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HomeMy WebLinkAboutResolutions - 2011.01.20 - 10356HUMAN RESOURCtS COMMITTEE *MISCELLANEOUS RESOLUTION h1018 „, CA,. ,...) COUNTY OF OAKLAND DEPARTMENT OF HEALTH AND HUMAN SERVICES - HEALTH DIVISION FY 2010/2011 COMPREHENSIVE PLANNING, BUDGETING, AND CONTRACTING AGREEMENT (CPBC) ACCEPTANCE The Oakland County Health Division (OCHD) is accepting funding through the CPBC Agreement from the Michigan Department of Community Health (MDCH) in the total amount of $9,339,870. • The Agreement is for the period October 1, 2010 through September 30, 2011. • The Agreement provides for categorical grant funding and partial reimbursement for services provided in accordance with the Public Health Code (P.A. 368 of 1978, as amended). Changes included in the FY 2010/11 Agreement include: • Funding in the amount of $113,169 has been awarded to equip and staff the laboratory to maintain "Level B" status, which will allow the laboratory to examine potential bioterrorism- related materials. • Other Bioterrorism-related funding includes $228,215 for the Cities Readiness Initiative, a program to dispense medications to large populations in very short time frames in the event of an emergency, and $10,000 to defray the costs of housing the Regional Epidemiologist. • Funding has been discontinued for the Expanded HIV Testing, Generations with Promise and H1N1 programs. COUNTY OF OAKLAND DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH DIVISION FY 2010/2011 COMPREHENSIVE PLANNING, BUDGETING, AND CONT • CTING AGREEMENT (CPBC) ACCEPTANCE • The Oakland County Health Division (OCHD) is accepting funding through the CPBC Agreement from the Michigan Department of Community Health (MDCH) in the total amount of $9,339,870. • The Agreement is for the period October 1, 2010 through September 30, 2011. • The Agreement provides for categorical grant funding and partial reimbursement for services provided in accordance with the Public Health Code (P.A. 368 of 1978, as amended). Changes included in the FY 2010/11 Agreement include: • Funding in the amount of $113,169 has been awarded to equip and staff the laboratory to maintain "Level B" status, which will allow the laboratory to examine potential bioterrorism- related materials. • Other Bioterrorism-related funding includes $228,215 for the Cities Readiness Initiative, a program to dispense medications to large populations in very short time frames in the event of an emergency, and $10,000 to defray the costs of housing the Regional Epidemiologist. • Funding has been discontinued for the Expanded HIV Testing, Generations with Promise and H1N1 programs. LAt LA-0 Page 1 of 2 Tom Fackler GRANT REVIEW SIGN OFF — Health Division GRANT NAME: 2011 Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement FUNDING AGENCY: Michigan Department of Community health DEPARTMENT CONTACT PERSON: Tom Fockler / 452-2151 STATUS: Grant Acceptance DATE: November 16, 2010 Pursuant to Misc. Resolution #01320, please be advised the captioned grant materials have completed internal grant review. Below are the returned comments. The captioned grant materials and grant acceptance package (which should include the Board of Commissioners' Liaison Committee Resolution, the grant agreement/contract, Finance Committee Fiscal Note, and this Sign Off email containing grant review comments) may bc requested to be placed on the appropriate Board of Commissioners' committee(s) for grant acceptance by Board resolution. DEPARTMENT REVIEW Department of Management and Budget: Approved. — Laurie Van Pelt (10/1/2010) Department of Human Resources: Approved. — Cathy Shallal (10/1/2010) Risk Management and Safety: Changes requested by Corporation Counsel noted (see attached). Approved by Risk Management. — Andrea Plotkowski (10/18/2010) Corporation Counsel: I have finally heard back from the State regarding my proposed changes to the county's Addendum A. I approve the CPBC grant for FYI 0/1 1 assuming it contains the new language in Addendum A regarding liability. — Bradley G. Berm (11/5/2010) COMPLIANCE The grant agreement and attachments reference an extensive number of federal and state regulations, including the American Recovery and Reinvestment Act (ARRA). Please refer to the documents for specifically cited 11/16/2010 Page 2 of 2 compliance requirements for this grant. &aka V. Piir Grants Compliance and Programs Coordinator Oakland County Fiscal Services bivision Phone (248) 858-1037 Fax (248) 858-9724 pi irgeoakgov.com 11/16/2010 11/17/2010 Contract #: Grant Agreement Between Michigan Department of Community Health hereinafter referred to as the "Department" and County of Oakland hereinafter referred to as the "Local Governing Entity" on Behalf of Health Department Oakland County Department of Health and Human Services/ Health Division 1200 N. Telegraph Rd. Pontiac MI 48341 0432 Federal I.D.#: 38-6004876 hereinafter referred to as the "Contractor" for Comprehensive Agreement - FY 2011 Part I 1. Purpose This agreement is entered into for the purpose of setting forth a joint and cooperative Contractor/Department relationship and basis for facilitating the delivery of public health services to the citizens of Michigan under their jurisdiction, as described in the attached Annual Budget, established Minimum Program Requirements, and all other applicable Federal, State and Local laws and regulations pertaining to the Contractor and the Department. Public health services to be delivered under this agreement include Local Public Health Operations (LPHO) and Categorical Programs as specified in the attachments to this agreement. 2. Period of Agreement: This agreement shall commence on October 1, 2010 and continue through September 30, 2011. This agreement is full force and effect for the period specified. The Department has the option to assume no responsibility for costs incurred by the Contractor prior to the signing of this agreement. 3. Program Budget and Agreement Amount A. Agreement Amount In accordance with Attachment IV - Funding/Reimbursement Matrix, the total State budget and amount committed for this period for the program elements covered by this agreement is $9,339,870.00. B. Equipment Purchases and Title Any equipment purchases supported in whole or in part by the Department with categorical funding must be specified in an attachment to the Program Budget Comprehensive Agreement - FY 2011 Page: 1 of 30 11/17/2010 equipment supports such retention or transfer of title. C. Budget Transfers and Adjustments 1. Transfers between categories within any program element budget supported in whole or in part by state/federal categorical sources of funding shall be limited to increases in an expenditure budget category by $10,000 or fifteen percent (15%) whichever is greater. This transfer authority does not authorize establishment of new budget categories, purchase of additional equipment items or new subcontracts with state/federal categorical funds without prior written approval of the Department. 2. Any transfers or adjustments invoiving State/Federal categorical funds, other than those covered by C.1, including any related adjustment to the total state amount of the budget, must be made in writing through a formal amendment executed by all parties to this agreement in accordance with Section VIII. A. of Part II. 3. The C.1 and C.2 provisions authorizing transfers or changes in local funds apply also to the Family Planning program, provided statewide local maintenance of effort is not diminished in total. Any statewide diminishing of total local effort for family planning and/or any related funding penalty experienced by the Department shall be recovered proportionately from each local Contractor that, during the course of the agreement period, chose to reduce or transfer local funds from the Family Planning program. 5. Statement of Work Comprehensive Agreement - FY 2011 Page: 2 of 30 11/17/2010 The Contractor agrees to undertake, perform and complete the services described in Attachment Ill - Program Specific Assurances and Requirements and the other applicable attachments to this agreement which are part of this agreement through reference. Comprehensive Agreement - FY 2011 Page: 3 of 30 11/17/2010 Name: Jeanette Hensler, COMP Liaison Location/Building: 4th Floor, Lewis Cass Building Telephone No.: 517-241-8764 Email Address: henslerj1@Michigan.gov OR Name: Lucie Taylor, COMP Liaison Location/Building: 4th Floor, Lewis Cass Building Telephone No.: 517-241-4834 Email Address: taylorluc@Michigan.gov Comprehensive Agreement - FY 2011 Page: 4 of 30 11/17/2010 Name (please print) Title Signature Date For the Michigan Department of Community Health Mary Jane Russell, Deputy Director, Operations Administration Date Comprehensive Agreement - FY 2011 Page: 5 of 30 11/17/2010 Part II General Provisions I. Responsibilities - Contractor The Contractor in accordance with the general purposes and objectives of this 2. Any materials copyrighted by the Contractor or modifications bearing acknowledgment of the Department's name must be approved by the Department prior to reproduction and use of such materials. 3. The Contractor shall give recognition to the Department in any and all publication papers and presentations arising from the program and service contract herein; the Department will do likewise. 4. The Contractor shall notify the Department's Grants and Purchasing Division 30 days prior to applying to register a copyright with the U.S. Copyright Office. B. Fees Make reasonable efforts to collect 1st and 3rd party fees, where applicable, and report these as outlined by the Department's fiscal procedures. Any underrecoveries of otherwise available fees resulting from failure to bill for eligible services will be excluded from reimbursable expenditures. C. Program Operation Provide the necessary administrative, professional, and technical staff for Comprehensive Agreement - FY 2011 Page: 6 of 30 11/17/2010 of the final expenditure report or until litigation and audit findings have been resolved. F. Authorized Access Permit upon reasonable notification and at reasonable times, access by authorized representatives of the Department, Federal Grantor Agency, Comptroller General of the United States and State Auditor General, or any of their duly authorized representatives, to records, files and documentation related to this agreement, to the extent authorized by applicable state or federal law, rule or regulation. 1. Single Audit Provide, consistent with the regulations set forth in the Single Audit Act Amendments of 1996, P.L. 104-156, and Section .320 of the Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," a copy of the Contractor's annual Single Audit reporting package, including the Corrective Action Plan, and management letter (if one is issued) with a response to the Department. The Contractor must assure that the Schedule of Expenditures of Federal Awards includes expenditures for all federally-funded grants. 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures' or additional audits to meet their needs. 3. Due Date The Single Audit reporting package, management letter (if one is issued) with a response and Corrective Action Plan shall be submitted to the Department within nine months after the end of the Contractor's fiscal year. The Single Audit reporting package, management letter, and Corrective Action Plan shall be filed with the Department even if there are no findings or disclosures reported in the audit pertaining to Department programs. Comprehensive Agreement - FY 2011 Page: 7 of 30 11/17/2010 the cognizant or oversight agency for audit. 5. Where to Send Alternatives to paper filing may be viewed at www.michigan.gov/mdch by selecting Inside Community Health MDCH Audit. H. SubrecipientNendor Monitoring The Contractor must ensure that each of its subrecipients comply with the Single Audit Act requirements. The Contractor must issue management decisions on audit findings of their subrecipients as required by OMB Circular A- 133. The Contractor must also develop a subrecipient monitoring plan that addresses "during the award monitoring" of subrecipients to provide reasonable assurance that the subreciplent administers Federal awards in compliance with laws, regulations, and the provisions of contracts, and that performance goals are achieved. The subrecipient monitoring plan should include a risk-based assessment to determine the level of oversight, and monitoring activities such as reviewing financial and performance reports, performing site visits, and maintaining regular contact with subrecipients. The Contractor must establish requirements to ensure compliance by for-profit subrecipients as required by OMB Circular A-133, Section .210(e). The Contractor must ensure that transactions with vendors comply with laws, regulations and provisions of contracts or grant agreements in compliance with OMB Circular A-133, Section .210 (f). Notification of Modifications Provide timely notification to the Department, in writing, of any action by the Contractor, its governing board or any other funding source which would require or result in significant modification in the provision of services, funding or compliance with operational procedures. J. Software Compliance Comprehensive Agreement - FY 2011 Page: 8 of 30 11/17/2010 The Contractor must ensure that software compliance and compatibility with the Department's data systems for services provided under this agreement including but not limited to: stored data, databases, and interfaces for the production of work products and reports. All required data under this agreement shall be provided in an accurate and timely manner without interruption, failure or errors due to the inaccuracy of the Contractor's business operations for processing date/time data. K. Human Subjects The Contractor will comply with Protection of Human Subjects Act, 45 CFR, Part 46. The Contractor agrees that prior to the initiation of the research, the Contractor will submit institutional Review Board (IRB) application material for all research involving human subjects, which is conducted in programs sponsored by the Department or in programs which receive funding from or through the State of Michigan, to the Department's IRB for review and approval, or the IRB application and approval materials for acceptance of the review of another IRB. All such research must be approved by a federally assured 1RB, but the Department's IRB can only accept the review and approval of another institution's IRB under a formally-approved interdepartmental agreement. The manner of the review will be agreed upon between the Department's IRB Chairperson and the Contractor's IRB Chairperson or Executive Officer(s). L. Terms To abide by the terms of this agreement including all attachments. M. Minimum Program Requirements To comply with Minimum Program Requirements promulgated in accordance with Section 2472.3 ot 1978 PA 368 as amended, MCL 333.2472.3, MSA 14.15 (2472.3), for each applicable program element funded under this agreement. N. Annual Budget and Plan Submission To submit an Annual Budget and Plan request to the Department, in accordance with instructions established by the Department, to serve as the basis for completion of specific details for Attachments I and IV of this agreement via Contractor/Department negotiated amendment(s). Failure to submit a complete Annual Budget and Plan by the due date will result in the deferral of Department payments until these documents are submitted. 0. Maintenance of Effort All agencies shall comply with maintenance of effort requirements for LPHO, as defined in the current Department appropriation act, and Family Planning in accordance with federal requirements, except as noted in Section 3.C.3 of Part I. P. Accreditation 1. All Contractors shall comply with the local public health accreditation standards and follow the accreditation process and schedule established by the Department to achieve full accreditation status. Contractors that fail to Comprehensive Agreement - FY 2011 Page: 9 of 30 11/17/2010 Contractors that disagree with on-site review findings or their accreditation status may request an inquiry through written request to the Department. The request must identify the disagreement and resolution sought. The inquiry participants will be comprised of Contractor staff, Department staff, the Accreditation Commission Chair, and the Accreditation Coordinator as needed. Participants will clarify facts, verify information and seek resolution. 2. Consent Agreements/Administrative Compliance Orders/Administrative Hearings for "Not Accredited" Contractors: a. Contractors designated as "Not Accredited", will receive a Consent Agreement Package from the Department. Contractors and their local governing entities shall be given 75 days to review the package, meet with the Department. and sign/return the Consent Agreement. b. Fulfillment of the terms and conditions of the Consent Agreement will not affect accreditation status, but impacts the Contractors' ability to fulfill its contractual obligations under the Comprehensive Planning, Budgeting and Contracting Agreement. Contractors designated as "Not Accredited", will retain this designation until the subsequent accreditation cycle. c. Contractor failure to fulfill the terms and conditions of the Consent Agreement within the prescribed time period will result in the issuance of an Administrative Compliance Order by the Department. d. Within 60 working days after receipt of an Administrative Compliance Order and proposed compliance period, a local governing entity may petition the Department for an administrative hearing. If the local governing entity does not petition the Department for a hearing within Q. Medicaid Outreach Activities Reimbursement Comprehensive Agreement - FY 2011 Page: 10 of 30 11/17/2010 The Contractor agrees to report allowable costs and request reimbursement for the Medicaid Outreach activities it provides in accordance with 2 CFR, Part 225 (OMB Circular A-87) and the requirements in Medicaid Bulletin number: MSA 05- 29. The Contractor agrees to submit a Cost Allocation Plan Certification to the Department to bill for the Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid until a change is made to the cost allocation plan or the Department determines it is invalid. The Contractor will submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR for the Children with Special Health Care Services Medicaid Outreach activities in accordance with the instructions contained in Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Contractor agrees to target their Medicaid outreach effort toward Department established priorities. For FY 10/11, the Department priorities are: lead testing, outreach and enrollment for the Family Planning waiver, and outreach for pregnant women, mothers and infants for the Maternal and Infant Health Program. The Contractor will submit a report using the MDCH Local Health Department Medicaid Outreach form describing their outreach activities targeting the priorities 30 days after the end of a fiscal year quarter and at the same time as the final COMPREHENSIVE FSR is due into the Department. The Local Health Department Medicaid Outreach report is to be sent to the Division of Family and Community Health as specified on the form. II. Responsibilities - Department The Department in accordance with the general purposes and objectives of this agreement will: A. Payment Provide payment in accordance with the terms and conditions of this agreement based upon appropriate reports, records, and documentation maintained by the Contractor. Comprehensive Agreement - FY 2011 Page: 11 of 30 11/17/2010 To identify for the Contractor relevant laws, rules, regulations, policies, procedures, guidelines and State and Federal manuals, and provide the Contractor with copies of these documents to the extent they are not otherwise available to the Contractor. G. Monitor Compliance To monitor compliance with all applicable provisions contained in federal grant awards and their attendant rules, regulations and requirements pertaining to program elements covered by this agreement. H. Reimbursement To reimburse local agencies for costs based upon timely, accurately completed Financial Status Reports in accordance with Section IV. Technical Assistance To make technical assistance available to the Contractor for the implementation of this agreement. J. Health Insurance Portability and Accountability The Department assures that it will be in compliance with the Health Insurance Portability and Accountability Act. K. Accreditation The Department agrees to adhere to the accreditation requirements including the process for "Not Accredited" Contractors. The process includes developing and monitoring consent agreements, issuing and monitoring administrative compliance orders, participating in administrative hearings and petitioning appropriate circuit courts. L. Medicaid Outreach Activities Reimbursement The Department agrees to reimburse the Contractor for all allowable Medicaid Outreach activities that meet the standards of the Medicaid Bulletin: MSA 05-29 including the cost allocation plan certification and that are billed in accordance with the requirements in Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Department will identify each fiscal year the Medicaid Outreach priorities and establish a reporting requirement for the Contractor. III. Assurances Comprehensive Agreement - FY 2011 Page: 12 of 30 11/17/2010 The following assurances are hereby given to the Department. A. Compliance with Applicable Laws The Contractor will comply with applicable federal and state laws, guidelines, rules and regulations in carrying out the terms of this agreement. The Contractor will also comply with all applicable general administrative requirements such as OMB Circulars covering cost principles, grant/agreement principles, and audits in carrying out the terms of this agreement. Comprehensive Agreement - FY 2011 Page: 13 of 30 11/17/2010 C. Non-Discrimination 1. The Contractor agrees not to discriminate against any employee or applicant for employment or service delivery and access, with respect to their hire, tenure, terms, conditions or privileges of employment, programs and services provided or any matter directly or indirectly related to employment, because of race, color, religion, national origin, ancestry, age, sex, height, weight, marital status, physical or mental disability unrelated to the individual's ability to perform the duties of the particular job or position or to receive services. The Contractor further agrees that every subcontract entered into for the performance of any contract or purchase order resulting herefrom will contain a provision requiring non-discrimination in employment, service delivery and access, as herein specified binding upon each subcontractor. This covenant is required pursuant to the Elliot Larsen Civil Rights Act, 1976 PA 453, as amended, MCL 37,2201 et seq, and the Persons with Disabilities Civil Rights Act, 1976 PA 220, as amended, MCL 37.1101 et seq, and any breach thereof may be regarded as a material breach of the contract or purchase order. 2. The Contractor will comply with all Federal statutes relating to nondiscrimination. These include but are not limited to: a. Title VI of the Civil Rights Act of 1964 (P.L. 88-352) which prohibits discrimination on the basis of race, color or national origin; b. Title IX of the Education Amendments of 1972, as amended (20 U.S.C. §§1681-1683, and 1685-1686), which prohibits discrimination on the basis of sex; c. Section 504 of the Rehabilitation Act of 1973, as amended (29 U.S.C. §794), which prohibits discrimination on the basis of handicaps; d. the Age Discrimination Act of 1975, as amended (42 U.S.C. §§6101- 6107), which prohibits discrimination on the basis of age; Comprehensive Agreement - FY 2011 Page: 14 of 30 11/17/2010 alcoholism; g- §§523 and 527 of the Public Health Service Act of 1912 (42 U.S.C. §§290 dd-3 and 290 ee 3), as amended, relating to confidentiality of alcohol and drug abuse patient records h. any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, the requirements of any other nondiscrimination statute(s) which may apply to the application. 3. Additionally, assurance is given to the Department that efforts will be made to identify and encourage the participation of minority owned and women owned businesses, and businesses owned by persons with disabilities in contract solicitations. The Contractor shall incorporate language in all contracts awarded: (1) prohibiting discrimination against minority owned and women owned businesses and businesses owned by persons with disabilities in subcontracting; and (2) making discrimination a material breach of contract. D. Debarment and Suspension Assurance is hereby given to the Department that the Contractor will comply with Federal Regulation 2 CFR part 180 and certifies to the best of its knowledge and belief that the Contractor's local health department or an official of the Contractor's local health department and the Contractor's subcontractors: 1. Are not presently debarred, suspended, proposed for debarment, declared ineligible, or voluntarily excluded from covered transactions by any federal department or Contractor; 2. Have not within a three-year period preceding this agreement been convicted of or had a civil judgment rendered against them for commission of fraud or a criminal offense in connection with obtaining, attempting to obtain, or performing a public (federal, state, or local) transaction or contract under a public transaction; violation of federal or state antitrust statutes or commission of embezzlement, theft, forgery, bribery, falsification or destruction of records, making false statements, or receiving stolen property; 3. Are not presently indicted or otherwise criminally or civilly charged by a government entity (federal, state or local) with commission of any of the offenses enumerated in section 2, and; 4. Have not within a three-year period preceding this agreement had one or more public transactions (federal, state or local) terminated for cause or default. Comprehensive Agreement - FY 2011 Page: 15 of 30 11/17/2010 regularly for the provision of health, day care, early childhood development services, education or library services to children under the age of 18, if the services are funded by federal programs either directly or through state or local governments, by federal grant, contract, loan or loan guarantee. The law also applies to children's services that are provided in indoor facilities that are constructed, operated, or maintained with such federal funds. The law does not apply to children's services provided in private residences; portions of facilities used for inpatient drug or alcohol treatment; service providers whose sole source of applicable federal funds is Medicare or Medicaid; or facilities where Women, Infants, and Children (WIC) coupons are redeemed. Failure to comply with the provisions of the law may result in the imposition of a civil monetary penalty of up to $1,000 for each violation and/or the imposition of an administrative compliance order on the responsible entity. The Contractor also assures that this language will be included in any subawards which contain provisions for children's services. 2. The Contractor also assures, in addition to compliance with Public Law 103- 227, any service or activity funded in whole or in part through this agreement will be delivered in a smoke-free facility or environment. Smoking shall not be permitted anywhere in the facility. or those parts of the facility under the control of the Contractor. If activities or services are delivered in facilities or areas that are not under the control of the Contractor (e.g., a mall, restaurant or private work site), the activities or services shall be smoke-free. Comprehensive Agreement - FY 2011 Page: 16 of 30 11/17/2010 programs. G. Home Health Services If the Contractor provides Home Health Services (as defined in Medicare Part B), the following requirements apply: 1. The Contractor shall not use State LPHO or categorical grant funds provided under this agreement to unfairly compete for home health services available from private providers of the same type of services in the Contractor's service area. 2. For purposes of this agreement, the term "unfair competition" shall be defined as offering of home health services at fees substantially less than those generally charged by private providers of the same type of services in the Contractor's area, except as allowed under Medicare customary charge regulations involving sliding fee scale discounts for low-income clients based upon their ability to pay. 3. If the Department finds that the Contractor is not in compliance with its assurance not to use state LPHO and categorical grant funds to unfairly compete, the Department shall follow the procedure required for failure by local health departments to adequately provide required services set forth in Sections 2497 and 2498 of 1978 PA 368 as amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15 (2497) and (2498). H. Subcontracts Assure for any subcontracted service, activity or product: 1. That a written subcontract is executed by all affected parties prior to the initiation of any new subcontract activity. Exceptions to this policy may be granted by the Department upon written request. 2. That any executed subcontract shall require the subcontractor to comply with all applicable terms and conditions of this agreement. In the event of a conflict Comprehensive Agreement - FY 2011 Page: 17 of 30 11/17/2010 5. That the Contractor will submit a copy of the executed subcontract if requested by the Department. 6. That subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $10,000 shall contain provisions or conditions that will: a. Allow the Contractor or Department to seek administrative, contractual or legal remedies in instances in which the Contractor violates or breaches contract terms, and provide for such remedial action as may be appropriate. b. Provide for termination by the Contractor, including the manner by which termination will be effected and the basis for settlement. 7. That all subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government of amounts in excess of $100000 shall contain a provision that requires compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970 (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), Executive Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15). 8. That all subcontracts and subgrants in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $2,000 for construction or repair, awarded by the Contractor shall include a provision: a. For compliance with the Copeland "Anti-Kickback" Act (18 USC 874) as supplemented in Department of Labor regulations (29 CFR, Part 3). employment of mechanics or laborers. Comprehensive Agreement - FY 2011 Page: 18 of 30 11/17/2010 I. Procurement Assure that all purchase transactions, whether negotiated or advertised, shall be conducted openly and competitively in accordance with the principles and requirements of OMB Circular A-102 as revised, implemented through applicable portions of the associated "Common Rule" as promulgated by responsible federal Contractor(s), or 2 CFR, Part 215 (OMB Circular A-110) as amended, as applicable and that records sufficient to document the significant history of all purchases are maintained for a minimum of three years after the end of the agreement period. J. Health Insurance Portability and Accountability Act To the extent that this act is pertinent to the services that the Contractor provides to the Department under this agreement, the Contractor assures that it is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements including the following: 1. The Contractor must not share any protected health data and information provided by the Department that falls within HIPAA requirements except to a subcontractor as appropriate under this agreement. 2. The Contractor must require the subcontractor not to share any protected health data and information from the Department that falls under HIPAA requirements in the terms and conditions of the subcontract. 3. The Contractor must only use the protected health data and information for the purposes of ithls agrc;ement. 4. The Contractor must have written policies and procedures addressing the use of protected health data and information that falls under the HIPAA requirements. The policies and procedures must meet all applicable federal and state requirements including the HIPAA regulations. These policies and procedures must include restricting access to the protected health data and information by the Contractor's employees. 5. The Contractor must have a policy and procedure to report to the Department unauthorized use or disclosure of protected health data and information that falls under the HIPAA requirements of which the Contractor becomes aware. 6. Failure to comply with any of these contractual requirements may result in the termination of this agreement in accordance with Part II, Section V. Termination. 7. In accordance with HIPAA requirements, the Contractor is liable for any claim, loss or damage relating to unauthorized use or disclosure of protected health data and information received by the Contractor from the Department or any other source. 8. The Contractor will enter into a business associate agreement should the Department determine such an agreement is required under HIPAA. Comprehensive Agreement - FY 2011 Page: 19 of 30 11/17/2010 IV. Payment and Reporting Procedures A. Operating Advance Under the pre-payment reimbursement method, no additional operating advances will be issued. B. Comprehensive Prepayments The Department will make monthly prepayments equal to 1/12th of the agreement amount for each non-fee-for-service program contained in Attachment IV of this agreement. One single payment covering all non-fee-for-service programs will be made within the first week of each month. The Department will send to the Contractor a worksheet itemizing the individual program amounts included in the monthly prepayment within five working days of processing the monthly prepayment. Prepayments for the months of October thru January will be based upon the initial agreement amounts in Attachment IV. SurDsequent monthly prepayments may be adjusted based upon agreement amendments and/or Contractor adjustment requests per Department approval. C. Prepayment Adjustments If the sum of the prepayments do rot equal at least 90% of the Contractor's expenditures for a quarter of the contract period, the Contractor may submit documentation for an adjustment to the monthly prepayment amount via the following process: 1. Submit a written request for the adjustment to the Department's Accounting Division, Expenditure Operations Section. 2. The adjustment request must be itemized by program and must list the amount received from the Department, the expenditure amount reported per the quarterly Financial Status Report (FSR), and the difference. The amount received from the Department and the expenditures must be for the same reporting quarterly FSR period. Comprehensive Agreement - FY 2011 Page: 20 of 30 11/17/2010 listed on Attachment IV. All FSR's must be prepared in accordance with the Department's FSR instructions and submitted not later than thirty (30) days after the close of the fiscal quarters. The reports are due 1/30/XX, 4130/XX, and 7/30/XX. FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Contractor for expenditures in accordance with the terms and conditions of this agreement. Failure to comply with the reporting due dates will result in the deferral of the Contractor's monthly prepayment. E. Reimbursement Method The Contractor will be reimbursed in accordance with the reimbursement methods for applicable program elements described as follows: Performance Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of State funds. Any local funds used to support program elements operated under such provisions of this agreement may be transferred by the Contractor within, among, to or from the affected elements without Department approval, subject to applicable provisions of Sections 3.B. and 3.C.3 of Part I and Section XIV of Part II. If local health department performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the State maximum allocation will be reduced equivalent to actual performance in relation to the minimum performance. 2. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total State allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable as a source before any local funding requirement unless a specific local match condition exists. 3- Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 4. LPHO - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. Comprehensive Agreement - FY 2011 Page: 21 of 30 11/1712010 F. Reimbursement Mechanism All Contractors must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits. Vendor registration information is available through the Department of Management and Budget's web site: http://www.cpexpress.state.mi.us/ G. Unobligated Funds Any unobligated balance of funds held by the Contractor at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. H. Fiscal Year-End Reporting A Preliminary Close Out Report is based on annual guidelines and due date using the format provided by the Department. The Contractor must provide, by program, an estimate of total expenditures for the entire agreement period (October 1 through September 30). This report must represent the Contractor's best estimate of total program expenditures for the agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables by program for this Agreement. The report assists the Department in reserving sufficient funding to reimburse the final expenditures that will be reported on the Final FSR without materially overstating or understating the year-end obligations for this agreement. The Department compares the total estimated expenditures from this report to the total amount reimbursed to the Contractor in the monthly prepayments and quarterly fee-for- service payments to establish accounts payable and accounts receivable entries at fiscal year-end. The Department recognizes that based upon payment adjustments and timing of agreement amendments, the Contractor may owe the Department funding for overpayment of a program and may be due funds from the Department for underpayment of a program at fiscal year-end. Within 75 days after the agreement fiscal year-end, the Contractor must liquidate any unpaid year-end commitments and obligations. Any obligation remaining unliquidated after 75 days from the end of the agreement period shall revert to the Department for disposition in accordance with applicable state and/or federal requirements, except as specifically authorized in writing by the Department. Final Total Contractor FSR Comprehensive Agreement - FY 2011 Page: 22 of 30 11/17/2010 reimbursement requested does not exceed the agreement amount that is due to the Contractor, the Department will make every effort to process full reimbursement to the Contractor per the Final FSR. Final payment may be delayed pending final disposition of the Department's year-end obligations. If funds are owed to the Department, it will generally not be necessary for Contractor to send in a payment. Instead the Department will make the necessary entries to offset other payments and as a result the Contractor will receive a net monthly prepayment. When this does occur, clarifying documentation will be provided to the Contractor by the Department's Accounting Division. J. Penalties for Reporting Noncompliance For failure to submit the final total Contractor FSR report by December 15, after the agreement period end date, the Contractor may be penalized with a one-time reduction in their current LPHO allocation for noncompliance with the fiscal year- end reporting deadlines. Any penalty funds will be reallocated to other Comprehensive Contractors (local hearth departments). Reductions will be one- time only and will not carryforward to the next fiscal year as an ongoing reduction to a Contractor's LPHO allocation. Penalties will be assessed based upon the submitted date in MI E-Grants: LPHO Penalties for Noncompliance with :Reporting Requirements: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the Contractor's LPHO allocation. V. Agreement Termination The Department may cancel this agreement without further liability or penalty to the Department for any of the following reasons: A. This agreement may be terminated by either party by giving thirty (30) days written notice to the other party stating the reasons for termination and the effective date. B. This agreement may also be terminated on thirty (30) days prior written notice upon the failure of either party to carry out the terms and conditions of this agreement, provided the alleged defaulting party is given notice of the alleged breach and fails to cure the default within the thirty (30) day period. C. This agreement may be terminated immediately if the Contractor's local health department, or an official of the Contractor's local health department, is convicted of any activity referenced in Part II, Section III.D, of this agreement during the term of this agreement or any extension thereof. Comprehensive Agreement - FY 2011 Page: 23 of 30 11/17/2010 VI. Final Reporting upon Termination Should this agreement be terminated by either party, within thirty (30) days after the termination, the Contractor shall provide the Department with all financial performance, and other reports required as a condition of the agreement. The Department will make payments to the Contractor for allowable reimbursable costs not covered by previous payments, other state or federal programs. The Contractor shall immediately refund to the Department funds not authorized for use and any payments advanced to the Contractor in excess of allowable reimbursable expenditures. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. VII. Severability If any provision of this agreement or any provision of any document attached to or incorporated by reference is waived or held to be invalid, such waiver or invalidity shall not affect other provisions of this agreement. VIII. Amendments Any changes to this agreement will be valid only if made in writing and accepted by all parties to this agreement. A. This agreement, including attachments, may be amended by mutual written consent of the Contractor and the Department. When submitting a proposed agreement/budget amendment, the Contractor must submit copies of the revised sheets and a summary description of the changes. B. In the event that circumstances occur that are not reasonably foreseeable, or are beyond the Contractor's or Department's control, which reduce or otherwise interfere with the Contractor's or Department's ability to provide or maintain specified services or operational procedures, immediate written notification must be provided to the other party and an amendment to this agreement negotiated. C. Amendments to this agreement shall be made as follows: Any change proposed by the Contractor which would affect the State funding of any element funded in whole or in part by funds provided by the Department, subject to Part I, Section 3.C, of the agreement, must be submitted in writing to the Department immediately upon determining the need for such change. The proposed change may be implemented upon receipt of written notification from the Department. Within thirty (30) days after receipt of the proposed change, the Department shall advise the Contractor in writing of its determination. Subsequently the Department will initiate any necessary formal amendment to the agreement for execution by all parties to the agreement. Any changes proposed by the Department must be agreed to in writing by the Contractor and upon such written agreement, the Department shall initiate any necessary formal amendment as above. Comprehensive Agreement - FY 2011 Page: 24 of 30 11/17/2010 2. Other amendments of a routine nature including applicable changes in budget categories, modified indirect rates, and similar conditions which do not modify the agreement scope, amount of funding to be provided by the Department or, the total amount of the budget may be submitted by the Contractor at any time prior to June 2nd. The Department will provide a written response within thirty (30) calendar days. All amendments must be submitted to the Department by June 15 through MI E- Grants to assure the amendment can be executed prior to the end of the agreement period. IX. Liability A. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as direct service delivery, to be carried out by the Contractor in the performance of this agreement shall be the responsibility of the Contractor, and not the responsibility of the Department, if the liability, loss, or damage is caused by, Cr arises out of, the actions or failure to act on the part of the Contractor, any subcontractor, anyone directly or indirectly employed by the Contractor, provided that nothing herein shall be construed as a waiver of any governmental immunity that has been provided to the Contractor or its employees by statute or court decisions. B. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as the provision of policy and procedural direction, to be carried out by the Department in the performance of this agreement shall be the responsibility of the Department, and not the responsibility of the Contractor, if the liability, loss, or damage is caused by, or arises out of, the action or failure to act on the part of any Department employee or agent, provided that nothing herein shall be construed as a waiver of any governmental immunity by the State, its agencies (the Department) or employees as provided by statute or court decisions. C. In the event that liability to third parties, loss, or damage arises as a result of activities conducted jointly by the Contractor and the Department in fulfillment of their responsibilities under this agreement, such liability, loss, or damage shall be borne by the Contractor and the Department in relation to each party's responsibilities under these joint activities, provided that nothing herein shall be construed as a waiver of any governmental immunity by the Contractor, the State, its agencies (the Department) or their employees, respectively, as provided by statute or court decisions. X. Conflict of Interest The Contractor and the Department are subject to the provisions of 1968 PA 317, as amended, MCL 15.321 et seq, MSA 4.1700(51) et seq, and 1973 PA 196, as amended, MCL 15.341 et seq, MSA 4.1700(71) et seq. Xl. State of Michigan Agreement 11/17/2010 This is a State of Michigan Agreement and is governed by the laws of Michigan. Any dispute arising as a result of this agreement shall be resolved in the State of Michigan. XII. Confidentiality Both the Department and the Contractor shall assure that medical services to and information contained in medical records of persons served under this agreement, or other such recorded information required to be held confidential by federal or state law, rule or regulation, in connection with the provision of services or other activity under this agreement shall be privileged communication, shall be held confidential, and shall not be divulged without the written consent of either the patient or a person responsible for the patient, except as may be otherwise required by applicable law or regulation. Such information may be disclosed in summary, statistical, or other form which does not directly or indirectly identify particular individuals. XIII. Waiver Any clause or condition of this agreement found to be an impediment to the intended and effective operation of this agreement may be waived in writing by the Department or the Contractor, upon presentation of written justification by the requesting party. Such waiver may be temporary or for the life of the agreement and may affect any or all program elements covered by this agreement. XIV. Funding A. State funding for this agreement shall be provided from the applicable and available Department appropriations for the current fiscal year. The Department provided funds shalt be as stated in the approved Annual Budget - Attachment I, the Program Specific Assurances and Requirements - Attachment Ill, and as outlined in the Funding/Reimbursement Matrix - Attachment IV. B. The funding provided through the Department for this agreement shall not exceed the amount shown for each federal and state categorical program element except as adjusted by amendment. The Contractor must advise the Department in writing by May 1 if the amount of Department funding may not be used in its entirety or appears to be insufficient for any program element. LPHO transfer requests between MDCH, MDA and MDEQ must also be requested in writing by May 1. All LPHO required services must be maintained throughout the entire period of the agreement. C. The Department may periodically redistribute funds between agencies during the agreement period in order to ensure that funds are expended to meet the varying needs for services. Such redistributions will be based upon projections obtained in consultation with the Contractor. Any redistributions will be effected through the established amendment process. Comprehensive Agreement - FY 2011 Page: 26 of 30 11/17/2010 AA Attachments Comprehensive Agreement - FY 2011 Page: 27 of 30 N/A N/A N/A N/A N/A N/A N/A N/A Contract # Date: 11/17/2010 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - FY 2011 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source MDCH Source Fed/St Funding Reimbursement Performance Total (c) State (d State Funded Minimum Vendor! (a) Amount Method Target Perform Funded Subrecepient (b) Output Expect Target Performance Percent (f) Measurement Perform Number (e) Adolescent STD Screening Reg. Alloc. F 14,921 Staffing (6) N/A N/A N/A N/A N/A Subrecepien Reg. Alloc. F 44,764 Reg. Alloc. F 13,315 Bioterrorism 10/1/10-7/31/11 Reg. Alloc. F 316,675 Staffing (6), (14) I fl/A N/A N/A N/A N/A Subrecepien Bioterrorism 8/1/11-9/30/11 Reg. Alloc. F 63,335 Staffing (6), (15', N/A N/A N/A N/A N/A Subrecepien Bioterrorism CRI (Cities Reg. Alloc. F 228,203 Staffing (6) (15) N/A. N/A N/A N/A N/A Subrecepien Readiness Initiative) Reg. Alloc. F 45,652 Bioterrorism Regional EPI Reg. Alloc. F 8,333 Staffing (6) N/A N/A N/A N/A N/A Subrecepien Support Reg. Alloc. F 1,667 Childhood Lead Poisoning Reg. Alloc. F 6.099 Staffing (6) N/A N/A N/A N/A N/A Subrecepien. Prevention Reg. Alloc. F 2,034 Reg. Alloc. F 1558 Reg. Alloc. F 32,885 Reg. Alloo. S 1,942 Childrens Special Hlth Care Calc. Amt. F 150.00/Vario Fixed Unit Rate (1), N/A N/A N/A N/A N/A Vendor Services (CSHCS) Care us (7) Coordination Childrens Special Hlth Care Reg. Alloc. F 91,656 Staffing (6) N/A N/A N/A N/A N/A Vendor Services (CSHCS) Outreach & Advocacy EVVIDS Travel Fetal Infant Mortality Review (FIMR) Case Abstraction Food LPHO Reg. Alloc. Reg. Alloc. Reg. Alloc. Reg. Alloc. LPHO Food 76,779 116,565 1,839 5,400 785,527 Staffing (6) Staffing (6) Performance Subrecepient Subrecepient Vendor Comprehensive Agreement - FY 2011 Page: 28 of 30 A ;Staffing (6) Fixed Unit Rate (2), (7) LPHO (3), (4) Staffing (6), (20) I Staffing (6) Staffing (6) Staffing (6) I Staffing (6) LPHO (3), (4) IN/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 94,191 18,978 15,000 30,000 470,195 340,487 321,457 16,080 46,414 Contract # Date: 11/17/2010 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - FY 2011 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source MDCH Source Fed/St Funding Reimbursement Performance Total (c) State (d) State Funded Minimum Vendor! (a) Amount Method Target Perform Funded Target Subreceplent (b) Output Expect Performance Percent (0 Measurement Perform Number (e) General Communicable Disease LPHO MDCH S 271,466 LPHO (3), (4) N/A N/A N/A N/A N/A Vendor LPHO Other Hearing LPHO LPHO S 219,078 NIA I N/A N/A N/A N/A Vendor Hearing HIV Prevention I Reg. Alloc. I F I 373,425IStaffing (6) NIA I N/AI N/A I N/A N/A I Su brecepien Immunization Action Plan (IAP) Immunization Fixed Fees Immunization LPHO Immunization Reaching More Children & Adults Immunization Vaccine Quality Assurance Laboratory Services Bio Laboratory Services ELC Local Tobacco Reduction MDNRE Drinking Water MDNRE On-site Sewage Other-MCH Sexually Transmitted Disease (STD) Control Reg. Alloc. LPHO MDCH Other Reg. Alloc. Reg. Alloc. Cal c. Amt. LPHO MDCH Other Reg. Alloc. Reg. Alloc. Reg. Alloc. Reg. Alloc. Reg. Alloc. Reg. Alloc. LPHO Drinking Water LPHO Onsite Sewage Local MCH Reg. Alloc. Reg. Alloc. 124,475 388,513 115,738 347,212 300.00/Numb ers 4 7 1,117 . 116,520 107,255 I LPHO (3), (4) Staffing (6) Performance N/A Subrecepient N/A Vendor N/A Vendor N/A Subrecepient N/A Vendor N/A Subrecepient N/A Subrecepient N/A Subrecepient N/A Vendor N/A Vendor N/A N/A N/A Subrecepient Comprehensive Agreement - FY 2011 Page: 29 of 30 Contract # Date: 11/17/2010 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - FY 2011 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source MDCH Source Fed/St Funding Reimbursement Performance Total (a) State (cl State Funded Minimum Vendor! (a) Amount Method Target Perform Funded Subreceplent (b) Output Expect Target Performance Percent (t) Measurement Perform Number (e) Reg. Alloc. F 28,172 Reg. Alloc. S 17,980 LPHO MDCH S 890,031 Other 1 TB Control Reg. Alloc. F 15,501 Staffing (6) INA N/A N/A N/A N/A Vendor : Reg. Alloc. F 46,502 1 Vision LPHO LPHO Vision S 213,433 LPHO (3), (4) IHIA N/A N/A N/A N/A Vendor WIC Breastfeeding Reg. Alloc. F 73,603 Performance (8) # Average N/A N/A 0 95 Subrecepient Monthly Participation WIC Resident Services Reg. Alloc. F 2,307,898 Performance (8) # Average N/A 15500 14725 95 Subrecepient Monthly i Partici eation TOTAL MDCH FUNDING .339,.87O *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT Comprehensive Agreement - FY 2011 Page: 30 of 30 Version: CPBC MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 10/11 AGREEMENT ADDENDUM A This addendum adds the following section to Part I and renumbers existing 11 Special Certification to 12 and existing 12 Signature Section to 13; and adds the following changes to CPBC Agreement for 10/01/10 through 9/30/11: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. Version: C PBC 2. This addendum modifies the following sections of Part II, General Provisions: Part ll I. Responsibilities-Contractor J. Software Compliance. This section will be deleted in its entirety and replaced with the following language: The Michigan Department of Community Health and the County of Oakland will work together to identify and overcome potential data incompatibility problems. Ill. Assurances A. Compliance with Applicable Laws. This first sentence of this paragraph will be stricken in its entirety and replaced with the following language: The Contractor will comply with applicable Federal and State laws, and lawfully enacted administrative rules or regulations, in carrying out the terms of this agreement. J. Health Insurance Portability and Accountability Act. The provisions in this section shall be deleted in their entirety and replaced with the following language: Contractor agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated thereunder. IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the following language: Version: CPBC 3. Special Certification: The individual or officer signing this agreement certifies by his or her signature that he or she is authorized to sign this agreement on behalf of the responsible governing board, official or Contractor. 4. Signature Section: For the COUNTY OF OAKLAND Name and Title Signature Date For the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH Kim Stephen, Director Date Bureau of Budget and Audit ATTACHMENT MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 10/11 Comprehensive Agreement INSTRUCTIONS FOR THE ANNUAL BUDGET INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH SERVICES TABLE OF CONTENTS Page A. Bioterrorism B. WIC C. Family Planning D. Breast and Cervical Cancer E. CSHCS Outreach and Advocacy F. Program Budget - Cost Detail Schedule (DCH-0387) Form Preparation Attachment 1-Annual Budget Forms G. Medicaid Outreach Activities Reimbursement Procedures Attachment 2-Medicaid Outreach Activities Cost Allocation Plan Certification Attachment 3-Medicaid Outreach Activities Cost Allocation Plan Sample 15 ....... 15 16 17 19 19 .......... 21 25 31 32 INSTRUCTIONS FOR THE MDCH/G&PD FY 10/11 Page 1 of 36 ANNUAL BUDGET FOR LOCAL HEALTH SERVICES INTRODUCTION The Annual Budget for Local Health Services is completed on a state fiscal year basis, and is used to establish budgets for many Department programs. In the Annual Budget. the Department consolidates many of its categorical programs' funding and local public health operation's funding (formerly known as state/local cost sharing) into a single, Comprehensive Agreement for local health departments. The Department's Plan and Budget Framework serves as a principal reference point for budget development. The Annual Budget for Local Health Services must be completed in accordance with and adhere to the established requirements as specified in these instructions and submitted to the Department as required by the agreement. II. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in 2 CFR, Part 225 (OMB Circular A-87), as amended. B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may not be used to: provide inpatient services; make cash payments to intended recipients of health services; purchase or improve land; purchase, contract or permanently improve (other than minor remodeling defined as work required to change the interior arrangements or other physical characteristics of any existing facility or installed equipment when the cost of the remodeling incident does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of patients, excluding equipment typically used in a laboratory); satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial assistance to any entity other than a public or nonprofit private entity. C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and negotiation activities must be budgeted at the individual expenditure and funding source category level on the Annual Budget for Local Health Services. D. Special Budget Requirements for Certain Categorical Program Elements - In addition to the Annual Budget for Local Health Services, a Program Budget-Cost Detail Schedule must be submitted for all program elements (excluding Administration and Contractor Support). MDCH/G&PD FY 10/11 Page 2 of 36 E. Local MCH - Local MCH funds can be used for general Maternal Child Health (MCH) activity. These funds are to be budgeted as a funding source under any of the appropriate program element(s) (i.e., Children's Special Health Care Services (CSHCS) Outreach and Advocacy, Child Health, Family Planning, Immunization, Maternal Infant Health Program, or a locally defined program which is defined in the LMCH Community Plan). If an agency wants to utilize this funding for another purpose, approval must be obtained from the Division of Family and Community Health. These funding sources cannot be used under the WIC element except in extreme circumstances where a waiver is requested in advance of expenditures, and evidence is provided that the expenditures satisfy all funding requirements. The MCH activities should address the priorities identified in the community health assessment and improvement process. III. REIMBURSEMENT CHART A. Program Element/Funding Source The Program Element/Funding Source column provides a listing of all currently funded MDCH programs that are included in the Comprehensive Agreement. When applicable, funding sources are specified. B. Reimbursement Methods The Reimbursement Methods column specifies the type of method used for each of the program element/funding sources. Funding under the Comprehensive Agreement can generally be grouped under four (4) different methods of reimbursement. These methods are defined as follows: 1. Performance Reimbursement - A reimbursement method by which local agencies are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of state funds prior to any utilization of local funds. Performance targets are negotiated starting from the last year's negotiated target and the most recent year's actual numbers except for programs in which caseload targets are directly tied to funding formulas/annual allocations. Other considerations in setting performance targets include changes in state allocations from past years, local fiscal and programmatic factors requiring adjustment of caseloads, etc. Once total performance targets are negotiated, a minimum state funded performance target percentage is applied (typically 90% unless otherwise specified). If local Contractor actual performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the state maximum allocation for cost reimbursement will be reduced equivalent to actual performance in relation to the minimum performance. 2. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 3. LPHO - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. 4. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total state allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable and a source before any local funding requirements unless a special local match MDCH/G&PD FY 10/11 Page 3 of 36 condition exists. C. Performance Level If Applicable The Performance Level column specifies the minimum state funded performance target percentage for all program elements/funding sources utilizing the performance reimbursement method (see above). If the program elements/funding source utilizes a reimbursement method other than performance or if a target is not specified, N/A (not-available) appears in the space provided. D. Performance Target Output Measures Performance Target Output Measure column specifies the output indicator that is applicable for the program elements/ funding source utilizing the performance reimbursement method. Output measures are based upon counts of services delivered. E. Subrecipient or Vendor Designation The Subrecipient or Vendor Designation column identifies the type of relationship that exists between the Department and the local health department on a program-by-program basis. Federal awards expended as a subrecipient are subject to audit or other requirements of OMB Circular A-133. Payments made to or received as a vendor are not considered Federal awards and are, therefore, not subject to such requirements. Subrecipient A subrecipient is a non-Federal entity that expends Federal awards received from a pass- through entity to carry out a Federal program, but does not include an individual that is a beneficiary of such a program; or is a recipient of other Federal awards directly from a Federal Awarding agency. Subrecipient characteristics include: a. Determines who is eligible to receive what Federal financial assistance; b. Has its performance measured against whether the objectives of the Federal program are met; c. Has responsibility for programmatic decision making; d. Has responsibility for adherence to applicable Federal program compliance requirements; and e. Uses the Federal funds to carry out a program of the organization as compared to providing services for a program of the pass-through entity. 2. Vendor A vendor is a dealer, distributor, merchant, or other seller providing goods or services that are required for conduct of a Federal program. These goods or services may be for an organization's own use or for the use of beneficiaries of the Federal Program. Vendor characteristics include: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; c. Operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; and e. Is not subject to compliance requirements of the Federal program. MDCH/G&PD FY 10/11 Page 4 of 36 F. Type of Project The type of project designation is indicated by footnote and is used if the project meets the Research and Development Project criteria. Research and Development Projects are defined by OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, as: Research and development (R&D) means all research activities, both basic and applied, and all development activities that are performed by a non-Federal entity. Research is defined as a systematic study directed toward fuller scientific knowledge or understanding of the subject studied. The term research also includes activities involving the training of individuals in research techniques where such activities utilize the same facilities as other research and development activities and where such activities are not included in the instruction function. Development is the systematic use of knowledge and understanding gained from research directed toward the production of useful materials, devices, systems, or methods, including design and development of prototypes and processes. The following Reimbursement Chart notes elements/funding sources, applicable payment methods, target levels, output measures for each program/element having a performance reimbursement option. In addition, the chart also provides the subrecipient/vendor designations, as in prior years: REIMBURSEMENT CHART Sub recipient Performance Performance or Program Element/ Reimbursement Level If Target Output Funding Source) Method(2) Applicable) Measure Vendor Designation Adolescent STD Staffing( 6) Screening N/A Subrecipient Advisory Group SNAP- Staffing(6) (16) N/A Subrecipient ED Bioterrorisnn Emergency Preparedness Bioterrorism Staffing(6) (14) N/A Subrecipient Emergency Preparedness Staffing(6) (15) N/A Subrecipient Bioterrorism Emergency N/A Subrecipient Preparedness Staffing(6) Cities of Readiness Staffing(6) N/A Subrecipient Initiative Regional Epidemiology Support Breast & Cervical Cancer Control Coordination Performance) 97% # Women Subrecipient Screened for Breast & Cervical Cancer MDCH/G&PD FY 10111 Page 5 of 36 REIMBURSEMENT CHART Subrecipient Performance Performance or Program Element/ Reimbursement Level If Target Output Funding Source ) Method(2) Applicable(3) Measure Vendor Designation Building Healthy Communities Staffing(8) N/A Subrecipient Child Health Staffing (8) N/A Subrecipient Childhood Lead Staffing(8) N/A Subrecipient Poisoning Prevention Complete Streets (CVD) - Staffing(6) (18) N/A Subrecipient ARRA , , CSHCS — Case Management/Care Fixed Unit Rate(7) N/A Vendor Coordination ' CSHCS - Outreach & Advocacy Staffing(8) N/A Vendor Early Warning Infectious Disease Surveillance Travel Staffing(8) N/A Subrecipient Early Warning Infectious Disease Surveillance Workshop Staffing(8) N/A Subrecipient Family Planning/BCCCP Joint Project Coordination Staffing(8) N/A Subrecipient Family Planning Services General Services Performance(5)(8) 95% # Unduplicated Subrecipient (13) Clinic Users Served Fetal Alcohol Spectrum Disorder Projects Staffing (8) N/A Subrecipient Fetal/Infant Mortality Review Abstractions Staffing (8) N/A Subrecipient Highly Targeted Community Based HIV Staffing (8) N/A Subrecipient Prevention Services HIV/AIDS Care Staffing (8) N/A Vendor MHI HIV/AIDS Maternal and Child Program-Ryan Staffing(8) N/A Subrecipient White Part D MDCH/G&PD FY 10111 Page 6 of 36 REIMBURSEMENT CHART Subrecipient Performance Performance or Program Element/ Reimbursement Level If Target Output Vendor Funding Source ) Method(2) Applicable) Measure Designation HIV Prevention Services Categorical Staffing(6) N/A Subrecipient Non-Categorical Red Unit Rat c7)(12) N/A Vendor HIV/AIDS Provider Education Staffing(6) N/A Subrecipient HIV Rapid Testing Project Staffing(6) N/A Subrecipient HIV/STD Partner Services Staffing(6) N/A Subrecipient HIV Surveillance Support Staffing (6) N/A Subrecipient HOPWA Staffing(6) N/A Subrecipient Immunization AFIX Follow-up Site Fixed Unit Rate N/A Vendor Visit (7) Field Service Reps N/A Subrecipient Staffing(6) Immunization Action N/A Subrecipient Plan Staffing(6) Michigan Care Improvement Registry N/A Subrecipient Staffing(6) Nurse Education N/A Vendor Fixed Unit RateM Reaching More N/A Subrecipient Children and Adults Staffing(6)(18) Vaccine Quality Assurance Program N/A Vendor Staffing(6) VFC/AFIX Site Visit N/A Vendor Fixed Unit Ratem Informed Consent Fixed Unit Ratem N/A Vendor Laboratory Services Staffing(6) N/A Subrecipient Bioterrorism Epi Lab Capacity Staffing(6)(16) N/A (ELC) Subrecipient MDCH/G&PD FY 10/11 Page 7 of 36 REIMBURSEMENT CHART Subrecipient Performance Performance or Program Element/ Reimbursement Level If Target Output Method(2) Applicable) Vendor Funding Source ) Measure Designation STARHS Staffing (6) N/A Subrecipient STD Staffing(6)/Fixed N/A Subrecipient Unit Rate(7)(10) Lead Safe Home Program Staffing (6) N/A Vendor Local Tobacco Reduction Staffing (6) N/A Subrecipient Local Tobacco ARRA 1 Staffing(6) (18) NA Subrecipient Local Tobacco ARRA 2 Staffing(6) (18) NA Subrecipient LPHO MDCH LPHO(4) N/A % of Food Vendor Service MDA Performance 75% Licensees Vendor received required inspections MDEQ LPHO(4) N/A Vendor Maternal Infant Health Staffing(6) N/A Subrecipient Program (MIHP) Safe Routes to Schools Staffing (6) NA Subrecipient Sexual Violence Prevention Staffing(6) N/A Subrecipient Sexually Transmitted Disease (STD) Control Staffing(6) N/A Subrecipient SIDS Fixed Unit Rate (11) N/A Vendor SEAL! Michigan Dental Sealant Program Staffing(6) N/A Subrecipient TB Control Directly Observed Therapy Stang(6) N/A Vendor (DOT) Staffing MDCH/G&PD FY 10/11 Page 8 of 36 REIMBURSEMENT CHART Subrecipient Performance Performance or Program Element/ Reimbursement Level If Target Output Method (2) Applicable) Vendor Funding Source ) Measure Designation Teen Pregnancy Number of Prevention Initiative Performance) 90% unduplicated N/A youth served with intense interventions (at least 14 hours of direct service) Youth Suicide Prevention I Staffing(6) N/A I I Subrecipient WIC — Resident Performance) 97% # Average Subrecipient Monthly Participation Breasffeeding Staffing (6) N/A Subrecipient Migrant Staffing(6) N/A Subrecipient WISEWOMAN Project Coordination Performance )(9) 95°/0 # Women Subrecipient Screened for Cardiovascular Disease Risk Factors MDCH/G&PD FY 10/11 Page 9 of 36 Footnotes: (1) Program element or funding source as applicable. (2) Refer to the master Comprehensive agreement and the program and budget instructions package for further explanation of applicability of these reimbursement methods. (3) Performance percent for applicable programs. (4) Funding source (not a single element). (5) Subject to statewide maintenance of effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by MDCH. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDCH agreement funding for coordination. (19) Fixed rate limited to contract amount. (11) $85 per visit, up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Quarterly FPAR data will be used to determine total Title X users and Plan First! enrollees. (14) Bioterrorism funding must be expended by 7/30/2011 and may be subject to a 10% match requirement as specified in the Public Health Preparedness Emergency (PHEP) Cooperative Agreement Guidance.. LHDs must submit a ten- month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Bioterrorism funds are for August 1, 2011 - September 30, 2011 and may be subject to a 10% match requirement as specified in the Public Health Preparedness Emergency (PHEP) Cooperative Agreement Guidance LHD's must submit a two-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. (17) Project meets the Research and Development Criteria as defined by OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations (18) American Recovery and Reinvestment Act (ARRA) provision applies. See attached appendix for provision. MDCH/G&PD FY 1011 Page 10 of 36 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES V. FORM PREPARATION - GENERAL VI. FORM PREPARATION - EXPENDITURE CATEGORIES Budgeted expenditures are to be entered for each program element, project or group of services by applicable major category. MDCH/G&PD FY 10/11 Page 11 01 36 supplies; medical supplies; contraceptives and vaccines; tape and gauze; prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value should be reported and identified on in Other Cost Distributions category. Do not combine with supplies. F. Travel - Travel costs of permanent and part-time employees assigned to each program element. This includes costs of mileage, per diem, lodging, meals, registration fees and other approved travel costs incurred by the employee. Travel of private, non-employee consultants should be reported under Other Expenses. G. Communication Costs - These are costs for telephone, Internet, telegraph, data lines, websites, fax, email, etc., when related directly to the operation of the program element. H. County/City Central Services - These are costs associated with central support activities of the local governing unit allocated to the local health department in accordance with 2 CFR, part 225 (OMB Circular A-87). Space Costs - These are costs of building space necessary for the operation of the program. J. All Others (Line II)- These are costs for all other items purchased exclusively for the operation of the program element and not appropriately included in any of the other categories including items such as repairs, janitorial services, consultant services, vendor services, equipment rental„ insurance, Automated Data Processing (ADP) systems, etc. K. Total Direct Expenditures — MI E-grants sums the direct expenditures budgeted for each program element, project or service grouping and records in the Total Direct Expenditure line of the Budget Surnmary. L. Admin. 0/H Cost Rate - Use to distribute costs of general administrative operations that have not been directly charged to individual programs. The Indirect/ Administrative Overhead (0/H) Cost Rate distributes administrative costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. The amount of Admin. 0/H should be allocated to all appropriate program elements with the total equivalent amount reflected as a credit or minus in the column(s) for Administration. M. Other Cost Distributions — Use to distribute various contributing activity costs to appropriate program areas based upon activity counts, time study supporting data or other reasonable and equitable means. An example of Other Cost Distributions is nursing supervision. The distribution process permits costs reflected in a single program element to be subsequently distributed, perhaps only in part, to other programs or projects as appropriate. If an allocation is made, the charges must be reflected in the appropriate program columns and the offsetting credit reflected in the program column being distributed. There must be a documented, well-defined rationale and audit trail for any cost distribution or allocation based upon 2 CFR, Part 225 (OMB Circular A-87) cost principles. Federal Provided Vaccine Value should be reported on a separate line and clearly identified. N. Total Direct & Admin. Expenditures - MI E-grants sums the indirect expenditures program element and records in the Total Indirect Expenditure line of the Budget Summary. 0. Total Expenditures - MI E-grants sums the direct and indirect expenditures and records in the Total Expenditure line of the Budget Summary. VII. FORM PREPARATION - SOURCE OF FUNDS Source of Funds are to be entered for each program element, project or group of services by applicable major category as follows: A. Fees & Collections - Fees 1st & 2nd pa •y_ rt Funds (1st party) projected to be received from private payers, including patients, source users and any member of the general population receiving services. Also includes funds (2nd party) received from organizations, private or public, who might MDCH/G&PD FY 1 0/1 1 Page 12 of 36 reimburse services for a group or under a special plan. B. Fees & Collections - 3rd Party - Third Party Fees - Funds projected to be received from private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly related to the cost of providing patient care or other services (e.g., includes Early Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.) C. Federal/State Funding (Non-MDCH) - Funds received directly from the federal government and from any state Contractor other than MDCH, such as the Department of Natural Resources and Environment (MDNRE). This line should also be used to exclude state aid funds such as those provided through the Michigan Department of Treasury under P.A. 264 of 1987 (cigarette tax). D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based Reimbursement which should be budgeted in the program in which they were earned. E. Federally Provided Vaccines — The projected value of federally provided vaccine. F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership program elements.) Funds projected to be received from the federal government for allowable Medicaid Outreach activities. This amount represents the anticipated 50% federal administrative match of local contributions. G. Required Match - Local — Funds projected to be local contribution for programs that have a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership, this amount represents the 50% matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid Outreach and Required Local match amounts should equal each other.) H. Local Non-LPHO - Local funds budgeted for the following expenditures: 1. Expenditures for services not designated as required and allowable for LPHO funding (e.g., medical examiner and inpatient maternity services); expenditures determined not to be reasonable; and, expenditures in excess of the maximum state share of funds available. 2. Any losses arising from uncollectible accounts and other related claims. Under-recovery of reimbursable expenditures from, or failure to bill, available funding sources that would otherwise result in exclusions from LPHO funding if recovered. However, no exclusion is required where the local jurisdiction has made and documented a decision to have local funds underwrite: a. the cost of uncollectible accounts or bad debts incurred in support of providing required or allowable health services. An example of this condition would be for services provided to indigents who are billed as a matter of procedure with little chance for receipt of payment. b. potential recoveries or under-recoveries from other sources for the principal purpose of providing required and allowable health services at free or reduced cost to the public served by the Contractor. An example would be keeping fees for services at a reduced level for the benefit of the people served by the Contractor while recognizing that to do so limits recovery from third parties for the same types of services. 3. Contributions to a contingency reserve or any similar provisions for unforeseen events. 4. Charitable contributions and donations. 5. Salaries and other incidental expenditures of the chief executive of a political subdivision (i.e., county executive and mayor). 6. Legislative expenditures; such as, salaries and other incidental expenditures of local governing bodies (i.e., county commissioners and city councils). Do not enter board of health expenses. 7. Expenditures for amusements, social activities and other incidental expenditures related thereto; such as, meals, beverages, lodging, rentals, transportation and gratuities. MDCH/G&PD FY 10/11 Page 13 of 36 8. Fines, penalties and interest on borrowings. 9. Capital Expenditures - Local capital outlay for purchase of facilities and equipment (assets) are excluded from LPHO funding. I. Other Non-LPHO - Funds budgeted from sources other than state, federal and local appropriations to the extent that they are not eligible for LPHO (e.g., funding from local substance abuse coordinating Contractor, local area on aging Contractor). J. MDCH - NON-COMPREHENSIVE - Funds budgeted for services provided under separate MDCH agreements. Examples include: funding provided directly by the Community Services for Substance Abuse for community grants, etc. K. MDCH - COMPREHENSIVE - This section includes all funding projected to be due under the Comprehensive (COMPREHENSIVE) agreement from categorical programs and needs to equal the allocation. L. LPHO - MDCH Hearing - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO MDCH Hearing program and has to equal the MDCH LPHO Hearing allocation. Additional LPHO to be budgeted for the Hearing Program must be entered into LPHO — MDCH Other. M. LPHO - MDCH Vision - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO MDCH Vision program and has to equal the LPHO MDCH Vision allocation. Additional LPHO to be budgeted for the Vision Program must be entered into LPHO — MDCH Other. N. LPHO — MDCH Other - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO MDCH Other program for eligible program elements. Please note: system validates the LPHO MDCH Other budgeted funds across the applicable program elements to assure the agreement does exceed the LPHO — MDCH Other allocation. 0. LPHO — Food - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO Food program and has to equal the LPHO Food allocation. P. LPHO — Drinking Water - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO Drinking Water program and has to equal the LPHO Drinking Water allocation. Q. LPHO — On-site Sewage - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the LPHO On-site Sewage program and has to equal the LPHO On-site Sewage allocation. R. MCH Funding - This section includes all funding projected to be due under Comprehensive (COMPREHENSIVE) agreement specific to the MCH eligible program elements. Please note: system validates the MCH budgeted funds across applicable program elements to assure the agreement does exceed the MCH allocation. S. Local Funds - Other - Enter all local support in the appropriate element, project or service group column. This may include local property tax, and other local revenues (does not include fees). VIII. SPECIAL BUDGET INSTRUCTIONS Certain elements are supported by federal or other categorical program funds for which special budgeting requirements are placed upon grantees and subgrantees. These include: Element Federal or Other Funding Contractor Bioterrorism U.S. Department of Health & Human Services, Centers for Disease Control MDCH/G&PD FY 10/11 Page 14 of 36 1. 2. WIC U.S. Department of Agriculture, Food & Nutrition Service Family Planning U.S. Department of Health & Human Services, Public Health Service Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control CSHCS Outreach & Advocacy Michigan Department of Community Health Medicaid Outreach Activities Centers for Medicare and Medicaid Services In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests and be in a format consistent with grantor Contractor requirements. Certain types of costs must receive approval of the federal grantor Contractor and/or the grantee prior to being incurred. A. Bioterrorism Special Budget Requirements Local Health Departments will receive the initial FY 10/11 allocation of the CDC Public Health Emergency Preparedness (PHEP) funds in ten equal prepayments for the period October 1, 2010 through July 31, 2011. LHDs must submit a ten-month budget and a quarterly Financial Status Report (FSR) column for each of the following COMPREHENSIVE program elements: 1. Bioterrorism (October 1, 2010 — July 31, 2011) 2. Bioterrorisnn — Cities of Readiness (October 1, 2010 — September 30, 2011) 3. Bioterrorism — Regional Epidemiology Support (October 1, 2010 — September 30, 2011) 4. Early Warning Infectious Disease Surveillance Travel (October 1, 2010— September 30, 2011) 5. Early Warning Infectious Disease Surveillance Workshop (October 1, 2010- September 30, 2011) 6. Laboratory Services - Bioterrorism (October 1, 2010 — September 30, 2011) B. WIC Special Budget Requirements Cost/Funding Categories - The following local budget breakdowns are required to fulfill WIC grant application budget requirements each fiscal year: Salaries & Fringe Benefits Automated Management Systems Space Utilization Costs Equipment Supplies Communications & Travel All Other Direct Costs Indirect Costs All Funding Sources By Type The WIC cost/funding categories and supporting budget detail requirements are satisfied by completion of a Cost Detail Schedule with the master budget. General instructions for these forms are contained at the end of this section. Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. And comply with special reporting requirements. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of the Michigan Department of Community Health as specified by the MDCH/G&PD FY 10/11 Page 15 of 36 U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7 CFR Part 246, and USDA-WIC Administrative Cost Handbook 3/86). Prior approval is accomplished by providing appropriate detail in the budget request approved by MDCH or subsequently in a written request approved in writing by MDCH. A. Automated Information Systems - which are required by a local Contractor except for those used in general management and payroll, including acquisition of automated data processing hardware or software whether by outright purchase or rental-purchase agreement or other method of acquisition. B. Capital Expenditures of $2,500 or More - such as the cost of facilities, equipment, including medical equipment, other capital assets and any repairs that materially increase the value or useful life of capital assets. C. Management Studies - performed by agencies or departments other than the local Contractor or those performed by outside consultants under contract with the local Contractor. D. Accounting and Auditing Services - performed by private sector firms under professional service contracts for purposes of preparation or audit of program and financial records/reports. E. Other Professional Services - rendered by individuals or organizations, not a part of the local Contractor, such as: 1. Contractual private physician providing certification data. 2. Contractual organization providing laboratory data. 3. Contractual translators and interpreters at the local Contractor level. F. Training and Education - provided for employee development, which directly or indirectly benefits the grant program, to the extent that such training is contracted for or involves out-of-service training over extended periods of time. G. Building Space and Related Facilities - the cost to buy, lease or rent space in privately or publicly owned buildings for the benefit of the program. H. Non-Fringe Insurance and Indemnification Costs All charges to WIC must be necessary, reasonable, allowable and allocable for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule, 2 CFR, Part 215 (OMB Circular A-110) and 7 CFR Part 3015. C. Family Planning Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill Family Planning grant application budget requirements each fiscal year: Salaries & Wages Fringe Benefits Travel Equipment Supplies Contractual Construction All Other Direct Costs Indirect Costs All Funding Sources By Type The Family Planning cost/funding categories and supporting budget detail requirements are MDCH/G&PD FY 10/11 Page 16 of 36 satisfied by completion of a Cost Detail Schedule with the master budget. General instructions for these forms are contained at the end of this section. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of MDCH. Prior approval is accomplished by providing appropriate detail in the budget request approved by MDCH or subsequently in a written request approved in writing by MDCH. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more per unit. E. Insurance - contributions to a reserve for a self-insurance program. F. Public Information Service Costs — for the cost of providing public information services. G. Publication and Printing Costs - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. J. Mass Severance Pay - involving grant-supported personnel. K. Organization/Reorganization Costs - allocable to the program. L. Overtime Premium - involving grant-supported personnel. M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a change in scope). N. Professional Services - in connection with Patent/Copyright Infringement Litigation. 0. Trailers or Modular Units — for costs of trailers and modular units. P. Transfers Between Construction and Nonconstruction - for approved construction funds. Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect costs to absorb increases in direct costs. R. Transfers for Substantive Programmatic Work - to a third party, by contracting or any other means used for the actual performance of substantive programmatic work. All charges to Family Planning must be necessary, reasonable, allowable and allocable for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB Circular A-110) D. Breast and Cervical Cancer Control Program Special Budget Requirements 1. The Breast and Cervical Cancer Control Program (BCCCP) budget is to be developed in the following way: One budget column, titled "BCCCP Coordination" should be used to budget costs associated with coordination of the program. Only coordination expenses will be reimbursed through the MDCH/G&PD FY 10/11 Page 17 of 36 COMPREHENSIVE agreement. All Direct Service claims including Case Management Reimbursement must be billed to the Third Party Administrator (TPA) contracted with the state for Direct Service claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the TPA. No Direct Services or Case Management expenses will be reimbursed through the COMPREHENSIVE Agreement. The Coordination amount is increased from $97 to $105 per woman based on a target caseload established by MDCH. The increase in BCCCP Coordination budget requires the following: a) The BCCCP budget must include BCCCP/WISEWOMAN annual meeting travel and related costs for a minimum the BCCCP Coordinator to attend the Wednesday Coordinators' Advisory Committee meeting and the Thursday/Friday sessions; and b) Any remaining balance must be included in the BCCCP budget for outreach and recruitment activities; for example, BCCCP incentives, BCCCP advertising and BCCCP community outreach and recruitment events. Planning/BCCCP Joint Project issued in August of each fiscal year. The above referenced documents are available at www. michigancancer.org/BCCCP. 2. The Family Planning (FP)/BCCCP Joint Project budget is to be developed in the following way: One budget column, titled "FP/BCCCP Coordination" should be used to budget costs associated with coordination of the program. Only coordination expenses will be reimbursed through the COMPREHENSIVE agreement. All Direct Service claims including Case Management Reimbursement must be billed to the Third Party Administrator (TPA) contracted with the state for Direct Service claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the TPA. No Direct Services or Case Management expenses will be reimbursed through the COMPREHENSIVE agreement. The Coordination amount is initially established by MDCH and may be adjusted at the discretion of MDCH through the COMPREHENSIVE amendment process. The Coordination amount will be reimbursed under the staffing grant reimbursement method. There is no performance requirement. There no longer is a match requirement. Match is recorded by the program TPA and reported to MDCH. 3. The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Project budget is to be developed in the following way: MDCH/G&PD FY 10/11 Page 18 of 36 E. CSHCS Outreach and Advocacy - Funds related to CSHCS Outreach and Advocacy shall be reflected as such under one column of the COMPREHENSIVE package. F. Program Budget - Cost Detail Schedule Form Entry Complete the appropriate budget forms contained within the MI E-Grants application for each program element. An example of this form is attached (see Attachment 1 for reference). 1. Salary and Wages - a. Position Description - Select from the expenditure row look-up all position titles or job descriptions required to staff the program. If the position is missing from the list, please use Other and type in the position in the drop down field provided. b. Positions Required - Enter the number of positions required for the program corresponding to the specific position title or description. This entry may be expressed as a decimal (e.g., Full-Time Equivalent — FTE) when necessary. If other than a full-time position is budgeted, it is necessary to have a basis in terms of time reports to support time charged to the program. c. Amount - MI E-grants calculates the salary for the position required and records it on the Budget Detail. Enter this amount in the Amount column. d. Total Salary — MI E-grants totals the amount of all positions required and records it on the Budget Summary. e. Notes - Enter any explanatory information that is necessary for the position description. Include an explanation of the computation of Total Salary in those instances when the computation is not straightforward (i.e., if the employee is limited term and/or does not receive fringe benefits). MDCH/G&PD FY 10/11 Page 19 of 36 2. Fringe Benefits — Select from the expenditure row look-up applicable fringe benefits for staff working in this program. Enter the percentage for each. MI E-grants updates the total amount for salary and wages in the unit field and calculates the fringe benefit amount. If the composite fringe benefit item is selected from the expenditure row look up, record the applicable fringe benefit items (i.e,. FICA, Life insurance, etc.) s in the notes tab. 13. Total Exp. - MI E-grants totals the amount of all positions required and records it on the Budget Summary. MDCH/G&PD FY 10/11 Page 20 of 36 Attachment 1 hr.-1-A El - Procirlr : 77 -tj....t..r.;;;' • t y.ar- • • I :JD .:•. -.7. J6/' itV ,7 ` 3P ER • _1: —E. 12 t MDCH/G&PD FY 10/11 Page 21 of 36 2.01,-..-- 7 ::-: ,D7-7 Ut.17 E MDCH/G&PD FY 10/11 Page 22 of 36 lith At:..7ii,',0-iri,•--: B2 - F7:7,ii_;_ ..,:ac-,1151 - ,7.i: '7 r_aitt..1 LI! 0 :.L.I.r.ie 65.1ii ,,- Cacti dnkr L l1, RECT EISEE'. _ ro' -ci — , FTE. 45,EriZiZZ- C„Ce Min -L4C.Ci I. ,... -., cr 11.3.3,C F77....: ...:_ _ - !trim 5 6511,5 .: i F..•n•. 7.1.iii•-•,. 1 C,riC !Clui., 2',77iiiiN. 7.. .i.: Si I „ - • N • i-:- 7L 7;11 ff.i. Cer.:Taaitlai turi,...lir.. !iric; 'kreirrialc -ravel 7 I an. 0.00 Z.03 &Mill 0 GO , MDCH/G&PD FY 10/11 Page 23 of 36 Lr iI 0, , !Jo r u.2Gr, :;rtWr -i Totat 4,r :r ,o.1 10 AII C:111 -c (ADP, Cr F..'"nt''',:.,ct". _ , tetz P7ogramE-....,:r: truz-,5z; C E 1..;, ..: .- , „ i CTL DIRECT:E.:5.PE"..L1E- ',: „ , :I.S: L:i. .J..-n., ,„ ____ r C17.47r, DIcti -,„tz,ziraz IetAi tr:,. TC.TAL .!All€,PEC7- E :.:PEt..V.1 E:?, 7C:TALF-1•,:PENDITUPE:', ' f ,E,,s' 4 CI MDCH/G&PD FY 10/11 Page 24 of 36 G. Medicaid Outreach Activities Reimbursement Procedures Medicaid Outreach Activities that are funded by local dollars and meet federal requirements are eligible for reimbursement at a 50% federal administrative match rate. Local Health Departments seeking reimbursement for the provision of locally funded allowable outreach activities specific to the Medicaid program may do so by submitting appropriate documentation to MDCH in accordance with the instructions listed below. Medicaid Outreach Activities funding is a subreicpient relationship. 1. Budget Preparation A. Complete the MI E-Grants application and budget forms for the application Medicaid Outreach Activities that occur during the fiscal year: 10/1/xx-091301xx. Reimbursable activities included in this column must conform to the requirements as specified in the MSA bulletin for Local Health Department Outreach Activities. Complete the MI E-Grants application and budget forms for this program. 1. Medicaid Outreach Activities: 10/01/xx-09/30/xx a. Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/xx-09/30/xx. Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in the MSA bulletin for Local Health Department Outreach Activities. Outreach activities must not be part of direct service. Expenditures must be reflected in the cost allocation plan. b. Source of Funds Tab List all exclusion items for the fiscal year: 10/01/xx-9/30/xx. Budget the amount expected from the federal government for allowable Medicaid Outreach activities. Federal Medicaid Outreach represents the anticipated 50% federal administrative match of local contributions. Budget the local contribution. Required Match - Local represents the 50% matching local contribution for Medicaid Outreach activities, These two amounts should match. c. Sources of Local Funds Types Local health departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the health department as a source for matching funds. Other state and/or federal grant awards for Medicaid Outreach must be recorded on the appropriate line as indicated in the Comprehensive Budget Instructions - Attachment I. (Please specify the source of funds as shown in the example.) MDCH/G&PD FY 10/11 Page 25 of 36 B. Complete the MI E-Grants application and budget forms for the application titled CSHCS Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx. 1. CSHCS Expenditures related to CSFICS Outreach and Advocacy should be reflected under one program element and adhere to Section IV, Special Instruction Section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period:10/1/xx-09/30/xx. a. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD CSHCS program has been applied. A table containing each health jurisdiction Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) b. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution. Federal Medicaid Outreach and Required Match — Local should equal each other. Additional local contribution that is not eligible for the 50% federal match should be reported on the Local Funds — Other line. c. Sources of Local Fund Types Local health departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the health department as a source for matching funds. d. Comprehensive Outreach and Advocacy and Care Coordination Funds Should be reported in a separate program element. C. Complete the MI E-Grants application and budget forms for the application titled Nurse Family Partnership for the timeframe: 10/01/xx-09/30/xx. Complete the MI E-Grants application and budget forms for this program. a. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD Nurse Family Partnership program has been applied. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) b. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution in Required Match — Local. Federal Medicaid Outreach and Required MDCH/G&PD FY 10/11 Page 26 of 36 Match — Local should equal each other. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds — Other. c. Sources of Local Fund Types Local health departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the health department as a source for matching funds. D. Cost Distributions Record costs distributions in box 16 of the Program Summary if costs associated with allowable Medicaid Outreach activities conducted in other Comprehensive programs (i.e., WIC, Family Planning, Immunization, etc.) are to be distributed. This may require a budget modification in the related program(s) to reflect the cost distribution movement. 2. Cost Allocation Certification This certification remains on file with the Department until no longer valid (see Attachment 2). 3. Cost Allocation Plan for Medicaid Outreach Activities LHDs seeking Medicaid Outreach reimbursement must keep on file a current cost allocation plan that reflects actual costs associated with Medicaid Outreach Activities, CSHCS Outreach and Advocacy and Nurse Family Partnership (see Attachment 3). The cost allocation plan must be supported by appropriate documentation, such as a time study, or other federally approved methodology for allocating costs, in accordance with 2 CFR, Part 225 (OMB Circular A-87). At a minimum, the cost allocation plan should contain both a narrative section and an allocation methodology section for both Medicaid Outreach activities and CSHCS Outreach and Advocacy for the fiscal year. The narrative section should briefly describe each program for which Medicaid Outreach activity expenditures are distributed and list the expenditure categories utilized. Non-reimbursable costs should be identified. The narrative section should also state the methodology utilized for distributing costs. The allocation methodology section provides the detailed calculations for how costs are determined. A. Medicaid Outreach Activities In the example provided (see Attachment 3), costs associated with providing Medicaid Outreach activities are incurred both through dedicated staff for conducting outreach activities and through the WIC program. In the Medicaid Outreach program, staff time, fringe benefits, supplies, materials, travel, other expenses, indirect and supervision associated with providing a Medicaid Outreach program are calculated for the time period at a cost of $89,074. In addition, through a time-study conducted in the WIC clinic on a quarterly basis, it was determined that, on the average, seven minutes of each certification and re-certification appointment is spent performing Medicaid Outreach activities. Time spent conducting outreach activities is multiplied by the number of encounters to determine the total number of hours spent on Medicaid Outreach. Number of hours is multiplied by the averaged hourly wage to determine the total outreach salary costs. Fringe costs and indirect costs associated with outreach salary costs are also added fora total of $47,532. MDCH/G&PD FY 10/11 Page 27 of 36 Total for Medicaid Outreach Activity expenses = $136,606, Non-reimbursable costs are subtracted from this amount. Total amount of local contribution spent for Medicaid Outreach Activities = $77,606 and the 50% federal administrative match is $38,803. B. CSHCS Outreach and Advocacy Program/Nurse Family Partnership Medicaid Outreach 4. Financial Status Report (FSR) — LHDs seeking 50% federal administrative match should request reimbursement by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through MI E-Grants. A. Medicaid Outreach Activities 1. Quarterly FSRs and Final FSR a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match for Medicaid Outreach. b. Required Match - Local Should be used to report the remaining portion of the local contribution of the Medicaid Outreach Match. Both amounts should equal. c. Other Source of Funds Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the COMPREHENSIVE Budget Instructions - Attachment I. Total Source of Funds should equal Total Expenditures. B. CSHCS Outreach and Advocacy CSHCS Outreach and Advocacy billing should occur on the final FSR through Mi E- Grants after Comprehensive Agreement funds have been expended. 1. Billing should occur as follows: a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the % of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. MDCH/G&PD FY 10/11 Page 28 of 36 b. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Additional local contribution that is not eligible for the 50% federal match should be reported in Local Funds - Other. c. Local Funds - Other Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. d. Comprehensive Outreach and Advocacy and Care Coordination Should be billed as separate program element. C. Nurse Family Partnership Outreach Reimbursement for Nurse Family Partnership Outreach should be requested by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through MI E-Grants. should occur on the final FSR after Comprehensive funds have been expended. 1. Billing should occur as follows: a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the ')/0 of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. b. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Both lines should equal. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds - Other. c. Local Funds - Other Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the CPBC Budget Instructions - Attachment I. 5. Comprehensive Agreement Preliminary Close Out Schedule —filed in September 20xx. This report is used to estimate the payable amount due to local health departments from MDCH. A. In the Agreement Amount Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach Activities to be earned from Medicaid Outreach. B. In the Agreement Amount Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from CSHSC — Medicaid Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. C. In the Agreement Amount Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from Nurse MDCH/G&PD FY 10/11 Page 29 of 36 Family Partnership Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. D. In the Expenditures Thru June FSR, enter amount reported on the 1s t, 2nd and 3rd quarter FSRs for Line 20 of the Medicaid Outreach column. E. In the Expenditures Thru June FSR, enter "0" for CSHCS — Medicaid Outreach (billing for CSHCS will occur only in the final FSR). F. In the Expenditures Thru June FSR, enter amount reported on the 1st, 2nd and 3rd quarter FSRs for Line 20 of the Nurse Family Partnership Outreach column. G. In the Estimated Expenditures for Medicaid Outreach, enter the projected 50% federal administrative match amount to be earned during the 4th quarter. H. In the Estimated Expenditures for CSHCS — Medicaid, enter the projected 50% federal match rate. This should equal the amount that is recorded in the Agreement Amount Column. Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the Comprehensive Agreement are recorded as separate program elements. MDCH/G&PD FY 10/11 Page 30 of 36 Attachment 2 (Name of Health Department) MEDICAID OUTREACH ACTIVITIES COST ALLOCATION PLAN Certification by the Responsible Health Department Official Date MDCH/G&PD FY 10/11 Page 31 of 36 Attachment 3 GREEN COUNTY HEALTH DEPARTMENT MEDICAID OUTREACH ACTIVITIES COST ALLOCATION PLAN OCTOBER 1, 20XXTO SEPTEMBER 30, 20XX MDCH/G&PD FY 10/11 Page 32 of 36 Green County Health Department Cost Allocation Methodology For Medicaid Outreach Activities The Green County Health Department has a specific staff person assigned to qualified Medicaid Outreach Activities. The actual costs of this position have been charged to the Medicaid Outreach Activities cost center. These costs are Salary, Fringe Benefits, Supplies & Materials, Communications, Space Cost, Other Misc., Indirect Costs and Nursing Supervision. Non-reimbursable costs have been deducted from these costs as an Exclusion Item (grant funding). The WIC program includes qualified Medicaid Outreach Activities in the initial and bi-annual recertification process. The cost of the Medicaid Outreach Activities included in the WIC Cost Center was determined by using a one-week time study (which will be repeated periodically). The result of the time study is the average number of minutes per certification or recertification involved in Medicaid Outreach Activities. The average time multiplied by the number of certifications and recertifications was converted into hours providing qualified activities. Total hours were multiplied by the average hourly salary of outreach staff to arrive at the salary costs of providing the outreach activities. Fringe benefit costs were calculated using the staff's fringe benefit/salary ratio and the indirect cost was calculated using the health department's standard indirect costs distribution allocation process. MDCH/G&PD FY 10/11 Page 33 of 36 Green County Health Department GREEN COUNTY HEALTH DEPARTMENT Cost Allocation Methodology Fn t•;;$.6Bid Activities — CSHCS The Green County Health DetgalfilkAiPci414;,..'-grh&VbiWgp*cial Health Care Services (CSHCS) program that provides qualified outreach activities to both Medicaid and Non-Medicaid children. BUDGETED FOR 10/1./05 - 9/310/006 The costs of thisprogram are considered,ftble for Medicaid Outreach reimbursement after the deduction of &grVitirKnWel- tW'EPHIMinff?-16-Mdicaid share for the remaining costs. Salary $38,200 Fringe Benefits a 48.% $18350 iitinlipQ R. MatrannIc cg1 nnn GREEN COUNTY HEALTH DEPARTMENT BUDGETED COSTS FOR MEDICAID OUTREACH ACTIVITiES - CSHCS PROGRAM OCTOBER 1, 2095 THROUGH SEPTEMBER 30, 2006 CSHCS PROGRAM COSTS MDCH/G&PD FY 10/11 Nursing Supervision Total budged Oostfor 1,0/1/05 - 9)30106 Grant 'Funding , MdforLocl 'Funded Cost • Local Funded Cost Prorated to this agency's CSHCS Projected Medicaid Participation Rate of 35% Anticipated Federal Medicaid Match at 50% Anticipated Federal Medicaid Match at 60% $3,922 $210,912 $100000 $110,912 $38,819 $19,410 $38,803 Page 34 of 36 FOOT NOTES: FY 10 11 AIDS/HIV Prevention Non- Categorical Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up Immunization Nurse Education Immunization VFC (only) Provider Site Visits Immunization VFC/AFIX Combined Provider Site Visits Informed Consent (a) Refer to Plan and Budget Framework for element definitions. (b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of these reimbursement (c) Negotiated starting from the average of the past two complete years actual number where available. (d) Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total (e) Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. (f) Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. (1) CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement - $201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL II CARE COORDINATION Level II Care Coordination is reimbursed at $30.00 per unit A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates $11.00 per blood draw for non-categorical health departments. Limited annually to $2,000. $100 per personal visit or $50 for a phone call (with information mailed afterward) to the provider office, not to exceed the maximum set for each individual contractor. $150 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement can only be made for one in-service module session per physician clinic site per year. $150 per site visit, not to exceed the maximum set for each individual Contractor. $300 per site visit, not to exceed the maximum set for each individual Contractor. $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services. Laboratory Services - STD & See contract language for gonorrhea and chlamydia testing reimbursement/performance requirements. AIDS SIDS $85 for each family support visit. A maximum of six (6) visits per infant death is reimbursable. Original Notes FY 10 11 9/2/2010 FOOTNOTES: FY 10 11 (17) American Recovery and Reinvestment Act (ARRA) provision applies. (18) Subject to match requirement as specified in Attachment Ill - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 10 11 9/2/2010 ATTACHMENT F ATTACHMENT II GUIDANCE TO STATE AGENCIES REGARDING THE USE OF FUNDS RECEIVED UNDER THE AMERICAN RECOVERY AND REINVESTMENT ACT (ARR.A) Table of Contents BACKGROUND 011•010.7.00811.0”0001.1”.”.."11Nteati.V.1n1"1410,....”111.1.460n41.800n04.0,0114nMO,41,116”.11.11151.41.1•11111“........n•nnn(”ler,110.O411. 4 PURPOSE 4004.10,1,10(0.11“1110.997.0,7./.nnnnnle.1.1nMpletelvt.4.0.411.....1106.11.6.4000.0...210111nnnnn4tlfaa}M.11.10q.A1116“11.00.1nAVV.07.4.6.9tleSPIPOP/Olet 1/06,. 4 INTRODUCTION 1611111111.,411/10".61,411.1.16..11,0460.4.60,4400"17.009.7090n111111,11e00611810.11.8141.111,11.,111.411.21110.1.".”11001e,..t.4461n 01“,....,”•ftaiS 5 SECTION 1 — CONTRACT AND GRANT TERMS AND REQUIREMENTS 1.1 - Buy Michigan Preference..................... ..... ...... 6 1.2 - Buy American Requirement... ..... ........... ....... ......... 1.3 - Whistleblower Protections.......................... ..... ............................ ....... ..... 1.4 - Wage Requirements ................................................................ ........... 1.5 - Publicizing Contract Actions ..... ..................... ..... 1.6 - Reporting Requirements ......... ....7 1.7 Inspection of Records ___________________ _____„,.......... ...... ...... 8 1.8 - Availability of Funding ........ ................... ..... ..........................._ ...... . ...... 1.9 - Non-Discrimination ..... ................ ....... ........................ .................. .......... .......... ....8 1.10 - Prohibition on Use of ....... ..... 8 1 ,11 - Publications ................. ..... ........... ............... .......... ...... ............... ..... .......... ...8 1 .12 - False Claims Act ....... .........................______ ..... . ....... ........ .............. . ..... ..... 8 1.13 - Conflicting Requirement........................................................................._ ....... ...9 1.14 - Sub-Recipient Requirements ..,............................ .............. ............ 9 1.15 - Competitive Fixed Price Contracts__ ......................... ...... ....... ....... 1 .16 - Segregation of Funds................................. ..... . ...... ................................ ..... .......9 1.17 - Job Opportunity Posting Requirements .............. ...... ............................. ..... . ..... .9 SECTION 2- COMPLIANCE AND CONTRACT 2.1 - General Planning and Process .............................. ...... ................. ......... . ..... ......10 2.2 - Determination of Responsibility ..... 2 .3 - Delegated Authority ................................................„..„................... ............ ......11 2.4 - Contract Surveillance/Administration ..... ................................................ ........ 11 2.5 - Emergency 2.7 - Segregation of Costs ............. ..... ......... ....... 13 2.8 - Government Accountability Office/Inspector General Access............................13 2.9- Ethics ............. ...........„.......... ........ ....... .......... .........14 2.10 - Michigan Economic Recovery Office Notification..................... ............... .........14 2.11 - Notice Requirements under PA 7 of Guidance to State Agencies Regarc5ng Funds Received April 16, 2009 1 Under the American Recovery and Reinvestment Act (ARRA) 2.12 Fraud Prevention 2.13 - Grant and Cooperative Agreements ........ ..... 2.14- Risk Considerations ..... 18 2.15- Buy American Requirement Applicable to State Agencies. ..... .........................18 2.16 - WhistleBlower Protection ............................................ ..... ....... 2.17- Internet Sites.............................. ...... SECTION 4- APPENDICES 4.1 - AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (TITLE XV & XVI)23 TITLE XV—ACCOUNTABILITY AND TRANSPARENCY Sec. 1501. ..... ..... . ...... ..............23 Guidance to State Agencies Regarding Funds Received April 16, 2009 2 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1527. Independence Of Inspectors Sec. 1528. Coordination With The Comptroller General And State Sec. 1529. Authorization Of Appropriations. Sec. 1530. Termination Of The Board. SUBTITLE C--RECOVERY INDEPENDENT ADVISORY PANEL-..............-..............31 SUBTITLE 0—ADDITIONAL ACCOUNTABILITY AIN.) TRANSPARENCY TITLE XVI—GENERAL PROVISIONS--THIS ACT........................................................39 Guidance to State Agencies Regarding Funds Re—ceived- April 16, 2009 3 Under the American Recover,/ and Reinvestment Act (ARRA) In addition, the ARRA has some specific contractual, grant, and reporting requirements that are outlined in 'Title XV Accountability and Transparency & Title XVI General Provisions of the Act. This document will be updated as necessary. Guidance provided herein is not intended to be exhaustive and the agency will have responsibility to research these two titles for complete detail. Guidance to State Agencies Regarding Funds Received April 16, Under the American Recovery and Reinvest,' rent Act (ARRA) Our task will be to administer contracts that include the reporting tools, monitoring procedures, and accountability requirements that will help prevent fraud, waste, and abuse of these funds. Guidance to State Agencies Regarding Funds Received April 16, 2009 Under the American Recovery and Reinvestment Act (ARRA) SECTION 1 — CONTRACT AND GRANT TERMS A. REQUIREMENTS All contracts, both new and existing, involving the use of ARRA funds must include provisions like those set forth in this Section. As used in this Section, "Recipient" refers to the recipient of ARRA funds from the State of Michigan (i.e. the contractor or grantee). 1.1 - Buy Michigan P: _Terence A preference is given to products manufactured or services offered by Michigan based firms if all other things are equal and if not inconsistent with federal statute (see MCL 18.1261). Guidance to State Agencies Regarding Funds Received April 16, 2009 Under the American Recovery and Reinvestment Act (ARRA} This term must be included in all subcontracts or sub-grants involving the use of funds made available under the ARRA. 1.5 • Publicizing Contract Actions An contract solicitations funded in whole or in part with ARRA funds will be posted on the vvww.bid4michioan.com website. Ail contracts resulting from the ARRA will be published on the State of Michigan's Recovery Web site, www.michigan.00v/recovery. The Recipient's failure to provide complete, accurate, and timely reports shall constitute an "Event of Default". Upon the occurrence of an Event of Default, the Guidance to State Agencies Regarding Funds Received April 16, 2009 Under the American Recovery and Reinvestment Act (ARRA) state department or agency may terminate this contract upon 30 days prior written notice if the default remains uncured within five calendar days following the last day of the calendar quarter, in addition to any other remedy available to the state department or agency in law or equity. Guidance to State Agencies Regarding Funds Received Apri416, 2009 Under the American Recovery and Reinvestment Act (ARRA) 113 - Conflicting Requirement If the ARRA requirements conflict with State of Michigan requirements, then ARRA requirements control. 1.14 - Sub-Recipient Requirements Recipient shall include these terms, including this requirement, in any of its subcontracts or subgrants in connection with projects funded in whole or in part with funds available under the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5. 1.15 - Competitive Fixed Price Contracts Recipient, to the maximum extent possible, shall award any subcontracts funded, in whole or in part, with Recovery Act funds as fixed-price contracts through the use of competitive procedures. 1.17 - Job Opportunity Posting Requirements Recipient shall post notice of job opportunities created funded in whole or in part with ARRA funds in www.michworks.orq/mtb. in connection with activities the Michigan Talent Bank, Guidance to State Agencies Regarding Funds Received April 16,2009 Under the American Recovery and Reinvestment Act (ARRA) SECTION 2 - COMPLIANCE ,ND CONTRACT MANAGEMENT: This Section provides guidance to state agencies on Compliance and Contract Management in connection with funds made available under the ARRA. As used in this Section, "Recipient" refers to the recipient of ARRA funds from the State of Michigan (i.e. the contractor or grantee). 2.1 - General Planning and Process In addition to any applicable state or federal procurement requirements, state agencies and Recipients, to the maximum extent possible, shall award any contracts funded, in whole or in part, with ARRA funds with the following provisions: Guidance to State Agencies Regarding Funds Received April 16, 2009 10 Under the American Recovery and Reinvestment Act (ARRA) This restriction does not apply to those contract types which are currently handled by the agency through statutory authority or Administrative Guide delegation (i.e. grants, direct human services, medical services, construction, MDOT, DNR leases, etc.). The agency should ensure that these persons have clear guidance as to their roles and responsibilities and that there is adequate training before assigning these roles. You will find the following tools on the DMB intranet, in the ARRA toolkit, to assist with contract administration and contract monitoring: Guidance to State Agencies Regarding Funds Received April 16, 2009 11 Under the American Recovery and Reinvestment Act (ARRA) 1. Risk Assessment Report & Worksheet 2. Kick-Off Meeting Record 3. Contract Compliance Report 4. Vendor Scorecard 5. Contract Closeout Report 2.5 - Emergency Purchases Agencies are cautioned that the ARRA does not independently trigger use of emergency procurement authorities in Administrative Guide 0510.38. These authorities are triggered in limited, statutorily identified, circumstances. Unless one of these circumstances exists, the special emergency authorities shall not be used. Guidance to State Agencies Regarding Funds Received April 16, 2009 12 Under the American Recovery and Reinvestment Act (ARRA) Besides these reports, the Government Accountability Office (GOA) is required to conduct bimonthly reviews and prepare reports on such reviews on the use by selected states and localities of funds made available in the ARRA. The ARRA does not specify the criteria by which the states and localities will be selected. The reports are to be available online. For additional details about the 'Reporting' requirements, see the Section 1512 of the ARRA and Federal Register, Volume 74, Number 61 available at: htt.://www.fta.dot..ovidocuments/040409 OMB Cmt Request 1512 data specs(1 ).pdf. Further guidance regarding the specific data element as well as the method for submission of the information will be provided as soon as it becomes available. 2.7 - Segregation of Costs Obligations and expenditures of ARRA funds must be segregated from other funding. No part of ARRA funds may be comingled with any other funds or used for a purpose other than that of making payments for costs allowable under the ARRA. Refer to section 3 for specific guidance on accounting and financial reporting requirements. The Purchase Request Form (PRF) and the Administrative Bid Tab will have a check box added to designate which contracts are using ARRA funds, in whole or in part. These ARRA-funded projects that must receive State Administrative Board approval will be considered on a separate State Administrative Board agenda. For the Comptroller General these alternate clauses provide specific authority to audit contracts and subcontracts and to interview contractor and subcontractor employees under contracts using Recovery Act funds. Agency inspector generals receive the same authorities, with the exception of interviewing subcontractor employees. Guidance to State Agencies Regarding Funds Received April 16, 2009 13 Under the American Recovery and Reinvestment Act (ARRA) For full details of the 'Government Accountability Office & Inspector General Access' requirements, see the Federal Registry Vol. 74 Rules and Regulations (March 31, 2009, pages 14646-14649). If your department is distributing funds received under the Recovery Act through a competitive grant process, you must notify the senate and house of representatives standing committees on appropriations, senate and house fiscal agencies, and state budget office at least one day prior to the issuance of the request for proposals. Please include the Michigan Economic Recovery Office on this notice. Most recently, in February 2009, the National Procurement Fraud Task Force (NPFTF) published a white paper A Guide to Grant Oversi•ht and Best Practices for Combating Grant Fraud, Washington, D.C.: February, 2009) that identified best practices and made recommendations for agencies to consider in preventing fraud, Guidance to State Agencies Regarding Funds Received April 16,2009 14 Under the American Recovery and Reinvestment Act (ARRA) waste, and abuse in grants they administer. These recommendations included enhanced certifications, increased training, improved communications with grant recipients, increased information sharing concerning potential fraud, and rigorous oversight of how grant dollars are spent after they are awarded. We recommend you access and read that report. Grant agreements must also include any terms needed to implement agency/program specific provisions and general provisions of ARRA. For complete details of the "Grants and Cooperative Agreements" requirements, see the Federal Office of Management & Budget guidance letter of April 3, 2009 (M- 09-15), Section 5 and Appendix 9. htte://www.recove .iov/sites/default/files/m09- 15. pdf We have included some excerpts pertinent to grant requirements: "5,1 Are there actions, beyond standard practice, that agencies must take while planning for competitive and formula grant awards under Recovery Act? (2) Competition Although the Recovery Act calls on agencies to commence expenditures and activities as quickly as possible consistent with prudent management, this Guidance to State Agencies Regarding Funds Received April 16, 2009 15 Under the American Recovery and Reinvestment Act (ARRA) (4) Timeliness of Awards Agencies need to assess existing processes for awarding formula allocations and announcing, evaluating and awarding discretionary grant opportunities to comport with the objective to make awards timely. 5.4 Are Federal agencies expected to initiate additional oversight requirements for grants, such as mandatory field visits or additional case examinations for error measurements, to comply with grant rules and regulations? Yes Agencies must take steps, beyond standard practice, to initiate additional oversight mechanisms in order to mitigate the unique implementation risks of the Recovery Act. At a minimum, agencies should be prepared to evaluate and demonstrate the effectiveness of standard monitoring and oversight practices. (1 ) Performance Management and Accountability Agencies must adapt current performance evaluation and review processes to include the ability to report periodically on completion status of the program or activity, and program and economic outcomes, consistent with Recovery Act requirements. Guidance to State Agencies Regarding Funds Received April 16, 2009 16 Under the American Recovery and Reinvestment Act (ARRA) Agencies, in consultation with the Inspectors General, shall establish procedures to validate the accuracy of information submitted on a statistical basis and/or risk based approach as approved by OMB. Also, consistent with Section 3 of this Guidance, agencies should initiate additional measures, as appropriate, to address higher risk areas. 5.9 Are there terms and conditions, beyond standard practice, that must be included in competitive and formula grant agreements under the Recovery Act? • Make clear that that any funding provided through the Recovery Act is one- time funding. Guidance to State Agencies Regarding Funds Received April 16, 2009 17 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 18 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarcfing Funds Received April 16, 2009 19 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 20 Under the American Recovery and Reinvestment Act (ARRA) SECTION 3 - ACCOUNTING AND FINANCIAL REPORTING GUIDANCE No part of ARRA funds may be comingled with any other funds or used for a purpose other than that of making payments for costs allowable under the ARRA. To assist in tracking and keeping ARRA funds separate from non-ARRA funds, the following steps will be taken. 3.1 - General R*Stars Coding Requirements In order to meet specific ARRA reporting guidelines, it is necessary to track all federal ARRA revenues separately from existing federal program revenue. Each ARRA-related line item appropriation will require unique appropriation (20 profile) and fund (D23 profile) numbers. Guidance to State Agencies Regarding Funds Received April 16, 2009 21 Under the American Recovery and Reinvestment Act (ARRA) 3.6 - Agency Receiving ARRA Revenue from another Agency If an Agency plans to receive ARRA funds from another Agency, the recipient agency should contact their OFM Accounting Liaison for guidance related to profile establishment and transaction processing. The data elements are listed in detail within the Federal Register, Volume 74, Number 61. A copy of those reporting data elements can be found at: hfto://www.fta.dotgovidocuments/040409 OMB Cmt Request 1512 data specs(1 ).pdf Further guidance regarding the specific data element as well as the method for submission of the information will be provided as soon as it becomes available. Guidance to State Agencies Regarding Funds Received April 16, 2009 22 Under the American Recovery and Reinvestment Act (ARRA) SECTION 4 - APPENDICES 4.1 - AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (TITLE XV & XVI) TITLE XV--ACCOUNTABILITY ND TRANSPARENCY SUBTITLE A-TRANSPARENCY AND OVERSIGHT REQUIREMENTS Guidance to State Agencies Regarding Funds Received April 16, 2009 23 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1513. Reports Of The Council Of Economic Advisers. (a) In General - In consultation with the Director of the Office of Management and Budget and the Secretary of the Treasury, the Chairperson of the Council of Guidance to State Agencies Regarding Funds Received April 16, 2009 24 Under the American Recovery and Reinvestment Act (ARRA) SUBTITLE B-RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD Guidance to State Agencies Regarding Funds Received April 16, 2009 25 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 26 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 27 Under the American Recovery and Reinvestment Act (ARRA) (A) whether the agency agrees or disagrees with the recommendations; and (B) any actions the agency will take to implement the recommendations. Sec. 1525. Employment, Personnel, And Related Authorities. (a) Employment and Personnel Authorities- Guidance to State Agencies Regarding Funds Received April 16, 2009 28 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 29 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16. 2009 30 Under the American Recovery and Reinvestment Act (ARRA) or to protect information that is not subject to disclosure under sections 552 and 552a of title 5, United States Code. Sec. 1528. Coordination With The Comptroller General And State Auditors. The Board shall coordinate its oversight activities with the Comptroller General of the United States and State auditors. Sec. 1529. Authorization Of Appropriations. There are authorized to be appropriated such sums as necessary to carry out this subtitle. Sec. 1530. Termination Of The Board. The Board shall terminate on September 30, 2013. SUBTITLE C—RECOVERY INDEPENDENT ADVISORY PANEL Guidance to State Agencies Regarding Funds Received April 16, 2009 31 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1542. Duties Of The Panel The Panel shall make recommendations to the Board on actions the Board could take to prevent fraud, waste, and abuse relating to covered funds. Guidance to State Agencies Regarding Funds Received April 16, 2009 32 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1545. Termination Of The Panel. The Panel shall terminate on September 30, 2013. Sec. 1546. Authorization Of Appropriations. There are authorized to be appropriated such sums as necessary to carry out this subtitle. SUBTITLE D--ADDITIONAL ACCOUNTABILITY AND TRANSPARENCY REQUIREMENTS Guidance lo State Agencies Regarding Funds Received April 16, 2009 33 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 34 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 35 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 36 Under the American Recovery and Reinvestment Act (ARRA) Guidance to Stale Agencies Regarding Funds Received April 16, 2009 37 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April la 2009 38 Under the American Recovery and Reinvestment Act (ARRA) TITLE XVI--G"INERAL PROVIV71S—THIS ACT RELATICilSHIP TO OTHER APPROPRIATIONS Sec. 1601. Each amount appropriated or made available in this Act is in addition to amounts otherwise appropriated for the fiscal year involved. Enactment of this Guidance to State Agencies Regarding Funds Received April 16, 2009 39 Under the American Recovery and Reinvestment Act (ARRA) Act shall have no effect on the availability of amounts under the Continuing Appropriations Resolution, 2009 (division A of Public Law 110-329). PERIOD OF AVAILABILITY SEC. 1603. All funds appropriated in this Act shall remain available for obligation until September 30, 2010, unless expressly provided otherwise in this Act. LIMIT ON FUNDS SEC. 1604. None of the funds appropriated or otherwise made available in this Act may be used by any State or local government, or any private entity, for any casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool. WAGE RATE REQUIREMENTS SEC. 1606. Notwithstanding any other provision of law and in a manner consistent with other provisions in this Act, all laborers and mechanics employed Guidance to State Agencies Regarding Funds Received April 16,2009 40 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 41 Under the American Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 42 Under the Arnedcan Recovery and Reinvestment Act (ARRA) Guidance to State Agencies Regarding Funds Received April 16, 2009 43 Under the American Recovery and Reinvestment Act (ARRA) Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS General - (Law) Annual State - 2CFR Part 225 (OMB Circular A-87) (Revised) Cos - Waiver Policy BCS- - Waiver Procedure BCS-2007.1* - (State) Local FMIS Manual* Administration Appropriation Bills* Principles for State, Local and Indian Tribal 2007 - Capital Outlay Prior Approval - (State) Treasury LHD - (Law) Public Health Governments - MDCH Funding Procedure BCS-014.1* Accounting Procedures Code P.A. 368 of 1978 - Federal OMB Circular A-102 (Revised) Implemented Allocation Policy* Manual* (as amended)* through "Common Rules- Grants Management* - Minimum Program - (State) MDCH Reporting - (Law) Single Audit Act - - P1-IS Grants Management Handbook* Requirements - Requirements Notebook Amended*1996 Department Policy - 45 CFR Part 96 Block Grant Regulations (1) (H-284)* - (Law) Federal MCH 8000* - 45 CFR Part 74 Administration of Grants (3) or; - (State) Minimum Program Block Grants-Pi. 97-35 - Capital Outlay Prior Requirements of 1981 (as amended)11) 45 CFR Part 92, Uniform Administrative Approval Policy - BCS- Requirements for Grants and Cooperative 014* - (Fed) PHS Grants Policy - (Law) Subcontract Agreements to State and Local Governments, as Statement* Requirements, Civil applicable* - (Fed) PHS Grants Rights Laws/Special Assurances as specified - Federal OMB Circular A-133 Audits of States, Local Administration Manual* Governments and Non-Profit Organizations* in the agreements* - (Fed) HI-IS Grants - (Law) Local Uniform - Federal OMB Circular A-133 Compliance Administration Manual* Budgeting Act P.A. 621 Supplement - (State) Annual Budget, FSR of 1978 (as amended) - 2 CFR Part 180 Guidelines to Agencies on & Indirect Instructions* - (Law) Local Uniform Govemmentwide Debarment and Suspension • Accounting Act P.A. 71 - 45 CFR Part 93 Lobbying* of 1919 (as amended)* - 45 CFR Part 6, Inventions and Patents* - (Law) Section 1352 of - 42 CFR Parts 432 and 433 (Title XIX Funded P.L. 101-121 (re: Programs) Lobbying) (3) - 45 CFR, Part 46, Protection of Human Subjects - (Law) Management and Budget Act" - Catalog of Federal Domestic Assistance (CFDA)* - (Law) OBRA 89 P.L. FOR SUBGRANTEES: 101-239 (amendment to - 2 C.F.R. Part 220 (OMB Circular A-21) Cost Title V)* Principles for Educational Institutions* - (Law) 1968 P.A. 317 and - 2 CFR Part 215 (OMB Circular A-110) Uniform 1973 PA. 196 as Administrative Requirements for Grants and Other amended regarding Agreements with Institutions of Higher Education, conflict of interest* Hospitals and Other Non-profit Organizations* - (Law) P.L. 103-227 - 2 C.F.R. Part 230 (OMB Circular A-122) Cost Part Principles for Non-profit Organizations* C Environmental Tobacco Smoke* - Federal OMB Circular A-133 Audit Requirements for - (Law) PA 533 of 2004 States, Local Governments and Non-Profit Organizations* - (Rules) 325.13053 - Federal OMB Circular A-133 Compliance Supplement - Americans With Disabilities Act of 1990* , Breast & - (Law) P.L. 101-354 of - Dept. of HHS, CDC: Annual Announcements, Early MDCH/CMS FY 10/11 Page 1 of 11 FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals Cervical 1990 Title XV of Detection & Control of Breast & Cervical Cancer; Cancer Preventive Health Program Guidance, Instruction and Information Services Act (42 U.S.C. 201) - Breast & Cervical Cancer Amendment of 1993 - (Law) Public Health Code P.A. 368 of 1978, Part 95- (Law) P.L. 105- 340-Women=s Health Research and Prevention Amendments of 1998. Campground - (Law) Public Health Inspection Code PA. 368 of 1978 as amended - (Rule) 325.1551 et, seq, Care for - (Law) Public Health Individuals with Code P.A. 368 of 1978 serious communicable - Part 53 disease or - (Rule) 325.177 infection Child Health - (1) - (1) Childhood Lead - (1) - (1) Poisoning Prevention - (Law) Public Health CDC Screening Young Children for Lead Poisoning, Program Code P.A. 368 of 1978 1977 Part 24 and 51 - CDC Managing Elevated Blood Lead Levels Among Young Children, 2002 - (Law) Lead Abatement Act - MDCH EBLL Protocol, 2005, or any subsequent revision - MDCH Case Management Protocol for Children, revised 2007- Provider Guidelines, MDCH CLPPP, September 2007, or any subsequent revision. - MDCH CLPPP Statewide Lead Testing/Lead Screening Plan, August 2007. - Lead Safe Home Program Regional Field Consultant Policy and Procedures Field Guide - CDC: "Preventing Lead Poisoning in Young Children", 2005 - CDC: "Screening Young Children for Lead Poisoning", 1997 - CDC: "Managing Elevated BLLs Among Young Children", 2002 - P.A. 55 of 2004 Children' s - (Law) Public Health Code PA. 368 of it MIDCH/C.AAS FY 1(1/1 1 Page 2 of 11 Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Special Health Part 58 Care Services (CSHCS) - (Law) Title V of the Social Security Act of 1935 42 U.S.C. 701 to 706 Emergency - (Law) Emergency Management- Management Act 310 of Community 1978 MCL 30.410 Health Annex Family - (1) - (1) - (State) Title X Family Planning - (Law) P.A. 303 (1965); - Catalog of Federal Domestic Assistance (93.217) Planning Standards & PA. 226 (1997); Public 42 CFR Part 59, Grants for Family Planning Review Manual (2006) Health Code P.A. 368 of -Services - (Fed) Federal Program 1978; P.A. 360 (2002) Guidelines for Project - (Law) The Family Grants for Family Planning Planning Population Services (2001) Research Act (Title X of - (Fed) Family Planning the Public Health Annual Report (Eff.2007) Service Act - (Fed) Family Planning - (Law) P Pl. I . 91-572, 1970 Annual Report, Effective2007, Standards and Guidelines Family - (Law) Public Health Planning Code PA. 368 of Services for 1978- MCL 333.9131 Indigent Women - (Rules) 325-151 et, seq, Food Protection - (Law) Food Law of 2000 Act 92 of 2000 MCL 289,3105 - (Rules) 285.553.1 et. seq. — - Health - (Law) Public Health Education Code P.A. 368 of 1978 MCL 33.2433 _ Hearing - (Law) P.A. 368 Sections - State of Michigan Hearing R325.3271-3276. Screening Technician Manual MDCH/CMS Fy 10111 Page 3 of 11 Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS HIV/AIDS Care - (Law) Michigan Law - DSS Policy Guidelines: - Prindples and Standards of - (Federal) Ryan White CARE MCL 333.5151 and MCL Services for HIV/AIDS Case Act Title II Manual - No. 1: Eligible 333.1299 Individuals and Management in Michigan. - (Law) —Ryan White Services for Individuals - CARF-MDCH Procedures for HIV/AIDS Treatment Not Infected with HIV completing the Client Authorization for Counselor Modernization Act of - No. 2: Allowable Uses 2006 of Funds for Discretely Assisted Referral form (CARP), Defined Categories of January, 2006, or any subsequent revisions. Services, including Supplement - HAPIS Administrative Versus — No 8: Staff Training Service/Program Cost Budget Guidance. - No. 4: DSS Policy on Contracting with For Profit Entities HAB Policy Notices: - No. 08-01: Use of Ryan White HIV/AIDS Program funds for Housing Referral Services and Short- term or Emergency Housing Needs. - No. 07-02: Use of Ryan White HIV/AIDS Program Funds for HIV Diagnostics and Laboratory Tests - No.07-01: Use of Ryan White HIV/AIDS Program Funds for American Indians and Alaska Natives and Indian Health Service Programs - No. 07-04 Transitional Social Support and Primary Care Services for Incarcerated Persons. - No. 07-06— Use of Ryan White HIV/AIDS Program Funds for Outreach Services - No. 07-07 Use of Ryan White HIV/AIDS Program Funds for Veterans. ML/U1-1/LiIM I-Y 1U/11 Page 4 of 11 Procedures Policies State/Federal Manuals Program/Element Laws/Administrative Rules Federal Regulations/Circulars FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS HIV Prevention - (Law) PA. 488 of 1988, Services as amended by Act 200 of 1994, and Act 420 of 1994 (MCL 333.5133) - (Law) PA. 489 of 1988 (MCL333.5144a) - (Law) PA. 86 of 1992 (MCL 333.5131) - (Law) Public Health Code P.A. 368 of 1978 (as amended) - Michigan HIV Event System CTR and Data definitions and data collection templates. - HIV Prevention Referral Guidelines and Toolbox MDCH, July 2007 MDCH/1-1APIS HIV Prevention Counseling Quality Assurance Toolbox, February, 2007 MDCH Rapid HIV Testing Quality Assurance Manual, 2008 or subsequent revisions. HIV Prevention Interventions, May 2003 or subsequent revisions. - MDCH, Important Health Information, DCH 0675 (previously HP-143). - Michigan HIV Event System CTR and PCRS modules. - Recommended Guidance for Conducting Partner Counseling and Referral Services (PCRS) Application for categorically Funded Local Public Health Departments, MDCH, October 2006 - Local Health Department PCRS Patient Field Investigation Form DCH-1275 or subsequent revisions. - Addendum to PCRS Guidance; Useful HIV and STD Investigation Techniques, January 2007 - Information Based Testing Guidance, MDCH 2004. - Policy for Provision of HIV Test results Via Telephone. MDCH, October 2002. - Michigan HIV Laws: What Physicians and Other Health Care Providers Need to know. MDCH, January 2006, - Confidential Request for Assistance with Partner Counseling and Referral Services Form (DCH -1221), or subsequent revisions. - MDCH Strategies to Improve Client Return Rates for Receiving HIV Test Results., May 2007, or subsequent revisions. MDCH/CMS FY 10111 Page 5 of 11 Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS • MDCH-Protocol for HIV Counseling and Testing using Oral Mucosal Transudate Technology, MDCH 2002. - CARF-MDCH Procedures for Completing the Client Authorization for Counselor Assisted Referral Form (CARF), August 2003, or any subsequent revisions. - Michigan Local Public Health Accreditation Standards: Section XII 2008, or subsequent revisions. - Protocol for Low Morbidity Health - Department Response to Request for Assistance with Disease Management, MDCH June 2006, or any subsequent revisions. - Recalcitrant Behaviors Among HIV/AIDS Diagnosed Populations: Guidance for Local Pubic Health Department Response to Health Threat to Other Situations, 2005 or any subsequent revisions. - CDC Integrated STD/HIV Partner Services Guidelines, June 2008 - MDCH Targeted partner Counseling and Referral Services for HIV-Infected Women, June 2008 or subsequent revisions HOPWA - MCL 112 of 1968, Fair - 24 CFR Part 574 - Adhere to HUD - MDCH Budget and Billing Housing; 42 USC documentation & instructions in Attachment III - 24 CFR part 5; income verification and subsidy MDCH/CMS FY 10/11 Page 6 0111 Procedures Policies Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Section 800, Fair calculation program requirements _ Completion of MDCH FSR Housing - The Lead-Based Paint Poisoning Prevention Act (42 Supplemental form with FSR U.S.C. 4821-4846), the Residential Lead-Based - MDCH Instructions for the Paint Hazard Reduction Act of 1992 (42 U.S.C. completion of the Quarterly- 4851-4856), and implementing regulations at part 35, Annual Report subparts A, B, H, J, K, M, and R of this part apply to activities under this program. - 24 CFR 82.306(d) receiving benefits when housed with a family member - The policies, guidelines, and requirements of 24 CFR part 85 (codified pursuant to OMB Circular No. A- 102) and 2 CFR Part 225 (OMB Circular No. A-87) apply with respect to the acceptance and use of funds under the program by States and units of general local government, including public agencies, and 2 CFR 215 (OMB Circular A-110) and 2 CFR Part 230 (OMB Circular A-122) apply with respect to the acceptance and use of funds under the program by private non-profit entities. - Section 504 of the Rehabilitation Act of 1973 ("Section 504"), and Title II of the Americans with Disabilities Act of 1990 ("ADA"). - Notice CPD-06-06 Issued: May 15, 2006 Subject: Standards for Fiscal Year 2006 HOPWA Permanent Supportive Housing Renewal Grant Applications - Notice CPD-06-07 Issued August 3, 2006 Subject: Standards for HOPWA Short-term Rent, Mortgage, and Utility (STRMU) Payments and Connections to Permanent Housing - Frequently asked questions on HOPVVA STRMU - NOTICE: CPD 04-10 Issued: September 29, 2004 SUBJECT: Guidelines for Ensuring Equal Treatment of Faith-based Organizations participating in the HOME, CDBG, HOPE 3, HOPWA, Emergency Shelter Grants, Shelter Plus Care, Supportive Housing, and Youth-build Programs - CAPER-Measuring Performance Outcomes OMB Number 2506-0133 Exp Date 12/31/2010 form HUD- 040110-C - APR — Measuring Performance Outcomes OMB number 2506-0133 Exp 12/31/2010 form HUD- 40110-C (revised 1/2006) - HUD Notice of Outcome Performance Measurement System for CPD Formula Grant Programs [Docket No. FR-4970-N-02] - Fed RegNol. 71, No. 45/Wednesday, March 8, 2006/Notices HOPWA Immunization - (1) - (1) - WIC policy - Vaccines for Children - (Law) P.L. 99-660, memorandum #2001 Operations Manual revised by P.L. 103-183, - Immunization Program The Preventive Health MDCH/CMS FY 10/11 Page 7 of 11 FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals Law of 1993, section Operations Manual (IPOM) 1928, Part IV and - Vaccine Preventable section 13631 Disease Reporting Manual - (Law) P.L. 99-660, The National Childhood - VFC Resource Book for Vaccine Injury Act of Providers 1986 - (Law) P.A. 540 of 1996 - (Law) Public Health Code PA. 368 of 1978, as amended - (Law) P.A. 273 of 1996 - (Law) Act 491 of 1988 - (Rules) 325.176 Immunization — - Guidance to State Agencies Regarding the Use of Reaching More Funds Received Under the American Recovery and Children and Reinvestment Act (ARRA) Adults Healthy Homes - (Law) Lead Abatement - Lead Safe Home Program - Lead Safe Act\ Regional Field Consultant Policy Home Program - Lead Hazard Control Rules and Procedures Field Guide Local Public - (Law) Public Health Health Code P.A. 368 of 1978 Operations (as amended) (LPHO) - (Law) P.A. 92 of 2000 - (Rules) R327.41 - R327.65 Infectious/ - (Law) Public Health Communicable Code P.A. 368 of 1978, Disease 333.2433; Parts 51 Control and 52 - (Rules) 325.171 et. seq. Maternal Infant - (1) - (1 ) -2008 MI Medicaid Provider Health Program - (Law) Comprehensive Manual Omnibus Reconciliation Act of 1985 (COBRA) - (Law) Omnibus Reconciliation Acts of 1987 and 1989 - (Law) OBRA 89 P.L. 101-239 (Amendment to Title V) MDCH/CMS FY 10/11 Page 8 of 11 FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals Nutrition - (Law) Public Health Services Code P.A. 368 of 1978, MCL 333,2433 Pregnancy Test - (Law) Public Health Related to Code RA. 368 of 1978, Informed MCL 333.17015 (18) Consent to Abortion Prenatal Care - (1) & (2) - (1) Clinic Services - (Law) OBRA 89 P.L. 101-239 (Amendment to Title V) - (Law) OBRA 90 - (Law) PA. 368, 1978 AIDS Section Public/Private - (Law) Public Health Sewer Code P.A. 368 of 1978, as amended* - (Rules) R299.4101 et. seq. Public/Private - (Law) Public Health Water Supply Code PA. 368 of 1978, as amended - (Rules) 325.2291 et, seq, - (Rules) 323.19691 et, seq, - (Rules) 325.11391 et, Public - (Law) Public Health Swimming Pool Code P.A. 368 of 1978 Inspections - (Rules) 325.2111 et. Sexual (Law) Violence Against Violence Women Act of 2005, Prevention TITLE 42, CHAPTER 6A, SUBCHAPTER II , Part J, § 280b-1c SMILE! - SEALS Data Collection Michigan Software, SEAL American, Dental Sealant SMILE! Michigan Dental Sealant User's Guide MDCH/CMS FY 10/11 Page 9 of 11 Procedures Policies Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals TB Control- I - Public Health Code 5203 DOT I & 5205 - (State) Core Curriculum - 7 CFR, Part 246 and Part 3015 and 3016 - USDA Policy Memos - (MDCHNVIC Laboratory Procedure Manual (DCH 0476) - (State) WIC/MDC;H - (State) WIC Policy and Procedure Manual (DCH- 0296) - (State) Vendor Unit Policy and Procedures Manual - (Fed) Food and Nutrition Service (FNS) Instructions 800-1 through 821-1 and 113-2 - (Fed) WIC Administrative Cost Handbook/Advance Planning Handbook - (Fed) Financial Management Handbook (FNS-154) WIC - (Law) Federal Public Law 95-627 (Reauthorized through P.L. 101-147 Pursuant to the Child Nutrition Act) - (Law) Section 17 of the Child Nutrition Act of 1966, as amended - (Law) Following Public Laws: 95-627, 96-499, 97-35, 99-500, 99-591, 100-237, 101-147, 102- 518, 107-249 (Reauthorized through P.L. 109-85 and P.L. 108-265) FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS STD Control - (Rules) MDCH, - CDC Integrated STD/HIV partner - (Fed) Centers for Disease Communicable & Services Guidelines, June 2008 Control and Prevention Related Diseases, by Program Operations and Authority of Sec. 5111 of Treatment Guidelines Public Health Code 368 (Advisory Only) PA. of 1978 (as amended), - (Rules) 326.1777 — SIDS - (Law) Act 350 P.A. of - (State) Sudden Infant Death 1974 (MCL 52.205a) Professional Services Manual - (State) SIDS Task Force Manual Vaccine Quality - (1) - (1) Assurance - (Law) Public Health - 42 CFR, Part 51b, Sub Parts A & B: Project Grants Code P.A. 368 of 1978, for Preventive Health Services; General Provisions; Part 92 Grants for Communicable Disease Control - (Law) Section 317 of the - Federal Register, Vol. 58, No, 63, April 5, 1993 Public Health Service Act (42 U.S.C. 247b) as amended Vision - (Law) P.A. 368, Sections - State of Michigan Vision R 325.13091-13096 Screening Technician Manual WISEVVOMAN - (Law) P.L. 101-354 of - Dept. of HHS, CDC: Annual Announcements, Early 1990 Title XV of Detection & Control of Breast & Cervical Cancer; Preventive Health Program Guidance, Instruction and Information Services Act (42 U.S.C. MDCH/CMS FY 10/11 Page 10 of 11 Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals FY 10/11 CPBC AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS 201) - Breast & Cervical Cancer Amendment of 1993 - (Law) Public Health Code P.A. 368 of 1978, Part 95 - (Law) P.L. 105-340- Women' s Health Research and Prevention Amendments of 1998. Footnotes: * Applies to multiple programs/elements, specific sections of the Law are noted for some programs/elements. (1) Initially noted under General Administration, but applies to other programs noted. (2) Initially noted under MINAS, but applies to other programs noted. (3) Initially noted under General Administration, but applies to all federally funded programs/elements. "Laws/Administrative Rules" column: (Law) signifies a Law, (Rule) signifies Administrative Rule. "State/Federal Manuals" column: (State) signifies a State Manual, (Fed) signifies a Federal Manual, MDCH/CMS FY 10/11 Page 11 of 11 ATTACHMENT III MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 10/11 COMPREHENSIVE AGREEMENT PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS B. Utilization of a Minimum Reporting Requirements Notebook listing specific reporting formats, source documentation, timeframes and utilization needs for required local data compilation and transmission on program elements funded under this agreement. C. Utilization of annual program and budget instructions describing special program performance and funding policies and requirements unique to each State fiscal year. D. Execution of an agreement setting forth the basic terms and conditions for administration and local service delivery of the program elements. E. Emphasis and reliance upon service definitions, minimum program requirements, local budgets and projected output measures reports, State/local agreements, and periodic department on-site program management evaluation and audits, while minimizing local program plan detail beyond that needed for input on the State budget process. Many program specific assurances and other requirements are defined within the referenced documents including Minimum Program Requirements established for the following program elements as of October 1,2006: A. AIDS/HIV Prevention B. Breast and Cervical Cancer Control C. Childhood Lead D. Clinical Laboratory E. Family Planning F. Food Service Sanitation G. General Communicable Disease Control H. Hearing Immunization — (Local Public Health Operations & Categorical) J. LHD/CSHCS K. Michigan Care Improvement Registry L. Sexually Transmitted Disease M. Vision N. WIC MDCH/P&GD FY 10/11 ATTACHMENT III Page 1 of 96 05/10 For FY 10/11, special requirements are appiicable for the remaining program elements listed in the attached pages. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 2 of 96 WIC Services VVISEWOMAN Coordination Youth Suicide Prevention Project MDCH/1364GD FY 10/11 ATTACHMENT III Page 3 of 96 05/10 FORMAT (PROGRAM/ELEMENT) SPECIAL REQUIREMENTS Budget and Agreement Requirements - Lists those special funding and agreement requirements applicable to the program/element as a whole. Contractor Requirements - Lists those special requirements applicable to all agencies administering the program element. Department Requirements - Lists those special requirements applicable to the Department. IV. Contractor Specific Requirements - Lists those unique requirements applicable only to the single Contractor covered by this agreement. MDCH/P&GD FY 10/11 ATTACHMENT III Page 4 of 96 05/10 ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING SPECIAL REQUIREMENTS (OAKLAND COUNTY HEALTH Di'v'ISION) Contractor Requirements Project Summary: Individuals 15-24 years of age will be screened for Chlamydia and gonorrhea at seven Oakland County sites serving adolescents and young adults. Those found positive will be treated and counseled regarding partner treatment and prevention of future infection. 1. Oakland County Children's Village Detention 2. Oakland County Children's Village Shelter Care 3. Oakland County Main Jail 4. Oakland County Male Detention — Frank Greenan 5. Pontiac Teen Health Center — Pontiac High School 6. Common Ground Sanctuary — County Runaway Shelter 7. Waterford Alternative High School — Teen Clinic Adolescents and young adults will be interviewed using a brief computerized sexual questionnaire and testing, treatment and counseling provided. The project will screen young adults, age 15-24, and compare positivity for infection with adjusted age parameters. Data will be collected, analyzed and forwarded to MDCH during the project year. Project Data will be presented to Oakland County Human Services, Michigan Infertility Prevention Project Alliance, Michigan Juvenile Detention Association and other professional associations. Utilizing the seven identified project sites: 1. Test at least 100 adolescents and young adults per month, using urine based tests for gonorrhea and Chlamydia. 2. Complete computerized sexual questionnaire on all clients tested. 3. Refer females for reproductive health services if indicated. 4. Develop a client centered risk reduction plan, promoting abstinence. 5. Treat and obtain partner information on positive clients. 6. Enter data from test results and questionnaire into Microsoft Access. 7. Analyze and forward data to MDCH every three months. 8. Develop data into presentations and present at various professional meetings. 9. Continue to promote awareness of prevalence of STDS within adolescent and young adult populations. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 5 of 96 ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING SPECIAL REQUIREMENTS (ST. CLAIR COUNTY HEALTH DEPARTMENT) Contractor Requirements Project Summary: Individuals 15-24 years of age will be screened for chlamydia and gonorrhea at 3 St. Clair County sites serving adolescents and young adults. Those found positive will be treated and counseled regarding partner treatment and prevention of future infection. St. Clair High School Clinic 2. St. Clair County Juvenile Detention Center (2 sites) MDCH provide 550 pre-paid laboratory screening forms project sites. St. Clair sites will: The Local Health Department will: implement the Advisory Group Project in local communities in its jurisdiction, delivering programming with a primary focus on nutrition education according to the approved Supplemental Nutrition Assistance Plan-Education (SNAP-Ed) plan between October 1, 2010 through September 30, 2011; assure that efforts are made to target Supplemental Nutrition Assistance Program (SNAP) participants and eligible populations; use appropriate educational strategies and implementation methods to reach potentially SNAP eligible individuals/families; collect and report data regarding participation in SNAP-Ed and characteristics of those served. Contractor Requirements The contractor's program plan will be on file with the department. 2. Develop an evaluation process for the project in collaboration with MDCH staff. 3. Assist MDCH staff and its partners with Advisory Group Project regional train ings for community leaders. 4. Attend required meetings and trainings as identified by MDCH. 5. The contractor shall collaborate with their program consultant to schedule site visits. 6. Implement the Advisory Group Project delivering programming with a primary focus on nutrition education according to the approved SNAP-Ed plan; assuring that efforts have been made to MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 6 of 96 target SNAP-Ed to SNAP participants and eligibles; using appropriate educational strategies and implementation methods to reach food stamp eligibles; collecting and reporting data regarding participation in SNAP-Ed and characteristics of those served. 7. Ensure cash or in-kind donations from other non-federal sources to SNAP-Ed have not been claimed or used as match or reimbursement under any other Federal program 8. Submit quarterly progress reports, using the reporting format as required and made available by the Cardiovascular Section of the MDCH. Reporting Period Report Due Dates October 1-December 31, 2010 January 30, 2011 January 1-March 31, 2011 April 30, 2011 April 1-June 30, 2011 July 30, 2011 July 1-September 30, 2011 December 15, 2011 9. Submit bi-annual progress reports, using the reporting format as required and made available by the Michigan Nutrition Network. The bi-annual progress reports shall be sent electronically to Lisa Goldenhar at goldenharlasnichigan.qov and should contain all deliverable materials for the reporting period on the dates below; Reporting Period Report Due Dates October 1. 2010-March 30, 2011 April 15, 2011 April 1-September 30, 2011 September 24, 2011 10. Submit monthly financial reports of local match spending and federal award expenditures to receive reimbursement, using the reporting format as required and made available to the MDCH by the Michigan Nutrition Network. All documents must: be signed in blue ink; copies must have "Copy" written or stamped on the appropriate document; all project expenses must be dated between October 1, 2010 and September 30, 2011; all project expenses are reasonable and necessary to accomplish SNAP-Ed objective and goals; any project expense submitted may be deemed "unallowable" by the MDCH, the Michigan Nutrition Network, Michigan Department of Human Services and/or the USDA without further explanation and will not be reimbursed. The monthly financial reports and supporting documents shall be sent via U.S. Mail to Jill Scott- Gregus at the following address and on the dates below: Jill Scott-Gregus Washington Square Building, 6 th Floor 109W. Michigan Ave., PO Box 30195 Lansing, MI 48909 Reporting Period Report Due Dates October 1-October 31, 2010 November 10, 2010 November 1-November 30, 2010 December 10, 2010 December 1-December 31, 2010 January 10, 2011 January 1-January 31, 2011 February 10, 2011 February 1-February 28, 2011 March 10, 2011 March 1-March 31, 2011 April 10, 2011 April 1-April 30, 2011 May 10, 2011 MDCH/P&GD FY 10/11 ATTACHMENT III Page 7 of 96 05/10 May 1-May 30, 2011 June 10, 2011 June 1-June 31,2011 July 10, 2011 July 1-July 31, 2011 August 10, 2011 August 1-August 31, 2011 September 10, 2011 September 1-September 30, 2011 October 10, 2011 11. Submit quarterly required state Financial Status Report (FSR) using the reporting format as required by the MDCH through MI E-Grants. Total amounts on the monthly financial reports of local match spending and federal award expenditures, and the state FSR for the program should match. FSR should be submitted on the dates below: Reporting Period Report Due Dates October 1-December 31, 2010 January 15, 2011 January 1-March 31, 2011 April 15, 2011 April 1-June 30, 2011 July 15, 2011 July 1-September 30, 2011 October 15, 2011 12. Documentation of local costs, payments, procedures, inventory, and itemized receipts for non- personnel expenses and original timesheets for billed hours must be maintained by the local agency and will be available for the MDCH, the Michigan Nutrition Network, the Michigan Department of Human Services and/or the USDA to review and audit. 13. All materials developed or printed with SNAP-Ed funds include the appropriate USDA nondiscrimination statement, credit to the SNAP, the Michigan Nutrition Network and the MDCH as a funding source, and a brief message about how the SNAP can help provide a healthy diet and how to apply for benefits. Materials that cannot be e-mailed should be mailed/faxed to: Lisa Goldenhar, WSB, 6 th Floor, 109W. Michigan Ave., PO Box 30195, Lansing MI 48909 Fax: 517-335-9056 14. Messages of nutrition education must be consistent with the Dietary Guidelines for Americans and stress the importance of variety, balance, and moderation, and do not disparage any specific food, beverage, or commodity. 15. Each Health Department has a required match amount. Discuss with your MDCH Consultant. Local Health Departments match spending must be documented and reported in the monthly financial report submitted to MDCH, BIOTERRORISM EMERGENCY PREPAREDNESS (INCLUDING CRI FUNDING FOR DETROIT, VVAYNE, OAKLAND, MACOMB, LIVINGSTON, LAPEER AND ST. CLAIR COUNTIES) Contractor Requirements Each local health department, as a sub-recipient of funding through the CDC Public Health Emergency Preparedness (PHEP) Cooperative Agreement, shall conduct activities to build preparedness and response capacity and capabilities as defined by the Public Health Emergency Preparedness (PHEP) Cooperative Agreement guidance 2010-2011, and all related guidance issued by the CDC and Michigan Department of Community Health (MDCH) to clarify or interpret program requirements, and consistent with MDCH/P&GD Pr' 10/11 ATTACHMENT Page 8 of 96 05/10 A. Funds may not be used for research B. Reimbursement of pre-award costs is not allowed. C. Cooperative agreement funds under this program cannot be used to purchase vehicles of any kind. D. Cooperative agreement funds may not be used to purchase incentive items. Supplantation: Cooperative agreement funds cannot supplant any current state or local expenditures. Supplantation refers to the replacement of non-federal funds with federal funds intended to support the same activities. The Public Health Service Act, Title I, Section 319 (c) specifically States: "SUPPLEMENT NOT SUPPLANT. -- Funds appropriated under this section shall be used to supplement and not supplant other federal, state, and local public funds provided for activities under this section." Therefore, the law strictly and expressly prohibits supplantation. 4. Required EPC attendance at the Great Lakes Homeland Security Conference-Spring 2011, 5. Exercise Requirements A. Incident Management (HPPG)-Facilitate exercise/drill to demonstrate capability of pre- identified staff with senior incident management roles to report for immediate duty outside of regular work hours. Target 60 minutes with 90% response rate. B. Demonstrate capability to receive stage, store, distribute and dispense material during a public health emergency. 1. Attain a score of 89% or higher on the Division of Strategic National Stockpile (DSNS). Local technical assessment review (TAR). 2. Conduct mass prophylaxis drills utilizing three of eight CDC DSNS points of dispensing (POD) templates. This activity is MANDATORY for all seven CRI jurisdictions and OPTIONAL, but recommended, for the other remaining LHDs. 3. CRI MSA must conduct one full scale or functional exercise (or real event) testing key components of mass dispensing/prophylaxis plan. 4. High Priority Performance Goal (HPPG) to ensure a timely and effective response MDCH/P&GD FY 10/11 ATTACHMENT III Page 9 of 96 05/10 C. Pandemic Influenza related exercise to progressively test local pandemic influenza plan with post-exercise revisions based on identified gaps. 6. Complete and maintain Pandemic Influenza plan and required activities as defined by Pandemic 9. Each sub-recipient agency must retain program-related documentation for activities and expenditures, consistent with Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, which will pass the scrutiny of audit. 10. Public Health Emergency Preparedness Funding (Base/CRI) must be included in single audit process completed in 2010 and every two years thereafter. Notification of audit completion report must be reported to OPHP for retrieval and submission to CDC within 90 days of completion. Note: The first submission may be for the audit of 2008-09 or 2009-10 Fiscal years. PHEP Base funding may be used to offset additional expense of inclusion/testing of PHEP funding (Base and CRI) 11. Comply with Match and Maintenance of Funding (defined as ensuring that the awardee expenditures for public health security are maintained at a level not less than the average of expenditures for the previous two years. Requirements as defined by CDC during the Cooperative Agreement Period. This match includes 10% for August 10, 2010 through August 9, 2011. LHD are required to submit a letter stating Source, Calculation and Narrative Description of how match was achieved. This will be due with the Narrative Budget Submission to MDCH/OPHP and with the Comprehensive budget submission and year end 2011 progress report as an attachment through MI E-Grants. The Pandemic and All Hazards Preparedness Act (PAHPA) of 2006 requires the withholding of amounts from entities that fail to achieve benchmarks, including influenza planning, beginning with federal fiscal year 2009 and each succeeding fiscal year. (reference CDC PHEP Cooperative Agreement 10-11, page 19 and 20) BIOTERRORISM REGIONAL EPIDEMIOLOGY SUPPORT SPECIAL REQUIREMENTS Regional Epidemiology Support For those local health departments receiving additional funds to provide workspace for Regional Epidemiologists, the contractor must provide adequate office space, telephone connections, and high- speed Internet access. The position must also have access to fax and photocopiers. BUILDING HEALTHY COMMUNITIES SPECIAL REQUIREMENTS Contractor Requirements 1, Develop and submit a work plan and budget which will be maintained on file in the Cardiovascular MDCH/P&GD FY 10/11 ATTACHMENT 10 05/10 Page 10 of 96 Materials that cannot be emailed should be sent to: Lisa Grost Cardiovascular Health, Nutrition and Physical Activity Section Michigan Department of Community Health P.O. Box 30195 Lansing, MI 48909 5. Attend required training. 6. Attend monthly grant conference calls. 7. The Contractor shall collaborate with the program consultant to schedule site visits. 8. Provide policy and environmental changes to support physical activity, nutrition and tobacco free life-styles. 9. Each Health Department will have a 25% required match. Your MDCH consultant will advise each Health Department of their match requirements. Contractor activities funded by MDCH are expected to be focused on the development and continuation of coalitions in the target communities: education and outreach; case management of children with blood lead levels equal to or greater than 20 ug/dL until blood lead levels are below 10 ug/dL; increasing testing of appropriate children; and surveillance. The terms of this contract require funding to be used in the target communities (not county-wide), and must be used for lead program services only. Continued funding is contingent on completion of the required activities. 1. Allowable uses for MDCH/CLPPP funding: A. Attendance at MDCH Lead Advisory Committee meetings is required: In person attendance at and participation in proceedings of the morning Advisory Committee meetings and the afternoon Lead Initiative Coordinators' meeting. These occur in March, June, and October, with dates/sites provided one year in advance by MDCH CLPPP. B. Local lead collation activities: Minutes, strategic (elimination) plans, action plans (testing strategy, strategy plan for eliminating unconfirmed capillary specimens, etc.) should be forwarded to MDCH CLPPP in quarterly reports, or separately, as the agency prefers. C. Prohibited expenditures as specified by the Centers for Disease Control and Prevention (CDC) and MDCH CLPPP funds: MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 11 of 96 2. Contractor Required Activity Toward Community Partnership/Collaboration Outcomes A. Contractor must collaborate with the medical home provider to assure adequate follow-up of each child in the jurisdiction with a blood lead level =>20 ug/c1L. B. The Contractor must be actively involved in a local partnership/collaboration working to, among other activities, identify a sustainable, local funding stream for home repair, using public and private funds, in a systematic process customized to the jurisdiction (e.g., Community Development Block Grants, HUD grants and community banking programs). C. Contractor must participate in target community partnership/collaboration meetings and MDCH Lead Advisory Committee meetings. D. Contractor must work actively with local stakeholders to identify or develop local ordinances related to property maintenance. 3. Required Reporting A case management report is required each month and includes information on all new cases. The report is due on the 10 th of each month for all new cases from the previous month, using the MDCH standard reporting form. Quarterly activity reports, using the MDCH standard reporting form, describe the agency's testing activities, and surveillance activities. The narrative portion of the report should reflect progress toward meeting required activities outlined in the agency developed work plan. Reporting Period Report Due Date October - December 2010 January 20, 2011 January — March 2011 April 20, 2011 April — June 2011 July 20, 2011 July September 2011 October 20, 2011 All reports are to be sent electronically via the File Transfer Application (FTP) on the single sign-on we bsite, https://sso.state.mi.us/ 4. Contractor Special Requirements Case Management A. Objectives 1. All children in the jurisdiction with a confirmed blood lead level equal to or greater than 20 micrograms per deciliter receive a full complement of case management services. Required components include: tailored nutritional evaluation and guidance, EBLL 2 MDCH/P&GD FY 10/11 ATTACHMENT III Page 12 of 96 05/10 investigation that includes secondary site inspection and non-housing source identification, developmental evaluation, linkage to appropriate housing, financial, education, nutrition, transportation, medical home and medical follow-up. 3. A child-specific plan of care is developed. 4. Children in case management demonstrate decreasing blood lead values. B. Activities/Strategies (REQUIRED) When Local Health Departments receive full cost reimbursement for services billed to Medicaid, revenues must be applied to programs in relation to how they were earned. Revenues attributable to Case Management and environmental services must be applied to the Lead program. C. Performance Measures Number of new cases of children with BLLs ?_ 20 micrograms per deciliter in the garget community (ies) receiving comprehensive nursing and environmental follow- up completed for each case within timeframes specified by MDCH and CDC. 2. Types of referral and community linkages made by the local public health agency. 3. Number and percentage of children who receive appropriate follow-up testing. 4. Number of public health nursing and environmental health visits. D. Reporting Requirements 1. Case management and outcomes must be reported to MCDH CLPPP monthly case Testing A. Objective: To increase blood lead testing for at-risk children under 6 years per the Statewide Testing/Screening Plan. B. Required Activities: A testing work plan for the target community. Outreach to providers occurs re: identifying high-risk children in their practices and targeting them for testing; and testing and retesting at appropriate ages and/or results. 2. Outreach activities to high-risk children and families for blood lead testing. MDCH/P&GD FY 10/11 ATTACHMENT III Page 13 of 96 05/10 3. Work plan for eliminating unconfirmed capillary tests in the target community is developed. 4. Children with increasing BLLS are tracked and appropriate responses are made and documented. C. Performance Measures Testing in the target communities will increase over the previous year by 5% for children one and two years of age (based on calendar year) D. Reporting Requirements 1. Direct testing and testing outreach activities must be reported to MDCH-CLPPP in the quarterly activity report. 2. MDCH-CLPPP standard forms must be used to report testing progress. 3. Quarterly reports must include testing strategies, strategies to respond to children with increasing blood lead levels and plans for the next quarter. Education and Outreach A. Objective: Increase public and professional awareness through intensive community outreach and education activities. B. Required Activities to Support the Community Collaboration Strategic Plan 1. Risk education is provided for: Primary care providers regarding testing and follow- up (monthly); parents and general public (quarterly); day care providers (quarterly); and targeted risk education for high-risk populations, including children in foster care, international foreign adoptees, refugees, immigrants, migrants and pregnant women. C. Performance Measures Number and type of professional and targeted educational activities occurring in the target community. Number and audience type for risk education sessions D. Reporting Requirements Quarterly activity reporting to MDCH, using format specified and developed by MDCH regarding all required activities. Surveillance A. Objective: Assure appropriate follow-up of children with elevated blood lead levels. B. Required Activities The STELLAR data system is actively used (by nursing and environmental health) for determining environmental status, including information regarding any inspection and/or interim controls performed and clearance status. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 14 of 96 2. The STELLAR data system is actively used (by nursing and environmental health) for monitoring the health status of all affected children. 3. Outreach occurs to children who are Medicaid enrolled but not tested using surveillance data. C. Performance Measures Monthly reports to MDCH-CLPPP contain information about both environmental and health status of children with elevated BLLs. 2. Number of children under the age of six years, enrolled in Medicaid and not previously tested, who are identified and tested. 3. Use of STELLAR data or any other data system to monitor trends related to testing, lead poisoning, patient demographics, increasing or decreasing blood levels. D. Reporting Requirements A monthly case management report of caseload and activities for children in the target communities with BLLs ?_ 20 micrograms per deciliter is submitted to MDCH. 1. A quarterly narrative report addressing the outcomes, activities and performance measures listed above will be submitted to MDCH. The quarterly narrative report will also include a written action plan for the next quarter. COMPLETE STREETS (CVD) — ARRA (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, INGHAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT AND WESTERN U.P. DISTRICT HEALTH DEPARTMENT) Local health departments will serve as the Complete Streets leader and/or facilitator within their jurisdiction. As a Complete Streets grantee, the health department staff and community will: Utilize a community health coalition (or related group) to obtain local governments, businesses, key transportation partners, and local residents to pass the Complete Streets ordinance. 2. Designate a local health department staff and possibly one partner who will be responsible for leading the community through the ordinance adoption process. 3. Implement the plan to pass a local Complete Streets ordinance listing key steps necessary for your community environment, key partners to include, community forms, and draft legislation. 4. Host, coordinate and attend a Complete Streets Training in your community. This training can be facilitated with the assistance of your local experts, Michigan Association of Planning, and/or Michigan Department of Community. 5. Pass a local Complete Streets ordinance by the local governing body by February 28, 2011. 6. Attend conference calls. Local health department staff will be required to attend regularly scheduled grant calls. 7. Complete evaluation protocol and reports. MDCH/P&GD FY 10/11 ATTACHMENT HI Page 15 of 96 05/10 Complete all required processes and forms outlined in MDCH's CPBC. The funding will be allocated to the health department and standard financial reports and documentation will be required. Submit the following electronic reports to Holly Madill (madillh(d)michician.aov) and copy Martha Mellow (mellommichigan.clov) A. Monthly Time Reports: A monthly report of the number of hours worked toward the project is due on the first business day of each month. While any format is acceptable, the report must include the person's name with the number of hours worked. Reporting Period Report Due Dates October 01 — 31, 2010 November 01, 2010 November 01 — 30, 2010 December 01, 2010 December 01 — 31, 2010 January 03, 2011 January 01 — 31, 2011 February 01, 2011 February 01 — 28, 2011 March 01, 2011 B. Quarterly Progress Reports: Use the reporting format as required and made available by the Cardiovascular Health Section of the MDCH (workplan template). The Quarterly Progress Reports are due on the dates listed below: Reporting Period Report Due Dates October 01 — December 31, 2010 January 03, 2011 January 01 — February 28, 2011 March 15, 2011 10. Submit quarterly required state Financial Status Report (FSR) with copies using the reporting format as required by MDCH. Submit quarterly FSRs electronically to PublichealthFSR©michigan.gov mailto:I‘lickell-i@rnichicTan.qovaiOng with mailing the signed original to MDCH's Accounting Office. Reporting Period Report Due Dates October 01 — December 31, 2010 January 15, 2011 January 01 — February 28, 2011 March 15, 2011 CSHCS SPECIAL REQUIREMENTS Contractor Requirements Staffing MDCH/P&GD FY 10/11 ATTACHMENT III Page 16 of 96 05/10 $28,000-$40,000 .25 FTE .25 FTE $80,000-$113,000 1.0 FTE .50 FTE $172,000-5285,000 2.0 FTE 1.0 FTE $565,000-$680,000 4.0 FTE 3.0 FTE Client Information To consistently, efficiently and effectively serve all CSHCS clients across the State, the CSHCS LHD program staff must routinely use the CSHCS On-Line database. Local CSHCS LHDs are trading partners with the State CSHCS Program and with each other, but should only access those records relevant to enrollees in the county of residence. If information is received in error, it should be deleted/destroyed and the sender should be notified. Program Management To assure consistency for CSHCS enrollees statewide, CSHCS LHD programs must maintain and regularly use the Children's Special Health Care Services Guidance Manual for Local Health Departments to effectively carry out program expectations, policies and requirements. All of the following activities must be implemented according to CSHCS issued policy. Program Representation and Advocacy A. Actively promote outreach and program representation which includes, but is not limited to the provision of information regarding Children's Special Health Care Services (CSHCS) policy on diagnostic referrals, program eligibility, covered services, prior authorization, and the appeals process to local hospitals, providers, the community, other agencies and families. B. Inform families of their rights and responsibilities in the CSHCS program. C. Describe I CSHCS benefits to families, including, but not limited to, the Children with Special Needs (CSN) Fund, the insurance premium payment benefit, skilled nursing respite, hospice and out-of-state care, and assist as needed. D. Actively promote and provide information, referral, and assist persons in making applications for other programs in the community for which the child and/or family may be eligible, such as Early On, WIC, MI-Child, Healthy Kids, Medicaid, and Medicare. E. Actively promote and provide assistance to help families advocate on their own behalf. Serve as a liaison with service providers as needed. F. Assure that family centered care is integrated into the local CSHCS system of care by facilitating the direct participation of families in program development, implementation, evaluation and policy formation. Application and Renewal MOCH/P&GD FY 10/11 ATTACHMENT III Page 17 of 96 05/10 E. Locate individuals or families who do not return a CSHCS Application within 30 days after being made medically eligible, and offer assistance with application completion. 3. Support Services 4. Case Management Requirements When local health departments provide CSHCS case management services, the most current case management policy and procedures as established by CSHCS must be followed. 5. Reporting Requirements A. A brief annual narrative report is due by November 15 following the end of the fiscal year, describing CSHCS successes, challenges and any technical assistance needs the LHD is requesting the State to address. Also, if your agency allocated any local MCH funds to CSHCS, briefly describe how those funds are used (e.g., CSHCS salaries, outreach materials, mailing costs, etc) B. Report the duplicated number of clients referred for diagnostic evaluations, the unduplicated number of CHSCS eligible clients assisted with CSHCS enrollment, and the unduplicated number of CSHCS clients assisted in the CSHCS renewal process. MDCH/P&GD FY 10/11 ATTACHMENT III Page 18 of 96 05/10 Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment is defined as: Number of CSHCS eligible clients the LHD assisted in the CSHCS enrollment process during the fiscal year. This assistance includes but is not limited to helping the family obtain necessary medical reports to determine clinical eligibility, completing the CSHCS Application for Services, completing the CSHCS financial assessment forms, etc. "Assisted" refers to help provided either over the telephone or in person with the client. Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process is defined as: Number of CSHCS enrollees the LHD assisted in the completion and/or submission of the documents required for MDCH to make a determination whether to continue/renew CSHCS coverage during the fiscal year. "Assisted" refers to help provided either over the telephone or in person with the client. Contractor Req_u_kements The local health department should utilize these funds for travel expenses related to international cross- border infectious disease surveillance work. Such travel might include meetings with cross-border communicable disease public health partners, or attending Great Lakes Border Health meetings or conferences. These funds may also be used for educational offerings related to infectious disease surveillance but every effort should be made to send representation to the annual Great Lakes Border Health Initiative Conference in 2011. Each health department must provide a report written 30 days after the end of the agreement citing how the funds were used related to EVVIDS. EARLY WARNING INFECTIOUS DISEASE SURVEILLANCE (EWIDS) WORKSHOP SPECIAL REQUIREMENTS (CHIPPEWA COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT AND WAYNE COUNTY HEALTH DEPARTMENT) Contractor Requirements The funding will be used to provide a face-to-face meeting of local health departments and tribal health facilities along the international Michigan-Ontario border. Area infection control or infectious disease specialists may be invited to participate as well. The intended purpose of the meeting is to educate participants on pertinent infectious disease topics and programs, and to facilitate relationship building between international partners. The local health department will submit a report to the Department listing the participants, facilities and organizations represented at the meeting as well as the objectives for the meeting and educational offerings. Participant evaluations will be included in the after-meeting documentation and supplied to the Department. MDCH/P&GD FY 10/11 ATTACHMENT III Page 19 of 96 05/10 The Department's EWIDS Coordinator should be notified at least 2 weeks prior to the event and may attend in an observational role unless a request has been made for participation in the event. Contractor Special Requirements The purpose of this agreement is to expand HIV testing in high prevalence health care settings, through implementation of HIV testing as a standard of care in health department STD clinics in order to address racial/ethnic disparities in access to HIV testing services. Priority in program activities is placed on serving African American communities. Methodology and Program Content: Resources provided in association with this agreement are to be used to support routine HIV testing for clients receiving services for the prevention and/or treatment of sexually transmitted diseases (STDs). Program development, implementation and evaluation will be delivered according to the methods, time line, work plan, and staffing plan approved by HAPIS/DHVVDC. Objectives: Develop, implement and monitor implementation of protocol and procedures to ensure that HIV testing is provided as a standard of care to clients seeking STD prevention and treatment services. The minimum number of clients expected to accept HIV testing in each agency is indicated below: Local Health Agency Minimum Number of HIV Tests Berrien County Health Department 950 Calhoun County Health Department 1840 Genesee County Health Department 3,000 Ingham County Health Department 2,220 Jackson County Health Department 250 Kalamazoo County Health and 3,035 Community Services Kent County Health Department 3,100 Muskegon County Health Department 1 1,755 MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 20 of 96 Oakland County Health Department 12,000 Saginaw County Health Department 1,465 Van Buren —Cass District Health 735 Department VVashtenaw County Health Department 1,400 Wayne County Health Department 1,500 2. Develop, implement and monitor implementation of protocol and procedures to facilitate achievement the performance indicators described in HIV/AIDS PREVENTION SPECIAL REQUIREMENTS (categorical funding) Department Requirements Provide rapid HIV test devices and external controls in sufficient quantity to facilitate achievement of program objectives and to facilitate staff training and proficiency testing. Additional quantities of rapid HIV test devices may be made available to local health agencies provided that the agency can demonstrate that test devices will be used in a manner consistent with the general purposes of this agreement and in accordance with approved program methodologies and predicated upon availability of resources. 2. Provide training and technical assistance in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. Program Requirements In carrying out the terms of this agreement, the Contractor shall: 1. Conduct prevention program activities in a manner consistent with applicable federal and state laws and program and quality assurance guidelines and standards issued by the Michigan Department of Community Health. 2. Comply with all Contractor Requirements for HIV/AIDS PREVENTION SPECIAL REQUIREMENTS (Categorical Funding) 3. Participate in contract monitoring and quality assurance activities conducted by and/or facilitated by HAPIS/DHVVDC. 4. Adhere to time lines, work plans, and staffing plans submitted to and approved by HAPIS/DHWDC. Deviations from approved time lines, work plans, and staffing plans must receive advanced authorization from HAPIS/DHVVDC. 5. Participate in technical assistance, training, and/or skills-enhancement opportunities as recommended or required by HAPIS/DHWDC. 6. Participate in program evaluation activities conducted and/or required by HAPIS/DHWDC. 7. Account for and monitor funds associated with these activities separately from other funds provided by HAPIS/DHVVDC that support HIV counseling and testing. Reporting Requirements The Contractor shall submit: 1. Narrative Progress Reports. The format and content of these reports are to conform to the guidelines issued by HAPIS/DHWDC. Narrative reports are due no later than 30 days after the close of each quarter: Reporting Period Narrative Report Due October - December 2010 January 28, 2011 MDCH/P&GD FY 10/11 ATTACHMENT III Page 21 of 96 05/10 January - March 2011 April 29, 2011 April - June 2011 July 29, 2011 July - September 2011 October 28, 2011 Quarterly narrative reports are to be submitted by the Contractor to the designated HAPIS/DHWDC contract monitor. Electronic submission is acceptable. 2. Process Monitoring Data, Process monitoring data are to be submitted by the Contractor via the HIV Event System (H ES). The time line and protocol for submitting these data are to conform to guidelines issued by HAPIS/DHWDC. 3. Any such other information as specified within these special requirements shall be developed and submitted by the Contractor as required by the Contract Manager. It is understood that the reports described above may be revised, supplemented or replaced at any time and that the agency will provide information and/or data responsive to modified reporting requirements. 4. The Contractor shall permit the Department and/or its designee to visit and to make an evaluation of the project as determined by Contract Manager. FAMILY PLANNING/BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP1 JOINT PROJECT SPECIAL REQUIREMENTS Contractor Requirements The FP/BCCCP Demonstration Project is a joint program between Family Planning and BCCCP designed to provide diagnostic services to Title X (Family Planning) clients who have Pap tests indicating possible cervical cancer. Extensive data is required by the Center for Disease Control and Prevention (CDC) for each woman served by federal funds. Dates of service and results of testing are required prior to authorizing reimbursement to providers. Therefore, data about the abnormal Pap smear will have to be transmitted from the Family Planning program to the designated BCCCP agency prior to arranging diagnostic services. 1. Women eligible for this program will be Title X clients, be uninsured or underinsured, and with income under 250% of poverty. A Family Planning client meeting these eligibility criteria will sign a release form to allow her data to be provided to the BCCCP. Forms will be provided to the Family Planning agencies for recording data required for referral to a BCCCP agency. All data required for enrollment in the BCCCP will be collected by the BCCCP agency. 9. Each delegate agencies must serve a minimum of 95% of proposed Title X users to access its total amount of allocated funds. In addition, each delegate agency must work with the Department to jointly establish and achieve a minimum target for Plan First! caseload enrollment. Quarterly FPAR data will be used to determine total Title X users and Plan First! enrollees. 3. Dates and results of all diagnostic procedures must be recorded in the Michigan Breast and Cervical Cancer Information System (MBCIS) by the BCCCP agency before reimbursement can be approved. 4. The data must indicate the outcome of testing with a final diagnosis of cancer/not cancer and, if cancer, the stage and date of treatment initiation, as well as the type of treatment. It is expected that there will be extensive communication between the referring Title X agency and the BCCCP agency managing the diagnostic process, so that the woman will proceed seamlessly through the medical system(s). MDCH/P&GD FY 10/11 ATTACHMENT III Page 22 of 96 05/10 FAMILY PLANNING - PREGNANCY PREVENTION SPECIAL REQUIREMENTS FETAL ALCOHOL SPECTRUM DISORDER PROJECTS - SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT AND PUBLIC HEALTH, DELTA-MENOMINEE COUNTIES) Contractor Requirements FASD project coordinator (or designee) must participate/attend: FASD Grantees Conference Calls provided by the department every other month in October 2010 — September 2011. FAST Grantee Evaluation meeting to be held in the Lansing area June 2011. Implement Option #2 of the Strategic Plan approved by the department. 3. Follow the implementation guidelines provided by the department and located on pages 11-20 of motivational interviews and/or referrals from the grantee's FASD community based program. The UDCT from is available at www.michigan.gov/fas. Department Requirements 1. Convene FASD Grantees: Conference Calls, in October 2010-September 2011 to discuss progress toward community project goals outlined in the cooperative agreement and provide technical assistance questions/answers with state consultants outlined in the cooperative agreement. • Evaluation meeting to be held in the Lansing area June 2011 to identify preliminary community project outcomes and provide technical assistance and skill building resources for submission of final community-based project evaluation report due September 2011. 2. Describe and provide resources and updates for the evidence-based interventions required by this contract. 3. Provide technical assistance for each requirement of this contract. 4. Provide reporting formats for data collection and deliverables. Reporting Requirements Deliverables are due QUARTERLY and a YEAR-END REPORT will summarize the results of the Implementation Period. The Contractor shall submit the following reports within 15 days after the end of each quarter on the following dates: Quarter End Date Report Due Date 1 st Qtr (12/31/10) 01/15/11 2nd Qtr (03/31/11) 04/15/11 3rd Qtr (06/30111) 07/15/11 4th Qtr (09/30/11) 10/15/11 2. The Contractor will collect data using the Uniform Data Collection Tool (UDCT) project evaluation/data tracking forms to monitor the FASD community program effectiveness, The Uniform Data Collection Tool (UDCT) is available at www.michigan.gov/fas. The Contractor shall submit the following information electronically in an encrypted manner to MDCH FASD Program: A. The Contractor's Option Year #2 Implementation Plan must be submitted and updated at the end of every quarter with all of the contractor requirements. B. The Contractor must provide documentation that FASD services are tracked for all individuals referred through the FASD community project program and shall submit a UDCT Data Tracking Form to be sent at the end of each quarter. This will be provided to grantees by September 1,2011, by the state FASD Coordinator. Send reports to: Debra Kimball, FASD State Program Coordinator Division of Family and Community Health Michigan Department of Community Health Kimballd1michigan gov Contact Information: P.O. Box 30195 Lansing, MI 48909 Phone (517)335-8379 MDCH/P&GD FY 10/11 ATTACHMENT III Page 24 of 96 05/10 Fax (517)335-8822 FETAL AND INFANT MORTALITY REVIEW (FIMR) CASE ABSTRACTIONS SPECIAL REQUIREMENTS Contractor Requirements Objective: To assist local communities to learn from individual cases of fetal and infant death what are factors contributing to poor pregnancy outcome in their community, for the purpose of improving care and services for women, infants and families. Key Activities: Qualified individuals will perform medical record case abstraction for Fetal Infant Mortality Review to include the following: 1. Review of medical records involved in fetal and infant death to include but not limited to hospital records, pre-natal records, pediatric records, emergency and medical examiner's record. 2. Interact with other agencies and service providers involved in infant's death (MI Department of Human Services, Child Protective Services, local health department, law enforcement). 3. Develop case summaries from the above abstracted information as well as the Home Interview, using Michigan FIMR Network tools and guidelines 4. Attend the review team meetings to facilitate the presentation of the cases. 5. Entry of cases into access data base and submission of cases to MPHI for MFIMR data base HIGHLY TARGETED COMMUNITY-BASED HIV PREVENTION SERVICES (INGHAM COUNTY HEALTH DEPARTMENT KENT COUNTY HEALTH DEPARTMENT) Contractor Special Requirements Purpose: The purpose of this agreement is to support highly targeted community-based HIV prevention. Funding provided through this agreement is to be used to support implementation of evidence-based interventions, as approved by HAPIS/DHVVDC. Program development, implementation and evaluation will be delivered according to the methods, time line, work plan, budget and staffing plan approved by MDCH/P&GD FY 10/11 ATTACHMENT III Page 25 of 96 05/10 HAPIS/DHVVDC. Ingham County Health Department Objectives and Performance Indicators: Health Education and Risk Reduction Model: Healthy Living Project (Individual Level Prevention Counseling) Process Objective 1: By September 30, 2011, provide up to 5 sessions (Module One) of Individual Level Prevention Counseling as screening and recruitment for the Healthy Living Project to 15 HIV positive clients. Process Objective 2: By September 30, 2011, provide up to 5 sessions (Module Two) of Individual Level Prevention Counseling as screening and recruitment for the Healthy Living Project to 15 HIV positive clients. Process Objective 3: By September 30, 2011, provide up to 5 sessions (Module Three) of Individual Level Prevention Counseling as screening and recruitment for the Healthy Living Project to 15 HIV positive clients. Performance Indicators: A. 95% of all persons who receive Individual Level Prevention Counseling contacts will be at High risk of STD acquisition and/or HIV transmission. B. 65% of all participants in Healthy Living Project 5-session intervention will complete all sessions. Kent County Health Department Objectives and Performance Indicators: Counseling, Testing and Referral Objective 1: By September 30, 2011, provide counseling, testing and referral services to 250 men who have sex with men (MSM). A minimum of 15% of all MSM tests shall be provided to African American MSM and 10% to Hispanic MSM. Performance Indicators A. 95% of all persons testing HIV positive under this agreement will receive their test result. B. 75% of all persons testing HIV negative under this agreement will receive their test result. C. 90% of all persons tested under this agreement will be at high risk.* Establish implement and maintain policies and procedures designed to assure services supported under this agreement are delivered pursuant to applicable federal and state laws, policies and established standards. Current referent documents include: * High risk populations are defined as: MSM, IDU, and HRH (sex partner MSM, sex partner IOU, sex partner HIV+, person with current STD infection, commercial sex workers and others who provide sex for money or drugs). MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 26 of 96 c. Michigan HIV Laws: How They Affect Physicians and Other Health Care Providers. Michigan Department of Community Health, HIV/AIDS Prevention and Intervention Section (Revised 2006). It is understood that the laws, guidelines and standards described in the referent documents above may be revised, supplemented or replaced at any time and that the Contractor will conduct prevention program activities in a manner consistent with the most current laws, guidelines and standards. 2. If providing HIV Testing, comply with all Contractor Requirements for HIV/AIDS PREVENTION SPECIAL REQUIREMENTS (Categorical Funding). If providing HIV Rapid Testing, Comply with all Contractor Requirements for HIV/AIDS PREVENTION RAPID TESTING SPECIAL REQUIREMENTS. 4. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to assure timely and efficient communication with HAPIS/DHWDC. 5. Adhere to time lines, work plans, budgets and staffing plans submitted to and approved by HAPIS/DHWDC. Deviations from approved time lines, work plans, budgets, and staffing plans must receive advanced authorization from HAPIS/DHWDC. 6. Participate in contract monitoring and quality assurance activities conducted by and/or facilitated by HAP IS/DHWDC. 7. Participate in technical assistance, training, and/or skills-enhancement opportunities as recommended or required by HAPIS/DHWDC. 8. Participate in program evaluation activities conducted and/or required by HAPIS/DHWDC. 9. Establish and maintain mechanisms to obtain, on an ongoing basis, the input of target populations regarding the design, implementation and evaluation of prevention interventions. Progress reports submitted by the contractor are to describe the process and/or mechanisms for obtaining such input. 10. Establish, maintain and document procedures to ensure data collected in conjunction with provision of services (e.g., data collected for submission to HES) is used for program monitoring and quality assurance. Progress reports submitted by the contractor are to describe the specific activities used in applying data to program monitoring and quality assurance. 11. Establish and implement policies and procedures to ensure confidentiality of client records as well as the security and integrity of data. Policies and procedures are to address collection, entry, use, storage and disposal of data. Policies and procedures are to conform to guidelines and standards issued by HAPIS/DHWDC. 12. Establish, maintain and document linkages with community resources, including other health and human service providers, that are necessary and appropriate to addressing the HIV prevention- related needs of targeted populations(s) and which will facilitate access to needed services. At minimum, a. Programs targeted to communities at sexual risk for HIV are to establish, maintain and document linkages to community resources for the prevention, screening and treatment of MDCH/P&GD FY 10/11 ATTACHMENT III Page 27 of 96 05/10 Reporting Period Narrative Report Due October - December 2010 January 1 — March 31, 2011 April 1 — June 30, 2011 July 1- September 30, 2011 January 15, 2011 April 15, 2011 July 15, 2011 October 15, 2011 15. Submit preliminary agendas to HAPIS/DHWDC for review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. 16. Submit program manuals, intervention curricula, training curricula and similar documents to HAPIS/DHVVDC for review and approval prior to publication and use if development and implementation is supported wholly or in part under this agreement or if such documents are to be used in conjunction with activities supported under this agreement. 17. All subcontracts issued under this funding agreement are to include the above requirements [1-16] and are subject to prior approval by MDCH/DHWDC/HAPIS. 18. All sub-contracts issued under this funding agreement are to include the above requirements and are subject to prior approval by DHVVDC/HAPIS. Reporting Requirements 1. The Contractor shall submit: A. Narrative Progress Reports. The Contractor is to submit narrative progress reports. The format and content of these reports are to conform to the guidelines issued by HAP IS/DHWDC. Narrative reports are due as follows: The original and one copy of the quarterly narrative report are to be submitted by the Contractor to the designated HAPIS/DHWDC contract monitor. Quarterly narrative reports may be submitted electronically. Attachments should be scanned and submitted as a PDF file. B. Program Activities Calendar. Grantees are required to submit a calendar of program activities. The format, content and time lines for submission are to conform to the guidelines issued by HAPIS/DHVVDC. C. Process and Outcome Monitoring Data. Applicable process monitoring data are to be submitted via the HIV Event System. The time line and protocol for submitting these data are to conform to guidelines issued by HAPIS/DHWDC. Reports presenting outcome data are to accompany quarterly narrative reports. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 28 of 96 The Contractor shall permit the Department and/or its designee to visit and to make an evaluation of the project as determined by Contract Manager. Reports and information shall be sent to: Michigan Department of Community Health Division of Health, Wellness and Disease Control HIV/AIDS Prevention and Intervention Section 109 West Michigan Avenue, 10th Floor Lansing, Michigan 48913 HIV/AIDS CARE — MHI - SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, INGHAM COUNTY HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT) Contractor Specific Requirements Adhere to all Ryan White HIV/AIDS Treatment Extension Act Part B (RVVTE Act Part B), and MDCH/DHVVDC-HAPIS Continuum of Care policies, standards and guidelines, as identified in the current Comprehensive "Applicable Laws, Rules, Regulations, Policies, Procedures and Manuals," or as issued by MDCH/DHWDC-HAPIS during the current contract year. 2. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 3. Assure RVVTE Act, Part B and Michigan Health Initiative (MHI) resources are used as payor of last resort. Develop written procedures to document and ensure that clients have been screened for eligibility for Medicaid, Medicare, veteran's health benefits, private health insurance or other programs to ensure that RVVTE Act funds are the payor of last resort. 4. Document that clients receiving services are eligible for services (documented HIV status). 5. Conduct quality assurance activities and participate in contract monitoring conducted and/or facilitated by MDCH/DHWDC-HAPIS. 6. Monitor subcontractors annually to assess compliance with the subcontract. Take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract. Report the results of all contract monitoring activities to MDCH/DHWDC-HAPIS. MDCH/P&GD FY 10/11 ATTACHMENT III Page 29 of 96 05/10 10. Provide immediate notification to the Department, in writing, of any formal grievance procedures initiated by a service recipient and subsequent resolution of that grievance. 11. Provide immediate notification to the Department, in writing, of any event occurring, or notice received by the contractor or subcontractor, that reasonably suggests that the contractor or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or contractor or subcontractor employees. 12. Establish a work plan that includes client-level outcome objectives for each service funded with RVVTE Act, Part B and MHI resources and conduct outcome evaluation based on those objectives. 13. Assess client or participant satisfaction annually and use methods, instruments and analysis that minimize bias and ensure confidentiality of responses. 14. Utilize results of client or participant satisfaction assessments and other evaluation activities to make appropriate program level changes and monitor the effects of these changes. 15. Demonstrate appropriate expenditure of funds consistent with the contract, HRSA regulations and MDCH/DHVVDC-HAPIS policies and guidelines. 16. Document that the agency provides opportunity and fiscally supports ongoing staff development and training. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. 17. The contractor and all HIV care service subcontractors funded by the contractor must collect and regularly maintain client-level Uniform Reporting System (URS) data that comply with all reporting requirements of the RWTE Act. The contractor and its subcontractors are required to use the HRSA-supported software CAREVVare 4 to enter U RS data into the centrally managed database on a secure server. URS data must include all clients who receive any RVVTE Act eligible service (regardless of the source of funding for the services) and all RVVTE Act eligible services delivered to HIV-infected or affected clients. Data entry of service activities should be completed in CAREWare no later than the 15 th day after the end of each quarter so that CAREWare reports can be used to supplement the required quarterly program Progress Reports referenced in item 28. 18. URS data is the property of MDCH/DHVVDC-HAPIS. In the event that services are no longer delivered under this agreement, electronic data files held outside of the central CAREWare database must be returned to MDCH/DHWDC-HAPIS. 19. Report the status of current quality indicators using CAREVVare, according to the table provided to you by MDCH/DHVVDC-HAPIS staff. Detailed instructions for CAREWare are found in 17 above. 20. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease, in accordance with RVVTE Act, Part B. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 30 of 96 A. Corporate name, address, telephone, fax numbers and project director of each organization. B. Amount awarded to each organization. C. Type of service and the amount budgeted for each service to be provided. D. Beginning and end dates of each subcontract. E. Amount and source of other federal, state and local funds for the same service. F. Minority provider status. 30. By October 15,2010 provide to MDCH/DHVVDC-HAPIS a programmatic, categorical budget and narrative justification (by funding source) for funded services. Use these budget categories: Personnel, Fringe Benefits, Travel, Supplies, Equipment, Contractual, Other and Indirect. Base the budgets on the State Fiscal year. Budgets should be prepared on MDCH budget forms. MDCH/P&GD FY 10/11 ATTACHMENT 111 Page 31 of 96 05/10 A. Establish and maintain appropriate organizational governance, guided by written by-laws. B. Convene and maintain a Board of Directors. Board members must possess expertise and experience appropriate and necessary to provide general oversight, develop organizational policy and work in partnership with the Executive Director to ensure achievement of its mission. C. Establish and maintain appropriate fiscal management of the agency consistent with generally accepted accounting principles. D. Establish and maintain written personnel policies and procedures. E. Ensure that all staff, including executive directors and program coordinators: 1. Possess the knowledge, skills, abilities and credentials essential to assigned responsibilities; 2. Are hired or discharged through fair and objective processes which are appropriately documented. 38. Use the Counselor-Assisted Referral Form (CARF), DCH-1225 to refer consenting HIV-positive individuals, identified through counseling and testing activities, to appropriate case management providers. 39. Assure that the agency and its employees, volunteers and subcontractors (if applicable), maintain confidentiality of all records. No information obtained in connection with individuals served by the contractor will be released without the expressed written consent of the individual client. 40. The Contract Manager shall evaluate the reports submitted as described in items 28 above. 41. The Contractor shall permit the Department or its designee to visit and to evaluate the project, as determined by the Contract Manager. 42. 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) MDCH/P&GD FY 10/11 ATTACHMENT III Page 32 of 96 05/10 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. HIV/AIDS MATERNAL AND CHILD PROGRAM — RYAN WHITE PART D — SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) Contractor Requirements 1. Provide health education and other support services to the program with Ryan White Part D funds as outlined in the Part D Work Plan. Provide necessary training and technical support to the program staff to assure services are provided in a family-centered manner. 2. Actively participate and maintain management level representation on the Executive Committee established for project oversight, implementation, quality assurance oversight, and evaluation of Part D programming. Participate in other Part D activities across the service area through attendance at partner network meetings. 3. Develop and implement quality improvement activities in accordance with the Part D quality management plan and participate in quality meetings. 4. Document that the agency provides opportunity and fiscally supports ongoing staff development and training. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. 5. Obtain consumers' consent to collect and share person-based data with agencies receiving Ryan White Part 0 program funding. 6. Encourage consumer involvement in Part D through the Community Advisory Board and other program activities. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease, in accordance with the Ryan White HIV/AIDS Treatment Extension Act. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters and community health centers. 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 and recipients of Federal research grants, shall clearly state (1) the percentage of the total costs of the program or project which will be financed with Federal money, (2) the dollar amount of Federal funds of the project or program, and (3) percentage and dollar amount of the total costs of the project or program that will be financed by non-governmental sources. Reporting Requirements Description Date Ramie of Services Provided Date Due to MDCH FY Quarter 1 October 1-December 31, 2010 January 15, 2011 4. Quarterly Reporting Requirements — Submit quarterly progress reports in accordance with the following dates and reporting format: Quarter Covered Due to MDCH/DHWDC-HAPIS August 1-September 30, 2010 (Part D only, grant year "bridge" report) October 15, 2010 October 1-December 31, 2010 January 15, 2011 January 1-March 31, 2011 April 15, 2011 April 1-June 30, 2011 July 15, 2011 July 1-September 30, 2011 October 15, 2011 Reporting Format Submit a quarterly narrative progress report using the template provided to you electronically by HAPIS staff. 5. On a quarterly basis, input data collected reflecting Evaluation Measures in the work plan provided MDCH/P&GD FY 10/11 ATTACHMENT III Page 34 of 96 05/10 with your contract 15. Document that clients receiving services are eligible beneficiaries of services (documented HIV status). 16. Conduct quality assurance activities and participate in contract monitoring conducted and/or facilitated by MDCH/DHVVDC-HAPIS. Collect all quality indicators, if applicable. Export data to HAPIS in the format provided by HAPIS. 17. Annually monitor subcontracted agencies to assess compliance with the subcontract. Take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract. Report the results of all contract monitoring activities to MDCH/DHWDC-HAPIS. 18. Participate in oversight of all remediation efforts for subcontractors found in non-compliance with established MDCH/DHWDC-HAPIS program and practice standards, policy directives, and program guidance. 19. Assure that the agency and its employees, volunteers and subcontractors (if applicable), maintain confidentiality of all records, and that no information obtained in connection with individuals served by the contractor will be released without the express written consent of the individual client. 20. Provide immediate notification to the Department, in writing, of any formal grievance procedures initiated by a service recipient and subsequent resolution of that grievance. Submit notification to the Continuum of Care Unit Manager within three days of receipt of the grievance. 21. Provide immediate notification to the Department, in writing, of any event occurring, or notice received by the contractor or subcontractor, that reasonably suggests that the contractor or MDCH/P&GD FY 10/11 ATTACHMENT HI 05/10 Page 35 of 96 subcontractor may be the subject of, or a defendant in, legal action, This includes, but is not limited to, events or notices related to grievances by service recipients or contractor or subcontractor employees. (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 27. Funds awarded for pharmaceuticals must only be spent to assist clients who have been determined not eligible for other pharmaceutical programs, especially the AIDS Drug Assistance Program, or while they await entrance into such programs, and/or for drugs that are not on the State ADAP or Medicaid formulary. 28. Resumes for professional staff not named in the original agreement budget or that are hired subsequent to the execution of this agreement, must be submitted to the MDCH/DHWDC, HAPIS within 30 days of identification or appointment to the project. 29. Assure that STD and HIV secondary prevention practices for the purposes of reducing risk of transmission and re-infection as well as HIV medication adherence practices are integrated into the delivery of HIV/AIDS care services. 30. Utilize sound accounting methods to distribute and monitor expenditures of funds for HIV Care Part D services, ensuring that expenditure of funds is in accordance with the approved work plan and budget(s).. 31. Submit one copy of all fully-signed subcontracts to MDCH/DHWDC-HAPIS by October 15, 2009, or within 30 days of execution. Include a listing of the following information: A. Corporate name, address, telephone, fax numbers and project director of each organization. B. Amount awarded to each organization. C. Type of service and amount budgeted for each service to be provided. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 36 of 96 D, Beginning and end dates of each subcontract, E. Amount and source of other federal, state and local funds for the same service. F. Minority provider status. 37. Maintain secure records of the following at the agency site: A. Contractor and subcontractor contracts. B. Documentation of all quality assurance activities conducted by the agency. C. Copies of all quality assurance reports prepared by MDCH/DHVVDC-HAPIS. D. All financial accounting records. E. All expenditure reports submitted to MDCH by the agency. F. Copies of all fiscal audits of the agency conducted either internally or externally. 38. Use the Counselor-Assisted Referral Form (CARF), DCH-1225 to refer consenting HIV-positive individuals, identified through counseling and testing activities, to appropriate case management providers. 39. Collaborate with MDCH/DHWDC-HAPIS to identify administrative costs in the contractor budget in order to assure MDCH's compliance with the 10% total administrative cap on Part D grant funds. HIV PREVENTION PROGRAM - SPECIAL REQUIREMENTS Contractor Requirements - Categorical Provide HIV Counseling, testing and referral services, pursuant to statute and MDCH-issued accreditation and quality assurance standards. HIV prevention counseling is to accompany HIV testing provided to clients who are at behavioral and/or clinical risk for HIV and other sexually transmitted diseases, including clients seeking services for the diagnosis and/or treatment of sexually transmitted diseases. For clients seeking other clinical or preventive services, risk for HIV should be determined on the basis of a risk assessment. 2. Conduct partner services (PS) for sex and needle sharing partners pursuant to statute and MDCH- issued accreditation requirements and associated quality assurance standards, 3. Develop, implement and monitor protocol and procedures to facilitate achievement the following performance indicators: MDCH/P&GD FY 10/11 ATTACHMENT III Page 37 of 96 05/10 A. Among all clients who are diagnosed as HIV-infected, 95% will receive their confirmed test result, appropriate prevention counseling, and referrals B. Among all clients who are diagnosed as HIV-infected and who receive their confirmed test results, 100% will receive a referral to medical care for evaluation and treatment of their HIV infection. C. Among all clients who are diagnosed as HIV-infected and who receive their test result, 90% will successfully complete referral to medical care for evaluation and treatment of their HIV infection. D. Among all clients who test HIV-negative, 75% will receive their test result and as appropriate, counseling and referrals. E. Among all sex and needle-sharing partners notified by the health department who have an unknown or negative HIV status, 70% will accept HIV testing. 4. Submit all educational materials (e.g. brochures, posters, pamphlets and videos) used in conjunction with program activities to the Department's Program Review Panel for review and approval prior to their use, regardless of the source of funding used to purchase these materials. Submit process monitoring data to the Division of Health, Wellness and Disease Control via the HIV Event System, a web-based data management system. The time line and procedures for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. 6. Establish, maintain and document procedures to ensure data collected in conjunction with provision of services (e.g., data collected for submission to HES) is used for program monitoring and quality assurance. 7. Establish and implement policies and procedures to ensure confidentiality of client records as well as the security and integrity of data. Policies and procedures are to address collection, entry, use, storage and disposal of data. Policies and procedures are to conform to guidelines and standards issued by HAP IS/DHVVDC. 8. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to ensure timely and efficient communication with the Department. 9. Participate in technical assistance/capacity development, quality assurance (e.g., direct observation of counseling and chart review) and program evaluation activities as directed by the Department and/or as needed. 10. If conducting HIV testing using rapid HIV testing, comply with guidelines and standards issued by the Michigan Department of Community Health and: A. Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised, are to be submitted to HAPIS/DHVVDC, Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing. Michigan Department of Community Health (October 2008, or subsequent revisions). B. Enroll and participate in the Model Performance Evaluation Program (MPEP), CDC's external proficiency testing program. C. Submit a photocopy of the local health department's current CLIA certificate to Division of Health, Wellness and Disease Control. D. Report anomalous test results to the Division of Health, Wellness and Disease Control, MDCH/P&GD FY 10/11 ATTACHMENT III Page 38 of 96 05110 Local Health Agency Maximum Number of Rapid HIV Test Devices Berrien County Health Department 1,140 Calhoun County Health Department 2,235 Detroit Department of Health and Wellness Promotion 9,020 Genesee County Health Department 3,300 Ingham County Health Department 2,440 Jackson County Health Department 300 Kalamazoo County Health and Community Services 3,340 Kent County Health Department 3,420 Muskegon County Health Department 2,200 ' Oakland County Health Division 14,420 Saginaw County Health Department 1,620 Washtenaw County Health Department 1,700 Wayne County Health Department 2200, Van Buren —Cass District Health Department 920 MDCH/P&GD FY 10/11 ATTACHMENT III Page 39 of 96 05/10 2. Provide training and technical assistance in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. Contractor Reauirements — Non-Cateaorical 3. Maintain the technological capacity necessary' to comply with monitoring and reporting requirements associated with this agreement and to ensure timely and efficient communication with the Department. Reimbursement requests must be submitted quarterly on the financial status reports. Requests for reimbursement will be verified based on data submitted to the Department via the HIV Event System (H ES). Local Health Departments will not receive reimbursement for tests not entered into the HES. Department Requirements — Non-Cateaorical Reimburse local health departments at a rate of $11.00 per test, not to exceed $2,000 for fiscal year 2010/2011. HIV PROVIDER EDUCATION SPECIAL REQUIREMENTS (KENT COUNTY HEALTH DEPARTMENT) • One (1) in Southeast Michigan • Description: Knowledge and skills to facilitate patient disclosure of HIV positive serostatus to sex and needle-sharing partners. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 40 of 96 Process Objective 2: By September 30, 2011, conduct one HIV Disclosure Issues: Overcoming Prevention Message Fatigue through Skills Practice training for 20 healthcare providers. • One (1) in Southeast Michigan • Description: Expand knowledge and skills to support clients in effective decision-making about disclosing HIV status to sex partner, needle-sharing partners, family, friends and service providers. Process Objective 3: By September 30, 2011, conduct at least thirteen Achieving the Comfort and Competence to Discuss Your Patients' Sexual Health trainings for 325 health profession students. • Four (4) in West Michigan • Four (4) in Mid-Michigan • Five (5) in Southeast Michigan • Description: Knowledge and skills to conduct sexual health risk assessment/risk reduction counseling with patients. Process Objective 4: By September 30, 2011, conduct at least one, onsite customized HIV prevention training for staff in clinical settings. • Description: Specific topics will be individualized to the expressed needs of the clinic. Outcome Objectives Outcome Objective 1: By September 30, 2011, 85% of HIV Disclosure Issues: A "Telling" Problem training participants will report that they are better prepared to facilitate client disclosure of their HIV positive serostatus to sex and needle-sharing partners. Outcome Objective 2: By September 30, 2011, 85% of HIV Disclosure Issues: Overcoming Prevention Message Fatigue through Skills Practice training participants will report that they are better prepared to support clients in effective decision-making about disclosing HIV status to sex partners, needle-sharing partners, family, friends and service providers. Outcome Objective 3: By September 30, 2011, 75% of participants attending an Achieving the Comfort and Competence to Discuss Your Patients' Sexual Health training will report that they are better prepared to discuss sexual health concerns with patients. Program Requirements In carrying out the terms of this agreement, the Contractor shall: Establish implement and maintain policies and procedures designed to assure services supported under this agreement are delivered pursuant to applicable federal and state laws, policies and established standards. Current referent documents include: A. Quality Assurance Standards for HIV Prevention Interventions. HIV/AIDS Prevention & Intervention Section, Division of HIV/AIDS - STD, Michigan Department of Community Health. (May 2003, Revision Forthcoming). B. Protocol for HIV Counseling and Testing Using Oral Mucosal Transudate Technology, MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 41 of 95 Michigan Department of Community Health, HIV/AIDS Prevention & Intervention Section (March 1997), 2. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to assure timely and efficient communication with HAP IS/DHWDC 3. Adhere to time lines, work plans, budgets and staffing plans submitted to and approved by HAPIS/DHWDC. Deviations from approved time lines, work plans, budgets, and staffing plans must receive advanced authorization from HAPIS/DHWDC. 4. Participate in contract monitoring and quality assurance activities conducted by and/or facilitated by HAPIS/DHWDC. . 5. Participate in technical assistance, training, and/or skills-enhancement opportunities as recommended or required by HAPIS/DHWDC. 6. Participate in program evaluation activities conducted and/or required by HAPIS/DHWDC. 7. Establish and maintain mechanisms to obtain, on an ongoing basis, the input of target populations regarding the design, implementation and evaluation of prevention interventions. Progress reports submitted by the contractor are to describe the process and/or mechanisms for obtaining such input. 8. Establish, maintain and document procedures to ensure data collected in conjunction with provision of services (e.g., data collected for submission to HES) is used for program monitoring and quality assurance. Progress reports submitted by the contractor are to describe the specific activities used in applying data to program monitoring and quality assurance. 9. Establish and implement policies and procedures to ensure confidentiality of client records as well as the security and integrity of data. Policies and procedures are to address collection, entry, use, storage and disposal of data. Policies and procedures are to conform to guidelines and standards issued by HAPIS/DHWDC. 10. Establish, maintain and document linkages with community resources, including other health and human service providers, that are necessary and appropriate to addressing the HIV prevention- related needs of targeted populations(s) and which will facilitate access to needed services. At minimum, A. Programs targeted to communities at sexual risk for HIV are to establish, maintain and document linkages to community resources for the prevention, screening and treatment of sexually transmitted diseases. Programs targeted to communities at risk through injecting drug use are to establish, maintain and document linkages to community resources for substance abuse prevention and treatment and viral hepatitis screening and treatment. C. Programs targeted to or serving HIV-infected persons are to establish, maintain and document linkages to appropriate care/treatment, case management and partner services. 11. Participate in social marketing, media and/or awareness activities conducted, supported and/or facilitated by HAPIS/DHWDC. MDCH/P&GD FY 10/11 ATTACHMENT III Page 42 of 96 05/10 Reporting Period October - December 2010 January 1 — March 31, 2011 April 1 —June 30, 2011 July 1- September 30, 2011 Narrative Report Due January 15, 2011 April 15, 2011 July 15, 2011 October 15, 2011 Reporting Requirements 1. The Contractor shall submit: A. Narrative Progress Reports. The Contractor is to submit narrative progress reports. The format and content of these reports are to conform to the guidelines issued by HAP IS/DHWDC. Narrative reports are due as follows: The original and one copy of the quarterly narrative report are to be submitted by the Contractor to the designated HAPIS/DHWDC contract monitor. Quarterly narrative reports may be submitted electronically. Attachments should be scanned and submitted as a PDF file. B. Program Activities Calendar. Grantees are required to submit a calendar of program activities. The format, content and time lines for submission are to conform to the guidelines issued by HAPIS/DHVVDC. C. Process and Outcome Monitoring Data. Applicable process monitoring data are to be submitted via the HIV Event System. The time line and protocol for submitting these data are to conform to guidelines issued by HAPIS/DHVVDC. Reports presenting outcome data are to accompany quarterly narrative reports. It is understood that the reports described above may be revised; supplemented or replaced at any time and that the agency will provide information and/or data responsive to modified reporting requirements. Any such other information as specified in the Program Goals and Objectives or Program Requirements shall be developed and submitted by the Contractor as required by the Contract Manager. It is understood that the reports described above may be revised, supplemented or MDCH/P&GID FY 10/11 ATTACHMENT III Page 43 of 96 05/10 replaced at any time and that the agency will provide information and/or data responsive to modified reporting requirements. 2. The Contract Manager shall evaluate the reports submitted as described in item 1, above for their completeness, adequacy, and demonstration of adherence to agreed upon work plans/timelines, budgets and staffing plans. The Contractor shall permit the Department and/or its designee to visit and to make an evaluation of the project as determined by Contract Manager. Reports and information shall be sent to: Michigan Department of Community Health Division of Health, Wellness and Disease Control HIV/AIDS Prevention and Intervention Section 109 West Michigan Avenue, 10th Floor Lansing, Michigan 48913 HIV RAPID TESTING SPECIAL REQUIREMENTS Detroit Department of Health and Wellness Promotion Contractor Special Requirements The purpose of this agreement is to facilitate HIV testing as standard of care in the STD clinic by providing support for staff to conduct rapid HIV testing in the stat lab. Methodology and Program Content: Resources provided in association with this agreement are to be used to support routine HIV testing for clients receiving services for the prevention and/or treatment of sexually transmitted diseases (STDs). Specifically, resources are to support staffing in the STD clinic stet lab Program Requirements In carrying out the terms of this agreement, the Contractor shall: Conduct prevention program activities in a manner consistent with applicable federal and state laws and program and quality assurance guidelines and standards issued by the Michigan Department of Community Health. Comply with all Contractor Requirements for HIV/AIDS PREVENTION SPECIAL REQUIREMENTS (Categorical Funding) Participate in contract monitoring and quality assurance activities conducted by and/or facilitated by HAPIS/DHWDC. 4. Adhere to time lines, work plans, and staffing plans submitted to and approved by HAP IS/DHWDC. Deviations from approved time lines, work plans, and staffing plans must receive advanced authorization from HAPIS/DHWDC. Participate in technical assistance, training, and/or skills-enhancement opportunities as recommended or required by HAPIS/DHWDC. 6. Participate in program evaluation activities conducted and/or required by HAPIS/DHWDC. 7. Account for and monitor funds associated with these activities separately from other funds provided by HAPIS/DHVVDC that support HIV counseling and testing. MDCH/P&GD FY 10/11 ATTACHMENT II Page 44 of 96 05/10 Department Requirements Provide training and technical assistance in the use of rapid HIV tests. HIV/STD PARTNER SERVICES PROGRAM SPECIAL REQUIREMENTS (FOR HIV POSITIVE TEST NOTIFICATION, PARTNER COUNSELING AND REFERRAL SERVICES AND SYPHILIS INVESTIGATION (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT) Contractor Requirements Pursuant to a protocol established by MDCH, provide positive test notification, HIV partner counseling and referral services, victim notification and recalcitrant and syphilis investigation for the following local health departments: Barry-Eaton District Health Department, Bay County Health Department, Benzie-Leelanau District Health Department, Central Michigan District Health Department, Chippewa County Health Department, Dickinson-Iron District Health Department, District Health Department # 2, District Health Department #4, District Health Department #10, Grand Traverse County Health Department, Huron County Health Department, Ionia County Health Department, Lapeer County Health Department, Ottawa County Health Department, Livingston County Health Department, Luce-Mackinac-Alger-Schoolcraft District Health Department, Marquette County Health Department, Mid-Michigan District Health Department, Midland County Health Department, Northwest Michigan Community Health Agency, Public Health, Delta and Menominee Counties, Sanilac County Health Department, Shiawassee County Health Department, St. Clair County Health Department, Tuscola County Health Department, and Western Upper Peninsula District Health Department. 2. Provide these services fifty-two weeks a year. 3. Conduct program activities in accordance with state law. Relevant statutes are summarized in the document: Michigan HIV Laws: How They Affect Physicians and Other Health Care Providers. Michigan Department of Community Health. January, 2006. 4. Establish, maintain and document linkages with community resources that are necessary and appropriate to addressing the needs of clients and that are essential to the success and effectiveness of services supported under this agreement. 5. Provide services supported under this agreement in accordance with guidelines and standards issued by the Michigan Department of Community Health and/or the US Centers for Disease Control and Prevention. Current guidelines and standards include: A. Revised Recommendations for HIV Screening of Pregnant Women. US Department of Health and Human Services. November 2001. B. Quality Assurance Standards for HIV Prevention Interventions, Michigan Department of Community Health. May 2003. C. Protocol for HIV Counseling and Testing Using Oral Mucosal Transudate Technology. Michigan Department of Community Health. March 1997. D. Strategies to Improve Client Failure to Return for HIV Test Results. Michigan Department of Community Health. May 2008. E. Partner Notification Guidelines. Michigan Department of Community Health. January 2006. F. Integrated STD/HIV Partner Services Guidelines, June 2009, CDC. G. Michigan Local Public Health Accreditation Standards. H. CDC STD Program Operation Guidelines and CDC STD Treatment Guidelines, latest versions. MDCH/P&GD FY 10/11 ATTACHMENT III Page 45 of 95 05/10 8. Participate in technical assistance, training and/or skills-enhancement opportunities as recommended or required by the Division of Health Wellness and Disease Control. It is understood that the Division will provide travel support associated with participation in training and skills- enhancement opportunities. 9. Participate in program evaluation activities conducted by or required by the Division of Health, Wellness and Disease Control. 10. Submit all educational materials (e.g. brochures, posters, pamphlets and videos) used in conjunction with program activities to the Department's Program Review Panel for review and approval prior to their use. 11. Submit HIV test and HIV partner counseling and referral services data to the Division of Health, Wellness and Disease Control via the HIV Event System. The time line and procedures for submitting these data are to conform to guidelines issued by the Division of Health, Wellness and Disease Control. Complete and submit currently accepted syphilis case management forms, as required by the Outstate STD Program Manager. 12. Maintain the technological capacity necessary to comply with monitoring, reporting and evaluation requirements associated with this agreement and to ensure timely and efficient communication with the Department. 13. Provide appropriate case management feedback to referring health departments to facilitate effective communication. HIV SURVELLANCE SUPPORT (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) Contractor Requirements: Provide the resources necessary to house the MDCH HIV Surveillance Staff at Herman Keifer. Support includes overhead costs for office space and includes costs and technical support for phone and technology lines. HOPWA SPECIAL REQUIREMENTS (Housing Opportunities for Persons Living with HIV/AIDS) (DISTRICT HEALTH DEPARTMENT #10, MARQUETTE COUNTY HEALTH DEPARTMENT) MDCH/P&GD FY 10/11 ATTACHMENT III Page 46 of 96 05/10 Budget and Agreement Requirements A. HOPVVA Eligibility HIV Status Determination HIV status must be documented for each client, subject to confidentiality procedures. Acceptable forms of documentation include the following: • Documentation from a health professional qualified to make such a determination. • Documentation from an HIV test conducted by a physician, community health center, or HIV counseling center. Income Determination Income must be determined and verified prior to housing assistance being provided and annually thereafter. Income determination includes all members of the household. B. Allowable Use of Funds Funds may be used to assist all forms of housing designed to prevent homelessness. This includes emergency housing, shared housing arrangements, apartments, single room occupancy (SRO) dwellings, and community residences. It includes assistance to remain in current homes, whether owned or rented, and assistance in relocating to another home if needed. The following activities may be carried out with HOPWA funds: 1. HOUSING ASSISTANCE Tenant Based Rental Assistance (TBRA): Subsidy for use on the open rental market. Tenant holds lease to unit rented at or under Fair Market rent (FMR) and meets Housing Quality Standards (HQS). Short-Term Rent, Mortgage and Utility (STRMU) payments: Subsidy to prevent homelessness of mortgagers or renters in their current place of residence. Limited to 21-weeks in any 52-week period. 2. SUPPORT SERVICES. A. Housing Case management: Client advocacy, and assistance with access to benefits, counseling and help to develop a housing application and assessment and budget on form provided by MDCH to establish stable permanent housing. This may also include fair housing counseling for eligible persons who may encounter discrimination on the basis of race, color, religion, sex, age, national origin, familial status, or handicap. B. Other Support Services: including, but not limited to, outreach, life, management, education, health, mental health, assessment, drug and alcohol abuse treatment and counseling, day care, personal assistance, nutritional services, intensive care when required, and assistance in gaining access to local, State, and Federal government benefits and services, except that health services may only be provided to individuals with acquired immunodeficiency syndrome or related diseases and not to family MDCH/P&GD FY 10/11 ATTACHMENT III Page 47 of 96 05/10 members of these individuals. HOPWA cannot fund services already available through other agencies or funding sources. C. Funds are provided according to the above categories/activities detailed in the submitted budget (See Contractor Requirements - Plan below). Deviations from the amounts budgeted are allowed as long as the total contract amount is not exceeded. Expenditures for Administration cannot exceed 7% of the total amount and fixed by law. Minor changes to a category/activity total (less than 20% of total budgeted for that activity) are allowed. Significant changes to an activity total (20% or more) or adding funds to an activity not previously funded need prior approval from DCH HOPWA staff. A formal amendment is required to increase the total contractual amount. Seventy-five percent of expenditures should be for direct housing assistance, housing information services, housing placement assistance, housing related case management, and resource identification. Staff working on and funded by the HOPWA program need to have Time distribution records retained to support reimbursement requests. For more information, please check the HOPWA regulations (24 CFR 574) 2. Contractor Requirements lye rson bmichigan.gov or mailed to MDCH/P&GD FY 10/11 ATTACHMENT III Page 48 of 96 05/10 Community Living Division Michigan Department of Community Health 320 S, Walnut, Lewis Cass 5 1h Floor N Lansing, Michigan 48913 Attention: HOPVVA PROGRAM HOPWA Annual Plan Components The plan consists of the following components. Generally a brief description of current year activities and the agency's plan for Operating Year July 1, 2010 through June 30, 2011 is required. a. Needs Describe the demographic characteristics of the population with HIV/AIDS in the agency's service area in comparison to the population served by the HOPVVA program. Describe the service needs of the PLWH/A's in your agency's service area using the HOPWA activities specified in allowable use of funds (TBRA, STRMU, Support Services, Housing Placement Assistance, and Resource Development. This is a narrative component and should reflect the outcome of regional needs assessment activities and analysis of demographic information. Specifically describe any needs assessment activities carried out. Provide a copy of your needs assessment tool(s). b. Coordination CARE Act (Ryan White)-funded HIV/AIDS related services, MDCH/P&GD FY 10/11 ATTACHMENT III Page 49 of 96 05/10 d. Reporting In addition to submitting the FSR and the FSR Supplemental Form for reimbursement per the billing instruction through MI E-Grants, both the FSR and the FSR Supplemental forms must be submitted monthly by email to the addresses provided below in their original format (Excel). Excel versions that have been provided to all agencies must be used to submit this information. It is important that the breakdown of costs according to the 10 activities in the annual CAPER match the FSR Supplemental Form figures submitted with the FSR for reimbursement. It is important to understand that the contract year and operating year to not coincide. NOTE: The information/data required for the Consolidated Annual Performance & Evaluation Report (CAPER) and the HOPWA Grantee CAPER Verification Worksheets (See attached) for the Operating Year 2010-2011 must be submitted to DCH or available in HMIS by July 31, 2011, and will include data from the period 7/1/2010 through 6/30/2011. Electronic versions to collect the data for the CAPER and the CAPER verification worksheets, as well as copies of the FSR and FSR Supplemental reports will be sent via Email from Brian Iverson. Copies can be requested by contacting Brian Iverson at iversonbmichician qov . All HOPWA Sponsors are required to obtain a DUNS (Data Universal Numbering System) number and be registered with the CCR (Central Contractor Registration). This registration must be updated or renewed at least once per year to remain active. The DUNS number and the CCR status are to be reported with the annual CAPER however maintaining MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 50 of 96 current CCR status is the responsibility of the HOPVVA Sponsor. References: Section 872 of the National Defense Authorization Act, the American Recovery and Reinvestment Act (ARRA) and the Federal Funding Accountability and Transparency Act (FFATA). Contractor Specific Requirements All fiduciaries and project sponsors using grant funds to provide housing must adhere to the following standards: A. Ensure that qualified service providers in the area make available appropriate supportive services to the individuals assisted with housing under HOPWA. For any individual with acquired immunodeficiency syndrome or a related disease who requires more intensive care than can be provided in housing assisted under HOPWA, the project sponsor shall provide assistance in locating a care provider who can appropriately care for the individual and for referring the individual to the care provider. B. Ensure that grant funds will not be used to make payments for health services for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service: under any State compensation program; under an insurance policy; under any Federal or State health benefits program; or by an entity that provides health services. C. Operate the program in accordance with the provision of 24 CFR 574 and other applicable HUD regulations. Prior to dispensing HOPWA direct housing assistance and at least annual thereafter, document the eligibility of each person receiving HOP WA benefits: To include documentation of HIV status of the eligible individual and verification of income of all members of the household (household income to be less than 80% of area Median income). D. Keep records and reports which are consistent with the information required by the current Consolidated Annual Performance and Evaluation Report (CAPER) and the HOPVVA Grantee CAPER Verification Worksheets as requested by MDCH through the operating year Annual reports for HOPVVA, Implement the Uniform Reporting System which includes data regarding HOPWA eligible persons and information needed for the CAPERNerification worksheets. Submit the data or have it fully available in HMIS for the operating year 2010-11 by July 31, 2011. E. Participate with MDCH in facilitating and conducting site visits. Comply with on-site and/or remote monitoring of their program. Monitoring may include but not limited to reviews of: Housing Applications and Assessment forms; documentation of eligibility — documentation of household income, number of persons in the household, HIV status; housing habitability inspection reports; tracking of TBRA & STRMU expenditures and the 21 week limit for STRMU; current conflict of interest statement; use of DCH specified mandatory forms; documentation relating to the annual report data; tracking of program income (tenant co- pay for TBRA; returned security deposits); adequate documentation of expenditures, etc. F. Provide services in accordance with an approved plan and comply with reporting requirements as specified by law, HUD and/or DCH. G. Retain documentation of the rental subsidy payment calculations, HOS inspections, and schedule for repayment of security deposits. H. The following supporting documentation titles address fundamental HUD HOP WA program requirements. The use of these documents is mandatory. These documents have already been distributed electronically, and additional copies can be secured by contacting the HOPVVA specialist. They are incorporated into the contract by reference: 1. Conflict of Interest - MDCH HOPVVA Contractor Assurances (attachment) MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 51 of 96 2. Housing Application & Assessment 0. Client File Documentation - STRMU Housing Assistance 4. Client Budget Worksheet 5. Zero Income Affidavit 6. Client File Contents Checklist — TBRA 7. Client File Contents Checklist — STRMU These documents must be completed in full and be legible and signed and dated where indicated, 2. Provide Oversight A. Oversee process and performance for subcontracts for the provision of HIV related HOPWA services. Ensure a contractual requirement to adhere to all applicable state and federal laws and regulations for all subcontractors. B. Assure that contractors and subcontractors have developed and make available to service recipients both grievance and appeals processes. C. Determine/document the unit cost per service for each funded service. Retain data supporting the per-unit cost and how it was determined. D. Assess client satisfaction of services provided. At least annually conduct formal, written and documented housing needs assessments of persons receiving housing assistance and of those you are unable to serve. At a minimum the assessment is to include a review of items from pages 3 & 4 of the Housing Application and Assessment form and an analysis of their current situation, future needs, and changes that are recommended. Prepare a summary report annually and keep original assessments on file. E. Assure the confidentiality of the name of any individual assisted and any other information regarding individuals receiving assistance per HIPAA standards that apply. F. Assure that no fee, except tenant portion of rent, shall be charged to an eligible person for housing or services. G. Assure that contractors and subcontractors have the capacity to effectively carry out the activity and that they agree to maintain and make available to HUD for inspection financial records sufficient to ensure proper accounting and disbursing of amounts received. Ensure that issue statements, press releases, RFP, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal funds, clearly state 1) the percentage or total cost of the program or project which will be funded with Federal funds; 2) the amount of Federal funds for the project or program; and 3) percentage and dollar amount of the total costs of the project or program that will be financed by non- governmental resources. Provide to DCH copies of statements and press releases issued by the Contractor. Retain copies of same on file for two (2) years. H. Ensure all services are available in the entire agency catchment's area, If Persons from outside your catchment's area are assisted, communicate with the Sponsor for that MDCH/P&GD FY 10/11 ATTACHMENT III Page 52 of 96 05/10 catchment's area to verify that assistance is not duplicated and that STRMU funds do not exceed the 21 week limit. Ensure that all activities funded under the program will meet urgent needs that are not being met by available public and private sources. Reporting Special Requirements IMMUNIZATION ACTION PLAN SPECIAL REQUIREMENTS Contractor Requirements Service Delivery: Offer immunization services to the public. MDCH/P&GD FY 10/11 ATTACHMENT III Page 53 of 96 05/10 A. Collaborate with public and private sector organizations to promote childhood, adolescent and adult immunization activities in the county including but not limited to recall activities. B. Inform providers that Hepatitis B, pneumococcal, and influenza vaccine and their accompanying administrative costs are Medicare covered benefits. F. Ensure clinic hours are convenient and accessible to the community, operating both walk-in and scheduled appointment hours. G. Coordinate immunization services, including WIC, Family Planning, and STD, developing plans or memorandums of understanding. H. Collaboratively work with regional MCIR staff to ensure providers are using MCIR appropriately. Develop strategies to identify and target local pocket of need areas. Adhere to federal and state appropriation laws pertaining to use of programmatic funds. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993, section 1928 Part IV — Immunizations and the most current CDC Vaccines for Children Operations Manual, Michigan Resource Book for VFC Providers, and documents that are updated throughout the year pertaining to the Vaccines For Children (VFC) Program. Ensure that federally procured vaccine is administered to eligible children only and is properly documented per VFC guidelines. A. The VFC Program provides VFC vaccine to only eligible children who meet the following criteria: are enrolled in Medicaid, have no health insurance, are American Indian or Alaskan Native, are served at a Federally Qualified Health Center (FQHC), a Rural Health Center (RHO) or a public health clinic affiliated with a FQHC and are also under-insured. B. Ensure state-supplied vaccines provided in the jurisdiction are administered only to eligible clients as determined by the state. This program allows for the immunization of select populations who are underinsured and not served at a FQHC, RHO, or a public health immunization clinic affiliated with a FQHC as defined by current state program requirements. 0. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility. D. Fraud or abuse of federally procured vaccine should be monitored and reported. 5. Adhere to all Federal and Michigan Laws pertaining to immunization administration and reporting including reporting to the MCIR, VAERS and schools and daycare reporting 6. Monitor any provider receiving federally procured vaccine at least once every 3 years, and preferable at least once every 2 years, as a VFC site visit 7, Ensure attendance of at least 1 LHD immunization program staff to two (2) Immunization Action Plan (IAP) meetings each year. 8. Submit original FSR's to MDCH on a quarterly basis. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 54 of 96 Period Covered 10/01/2010 — 03/31/2011 04/01/2011 — 10/30/2011 Date Due April 15, 2011 October 15, 2011 9. IAP Reports are submitted electronically through HEALTH WATCH with a copy to the regionally assigned immunization field representative or other designated point of contact in accordance with the following dates: 10. Develop, implement and submit an IAP Plan for 2011 using a template provided by the Department, due to the Immunization Field Representative or other designated point of contact by January 15, 2011. The LHD is also required to submit the report electronically through HEALTHVVATCH. 11. By February 15 of each year provide one copy of the provider enrollment form which include: profile, varicella agreement and storage capacity survey for each provider who receives vaccine from the state. These documents must be postmarked or filed electronically no later than February 15. 12. Implements Perinatal Hepatitis B program activities to prevent the spread of Hepatitis B Virus (HBV) from mother to newborn. 2. Ensure that all susceptible household and sexual contacts associated with HBsAg positive women receive appropriate testing, vaccination, and support services. D. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns prior to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination Program for Newborns. 13. Surveillance of vaccine preventable disease (VPD) activities: A. Ensure that all reportable diseases are reported to MDCH in the time specified in the public health code and appropriate case investigation is completed. B. Conduct active surveillance when indicated (i.e. during an outbreak) and contact hospitals, laboratories, and/or other providers on a regular basis. C. Utilize VAERS to report all adverse vaccine reactions. Department Requirements 1. The department will receive, review and summarize IAP reports and the annual IAP plan, and share this information with the local health departments. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MCIR activities through regional coordinators. MDCH/P&GD FY 10/11 ATTACHMENT III Page 55 of 98 05/10 4. Provide supportive services and resource identification when needed. 5. Provide financial support for LHD and Community / Migrant Health Centers for immunization in pocket of need (PON) areas. 6. Each LHD will have an annual VFC site visit by the Department. 7. Develop pre-formatted tools including training for new initiatives and IAP reports / plan. received a VFC/AFIX site visit in the most recent cycle of site visits. LHD staff should contact MDCH prior to conducting an AFIX follow-up to assure the site meets current criteria for reimbursement. 2. Data from the MDCH/Immunization Program regarding the number of AFIX follow-ups will be used to reconcile the reimbursement. The AFIX Follow-up report form must be received at MDCH/Immunization Program within 30 days of the follow-up to qualify for reimbursement. For additional detail on the program requirements, refer to the guidance provided by the MDCH/Immunization Program in correspondence to Immunization Action Plan (IAP), Immunization Coordinators, or through health officers. Department Requirements 1. The Department will provide payment annually based on the fixed unit rate reimbursement mechanism upon completion and timely submission of the required documents mentioned above. 2. The Department will develop pre-formatted tools. The Department will provide support to the Contractors. 3, The Department will provide AFIX training module upon request by the LHD and will also provide guidance at LAP meetings and through the MDCH Immunization field representatives. MDCH/P&GD FY 10/11 ATTACHMENT III Page 56 of 96 05/10 Contractor Requirements (Except Barry-Eaton, Kalamazoo. Livingston and Monroe) 1. Employ and supervise a full-time Immunization Field Representative for the Immunization Program who shall be acceptable to the Department and who shall be supported by this agreement, understanding that their full time is to be devoted for regional immunization related activities. 2. Provide the Immunization Field Representative with permanent office space and supplies, including, but not limited to: a telephone, general office supplies, a computer with high speed internet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned regions to provide Immunization Program activities equitable and at the direction of the Department. Refer to field representative responsibilities as defined by the Department and distributed to the contractor. 4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of business by the Immunization Field Representative unless otherwise arranged. 5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the Immunization Field Representative necessary to the conduct of the Immunization Program. Travel will include the annual National Immunization Conference and other professional immunization related conferences, attendance at the MDCH Immunization staff meetings and trainings, and accreditation visits made in other areas of the state. Field Representative Roles and Responsibilities - (Except Barry-Eaton, Kalamazoo, Livingston and Monroe) This position serves as a liaison, resource person and as a regional expert for local health jurisdictions regarding all MDCH immunization programs and initiatives. 1. PROGRAM SUPPORT: A. Assist with the regional MCIR activities and act as a regional resource on MCIR processes and assessment protocols. B. Assist regional LHDs in transition to centralized distribution and act as a liaison between LHD and the Department on troubleshooting issues. C. Assist with the local implementation and monitoring of all state programs at the regional level- including IAP implementation, VFC, AFIX, Accreditation, Perinatal Hepatitis B, School / Childcare reporting, special projects and the I NE program. D. Participate in planning for regional conferences, IAP Coordinator meetings, and other MDCH programs and initiatives as needed. E. Assist state, regional and local epidemiologists and communicable disease staff as needed with VPD surveillance and outbreak control. 2. PROGRAM QUALITY ASSURANCE: A. Assist in the orientation of new IAP Coordinators. MDCH/P&CD FY 10/11 ATTACHMENT III Page 57 of 96 05/10 3. PROGRAM COMPLIANCE: A. Monitor compliance with policies/legislation at national/state and local levels such as: 1. VFC program requirements and vaccine distribution 2. VAERS program 3. Public Health Code 4. Administrative Rules a. School and childcare legislation and reporting requirements b. MCIR legislation and rules c. Communicable Disease Rules 4. PROGRAM OVERSIGHT and PROGRAM REVIEW: A. Perform oversight of the following programs with assigned local health departments. B. Accreditation-Conduct reviews, and monitor corrective actions. C. VFC including orientation to annual VFC site visit process, monitoring of VFC vaccine losses, submission of mandatory reports, annual LHD VFC site visits and support of the transition to centralized vaccine distribution. D. AF1X—including assuring local feedback with providers, and follow up on recommendations. E. Perinatal Hepatitis B-regional birth dose levels and universal vaccine program. F. Review and summarize LHD 1AP Annual Plans and Biannual IAP Reports. G. Monitor LHD compliance with COMPREHENSIVE agreements and special requirements Department Requirements MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 58 of 96 1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field Representatives for the duplicating/printing of materials and the packaging and distribution of these materials, 2. Provide program direction, responsibilities and definition of Immunization Field Service Representative responsibilities, 3. Support or solicit the Immunization Field Service Representative input into policy-making decisions. IMMUNIZATION — NURSE EDUCATION REIMBURSEMENT SPECIAL REQUIREMENTS Budget and Agreement Requirements The rate of reimbursement is $150 per eligible educational session for all modules except Vaccines Across the Lifespan, which is to be reimbursed at $200 per eligible educational session to the Contractor, upon completion and submission of INE Provider Contact and Report Forms. Reimbursement will be based on a first come-first served basis and also based on most current INE Program Guidelines. Contractor Requirements 1. Ensure that all Immunization Nurse Educators are trained as required by the Department. 2. Ensure that the INE Provider Contact and Report Form is complete and submitted to the Department/Immunization Program within 5 days after the presentation. Department Requirements The Department will provide payment annually based upon the fixed unit rate reimbursement mechanism upon completion and submission of the INE Provider Contact and Report Forms for eligible sessions. 2. The Department will provide two (2) sessions per calendar year for Contractor Immunization Nurse Educators. Department Requirements The Department will provide payment annually based upon the fixed unit rate reimbursement mechanism upon completion and submission of the INE Provider Contact and Report Forms. The Department will provide two (2) sessions per calendar year for Contractor Immunization Nurse Educators. IMMUNIZATION — REACHING MORE CHILDREN AND ADULTS SPECIAL REQUIREMENTS — AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) Budget Requirements This program is supported with American Recovery and Reinvestment Act funds and must be budgeted as a separate element. Funding cannot be co-mingled with other funding. The contract must comply with all provisions as outlined in Attachment H — American Recovery and Reinvestment Act. Contractor Requirements Vaccinate uninsured and under-insured adults 19 years and older as part of the Michigan Vaccine Replacement Program (MI-VRP) with following vaccines while vaccine supplies are available: A. Tdap vaccine for individuals who have not received a prior dose of Tdap vaccine. B. MMR vaccine for individuals born after 1956 with no prior history of vaccination or documentation of disease. MDCH/P&GD FY 10/11 ATTACHMENT IS Page 59 of 96 05/10 G. HPV vaccine for girls through 26 years of age. H. Zoster vaccine for adults age 60 through 64 years of age. 2. Appropriately screen for eligibility all adults participating in the MI-VRP program. 3. Report all doses to the MCIR using the "Special 317" vaccine eligibility. 4. Use the Vaccine Inventory Module (VIM) in the MCIR to track all publicly purchased vaccines. 5. Communicate the expansion of the MI-VRP program to the public. 6. Make clinics available to the public to meet the need of the populations being served in the MI VRP program. 7. Coordinate services with other clinics seeing high risk adults. 8. Report on the number of FTEs funded using this funding. 9. MDCH will request quarterly reporting on activities related to these funds. MCDH will send out an electronic reporting tool. Department Requirements 1. Monitor and approve vaccine orders for Local Health Departments. Provide guidance on the use of the vaccine intended for these populations. 3. Assist Local Health Departments on education and intervention on the inappropriate use of publicly purchased vaccine. 4. Assist Local Health Departments on issues related to MCIR functionality and operation. 6. Follow-up on VFC site visit corrective action issues. 7. Assist VFC providers within the jurisdiction on issues related to balancing vaccine inventories. 8. Assist with the redistribution of short dated vaccine for providers within the jurisdiction. MDCH/P&GD FY 10/11 ATTACHMENT III Page 60 of 96 05/10 Department Requirements 3. Combined VFC/AFIX site visits shall be conducted in practices that have any children 19-35 months of age in the MCIR, using the AFIX reports. The site visit questionnaire is answered using the AFIX Reports generated from MCIR, no earlier than 10 days prior to the date of the site visit and using information from previous years VFC/AFIX site visit questionnaires. LHD staff must generate and review the AFIX reports along with the previous years' site visit questionnaire and then complete the AFIX portion of the questionnaire prior to arrival at the site visit. The data contained in the AFIX reports and the previous years' questionnaire assist LHD staff to identify coverage level percentages, possible issues around missed opportunities for vaccination, invalid doses and patients overdue for immunizations. Two recommendations for the provider to focus on immunization behaviors must be identified and included in the questionnaire, including specific information that facilitates feedback and exchange of information with the provider office to further develop strategies and efforts for improving coverage levels and protecting their patients from VPD. [HO staff must submit the completed site visit questionnaire to MDCH within 30 days of the site visit. 4. The format of the site visit will be based on the complete site visit questionnaire distributed at the most recent Fall IAP meeting and the site visit guidance documents (VFC and AFIX) provided by the department and the CDC. Completed site visit documents shall be sent to the MDCH/Immunization Program within 30 days of the site visit. 5. Data from the MDCH/Immunization Program regarding the number of site visits will be used to reconcile the request for reimbursement. The minimum number of site visits must be submitted by MDCH/P&GD FY 10/11 ATTACHMENT III Page 61 of 96 05/10 April 30 to qualify for reimbursement. For additional detail on the program requirements, refer to the Resource Book for Vaccine For Children Providers and the AFIX site visit guidance documents, as well as other guidance provided by the MDCH/Immunization Program in correspondence to Immunization Action Plan (IAP), Immunization Coordinators, or through health officers. Department Requirements INFORMED CONSENT SPECIAL REQUIREMENTS Effective January 1, 2010, the local health department is to cease performing HIV testing on behalf of the Department. (Detroit and Kent only) MDCH/P&GD FY 10/11 ATTACHMENT III Page 62 of 96 05/10 Contractor Requirements 1. Contractor Specific Requirements - All Contractors A. Meet established standards of performance and objectives in the following areas: Bioterrorism: a. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT). b. Train additional staff to perform Laboratory Response Network (LRN) Sentinel and Reference level laboratory procedures, g. Provide secure facilities to store reagents, quality control organisms and patient isolates, B. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not specifically supplied by the Department in this agreement. C. Provide the Bureau of Epidemiology, and Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Contractor for MDCH all specimen submission data and reporting data will be entered and reported using Bureau of Laboratories (BOL) Laboratory Information Management Systems (LIMS) software. The Contractor will designate one staff member as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff to take part in LIMS training activities. D. Provide information on specimen submission to local health jurisdictions to assure that specimens are submitted to Agency regional laboratory, or nearest laboratory as determined by the Department. E. Meet established standards of performance and objectives in the following areas: 1. Provide laboratory support (examination of food specimens) to investigate up to 12 foodborne disease outbreaks. Laboratory support includes providing test reports and food samples to the Bureau of Laboratories. Specimens will be processed within 36 hours of collection, except fish, which will be processed within 6 hours of collection. MDCH/P&GD FY 10/11 ATTACHMENT III Page 63 of 96 05/10 2. Provide Laboratory support for examination of up to 100 stool specimens associated with foodborne disease outbreaks. Specimens will be processed within one hour of receipt if not in transport or 24 hours if stabilized in transport. 3. Renew yearly a Memorandum of Understanding (MOU) with MDCH BOL for Laboratory response Network (LRN) testing. 2. Contractor Requirements — Detroit Department of Health and Wellness Promotion Only A. Meet established standards of performance and objectives in the following areas: 3. Test gonorrhea and chlamydia specimens from approved agencies within one working day of receipt of specimen. 4. Send laboratory test reports to submitters within one day of completing testing via a system of delivery at least as expedient as the US Postal Service. 5. Establish testing personnel training program and maintain documentation of training of all testing personnel. 6. Order and maintain adequate supplies and reagents for gonorrhea and Chlamydia testing such that the turn around time for testing is not compromised. B. Communicate reagent and shipment needs to test manufacturer. C. Inform the Infectious Disease Division by May 15, 2011 if more than 9,580 chlamydia/gonorrhea or more than 2,400 chlamydia only commercial nucleic acid amplification specimens for will be performed during FY 2011. D. On a quarterly basis, the regional laboratory will be billed $1.80 for each collection kit shipped by MDCH that is used to perform a billed test. The number of billed tests performed by the laboratory will be determined from the laboratory information system. The fee will be deducted from payments made to perform non-billed tests. 3. Contractor Requirements — Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health Only A. Administration of the Michigan Regional Laboratory System. 1. Administer the regional laboratories as specified: MDCH/P&GD FY 10/11 ATTACHMENT Iii Page 64 of 96 05/10 2. Provide a qualified (as defined by CLIA) Technical Consultant for their region. 3. Technical Consultants will: 4. Contractor Requirements — Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health Only A. Meet established standards of performance and objectives in the following areas: 1. Perform tests for diagnosis of gonorrhea and chlamydia infections using commercial nucleic acid amplification assay and perform testing for detection of foodborne disease outbreaks as specified in item 1.E. 2. Utilize standardized testing procedures approved by the laboratory director and standards of quality assurance and quality control. Assist Department in quality assurance assessment of testing annually or as determined by Department. Subscribe to a CMS proficiency testing program and maintain performance that meets the requirements specified in CLIA regulations. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 65 of 96 D. Saginaw County Health Department performs more than 6,976 chlamydia/gonorrhea or G. The Saginaw laboratory will be reimbursed $119,184 on an annual basis to perform 6,976 gonorrhea/Chlamydia combo tests and 2,524 chlamydia only tests. This reimbursement covers the cost of all reagents and supplies necessary to perform testing and all associated labor costs. Reimbursement is based on $1,090 for every 85 reported gonorrhea/Chlamydia combo tests; $929 for every 85 reported Chlamydia only tests; $1,584 annually for syringe tips; and $350 annually for proficiency testing. The level of reimbursement may be adjusted during the course of the year to reflect changes in actual testing volume or to change testing volumes based on budgetary constraints. 5. Contractor Requirements - Kent County Health Department Only A. Meet established standards of performance and objectives in the following areas: 1. Perform tests for diagnosis of gonorrhea and chlamydia infections using a commercial assay, perform testing for detection of foodborne disease outbreaks as specified in item 1.E. 2. Utilize standardized testing procedures, standards of quality assurance and quality control approved by the laboratory director. Assist Department in quality assurance assessment of testing semi-annually or as determined by the Department (including test and report turn-around times, indeterminate rate). Subscribe to a CMS proficiency testing program and maintain performance that meets the requirements in CLIA regulations. 3. Test gonorrhea and chlamydia specimens from approved agencies/physicians within one working day of receipt of specimen. 4. Send laboratory test reports to submitters within one day of completing testing via a system of delivery at least as expedient as the US Postal Service. Establish testing personnel training program and maintain documentation of training of all testing personnel. Arrange on-site training of personnel with test kit manufacturer's representative. MDCH/P&GD FY 10/11 ATTACHMENT 10 Page 66 of 96 05/10 Department Requirements Department Requirements (for All Contractors): A. Reimburse the Contractor for the examination of specimens related to foodborne disease outbreaks to the extent outlined in itern 1.E above. Reimburse the Contractor at the fixed unit rate for the diagnosis of gonorrhea and chlamydia infections using a nucleic acid amplification assay. B. Notification and explicit instruction for stop and start days to Contractor laboratory regarding this contractual arrangement prior to its implementation. C. The Department will provide access to LIMS, support for LIMS hardware (UNIX server) and software, provide one computer, user training for LIMS module(s)/customization(s) utilized for testing performed under contract, advanced training for LIMS liaisons for test master and Contractor specific data base support, and support for network communications between the Contractor and the LIMS server. The Department will maintain the sole contract with LIMS vendor. Payment for additional module(s)/customization(s) and maintenance fees for those modules will be paid for by the Contractor(s) through MDCH. Tape backups and maintenance of all module(s)/customization(s) will be performed by MDCH staff. D. Analyze data from reports submitted from Contractor. Supply timely feedback of statistical analysis and other data related to on going program activities. E. Assist in technical training of testing personnel and computer software utilization. F. Supply Contractor with a copy of the contracts associated with this program. G. Monitor monthly utilization reports. H. Provide reagents and culture media for food and stool specimen examination related to food borne disease outbreaks. 2. Department Re Detroit Department of Health and Wellness Promotion 004 A. Purchase and arrange for shipment of test kits and reagents from manufacturer. B. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. MDCH/P&GD FY 10/11 ATTACHMENT III Page 67 of 96 05/10 3. Department Requirements (for Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health Only B. Michigan Department of Community Health (MDCH): 1, Designate and assign personnel who meet the qualifications required as a high complexity laboratory director in CLIA 1988. 2. Laboratory Directors will: a. Sign the appropriate CMS paperwork for CLIA certification for their region as needed. b. Visit Agency Laboratory at least twice a year and participate in annual site coordinator's meeting. c. Be available for consultation to the Agency laboratory by telephone, email, and other communication methods. d. Provide laboratory guidelines, testing procedures, quality control methods and quality assurance in accordance with CLIA requirements. e. Review Quality Assurance program with attention to effective quality control activity and corrective action. f. Review and perform, as needed competency evaluations. 9- Review external proficiency testing results in a timely manner. h. Review and sign procedure manual(s) annually, and any new procedure prior to its implementation. 4. Notify Agency of funding changes for state supported testing initiatives. 5. Provide training for state-funded initiatives. 6. Provide information on specimen submission to local health jurisdictions to assure that specimens are submitted to Agency laboratory, or nearest Regional laboratory as determined by the Department. 4. Department Requirements - Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health only A. Purchase and arrange for shipment of test kits and reagents from manufacturer. B. Purchase specimen collection kits. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. MDCH/P&GD FY 10/11 ATTACHMENT III Page 68 of 96 05/10 5. Department Requirements - Kent County Health Department only A. Purchase and arrange for shipment of test kits and reagents from manufacturer as outlined in item 1.E. B. Purchase specimen collection kits for diagnostic testing. Ship collection kits to designated agencies/physician submitters. Monitor specimen collection kit utilization. LABORATORY SERVICES SPECIAL REQUIREMENTS (OAKLAND COUNTY HEALTH DIVISION AND HEALTH DEPARTMENT OF NORTHWEST MICHIGAN) Contractor Specific Requirements — Oakland County Health Division and Health Department of Northwest Michigan Meet established standards of performance and objectives in the following areas: A. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT). B. Train additional staff to perform Laboratory Response Network (LRN) Sentinel and Reference level laboratory procedures. C. Secure and maintain Select Agent Registration. Maintain Clinical Laboratory Improvement Amendments of 1988 certification for high complexity testing. D. Maintain competency and proficiency for testing procedures described in the LRN protocols, E. Temporarily assign one FTE to MDCH or another LRN Reference level laboratory as surge capacity for emergency situations, if needed. F. Develop a plan to provide laboratory services 24 hours a day, 7 days a week for a BT event. G. Provide secure facilities to store reagents, quality control organisms and patient isolates. 2. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not specifically supplied by the Department in this agreement. 3. Provide the Bureau of Epidemiology and Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Contractor for MDCH (e.g. BT), all specimen submission data and reporting data will be entered and reported using LIMS software. The Contractor will designate one staff member as a liaison to the Bureau of Laboratories. Each Contractor must designate appropriate staff to take part in LIMS training activities. Training and purchase of module(s)/customization(s) for LIMS other than those modules provided by MDCH will be the responsibility of the Contractor. The Contractor is responsible for module(s)/customization(s) not directly related to testing performed under this agreement with the Bureau of Laboratories — - Initial Purchase Price (paid to MDCH) - Monthly maintenance fees (paid to MDCH) - Use of module(s)/customization(s) purchased by a Contractor can be negotiated (formulas for payment will be based upon the percentage of total specimens entered into the module(s)/customization(s)). Models purchased by any Contractor will become available to any participating Contractor at no cost after five years. However, each Contractor using the module(s)/customization(s) will share in the maintenance fees. MDCH/P&GD FY 10111 ATTACHMENT III Page 69 of 96 05/10 LABORATORY SERVICES — STARHS SPECIAL REQUIREMENTS DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION Contractor Requirements Provide specimen tracking, packaging and shipping of Serologic Testing Algorithm for Determining Recent HIV Seroconversion (STARHS) and Variant and Atypical Resistant HIV Surveillance (VARHS) specimens as indicated in the study design. Department Requirements Support specimen tracking, packaging and shipping of VARHS and STARHS through funds for personnel and supplies. Provide instructions, training and study design. Perform VARHS testing in the Department's Lansing Laboratory. LEAD SAFE HOME PROGRAM SPECIAL REQUIREMENTS (INGHAM COUNTY HEALTH DEPARTMENT) Contractor Requirements Provide lead-based paint hazard control activities for eligible families residing in high-risk homes containing lead-based paint. Healthy Homes Section (HHS), Lead Safe Home Program (LSHP) requirements are MDCH/P&GD FY 10/11 ATTACHMENT IN Page 70 of 96 05/10 divided into the following categories: 1) Education and Outreach; 2) Identification of Candidate Housing Units; 3) Lead Hazard Control Activities; 4) Follow-up Activities; and 5) Post Remediation Client Surveys and Data Collection. These procedures are to be adhered to and should not be interpreted to be inclusive of all present and future program requirements. County will herein be referred to as Regional Field Consultant (RFC). Education and Outreach It is expected that each RFC will provide a minimum of 16 local presentations on lead poisoning prevention issues per year in all RFC target areas.. A. Develop new partnerships with other affiliated housing and non-profit agencies in the jurisdiction and collaboration on housing projects. B. Assist LSHP in identifying and accessing private sector funding mechanisms for lead hazard control activities to include rental property owner contributions. C. Plan and implement local activities for Michigan's Lead Poisoning Prevention Week education campaign. D. Attend, be prompt and participate in all scheduled Regional Field Consultant (RFC) meetings and site visits. E. Each Regional Field Consultant is expected to promote and distribute the application for the Michigan State Housing Development Authority's (MSHDA) Property Improvement Loan Program (PIP) to homeowners and rental property owners. County should strive to submit between 5 and 10 applications to MSHDA Approved Lender. HHS staff can assist in this process, as needed. . F. RFC will be required to seek out and work with community-based organizations in their target areas in an effort to leverage or blend funds on projects. 2. Identification of Candidate Housing Units A. Per the Lead Abatement Act, perform combination Lead Inspection/Risk Assessment to identify all present and potential lead-based paint hazards and document accordingly. Use this information to develop abatement specifications. HHS model Lead Investigation Report should be consulted for format. A copy of each report must be provided to LSHP staff immediately upon completion. In cases of an EBL child over 2Oug/dL or two consecutive tests of 15-19ug/d1, RFC shall conduct EBL Environmental Investigation and attempt to enroll client into program. B. Follow Lead Safe Home Program, Regional Field Consultant Policy and Procedures Field Guide. C. Assist in lead hazard control activities. This includes field investigations, working with families (serve as household liaison for lead hazard control activities), and verifying program requirements. Submit to LSHP accurate and complete documentation on each unit. Field investigation reports must include digital photos of lead hazards found within the interior and exterior of the unit. D. Obtain and verify blood levels of children residing in units. Collaborate with local housing rehabilitation organizations and other community organizations. 4. Address historic preservation issues, if necessary. 5. All applicants will be required to come into HHS for prioritization and assignment to counties for lead hazard control activities. There will be no holding of applications by the Regional Field Consultant. H HS staff will determine and provide approval for which units will be addressed. 6. RFC will be required to actively search for and identify homes in their target communities through MDCH/P&GD FY 10/11 ATTACHMENT If Page 71 of 96 05/10 any means necessary (Le., agency presentations, events, etc). Failure to demonstrate a need in the designated community (ie, lack of applications) may be cause for dismissal from the LSHP. 7. RFC will be required to attempt to blend funds for every project. Leveraged funds may consist of MSHDA PIP loan dollars, CDBG dollars, homeowner/RPO private funds, etc. It will be mandatory that the Regional Field Consultant seek leveraged dollars on projects as part of the standardization process. 8. Conduct local activities targeting remodelers, renovators, rental property owners and agents and other segments of the population for the purpose of marketing the LS HP. 9. RFC will be responsible for referring and receiving referrals from the MDCH, Healthy Homes University Program. 10. Lead Hazard Control Activities B. Perform pre-bid walk-through on units. C. Process bid documents and addendums and provide to LSHP office D. Ensure home and families are prepared for lead-hazard control activities. E. If necessary, assist the residents of the home in arranging for temporary lodging while lead hazard control work is being completed. F. Perform project oversight. Spend a minimum of 50% of time for on-site supervision of lead abatement contractors that are new to the program in your county and 25% of time for on- site supervision of lead abatement contractors that are established within your county during lead hazard control work for each project to ensure that work is being done according to project specifications and in compliance with LSHP work standards. Documentation of oversight hours is required by LSHP. RFC is responsible for meeting the HUD Benchmark Standards each quarter. Failure to meet benchmarks may be cause for dismissal from the program. RFC is responsible for completing and clearing 24-31 units per year, as per HUD Benchmark Standards. RFC is responsible for performing Lead Inspection/Risk Assessment combination on approximately 35-39 units per year as per HUD Benchmark Standards. RFC should refer to HUD Benchmark Standards for exact unit goals to be acquired each quarter. 2. All processes involved in the Lead Safe Home Program have been standardized, including project specifications, forms processing/procedures and the method by which each RFC is dealing with the abatement contractors. RFC is subject to this standardization and any modifications. 3. Assist LSHP in monitoring the quality and cost effectiveness of lead hazard control projects. 4. Problems or concerns with projects, contractors or other issues should be addressed in writing via email to HHS staff. MDCH/P&GD FY 10/11 ATTACHMENT III Page 72 of 96 05/10 5. RFC will be responsible for addressing some healthy homes issues within LHC specifications as discussed in HUD grant application. 4. Follow-up Activities F. Conduct ongoing data collection and thorough and timely quarterly reporting to LSHP. Budget and Agreement Requirements As an established contractor (a contractor who has been awarded a Lead-Based Paint Hazard Control Grant before), agree to coordinate lead-based paint hazard control activities in approximately 79 homes for the period. Additionally, all contractors are required to appoint a full- time equivalent individual to provide all program requirements as stated in this contract. The contractor will provide thorough and accurate quarterly reports in accordance with format, instructions and data from HHS. The report must be submitted by the fifteenth of the month following the end of each quarter. In addition, monthly reports must be electronically submitted to LSHP prior to RFC meetings by the 10th of the following month. 2. The contractor will provide to LSHP during the periodic site visits a summary of all expenditures related to this agreement in excess of $500 in a format specified by the department, including contracted services. 3. HHS will pay for 1.0 FTE or the equivalent for HUD grant activities ONLY. 4. RFC (field staff) should work on HUD grant objectives ONLY, however may complete EBL Investigations as needed if family may qualify for LSHP services. 5. Each RFC will be evaluated on quarterly performance. RFCs will be evaluated on the number of inspections/risk assessments completed, number of units abated and amount of education/outreach performed at a minimum and may be dismissed from the LSHP if RFC fails to meet mandated benchmarks. 6. RFC site visits will be conducted by HHS staff, approximately every 4-5 months or at the discretion of HHS. Meeting attendance is mandatory by each RFC. 7, RFC (field staff) will be required to attend, be prompt and actively participate in RFC meetings as scheduled. 8. RFCs will be required to follow all lead regulations/laws. 9. For any subcontracts for field coordination activities (i.e., inspection/risk assessments, specification writing) used by the RFC, the RFC will be responsible for making sure the subcontractor follows the above procedures. Performance monitoring, evaluation and training of the field coordination MDCH/P&GD FY 10/11 ATTACHMENT III Page 73 of 96 05/10 For reporting period of: October 1-December 31 January 1-March 31 Due on: January 15 April 15 These target areas are subject to change pending issuance of grant award. Reference Documents The following reference documents are essential to performing the stated requirements in this contract: LSHP quarterly report guidance LSHP RFC Policy and Procedures Field Guide HUD 2009 Grant Proposal Lead Abatement Act and corresponding rules XRF Performance Characteristics Sheets Lead Safe Home Project Procession and accompanying MDCH form. PERFORMANCE/PROGRESS REPORT REQUIREMENTS A. The Contractor shall submit progress reports on the following dates: A quarterly progress report is due from the RFC to the HHS office 15 days after the end of each fiscal quarter. The agency must utilize the HHS Quarterly Reporting form, which will be provided to the agency at contract approval. Quarterly reports are due on the dates as follows: MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 74 of 96 April 1- June 30 July 15 July 1- September 30 October 15 2. A monthly progress report is due from the RFC to the NHS office 10 days after the end of each month. The agency must utilize the HHS Monthly Reporting form, which will be provided to the agency at contract approval. B. Reports and Information shall be submitted electronically to: Carin Speidel Speidelc(Wichigan.gov (517) 335-9833 C. The Contract Manager shall evaluate the reports submitted as described in A and B above, for their completeness and adequacy. D. The Contract Manager shall permit the Department or its designee to visit and to make an evaluation of the project as determined by Contract Manager. LOCAL MATERNAL AND CHILD HEALTH (MCH) PROGRAM SPECIAL REQUIREMENTS General Performance Requirements LOCAL MATERNAL AND CHILD HEALTH Local MCH funds are intended to be flexible and available to local health departments to address locally identified needs related to the health of women and children in their jurisdictions. It is expected that each local health department will use a defined needs assessment process to determine and identify its MCH needs. In addition, local health departments are asked to examine, (to the extent data is available) their status on each of 26 MCH National and State Performance Measures. Eighteen of these indicators have been established by the MCH Bureau (MCHB) of the federal Department of Health and Human Services (DHHS) as mandated reporting requirements for all states. An additional 8 measures have been selected as State measures by MDCH for annual monitoring and reporting to DHHS in accordance with Title V MCH Block Grant requirements. It is important that local jurisdictions review these performance measures and identify any efforts to address these measures using their Local MCH allocation. It is left to local health departments to determine how Local MCH funds are to be used to address MCH needs. Contractor Requirements Submit a Local Maternal and Child Health Community Plan for use of the funds allocated for Local MCH Programs and report on the previous year's activity. The department will develop the format for the plan and the previous year's report. Local MOH funds are to be budgeted as a funding source under any appropriate program element(s) (i.e., CSHCS, Child Health, Family Planning, Immunization, Maternal Infant Health Program, or Other Local MCH (locally defined program as described in the Local MCH Community Plan). This funding source cannot be used under the WIC element except in extreme circumstances where a waiver is requested in advance of the expenditures and evidence is provided that the expenditures satisfy all funding requirements. Local MCH funds may not be used to supplant available/billable program income such as Medicaid or Plan Firstl fees or additional funding under the Medicaid Cost-Based Reimbursement process. MDCH/P&GD FY 10/11 ATTACHMENT III Page 75 of 95 05/10 Local effort for program elements supported by Local MCH funds must not be reduced in instances in which added Medicaid has been generated through enhanced collection of Medicaid fees and/or funding under the Medicaid Cost-Based Reimbursement process. LOCAL PUBLIC HEALTH OPERATIONS (LPHO) SPECIAL REQUIREMENTS Budget and Agreement Requirements State funding for LPHO shall support and the agency shall provide for all of the following required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended, Part 24 and Act No. 336, of 1998 Section 909. Drinking Water Supply Immunization Food Service Sanitation On-Site Sewage Treatment Management Infectious/Communicable Disease Control Sexually Transmitted Disease Hearing Vision State funding for LPHO can support administrative cost for the eight required services including allowable indirect cost, or an agency's cost allocation plan. 2. LPHO funding can also be used to fund other core health functions including: Community Health Assessment & Improvement, Public Policy Development, Health Services Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and Local Public Health Accreditation. These services may be budgeted separately as part of the Administrative Budget element. 6. A final statewide cost settlement will be performed to assure that all available LPHO funds are fully distributed and applied for required services. Contractor Requirements Assure the availability and accessibility of services for the following basic health services: Prenatal Care; Immunizations; Communicable Disease Control; STD Disease Control; Tuberculosis Control; Health/Medical Annex of Emergency Preparedness Plan. 2. Fully comply with the Minimum Program Requirements for each of the required services. Department Reguirements MDCH/P&GD FY 10111 ATTACHMENT III Page 76 of 96 05/10 3. Reprint any licenses requiring correction and send corrected copies to the local health department. 4. Bill the local health department for state fees upon notification by the local health department that the license has been approved and issued. Temporary Food Service Establishment Licensing 1. Furnish blank temporary food service license application forms (forms Fl-231, Fl-231A) and blank Combined License/Inspection forms (Fl-229) upon request from the local health department. a. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. b. Periodically reconcile temporary food service establishment licenses sent to the local health department with the licenses that have been issued (copy returned to MDA). c. Bill the local health department for state fees upon notification by the local health department that the license has been approved and issued. Contractor Requirements The local health department agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of Licenses Received." 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Provide updates to MDA on the 1 st and 151h of each month, as necessary to: A. Provide a list of food service establishments approved for licensure/license issued. B. Provide a list of food service establishment licenses that have not been approved for licensure and are considered voided or deleted, C. Return the actual licenses to MDA that are to be voided or deleted. D. Return renewal license applications and licenses that require correction. Mark the corrections on the renewal application. Temporary Food Establishment Licensing 1, Upon receipt, sign and return the "Record of Licenses Received" to MDA. 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Make every effort to issue temporary food establishment licenses in numerical order. MDCH/P&GD FY 10/11 ATTACHMENT III Page 77 of 96 05/10 4. Provide updates to MDA on the 1 st and 15th of each month, as necessary, to provide: A. A copy of each temporary food establishment license B. A list of lost or voided licenses by license number. Contractor Specific Requirements — Private and Type III Drinking Water Supply Requirements The local health department shall perform the following services including but not limited to: Perform the activities described in items 5 through 8 of the attached Minimum Program Requirements (MPRs), Drinking Water Supply, dated October 1, 1996, the associated performance indicators, and use the "Guidance Manual for the Private and Type Ill Drinking Water Supply Program," October 2002, 7/2002, as furnished by the State to implement the MPR provisions. The guidance manual is available online at www.michidan.qovidocuments/ded/decHwb-dwehs-wcu- guidancemanual 221342 Tpdf 3. Accurately record on the permit to install the initial or replacement System or on an attachment to the permit the site conditions for each parcel evaluated including soil profile data, seasonal high water table, topography, isolation distances, and the available area and location for initial and replacement Systems. 4. Issue a permit, prior to construction, in accord with applicable regulation(s) for those sites that meet the criteria for the installation of a System. The permit shall include a detailed plan and/or specifications that accurately define the location of the initial or replacement System, System size, other pertinent construction details, and any documented variances. Detailed plans and/or specifications of the initial System shall also define the available area and location for a future replacement System. 5. Provide and keep on file formal written denials, stating the reason for denial, for those applications where site conditions are found to be unsuitable. 6. Conduct a construction inspection prior to covering each System to confirm that the completed System complies with the requirements of the permit that has been issued. In limited MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 78 of 96 circumstances where constraints prohibit staff from completing the required construction inspection in a timely manner, an effective alternate method to confirm the adequacy of the completed System shall be established. The effective alternative method shall be utilized for no more than 10 percent of the total number of final inspections unless specific authorization has been granted by the State for other percentage. The results of all such inspections or an alternate method shall be clearly documented. 7. Maintain an up-to-date functional filing system that includes easily retrievable information regarding 10. Maintain quarterly reports that summarize the total number of parcels evaluated, permits issued, alternative or engineered plans reviewed, number of appeals, number of inspections during construction, number of failed systems evaluated, and number of sewage complaints received and investigated. The report form EQP 2057a is available on the MDEQ website. All quarterly reports are to be submitted directly to MDEQ address noted on the form. 11. Review all engineered or alternative System plans. Conduct adequate inspections during the various phases of construction to ensure proper installation. 12. Collect data at the time of permit issuance when a System has failed to document the System age, design, site conditions, and other pertinent factors that may have contributed to the failure of the original System. The results for all failed Systems evaluated shall be maintained in a retrievable file and assembled in an annual calendar year report summarizing the overall results. This report shall be provided on an annual basis to the State no later than February 1st of the year following the calendar year for which the data has been collected. 13. Provide training for staff involved in the Program as necessary to maintain knowledge of current regulations and internal policies and procedures and to keep staff informed of technological improvements and advancements in Systems. 14. Establish and maintain an enforcement process that is utilized to resolve violations of the Local Entity and/or State's rules and regulations. 15. Investigate and respond to all complaints related to Systems in a timely manner. Documentation confirming the nature of the complaint and resolution shall be maintained in a retrievable file. LOCAL TOBACCO REDUCTION SPECIAL REQUIREMENTS Budget and Agreement Requirements No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. MDCH/P&GD FY 10/11 ATTACHMENT Page 79 of 96 05/10 Agency Requirements Develop and maintain a network of tobacco control supporters in the community. This can be a network, subcommittee of another body, or a specific tobacco-free coalition. Purpose The American Recovery and Reinvestment Act of 2009 (ARRA) is designed to stimulate economic recovery by preserving and creating jobs, strengthening the Nation's healthcare infrastructure, and reducing health care costs through prevention activities. The ARRA also provides an opportunity for communities, states, cities, rural areas and tribes to advance public health across the lifespan, eliminate health disparities and promote wellness and prevention of chronic disease through statewide and local policy. Agency Requirements Ensure compliance and enforcement of the Dr. Ron Davis Law. Monitor and evaluate activities six months to one year and ongoing from effective date of the law. MDCH/P&GD FY 10/11 ATTACHMENT III Page 80 of 96 05/10 Purpose The American Recovery and Reinvestment Act of 2009 (ARRA) is designed to stimulate economic recovery by preserving and creating jobs, strengthening the Nation's healthcare infrastructure, and reducing health care costs through prevention activities. The ARRA also provides an opportunity for communities, states, cities, rural areas and tribes to advance public health across the lifespan, eliminate health disparities and promote wellness and prevention of chronic disease through statewide and local policy. Agency Requirements Increase the percentage of smoke-free public and affordable housing properties. Track and report to MDCH Tobacco Section the number of public and affordable housing properties that go smoke free as a result of the smoke-free housing initiative. 2. Prepare and implement an annual agency Tobacco ARRA-2 work plan. 3. Submit reports and other required program documentation to Tobacco Program Consultant on a timely basis as described in the agency's approved Tobacco ARRA-2 work plan. 4. Attend Department regional and statewide ARRA Contractor training/meetings. MICHIGAN CARE IMPROVEMENT REGISTRY SPECIAL REQUIREMENTS Contractor Requirements Michigan Care Improvement Registry (MCIR) responsibilities: A. Ensure that all immunizations administered to persons born after December 31, 1993 by the contractor, or by any agency or provider participating in any of the vaccine distribution programs on behalf of the Contractor, are reported to the MCIR. B. Ensure that all immunization providers within the Contractor's jurisdiction are registered through the MCIR and that all of their activities are coordinated with the regional contractor of the Department and operated within their guidelines. 3. Provide monthly reports to regions and the Department on doses entered per user. Contractor Requirements - All Other Departments The Contractor shall ensure the performance of the following activities on behalf of the Department to support the MCIR 1. Promote and train providers and Health Care Organizations (HC0s) on all features of the MCIR Web application. 2. Support regional MCIR users by operating the regional help desk in accordance with Department approved procedures. Monitor and develop strategies to increase private provider and HCO enrollment and participation in the MCIR which includes development of strategies to encourage all providers to fully participate with the MCIR, (such as sites of excellence awards). 4. Process all user/usage agreements, according to the Department's approved procedures, to create user accounts. 5. Implement and update marketing plans in support of increased provider and parent acceptance and use of the MCIR. 6. Keep regional users updated on MCIR status and system changes. 7. Conduct ad hoc reporting and querying on behalf of MCIR users. 8. Work with local health departments to establish a mechanism to assure persons who have died within their county are appropriately flagged in the MCIR. 9. Maintain a listing of HCO private and public immunization providers. This listing should be as comprehensive as possible and should include all providers in the region. 10. Conduct regular de-duplication activities to assure that duplicate records are removed from the MCIR as quickly as possible. 11. Process user petitions to change MCIR data according to Department approved procedures. 12. Monitor ongoing immunization data submission for all local health departments and private providers. 13. Conduct training functions as needed to assure that local health department staff can train and educate providers on how to access and submit data into MCIR. 14. Maintain a policy/procedure manual, approved by the Department. 15. Process and file all "opt out" forms according to the Department approved procedures. 16. Attend regular MCIR regional contractor/coordinator meetings. 17. Perform quality assurance checks on the MCIR data for the region as prescribed by the Department. A. Assist local health departments and private providers with methodologies to "clean up" their data. B. Provide assistance to the Department on User Acceptance Testing (UAT) enhancements. C. Attend all UAT training sessions as required by the Department. 18. The Contractor shall provide to the MCIR Regional Coordinator: a) permanent office space; b) MDCH/P&GD FY 10111 ATTACHMENT III Page 82 of 96 05/10 21. Facilitate the Department's attendance in the interview process for hiring of a MCIR Regional Coordinator / MCIR staff. This process includes consultation with the Department regarding selection of interview candidates as well as participation in the and hiring determination. Contractor Performance/Progress Report Requirements Ensure the quarterly submission of status reports on work plan progress. Reports are due within 30 days of the end of each quarter. (January 31, April 30, July 31, October 31). 2. Final quarterly report shall be an annual report. The annual report will be distributed to the Department and shall include: A. Summary of provider enrollment (breakdown by role); B. The amount of data submitted to the region during the fiscal year; C. Summary of staff resources; D. Sites of excellence award recipients. 3. Any other information as specified in the special requirements shall be developed and submitted by the Contractor as required by the Department. Reports and information should be submitted to: Robert C. Miller, JD, MSA Michigan Department of Community Health Immunization Division P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-8159 The Contractor shall permit the Department or its designee to visit and to evaluate on an as- needed basis.. Department Requirements 1. Provide support and technical assistance to Regional staff. 2. Provide initial training and support to a MCIR Regional Coordinator 3. The Department shall evaluate submitted reports as described above for their completeness and adequacy, NURSE FAMILY PARTNERSHIP NFP PROJECT SPECIAL REQUIREMENTS MDCH/P&GD FY 10/11 ATTACHMENT III Page 83 of 96 05/10 A. Benton Harbor and Benton Township, Michigan for Berrien County Health Department. B. Grand Rapids and CENSUS TRACTS 126, 127, and 128 of the Community of Kentwood, Michigan for Kent County Health Department. C. Pontiac, Michigan for Oakland County Health Division. D. Kalamazoo for Kalamazoo County Health Department. 4. NFP home visiting nursing staff will reflect the community served. Submit a staff roster for the fiscal year and within 30 days of a change. 5. Authorize the Michigan Department of Community Health (MDCH) access to the community's NFP Clinical Information System (CIS) and provide all necessary information for client identification, such as clients' demographic information and NFP or local identification numbers used in the CIS database. 6. Subject to a 25% match requirement (hard or in-kind) of two dollars and fifty cents ($2.50)for each ten dollars ($10.00)for MDCH agreement funding. 7. Provide MDCH consultant or authorized contractor program access. 8. Build upon and maintain diverse community and target population collaboration and support. 9. Develop and maintain a broad-based NFP community advisory committee. The committee shall consist of at least 50% consumers/community leaders from the target population and the remainder from referring/partnering/supporting agencies. Additional members would include appropriate health department staff. Meetings will be held once per quarter in coordination with the Michigan N FP Consultant or an MDCH designee, who will serve as an ad hoc member. 10. Submit all required reports in accordance with the MDCH reporting requirements. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 84 of 96 Reporting Period Report Due Dates October 1 — December 31, 2010 January 1 - March 31, 2011 April 1 — June 30, 2011 July 1 — September 30, 2011 January 15, 2011 April 15, 2011 July 15, 2011 October 15, 2011 Reporting Requirements 1. The contractor shall adhere to the NFP, Inc., National Office program reporting requirements. 2. Submit to MDCH the broad-based community advisory committee minutes and attendance records 45 days after the end of the quarter. Attendance records should include attendees names and reflect their advisory committee representation as a consumer/community leader, referring/partnering/supporting agency staff or implementing agency staff. 3. Reports and information shall be submitted to: Nurse Family Partnership Division of Family and Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, Michigan 48909 Or Rosemary Asman at asmanr©michigan.gov . (Please put "Nurse Family Partnership Reports FY 11" in the subject line.) SAFE ROUTES TO SCHOOLS SPECIAL REQUIREMENTS PUBLIC HEALTH, DELTA & MENOMINEE COUNTIES, MID MICHIGAN DISTRICT HEALTH DEPARTMENT, SA,GINA,W COUNTY DEPARTMENT OF PUBLIC HEALTH, WAS HTENAW COUNTY HEALTH DEPARTMENT Contractor Requirements 1. The contractor's program plan will be on file with the department. 2. Develop an evaluation process for the project in collaboration with MDCH staff. 3. Assist MDCH staff and its partners with SRTS regional trainings for schools and community leaders. 4. Attend required meetings and trainings as identified by MDCH. 5. The contractor shall collaborate with their program consultant to schedule site visits. 6. Implement the Safe Routes to School Handbook process completing surveys, audits, Walk to School Day, action plans, and EGRAMS pre-applications. 7. Submit quarterly progress reports, using the reporting format as required and made available by the section. The quarterly progress reports, federal expense reports and receipt copies for all expenses shall be sent electronically to Holly Nickel at NickleHmichigan.ciov on the dates below. All receipts must be itemized and must identify the store name, date of purchase, items purchased and purchase total. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 85 of 96 9. Submit quarterly required federal expense reports (personnel and non-personnel) with copies of all itemized receipts, using the reporting format as required and made available to MDCH by the MDOT/Michigan Fitness Foundation. Total amounts on the expense reports and Financial Status Report (FSR) for the program should match. 10. All itemized receipts for non-personnel expenses and original timesheets for billed hours must be retained through 2013 or until the final MDOT audit — whichever is later. Holly Nickel MDCH Cardiovascular Health, Nutrition and Physical Activity Section PO Box 30195 Lansing, MI 48909 Fax: 517-335-9056 11. Submit quarterly Financial Status Reports (FSR) electronically to PublichealthFSR(5),michican gov and cc: Holly Nickel at Nickell-I • michigan.qov along with mailing the signed original to Accounting. SEXUAL VIOLENCE PREVENTION SPECIAL REQUIREMENTS (KENT COUNTY HEALTH DEPARTMENT) Contractor Requirements Forward subcontracts, as applicable by January 2011. 2. Conduct educational sessions with at least 1 priority population (Ongoing). 3. Provide primary prevention resources to at least 2 key community groups (Ongoing). 4. Increase capacity of at least 2 priority professional groups (Ongoing). 5. Foster SVP Coalitions (Ongoing). 6. Assist at least 1 local entity to review and revise policies (Ongoing). Provide technical assistance to at least 2 key community leaders and/or policy makers to increase their ability to make informed decisions. Reporting Requirements The Contractor shall submit the following reports on the following dates: Deliverable Period Covered Due Date Project Report 1 11/01/10 — 02/29/11 03/15/11 Project Report 2 03/01/11 —06/30/11 07/15/11 Final Project Report 11/01/10 — 09/30/11 10/15/11 Evaluation Report 11/01/10 — 09/30/11 10/15/11 2. Any such other information as specified in the Contractor Requirements section shall be developed and submitted by the Contractor as required by the Contract Manager. 3. Reports and information shall be submitted to the Contract Manager at: qrzwaczirmichigan.gov . MDCH/P&CD FY 10/11 ATTACHMENT III Page 86 of 96 05/10 SEXUALLY TRANSMITTED DISEASE (STD) CONTROL SPECIAL REQUIREMENTS For medical providers that identify 5% or more of the County's gonorrhea, chlamydia, and/or syphilis morbidity, the local STD program will visit them at least annually to review provider screening, reporting, treatment, and partner management methods, Submit all Quarterly Clinic Activity Reports and Medication Inventory Reports within 10 calendar days after the end of each quarter. SEAL! MICHIGAN DENTAL SEALANT PROGRAM SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, OTTAWA COUNTY HEALTH DEPARTMENT) Contractor Requirements MDCH/P&GD FY 10/11 ATTACHMENT III Page 87 of 96 05/10 1. Administer screening, fluoride and dental sealant applications to all eligible children with a signed MDCH/P&GD FY 10/11 ATTACHMENT III Page 88 of 96 05/10 1 st Qtr (12/31/10) 01/15/11 2'd Qtr (03/31/11) 04/15/11 3rd Qtr (06/30/11) 07/15/11 4th Qtr (09/30/11) 10/15/11 1. Collect data through SEALS software so as to monitor the program effectiveness, final reporting due within two (2) weeks of the end of the year fourth quarter grant period. 2. The Contractor shall submit the following information electronically in an encrypted manner to MDCH Oral Health Program or through the State of Michigan File Transfer system. 1. A sampling of 20% of the teeth sealed by new employees must be checked for retention within 3-6 weeks following sealant placement. All retention checks shall be entered into SEALS within each grant year. 3. A work plan should be submitted at the end of every quarter. The work plan should include an update on all of the contractor requirements. 4. Provide documentation that emergency dental restorative services are tracked for children referred through the SEAL! Michigan dental sealant program within a 20 mile radius of the sealant program. 5. The Contractor shall submit an Evaluation Form to be sent at the end 4th quarter. This will be provided to grantees by September 1, 2011, by Oral Health Coordinator. Send reports to: Jill Moore, Dental Sealant Coordinator Oral Health Program - SEAL! Michigan Division of Family and Community Health Michigan Department of Community Health MooreJ14@michigan.qov Contact Information: P.O. Box 30195 Lansing, MI 48909 Phone (517)373-4943 Fax (517)335-8697 TB CONTROL (DOT) SPECIAL REQUIREMENTS General Requirements Directly Observed Therapy (DOT) is defined by the CDC Core Curriculum on Tuberculosis 2004 as: "a health care worker or another designated person watches the TB patient swallow each dose of the prescribed drugs." The most current American Thoracic Society (ATS) document Treatment of Tuberculosis regards DOT as "the preferred core management strategy for all patients with tuberculosis". Multi-drug resistant TB (MDR TB) should always be treated with a daily regimen and under direct observation. MDCH/P&GD FY 10/11 ATTACHMENT III 05/10 Page 89 of 96 Requirements for eligibility in this program include providing DOT at least 5 days/week (excluding holidays) for daily regimens, and 2 or 3 days/week for intermittent regimens. Contract Specific Requirements 3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 35 percent or more of the amount requested. 5. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. Department Requirements 1. Provide administrative professional and technical consultation to the program. 2. Provide one TPPI-sponsored Coordinators meeting/training per year. Reporting Requirements The contractor shall submit progress reports on the following dates: Type of Report and Timeframe Due Date Quarterly Report (Oct 1,2010 — Dec 31, 2010) Jan 30, 2011 Quarterly Report (Jan 1, 2011 - March 31, 2011) Apr 30, 20011 Quarterly Report (Apr 1, 2011 — June 30, 2011) July 30, 2011 Year-End Report (October 1, 2010 - September 30, 2011) November 30, 2011 MDCH/P&GD FY 10/11 ATTACHMENT HI 05/10 Page 90 of 96 2. Any such information as specified in the contract requirements shall be developed and submitted by the Contractor as required by the Contract Manager. 3. Reports and information shall be submitted to the Contract Manager at: Kara Anderson Teen Pregnancy Prevention Consultant Michigan Department of Community Health Washington Square Building 109 W. Michigan Ave., 4 th Floor Lansing, MI 48913 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Contractor shall permit the Department or its designee to visit and to make and evaluation of the projects as determined by the Contract Manager. WIC SPECIAL REQUIREMENTS Contractor Requirements 1. Provide for security of Project FRESH coupons and WIC EBT cards stored in the local contractor prior to issuance. The Contractor must notify the WIC Division in writing of any lost, stolen, inappropriately issued or otherwise unaccounted for Project FRESH coupons or EBT cards, immediately upon recognition of such condition. 2. Comply with the requirements of the WIC program as prescribed in the Code of Federal Regulations (7 CFR, Part 246) including the following special provisions: If a local Contractor operates a WIC Program within a hospital or has a cooperative agreement with one or more hospitals, the hospital is required to advise the potentially eligible individuals that receive inpatient or outpatient prenatal, maternity, or postpartum services or accompany a child under age 5 years who receives well-child services, of the availability of WIC benefits [246.6(F)(1)]. 3. Maintain an inventory of all equipment purchased with WIC program funds and maintain such inventory at each WIC clinic location. 4. Assure each Contractor employee authorized for or requesting access to the automated WIC system complete and sign a security agreement. 5. The Agency in accordance with the general purposes and objectives of this agreement, will comply with the federal regulations requiring that any individual that embezzles, willfully misapplies, steals or obtains by fraud, any funds, assets or property provided, whether received directly or indirectly from the USDA, that are of a value of $100 or more, shall be subject to a fine of not more than $25,000. 6. The Agency is responsible for installation and maintenance of WIC hardware according to guidance provided by the MDCH WIC Program. Special Reporting Requirements to Travel, Equipment, Subcontract and Other Expense categories and will not include expenditures related to salaries, wages and fringe benefits. Additionally, only expenditures supported by regular WIC funds should be reflected on this supplemental form. Expenditures incurred that are related to general nutrition education and for the promotion and support of breastfeeding are to be summarized as: Nutrition Education 2. Breastfeeding Allowable Nutrition Education (NE) Expenses are: 1. Costs for procuring equipment for NE (as approved by the State WIC Program). 2. Interpreter or translator services to facilitate NE. 3. Evaluation or monitoring of NE. 4. NE material costs. 5. Costs of training nutrition educators, including costs related conducting training sessions and purchasing & producing training materials. 6. Costs for clinic space devoted to NE activities. 7. Travel and related expenses incurred by WIC staff to conduct any NE activity. 8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to WIC participants. Allowable Breastfeedinq (BF) Promotion & Support Expenses are: 1. Peer counseling if supported with funds allocated through the WIC funding formula. (Report as time study data.) 2. Cost of procuring BF educational materials. 3. Interpreter or translator services to facilitate BF promotion and support. 4. Costs of training BF promotion & support educators, including costs related to conducting training sessions and purchasing and producing training materials. 5. Costs of clinic space devoted to BF promotion & support educational and training activities, including space set aside for BF WIC infants. 6. BF aids which directly support the initiation and continuation of BF, as purchased with WIC funds allocated through the funding formula. 7. Costs of documenting, monitoring and/or evaluating BF promotion and support staff, activities, methods and materials. This includes the cost of collecting, analyzing and evaluating data concerning WIC participants opinions on the effectiveness of the BF promotion and support they received. (Report as time study data.) 8. Travel and related expenses incurred by WIC staff to conduct any BF promotion and support activity. 9. Costs of reimbursable agreements with other organizations, public or private, to undertake training and direct service delivery to WIC participants concerning BF promotion and support. The examples above are not all inclusive. In-kind support can also be included, if other non-WIC resources are used for those costs. Please note that costs for data processing, communications, postage, freight, rent and utilities necessary to conduct NE and BF activities must be prorated to the applicable functional category (NE/ BE promotion and support). MDCH/P&GD FY 10/11 ATTACHMENT III Page 92 of 96 05/10 Staff Training and Education Designated local agency staff are required: • To attend Supervisory training. • To include designated State Lactation Consultants (LC) as part of the peer counselor recruitment and applicant interview team. • To attend a minimum of two program updates. • To train the peer counselors per standards set forth by USDA and the State WIC Division. Peer Counselors are required to attend specific training that includes, but is not limited to Breastfeeding Basics Training, State WIC Peer Counselor meetings and Annual WIC Conference. MDCH/P&GD FY 10/11 ATTACHMENT III Page 93 of 96 05/10 Other Local Agency Obligations The following requirements apply to the local agency receiving a special allocation for the Breastfeeding Peer Counseling Program. USDA and MDCH/WIC require the local agency to comply with the following 10 components: Hire staff that meet the definition of Peer Counselor. 2. Designate a Breastfeeding Peer Counselor Manager at the local level. 3. Establish job parameters and a description for the peer counselor that is consistent with State WIC policy. 4. Establish compensation and reimbursement rates for peer counselors. 5. Train appropriate WIC local peer counseling management and clinic staff. 6. Establish standardized breastfeeding peer counseling program procedures at the local level as part of the Agency's WIC Nutrition Services Plan. 7. Supervise and monitor the peer counselor(s)Establish community partnerships to enhance the effectiveness of the WIC peer counseling program. WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION (WISEWOR Contractor Requirements WISEVVOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is a program designed to screen women for chronic disease risk factors, counsel them about lifestyle changes to reduce risk factors, and refer them for medical treatment of hypertension, hyperlipidemia, and/or diabetes mellitus. This program will be based within Michigan's Breast and Cervical Cancer Control Program. For specific VVISEWOMAN Program requirements, refer to the most current WISEWOMAN Program Policies and Procedures Manual. YOUTH SUICIDE PREVENTION PROJECT SPECIAL REQUIRMENTS (CHIPPEWA COUNTY HEALTH DEPARTMENT AND WASHTENAW COUNTY HEALTH DEPARTMENT) Chippewa County Health Department Only: Budget and Agreement Requirements: 1. Prior written, informed voluntary consent from the child's parent or legal guardian must be suicide, 2. At least one person involved with the project must attend the annual Community Technical Assistance and Grantee Meeting to be held in April or May, 2011, 3. Project staff must participate in a multi-level evaluation process in conjunction with the MDCH Project Officer and the state evaluation consultant. 4. The project must maintain a public/private partnership to oversee implementation, performance, and evaluation of activities supported by this grant. This role can be fulfilled by a workgroup/subcommittee of the Community Collaborative or the local suicide prevention coalition, if appropriate. Contractor Requirements: Additional detail on activities, as set forth in the Contractor's proposal, is made part of this work plan by reference. By September 30, 2011, the Contractor will: Continue to educate community members and key stakeholders on the risk factors for suicide. 4. Continue development and support of post-prevention services. 5. Continue collaboration with other suicide prevention efforts underway in the county. Washtenaw County Health Department Only - Foster Hope Project only: Budget and Agreement Requirements: Prior written, informed voluntary consent from the child's parent or legal guardian must be obtained for any youth under the age of 18 years who will be participating in assessment services, school sponsored programs, or treatment involving medication related to youth suicide. A. At least one person involved with the project must attend the annual Community Technical Assistance and Grantee Meeting to be held in April or May, 2011 3. Project staff must participate in a multi-level evaluation process in conjunction with the MDCH Project Officer and the state evaluation consultant. 4. The project must maintain a public/private partnership to oversee implementation, performance, and evaluation of activities supported by this grant. This role can be fulfilled by a workgroup/subcommittee of the Community Collaborative or the local suicide prevention coalition, if appropriate. Contractor Requirements: Additional detail on activities, as set forth in the Contractor's proposal, is made part of this work plan by reference. By September 30, 2011, the Contractor will: MDCH/P&GD FY 10/11 ATTACHMENT HI 05/10 Page 95 of 95 Conduct a safeTALK T4T for 10 individuals in youth serving organizations. Train a minimum of 60 mental and non-mental health professionals in the Columbia Suicide Severity Rating Scale. MDCH/P&GD FY 10/11 ATTACHMENT III Page 96 of 96 05/10 7. Detail of the Total Grant Fund Revenue is as follows: Aids Prevention $ 497,900 Bioterrorism Coordinator 380,010 Cities Readiness Initiative 273,855 Childhood Lead 44,518 EPI Planner Workplace 10,000 Fetal Infant Mortality 5,400 Tobacco Reduction 30,000 CSHCS Outreach and Advocacy 285,000 Early Warning infectious Dis. Surv 1,839 Immunization Action Plan 462,950 Adolescent Screening 73,000 Maternal and Infant Support 321,457 TB Control 62,003 BT Lab Program 113,169 Lab — ELC 15,000 Reaching More Child and Adults 116,520 Vaccine Replacement/Handling 107,255 WIC Breastfeeding Peer Council 73,603 WIC 2,307,898 Total Grants $5,181,377 Total Program $9,339,870 FINANCE COMMITTEE Resolution #11018 January 20, 2011 Moved by Long supported by Potts to suspend the rules and vote on Miscellaneous Resolution #11018 — Department of Health and Human Services/Health Division — 2010/2011 Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement Acceptance. Vote on motion to suspend the rules: AYES: Gingell, Gosselin, Greimel, Hatchett, Hoffman, Long, Matis, McGillivray, Middleton, Nash, Nuccio, Potts, Quarles, Runestad, Scott, Taub, Weipert, Woodward, Zack, Bosnic, Covey, Crawford, Dwyer, Gershenson. (24) NAYS: None. (0) A sufficient majority having voted in favor, the motion to suspend the rules and vote on Miscellaneous Resolution #11018 — Department of Health and Human Services/Health Division — 2010/2011 Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement Acceptance carried. Moved by Long supported by Potts the resolution be adopted. AYES: Gosselin, Greimel, Hatchett, Hoffman, Long, Matis, McGillivray, Middleton, Nash, Nuccio, Potts, Quarles, Runestad, Scott, Taub, Weipert, Woodward, Zack, Bosnic, Covey, Crawford, Dwyer, Gershenson, Gingell. (24) NAYS: None. (0) A sufficient majority having voted in favor, the resolution was adopted. in , ,,-/--‘,, / ....) -_- I HEREL A '','Ir: TriE-FGREgOING RESOLUTION ,c1SIJA.fa TO 1973 PA STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Bill Bullard Jr., Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on January 20, 2011, with the original record thereof now remaining in my office. In Testimony Whereof, 1 have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac, Michigan this 20th day of January, 2011. Bill Bullard Jr., Oakland County