'25,68214,019o9,33,50(4,637175,42819,20C

45.12%17.40%8.48%

7.48%9.64%2.12%

OTHER OTHERFEDERAU LOCALSTATE PRIVATE

H96,

79,1271-3;58,1961 9,03:6,96463,6682,714,097

INCOMEJ

17,2953,82950,000

4,00075,12424,8:

TOTALFUNDINGSOURCES

K

116,86750,000170,4651 607,907

1,473,72:

771;272 : : . S85 ,P! ! , : ; , , J !83 ,93 l ) . ; v': ::19:'1,g282;924;;'I,@::g;QoSi : : , 1 0 0 ; O O O , W a . 6 , 6 . 2 ~ 9


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EXHIBIT C2: ALLOCATION FORMAGENCY: AIDS Arms, Inc351 W. Jefferson, Suite 300Dallas, Texas 75208

. ' U ' A ' : ~ N : , e ~ u u " (Direct and Indirect Combined)

I ii

FY 2012-2013 Ryan White Part A, Band DSHS

EIN: 752306145

INCOME(%j SOURCES~ ~ ~ ; ~


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DALLAS COUNTYHEALTH AND HUMAN SERVICESGRANTS MANAGEMENTZACHARY THOMPSONDIRECTOR

TO: Zachary Thompson, DirectorFROM: Anrelio Rodriguez, Grants Management OfficerDATE: February 12,2013SUBJECT: FY 2012 - 2013 Part A Formula BudgetCONTRACTOR NAME: Dallas County Hospital DistrictGRANT PROGRAM: FY 2012 - 2013 Part A Formula BudgetThe attached contract was reviewed by Grants Management staff and is ready for signature. Thefollowing items were verified:ITEM1. Amount corresponds with Briefing and Court Order documents.


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CONTRACT FOR HIV/AIDS SERVICES DELIVERYFUNDED UNDER THE FY 2012 TITLE XXVI OF TIlE PHS ACT,AS AMENDED BY THE RYAN WHITE HIV/AIDS TREATMENTEXTENSION ACT OF 2009: PART A FORMULA FUNDING GRANT

CATALOG OF FEDERAL DOMESTIC ASSISTANCE (CDFA) NO. 93.914Between

DALLAS COUNTY HEALTH & HUMAN SERVICES(Contractor)

andDallas Connty Hospital District d.b.a. Parkland Healtb an d Hospital System

(Sub-Contractor)

I. PURPOSE:Contract Amendment No, 3 amends the HIV/AIDS Services Delivery Fnnded under the FY 2012Title XXVI of the PHS Act, as amended by the Ryan White HIV AIDS Treatment Extension Actof2009: Part A Formula grant agreement executed between Dallas County Health & HumanServices and Parkland Health and Hospital System, effective March 23, 2012,

n. AMENDED PROVISIONS:Contract Amendment No, 3 shall not change any contractual provisions agreed upon in the RyanWhite HIV/AIDS Treatment Extension Act Part A Formula funded agreement; each provision


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For:

B: AMENDED PROVISIONS:The revised Exhibit A-I (detailed for the line item service budget), A-3 (budgetjustification),B-1 (performance objectives), and CI and C2 (multiple funding sources)reflect increased funding in the AIDS Pharmaceutical Assistance, Case Management andAmbulatory/Outpatient Medical Care service categories.

C. TERM:Contract Amendment No.3 shall not affect the original term of the contact that is ineffectthrough Febl1lary 28, 2013.

Parkland Health and Hospital System

Walter Shaw__________(Print or type name)

For: Dallas County

Date


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EXHIBIT A-I (a): DETAILED LINE ITEM BUDGET FOR DIRECT COSTAGENCY: Dallas County Hospital District EIN:7S-6004221 GRANT: Ryan White Part A Formula Amend. #35201 Harry Hines Blvd., Dallas, Texas 75235-7793SERVICE CATEGORY:AIDS Pharmaceutical Assistance GRANT PERIOD: 03/23/2012 - 02128/2013

ALANNUALPOSITION SALARY


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EXIDBITA-I (b): DETAILED LINE ITEM BUDGET FOR INDIRECT COSTAGENCY: Dallas County Hospital District EIN:75-60042215201 Harry Hines Blvd., Dallas, Texas 75235-7793SERVICE CATEGORY:AIDS Pharmaceutical Assistance

GRANT: Rvan White Part A Formula Amend. #3

GRANT PERIOD: 0312312012 - 0212812013

ALLOCATED


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DIRECT PERSONNEL

DALLAS COUNTY HOSPITAL DISTRICTDBA/Parkland Health & Hospital System5201 Harry Hines Boulevard Dallas, Texas 75235-7793EIN: 75-6004221BUDGET JUSTIFICATION FOR DIRECT COSTSEXHIBIT A-3 (a)FY 2012 - 2013 Ryan White Part A Formula Amend. #3AIDS PHARMACEUTICAL ASSISTANCE

No Funds requested during this grant cycle.II FRINGE BENEFITS

No Funds requested during this grant cycle.III TRAVEL

No Funds requested during this grant cycle.IV EQUIPMENT

No Funds requested during this grant cycle.V SUPPLIES

No Funds requested during this grant cycle.VI CONTRACTUALNo Funds requested during this grant cycle.VII OTHER DIRECT COSTSOutpatient Medication Therapy: Medications that will improve the quality of life for the PLWH/Apopulation serviced by Dallas County Hospital District.VIII TOTAL DIRECT COSTSIX PROGRAM INCOME

No program income will be generated for this service category.

$

$

$

$

$

$

$

$$

X THIRD-PARTY REIMBURSEMENTS $All clients are screened at intake and re-assessed every six (6) months for eligibility and the potential for collectionof third party reimbursements. All third party reimbursement sources are utilized first before Ryan White Fundsare made available, making Ryan White funds the Payor of Last Resort. All third party reimbursements

441,093.00

441,093.00


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DALLAS COUNTY HOSPITAL DISTRICTDBA/Parkland Health & Hospital System5201 Harry Hines Boulevard Dallas, Texas 75235-7793EIN: 75-6004221BUDGET JUSTIFICATION FOR INDIRECT COSTS

Exhibit A-3 (b)FY 2012 - 2013 Ryan White Part A Formula Amend. #3AIDS PHARMACEUTICAL ASSISTANCEINDIRECT PERSONNELNo Funds requested during this grant cycle.

II FRINGE BENEFITSNo Funds requested during this grant cycle.

III TRAVEL No Funds requested during this grant cycle.IV EQUIPMENTNo Funds requested during this grant cycle.V SUPPLIESNo Funds requested during this grant cycle.VI CONTRACTUALNo Funds requested during this grant cycle.VII OTHER INDIRECT COSTSDallas County Hospital District has an approved Indirect Cost Rate of 23.4% (see attachment),we are requesting the 10% maximum authorized by Ryan White Legislation.VIII TOTAL INDIRECT COSTS

$$

$

$ $$$$$$

$

$ 49,010$ 49,010

$ 49,010


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EXHIBIT A2: DETAILED FEE FOR SERVICE BUDGETAGENCY: Dallas County Hospital District EIN:7560042215201 Harry Hines Blvd. , Dallas, Texas 752357793SERVICE CATEGORY: Outpatient/Ambulatory Medical Care

1. PROPOSED UNIT/UNITS OF SERVICE: Visi ts2. NUMBER OF UNITS OF SERVICES TO BE PROVIDED: 3,857

3. TOTAL COST OF SERVICES: $1,619.7364. PROPOSED UNIT COST FOR SERVICE: $420.005. BREAKDOWN OF TOTAL COSTS AND PROPOSED FEE FOR SERVICE:

GRANT: FY 12 1 3 Ryan White Part A FonnAmend. #3GRANT PERIOD: 03/23/201203/31/2013


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DIRECT PERSONNEL

DALLAS COUNTY HOSPITAL DISTRICTDBAIParkland Health & Hospital System5201 Harry Hines Boulevard DaUas, Texas 75235-7793EIN: 75-6004221BUDGET JUSTIFICATION FO R DIRECT COSTSEXHIBIT A-3 (a)

FY 2012 - 2013 Ryan White Part A Form Amend. #3OUTPATIENT/AMBULATORY MEDICAL CARE

A. Medical Assistant, (T. Bamett)(C. Parramore) (S. Copland)(VACANT)(A. Lara) (A. Jackson) (G. Hernandez)Annual Salari es"" $196,602 40%Job Duties: Assists clinical staff with patient care including vital signs and dressing changes.

B. Clinic Staff Assistant, (L. Ayers)(C. McCoy)(S. Green)(C. McKinney)(V. Nunez)(C. Rodriguez)(H. Rodriguez)(1 Jackman)(W. Powers) Annual Salaries"" $286,415 39%Job Duties: Must be proficient with automated office equipment; will prioritize and transcribephysician orders; management of medical records and telephones.

C. Physician Assistant,(c. Cole-Johnson)Annua! Salaries = $140,026 37%Job Duties: Performs patient services and treatments under the supervision of a physician;assesses health status of patients; formulates, initiates; and implements plan of care.D. Business Operations Supervisor, (M. Briones)Annual Salaries == $46,634 40%Job Duties: Directs duties of Clinic Staf f Assistants. Must be proficient with automated officeequipment, will prioritize and transcribe physician orders; management of medical recordsand telephoneE. Dietician, (M. Medina)Annual Salaries "" $46,820 39%Job Duties: Provides nutrition counseling and diet instruction according to physician orders.F. AIDS Regisrrar,(W. Traylor)( R. Thompson)(G. Pedroza)(S. Contreras)

Annual Salaries"" $170,040 38%Job Duties: Abstracts medical charts of HIV and AIDS patients treated at PHHS to ensureaccurate grants management and reporting to funding sources. Provides support for ARIESoperation, report generation and data entry.G. Departmental Systems Manager, (D.Olivarez)Annual Salaries = $99,195 40%

Job Duties: Responsible for tbe overall information systems operations management in the HIVDepartment including database creation/implementation/maintenance, applications analysis, project

$ 1,214,673

$ 78,640

112,477

51,879

18,653

18,260

64,103

39,678


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DIRECT PERSONNEL (con'td)

DALLAS COUNTY UOSI'ITAL DISTR[CTDBA/ParkJand Health & Hospital System

5201 Harry Hines Boulevard Dallas, Texas 7 5 2 3 5 ~ 7 7 9 3 E[N: 75-6004221

BUDGET JUSTIFICATION FOR DIRECT COSTSEXHIBIT A-3 (a)

FY 2012 - 2013 Ryan White Par t A Form Amend. #3OUTPATIENT/AMBULATORY MEDICAL CAREK. Registered Nurse,(W. Milne)(Y. Murphy) (A Moore)(D. Peters)(T. Sullins)(M. Olivo)(M. D'Andrad e)

(A Williams) (VACANT)Annual Salaries"" $622,252 41%Job Duties: For advocacy; explains clinic services; facilitates management ofpaticnt concerns.Clinically responsibility for total nursing ca re of patients; assesses, plans, and evaluates patientneeds, directs clinic staff, and teaches self-help measures.

L. Amb. Clinical StaffPhannacist,(H. Ekpunobi) (P.T. Lam)Annual Sal ar ies'" $233,147 40%Job Duties: Provides needed clinic medications; serves as an active member of the HIV ClinicTeam, provides pharmaceutical consulting services for HIV patients.

M. Staff Adult HIV Physician,(M. Akbar) (D. Morris-Harris)(E. Rahman)(R. Ghurani)Annual Salaries:= $718,800" 24%Job Duties: Provide medical care to DCHD HIV/AIDS patients; responsible for the longitudinalcare of p a t i e n t ~ < Monitor the care of patients which includes, quality improvement, databasedevelopment, and mentoring of HlV/ AIDS care providers.

N. Lead Registered Nurse, (c . Loreto) (M. Brown)Annual Salaries = $133,057 40%Job Duties: Responsible for lead capacity supervision of assigned nursing staff in order to ensurethe provision of comprehensive health care for patients accessing COPC Health Centers.

O. Radiology Technician,(V. Duke: Annual Salaries = $77 459 38%.Tob Duties: Performs general diagnostic radiological exams and basic phlebotomy functions, as credentialed.

P. Phannacy Tech,(L Corpus) Annual Salari es"" $48,443 40%Job Duties: Prepares medications (inhalation/injectable) under the direct supervision ofphannacist.

Merit Increases: Parkland employees historically receive merit raises at an average rate of 4%.Total salaries: $0.00/26 X .04 X 10"" $0.00

$ 255,124

93,259

174,2[9

53,223

29,435

19,377

so

tActual base full time salaries are: Dr. Akbar ($212,784). Dr. Ghurani ($181,709), Dr. Morris- Harris ($218,046) and Dr. R.ahmann ($191,755); RW legislativesalary limitation for Executive Level !I is $179,700; Parkland Health and Hospital System agrees to fund salaries in excess oftbe mandated cap.


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IX PROGRAM INCOME

DALLAS COUNTY HOSPITAL DISTRICTDBA/Parkland Health & Hospital System

5201 Harry Hines Boulevard Dallas, Texas 75235M 7793EIN: 75-6004221

BUDGET JUSTIFICATION FO R DIRECT COSTSEXHIBIT A-3 (a)

FY 2012 - 2013 Ryan White Part A Form Amend. #3OUTI'ATIENT/AMBULATO RY MEDICAL CARE

Dallas County Hospital District (HIV Clinics) charges a flat fee for services based on the following:No charges to persons with income less than or equal to one hundred perce nt (lOO%) of heU.S. Department of Health and Human Services Poverty Guidelines published annually in the Federal Register.Charges are assessed to persons with an income greater than one hundred perc ent (100%) of he PovertyGuidelines but less than three hundred percent (300%). This is based 011 gross individual/family incomewhich is assessed at intake and fe-assessed every six (6) months, Individual/family annual aggregate fees will confomlto the limitation established in the table listed in this contract under "7. CONTRACTOR'S OBLIGATIONS: (I)Charges to Clients.The Dallas County Hospital District (HIV Clinic) has a policy of not denying anyone services based on theirinability to pay a fee,

Any income generated from fee coi!ectioll is used to provide HIV primary care services.X THIRD-PARTY REIMBURSEMENTS

All client'! are screened at intake and r e ~ a s s e s s e d every six (6) months for eligibility and the potential for collectionof hird party reimbursements. All third party reimbursement sources are utilized first before Ryan White Fundsare made available, making Ryan White funds the Payor of Last Resort. All third party reimbursementsare tracked separately.

$0

so


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II

DALLAS COUNTY HOSPITAL DISTRICTDBAlParkland Health & Hospital System

5201 Harry Hines Boulevard Dallas, Texas 7 5 2 3 S ~ 7 7 9 3 EIN: 75-6004221BUDGET JUSTIFICATION FOR INDIRECT COSTS.EXHIBIT A-3 (b)FY 2012- 2013 RyanWhite Part A Form Amend. #3OUTPATIENT/AMBULATORYMEDICAL CARE

INDIRECT PERSONNELA Performance Improvement Analayst, (VACANT)

Annual Salaries = $80,454 19%Job Duties: Organizes and coordinates Quality Improvement activities and analyzes and developsreports to ensure compliance with regulatory standards.B. Sr. Grant Specialist cr. Stanfield)Annual Salaries"'" $67,600 30%Job Duties: Directs the management of all fiscal, administrative, monitoring and reporting activities.Prepares and submits financial spreadsheets and program management reports to appropriatedepartments. Assists in audits and the preparation of grant proposals. Furnishes technicalguidance to help ensure we develop and maintain a cost-effective operation.C. Administrative Assistant, (S. Villanueva)Annual Salaries = $47,653 28%Job Duties: Manages administrative support functions for the HIV Department. Provides directservices to HIV adminstrative personnel. Organizes meetings, develops correspondence,maintains schedules and works on special projects.D. Development Associate, (N. Piel Brown)Annual Salaries = $71,677 13%Job Duties: Plans, writes, budgets and submits grant proposals for HIV/AlDS programs tofederal, state, and local govemments, foundations and donors to provide optimal granl/donorsource revenue that supports the missions, goals and objectives of PHHS and the HIV/AIDS area.Merit Increases: Parkland employees historically receive merit raises at an average rate 01'4%.Total salaries: $0.00/26 X .04 X 10 = $0.00FRINGE BENEFITS 20.1%

Insurance(MedicaI/Life) 11.0%Socia! Security 0%Retirement 3.0%Workers Compensation 0.3%

$ 58,640$ 15,206

20,280

13,478

9,676

$0

11,7866,4501,759176


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EXHIBIT A-I (a): DETAILED LINE ITEM BUDGET FOR DIRECT COSTAGENCY: Dallas Countv Hospital District EIN:75-60042215201 HarryHines Blvd., Dallas, Texas 75235-7793SERVICE CATEGORY: Case Management (Non-Medical)

TOTALANNUAL

GRANT: FY 12 -13 Ryan White Part A Formula Amend. #3

GRANT PERIOD: 03/23/2012 - 02/28/2013% Bdgtd. TOTAL AMOUNT

from ALLOCATED


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EXIDBIT A-I (b): DETAILED LINE ITEM BUDGET FOR INDIRECT COSTAGENCY: Dallas County Hospital District EIN:75-60042215201 Harry Hines Blvd., Dallas, Texas 75235-7793SERVICE CATEGORY: Case Management (Non-MedicaI)

POSITION TITLE

GRANT: FY 12 13 RvanWhite Part A Fonnula Amend. #3

GRANT PERIOD: 03/2312012 - 0212812013


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DmEeT PERSONNEL

DALLAS COUNTY HOSPITAL DISTRICTDBAlParldand Health & Hospital System

5201 Harry Hines Boulevard Dallas , Texas 75235-7793EIN: 75-6004221

BUDGET JUSTIFICATION FOR DIRECT COSTSEXHIBIT A-3 (a)

FY 2012 2013 Ryan White PartA Formula Amend. #3CASE MANAGEMENT (Non-Medical)

A MSW Case Manager, (L. Barnes), (E. Bockarie), (M.Gonnan), (J. Green) Cc. Martin) CW. Robinson) (0Williams) (J. Wilson),(Annual Salaries"" $518,056), 26%Job Duties: Responsible for completing patient assessment based on targeted population and financial planauthorization, Estabiishes plan of care for identifie d patients. Implements plan of care based on patient assessmentPromotes collaborative practice between the patient, family, and healthcare disciplines. Intervenes to optimize useof resources. Serves as a communication liaison with patient/family, significant otner. Evaluates and revises plan ofcare. Co-ordinates planning and completes documentation in the medical record. Collects outcome data, Participatesin perfonnance improvemen t

B. Client Advocate, (E. Trevino), Annual Sa)ary = $ 44,886 37%Job Duties: Respons ible for conduc ting intake, screening, and triage at point of entry for Initia Service Visit (ISV)and Walk-in patients.

S134,376

$16,797

C. MSW Program Manager, (A. DeLa Rosa), Annual Salary "" $ 74,173 23% S16,797Job Duties: Responsible for providing quality control for case managerment (non-medical) services. Also assist with completingpatient assesments based on targeted populatio n and financial plan authorization. Establi shes plan of care for identified

$ 167,970

Implements plan of care based on patient assessment. Promotes collaborative practice between the patient, family, and healthcare disciplines.Intervenes to optimize use of resources. Serves as a communication liaison with patient/family, significant other. Evaluates and revises plan ofcare. Co-ordinates planning and completes documentation in the medical record. Collects outcome data_ Participates in performance improvement

Merit Increases: Parkland employees historically receive meri t raises at an average rate of 4%Total salaries: $0.00/26 X .04 X 10 = $0,00

II FRINGE BENKFlTSI nsurance(M edicaJlLifeSocial SecurityRetirementWorkers Compensation

20.1%

Others (Disability, Unemployment,Medicare, Life Insurance, and Supp. Ret.)

11.0%3.0%0.3%5.8%

so

$ 33,76218,4775,039504

9.742


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INDIRECT PERSONNEL

DALLAS COUNTY HOSPITAL DISTRICTDBAlParldand Health & Hospital System

5201 Harry Hines Boulevard Dallas, Texas 75235R7793EIN: 75-6004221BUDGET JUSTIFICATION FO R INDIRECT COSTSEXHIBIT A-3 (b)

FY 2012 - 2013 Ryan White Part A Formula Amend. #3CASE MANAGEMENT (Non-Medical)

A. RN Case Management Manager, (Vacant), Annual Salary = $93,600 20%Job Duties: Plans, organizes, develops and monitors all activities of he Case Management Program, including hiringorienting, conducting staff meetings and perfonning perfonnance improvement. Assists in the coordi nation of allhealth and human services and empowering families and clients to access appropriate healthRrelated resources.Ensures that all Case Managers (R N and MSW) individualize plan of service and coordinate activities within the programplan of service and coordinate activities within the program.

Merit Increases: Parkland employees historically receive merit raises at an average rate of 4%.Total salaries: $0,00/26 X ,04 X 10 =$0.00

II FRINGE BENEFITS 20.1%Insurance(MedicallLife)Social SecurityRetirement

11.0%

Workers CompensationOthers (Disability, Unemployment, Medicare,Life Insurance, and Supp. Ret.)

II I TRAVELNo Funds requested during this grant cycle.

IV EQUIPMENTNo Funds requested during this grant cycle.

V SUPPLIESNo Funds requested during this grant cycle.

3,0%0.3%5.8%

$ 18,661S 18,661

$0

$ 3,7512,053

56056

1,082

$$

$


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5201 Harry Hines BlvdI ,Texas 752357793

PERFORMANCE OBJECTIVE FORMEXHIBIT 81

Target Completion Dates andOther


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PERFORMANCE OBJECTIVE FORMEXHIBIT B-1

Annual Target Completion Dates andOther I Comments


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EXHIBIT C- l : MULTIPLE FUNDING SOURCE FORMAGENCY: DALLAS COUNTY HOSPITAL DISTRICTADDRESS : 5201 Harry Hines Blvd

Dallas Texas 75235-7793

# TOTAL LINE ITEM COSTRW Part AFormulaAmend.#3

A B1 Personnel $1,717,1262 Frinqe Benefits $345,1443 Travel4 Eauioment5 Supplies6 Contractual7 Other $441,093

% OF TOTAL BUDGET FUNDED BY (Part A Formula Amd#3): 27%% OF TOTAL BUDGET FUNDED BY (Part A Supplemental Amd.#2):% OF TOTAL BUDGET FUNDED BY (Part A MAl Amd.#1):% OF TOTAL BUDGE T FUNDED BY (Part B):% OF TOTAL BUDGET FUNDED BY (State Services):

FUNDING SOURCES

1:!%0.3%13%1_2%

DALLAS COUNTY PA::;S THROUGH GRANTSRW Part A RW Part A RW STATE DSHS OTHERSupplemental MAl Part 8 SRVCS. HOPWA FED.Amend.#2 Amend.#1

C D E F G H$779,765 $24,612 $927,336 $37,272 $1,758,855$152,054 $5,538 $208,651 $8,386 $397,258

$1,010

$15,857$25,467

$184,910 $28,577 $68,067 $10,693

OTHER GRANTSOTHER OTHERSTATE LOCAUPRIVATEI J

$223,970 $ 1,596,150$51,513 $ 416,151

$115,962

8 . l l I ' ~ l I j l l \ ' Q l l m l ~ i l l l ! 1 i ! . I l m 1 : . i l t i ! ~ 877J!-iI'.i$l!'ll'llI'lll1 f J 1 f l K 2 ~ 1 f ' ~ 1 ~ : i f u f l i i ~ ~ ' ~ ~ t 4 ~ : k ~ 2 } : 1 ; ) : r f ~ r ~ \ l $ , : , t t } ? i r J ? t A t 1 1 " ~ ~ f ; l ~ _ ~ 9101112131415161718192021

Indirect Costs $271,162 $120,935 $3,350

Dallas County Hospital District dba Parkland Health & Hospital SystemFY 2012 RW Programs

$121,937 $12,636 $155,712 $28,555

PROGRAM TOTALINCOME FUNDINGSOURCESK L

$ 7,065,086$ 1,584,695$ 1,010$ -$ 131,819$ 25,467$ 733,340

~ 1 . j ( & , $ 714,287

I


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EXHIBIT C-2: ALLOCATION fORMAGENCY: DALLAS COUNTY HOSPITAl PISTRICTADDRESS: 5201 Harr y HinesBNdDanas. Texas 75235-7793

(Direct and indirect Combined)

DeUas County Hospital DistrictdDa Parkland Heatlh & Hospital SystemFY 2012 RW Programs

E I N : ~

(%) INCOME("10)

Page 2 of 3


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EXHIBIT C_2: ALLOCATION FORMAGENCY; QAt! ASCOUNTI HOSPITAl DISTRICTADDRESS: 52Q1 Hany Hines BM:!Dallas. Texas 7 5 2 . ~

(Direct and Indirect Combined)

Admll1

Dallas County Hospital District dba Parkland Health & Hospital System

EXPENSEMAl(%)

E I N ; ~

(%) (%) FUNDING(%) INCOME(%)

Documents

DalCo 2013-02-26 RyanWhiteFunds