HomeMy WebLinkAboutResolutions - 2011.12.15 - 18823MISCELLANEOUS RESOLUTION #11.309 December 15, 2011
BY: General Government Committee, Christine Long, Chairperson
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION — 2011/2012
SUBSTANCE USE DISORDER GRANT ACCEPTANCE
To the Oakland County Board of Commissioners
Chairperson, Ladies and Gentlemen:
WHEREAS the Michigan Department of Community Health (MDCH) has awarded the Health Division
Substance Use Disorder Grant Funds for the period of October 1, 2011 through September 30, 2012; and
WHEREAS the 2010/2011 Substance Use Disorder Grant award included a total funding amount of
$4,293,323 in grant revenue and expenditures for this program; and
WHEREAS the 2011/2012 Substance Use Disorder Grant award reflects grant funding in the amount
of $4,403,645, an increase of $110,322 from the previous year; and
WHEREAS a 10% cash match is required, based on the total program budget for Substance Abuse
Services, and is estimated to be $656,060 for FY 2012; and
WHEREAS these funds are used to support subcontracting with agencies to prevent, treat and reduce
the incidence of drug and alcohol abuse and dependency; and
WHEREAS these funds also support staffing which includes screening and coordinating treatment
services for residents of Oakland County as well as monitoring subcontracts; and
WHEREAS these contracts were awarded through the County's competitive bidding process; and
WHEREAS acceptance of this grant does not obligate the County to any future commitment; and
WHEREAS the grant agreement has been submitted through the County Executive's Contract Review
Process and is recommended for approval.
NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners accepts the
2011/2012 Substance Use Disorder Grant from the Michigan Department of Community Health in the amount
of $4,403,645 with a required 10% cash match of $656,060 for a total of $5,059,705.
BE IT FURTHER RESOLVED that the Chairperson of the Board of Commissioners is authorized to
execute the grant agreement and to approve minor changes and grant extensions, not to exceed fifteen (15)
percent variance from the original award.
BE IT FURTHER RESOLVED that the future level of service, including personnel, be contingent upon
the level of funding for this program.
Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing
resolution.
GENERAL GOVERNMENT COMMITTEE
Ai.
GENERAL GOVERNMENT COMMITTEE'
Motion carried unanimously on a roll call vote.
GRANT REVIEW SIGN OFF — Health Division
GRANT NAME: FY 2012 MDCH - Substance Use Disorder Grant Agreement
FUNDING AGENCY: Michigan Department of Community Health
DEPARTMENT CONTACT PERSON: Rachel Shymkiw / 2-2151
STATUS: Grant Acceptance
DATE: November 2, 2011
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 be
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 (10/25/2011)
Department of Human Resources:
Approved. - Karen Jones (10/25/2011)
Risk Management and Safety:
Approved by Risk Management. - Andrea Plotkowski (11/1/2011)
Corporation Counsel:
Approved. - Bradley G. Berm (11/1/2011)
COMPLIANCE
The grant agreement and attachments reference an extensive number of federal and state
regulations. Please refer to the agreement for specifically cited compliance requirements for this
grant.
FY 2011/2012 SUBSTANCE USE DISO ER GRANT ACCEPTANCE II I
DEPARTMENT OF HEALTH AND HUMAN SERVICES/
HEALTH DIVISION
The Substance Use Disorder Grant is funded by the Michigan Department of Community Health
(MDCH) to the Office of Substance Abuse in the Health Division. The purpose of the grant is to
reduce the incidence of drug and alcohol abuse and dependency, and/or to provide
comprehensive treatment services to the substance abusing population. The Office of Substance
Abuse is designated as the Coordinating Agency for Oakland County and also includes the
PACE Unit, which is an Access Assessment and Referral Service.
• This grant acceptance from MDCH provides for substance abuse treatment services for Oakland
County residents who are low income, uninsured, non-Medicaid recipients.
• PACE provides a central point of entry; determines financial eligibility; provides screenings,
referrals and care coordination services. The Coordinating Agency assures a continuum of
substance abuse prevention and treatment services, based on local needs, and federal and state
requirements. The continuum of treatment services made available to uninsured clients in
Oakland County include detoxification, short-term residential, long-term residential, intensive
outpatient and outpatient services.
• Prevention services are targeted to high-risk populations such as school dropouts, pregnant
women and teens, economically disadvantaged children of substance abusers, and community
coalitions. Other services include general prevention, regional HIV education, and HIV early
intervention.
• The Coordinating Agency subcontracts through a competitive bid process with substance abuse
prevention and treatment providers to provide the above services. They serve as expert resources
on substance abuse within the Health Division and in collaboration with other units of county
government.
• Required match fund sources are Convention Facility Tax, fees and collections from
subcontractors, and county general fund.
The grant acceptance is for S4,403,645 and covers the period of October 1,2011 through September
30, 2012.
ATTACHMENT A
STATEMENT OF WORK
Please note: Items in this Statement of Work have been placed into one of three
categories: General; Administrative and Financial; and Services. This categorization is
for convenience of reference only. It is not intended, and should not be interpreted, as
limiting the applicability or scope of any item or items.
General
General Statement of Work
The general responsibilities of the coordinating agency (CA) under this
Agreement, based on P.A. 368 of 1978, as amended, are to:
a. Develop comprehensive plans for substance abuse treatment and
rehabilitation services and prevention services consistent with guidelines
established by the Department.
b. Review and comment to the Department on applications for licenses
submitted by local treatment, rehabilitation, and prevention organizations.
c. Provide technical assistance for local substance abuse service
organizations.
d. Collect and transfer data and financial information from local organizations
to the Department.
e. Submit an annual budget request to the Department for use of state
administered funds for its city, county, or region for substance abuse
treatments and rehabilitation services and prevention services in
accordance with guidelines established by the Department.
f. Make contracts necessary and incidental to the performance of the
Agency functions. The contracts may be made with public or private
agencies, organizations, associations, and individuals to provide for
substance abuse treatment and rehabilitation services and prevention
services.
g. Annually evaluate and assess substance abuse services in the city,
county, or region in accordance with guidelines established by the
Department and federal goals.
2. Action Plan
The CA will carry out its responsibilities under this Agreement consistent with the
CA's most recent Action Plan as approved by the Department.
3. Substance Abuse Prevention and Treatment (SAPT) Block Grant
Requirements and Applicability to State Funds
Federal requirements deriving from Public Law 102-321, as amended by Public
Law 106-310, and federal regulations in 45 CFR Part 96 are pass-through
Att A Statement of Work Initial FY2012.doc Page 1 of 32
ATTACHMENT A
requirements. Federal Substance Abuse Prevention and Treatment (SAPT)
Block Grant requirements that are applicable to states are passed on to CAs
unless otherwise specified.
42 CFR Parts 54 and 54a, and 45 CFR Parts 96, 260, and 1050, pertaining to the
final rules for the Charitable Choice Provisions and Regulations, are applicable to
CAs as stated elsewhere in this Agreement.
Sections from PL 102-321, as amended, that apply to CAs and contractors
include but are not limited to: 1921(b); 1922 (a)(1)(2); 1922(b)(1)(2); 1923;
1923(a)(1) and (2), and 1923(b); 1924(a)(1)(A) and (B); 1924(c)(2)(A) and (B);
1927(a)(1) and (2), and 1927(b)(1); 1927(b)(2); 1928(b) and (c); 1929;
1931(a)(1)(A), (B), (C), (D), (E) and (F); 1932(b)(1); 1941; 1942(a); 1943(b);
1947(a)(1) and (2).
Selected specific requirements applicable to CAs are as follows:
a. Block Grant funds shall not be used to pay for inpatient hospital services
except under condition specified in federal law.
b. Funds shall not be used to make cash payments to intended recipients of
services.
c. Funds shall not be used to purchase or improve land, purchase, construct,
or permanently improve (other than minor remodeling) any building or any
other facility, or purchase major medical equipment.
d. Funds shall not be used to satisfy any requirement for the expenditure of
non-Federal funds as a condition for the receipt of Federal funding.
e. Funds shall not be used to provide individuals with hypodermic needles or
syringes so that such individuals may use illegal drugs.
f. Funds shall not be used to enforce state laws regarding the sale of
tobacco products to individuals under the age of 18.
g. Funds shall not be used to pay the salary of an individual at a rate in
excess of Level I of the Federal Executive Schedule, or approximately
$186,600.
SAPT Block Grant requirements also apply to the Michigan Department of
Community Health (MDCH) administered state funds, unless a written exception
is obtained from MDCH.
4. Licensure of Subcontractors
The CA shall enter into agreements for substance use disorder prevention,
treatment, and recovery services only with providers appropriately licensed for
the service provided as required by Section 6231 of P.A. 368 of 1978, as
amended.
Aft A Statement of Work Initial FY2012:cloc Page 2 of 32
ATTACHMENT A
The CA must ensure that network providers residing and providing services in
bordering states meet all applicable licensing and certification requirements
within their states, that such providers are accredited per the requirements of this
Agreement, and that provider staff are credentialed per the requirements of this
Agreement.
5. Accreditation of Subcontractors
The CA shall enter into agreements for treatment services provided through
outpatient, early intervention, Methadone, sub-acute detoxification and residential
providers only with providers accredited by one of the following accrediting
bodies: The Joint Commission (TJC formerly JCAH0); Commission on
Accreditation of Rehabilitation Facilities (CARF); the American Osteopathic
Association (AOA); Council on Accreditation of Services for Families and
Children (COA); National Committee on Quality Assurance (NCQA), or
Accreditation Association for Ambulatory Health Care (AAAHC). The CA must
determine compliance through review of original correspondence from
accreditation bodies to providers.
Accreditation is not needed in order to provide access management system
(AMS) services, whether these services are operated by a CA or through an
agreement with a CA or for the provision of broker/generalist case management
services. Accreditation is required for AMS providers that also provide treatment
services and for case management providers that either also provide treatment
services or provide therapeutic case management. Accreditation is not required
for peer recovery and recovery support services when these are provided
through a prevention license.
If the CA plans to purchase case management services or peer recovery and
recovery support services, and only these services, from an agency that is not
accredited per this agreement, the CA may request a waiver of the accreditation
requirement.
6. SAMHSA/DHHS License
The federal awarding agency, Substance Abuse and Mental Health Services
Administration, Department of Health and Human Services (SAMHSA/DHHS),
reserves a royalty-free, nonexclusive and irrevocable license to reproduce,
publish or otherwise use, and to authorize others to use, for federal government
purposes: (a) The copyright in any work developed under a grant, sub-grant, or
contract under a grant or sub-grant; and (b) Any rights of copyright to which a
grantee, sub-grantee or a contractor purchases ownership with grant support.
Att A Statement of Work Initial FY2012.doc Page 3 of 32
ATTACHMENT A
7. Cooperation with External Medicaid Evaluation
The CA is expected to cooperate with Department efforts in external evaluation
of Medicaid services, if the CA administers Medicaid services. The CA is
expected to ensure that CA-funded providers will provide necessary data and will
facilitate access to individuals' files and other records as required.
8. Monitoring of Subcontractors
The CA is required to assure that subcontractors comply with all applicable
requirements contained in this agreement. To this end, the CA must adopt
written policy and must implement procedures regarding monitoring of
subcontractors. The monitoring policy and procedures must be consistent with
requirements in this agreement, with the current MDCH substance use disorder
audit guidelines, and with applicable federal Office of Management and Budget
(OMB) circulars. The CA must prepare a report of monitoring findings, and must
make this report available to the public at least once every two years.
Part II of the agreement, section I.H on Sub-recipient/Vendor Monitoring, requires
that contractors conduct monitoring and risk-based assessments of sub-
recipients during the period of the agreement. The CA must conduct monitoring
and risk-based assessments of all subcontractors, during the period of the
agreement, including subcontractors that are vendors.
Administrative and Financial
Match Rules
Pursuant to Section 6213 of Public Act No. 368 of 1978, as amended, Michigan
has promulgated match requirement rules. Rules 325.4151 through 325.4153
appear in the 1981 Annual Administrative Code Supplement. In brief, the rule
defines allowable matching fund sources and states that the allowable match
must equal at least ten percent of each comprehensive CA budget (see
Attachment B to the Agreement) - less direct federal and other state funds.
Per PA 368, Administrative Rules, and contract, direct state/federal funds are
funds that come to the CA directly from a federal agency or another state source.
Funds that flow to the CA from the Department are not in this category, such as,
SDA, and, therefore, are subject to the local match requirement.
Match requirements apply both to budgeted funds during the agreement period
and to actual expenditures at year-end.
"Fees and collections" as defined in the Rule include only those fees and
collections that are associated with services paid for by the CA.
Aft A Statement of Work Initial FY2012.doc Page 4 of 32
ATTACHMENT A
If the CA is found not to be in compliance with Match requirements, or cannot
provide reasonable evidence of compliance, the Department may withhold
payment or recover payment in an amount equal to the amount of the Match
shortfall.
2. Reporting Fees and Collections Revenues
On the initial Revenues and Expenditures Report (RER), the CA is required to
report all estimated fees and collections revenue to be received by the CA and all
estimated fees and collections revenue to be received and reported by its
contracted services providers (see Attachment B to this Agreement).
On the final RER, the CA is required to report all actual fees and collections
revenue received by the CA and all actual fees and collections revenue received
and reported by its contracted services providers (see Attachment B to this
Agreement).
"Fees and collections" are as defined in the Annual Administrative Code
Supplement, Rule 325.4151 and in the Match Rule section of this Attachment.
3. Management of Department-Administered Funds
The CA shall manage all Department-administered funds under its control in
such a way as to assure reasonable balance among the separate requirements
for each funds source.
4. Sliding Fee Scale
The CA shall implement a sliding fee scale. All treatment providers shall utilize
the scale. The CA must adopt written policies and implement procedures for
determining when an individual has no ability to pay for services and for
determining when payment liability is to be waived.
Financial information needed to determine ability to pay (financial responsibility)
must be reviewed annually or at a change in an individual's financial status,
whichever occurs sooner.
The CA sliding fee scale must be applied to all persons (except Medicaid,
MIChild, and ABW recipients) seeking substance use disorders services funded
in whole or in part by the CA. The CA has the option to charge fees for AMS
services, or not to charge. If the CA charges for AMS services, the same sliding
fee scale as applied to treatment services must be used.
The CA must assure that all available sources of payments are identified and
applied prior to the use of Department-administered funds. The CA must have
written policies and procedures to be used by network providers in determining
Att A Statement of Work Initial FY2012.doc Page 5 of 32
ATTACHMENT A
an individual's ability to pay, and in identifying all other liable third parties. The
CA must also have policies and procedures for monitoring providers and for
sanctioning noncompliance.
5. Inability to Pay
Services may not be denied because of inability to pay. If a person's income falls
within the CA's regional sliding fee scale, clinical need must be determined
through the standard assessment and patient placement process. If a financially
and clinically eligible person has third party insurance, that insurance must be
utilized to its full extent. Then, if benefits are exhausted, or if the person needs a
service not fully covered by that third party insurance, or if the co-pay or
deductible amount is greater than the person's ability to pay, Community Grant
funds may be applied. Community Grant funds may not be denied solely on the
basis of a person having third party insurance.
6. Subcontracts with Hospitals
Funds made available through the Department shall not be made available to
public or private hospitals which refuse, solely on the basis of an individual's
substance use disorder, admission or treatment for emergency medical
conditions.
7. Residency in CA Region
The CA may not limit access to the programs and services funded by this
Agreement only to the residents of the CA's region, because the funds provided
by the Department under this Agreement come from federal and statewide
resources. Members of federal and state-identified priority populations must be
given access to screening and to assessment and treatment services, consistent
with the requirements of this Agreement, regardless of their residency. However,
for non-priority populations, the CA may give its residents priority in obtaining
services funded under this Agreement when the actual demand for services by
residents eligible for services under this Agreement exceeds the capacity of the
agencies funded under this Agreement.
8. Out-of- Network and Out-of-Region Services
The CA must have written policies and procedures for authorizing and
purchasing treatment services from out-of-network and out-of-region providers
for residents of the CA region who need care from such providers.
9. Reimbursement Rates for Community Grant, Medicaid and Other Services
The CA must pay the same rate when purchasing the same service from the
same provider, regardless of whether the services are paid for by Community
Att A Statement of Work Initial FY2012.doc Pagir, 6 of 32
ATTACHMENT A
Grant funds, Medicaid funds, or other Department administered funds, including
Adult Benefit Waiver (ABW) and MIChild funds.
10. Minimum Criteria for Reimbursin. for Services to Persons with Co-
Occurring Disorders
Department funds made available to the CA through this Agreement, and which
are allowable for treatment services, may be used to reimburse providers for
integrated mental health and substance use disorder treatment services to
persons with co-occurring substance use and mental health disorders.
The CA may reimburse a Community Mental Health Services Program (CMHSP)
or Pre-paid Inpatient Health Plan (PIHP) for substance use disorders treatment
services for such persons who are receiving mental health treatment services
through the CMHSP or PIHP. The CA may also reimburse a provider, other than
a CMHSP or PIHP, for substance use disorders treatment provided to persons
with co-occurring substance use and mental health disorders. As always, when
reimbursing for substance use disorders treatment, the CA must have an
agreement with the CMHSP (or other provider); and the CMHSP (or other
provider) must meet all minimum qualifications, including licensure, accreditation
and data reporting.
11. Media Campaigns
A media campaign, very broadly, is a message or series of messages conveyed
through mass media channels including print, broadcast, and electronic media.
Messages regarding the availability of services in the CA region are not
considered to be media campaigns. Media campaigns must be compatible with
MDCH values, be coordinated with MDCH campaigns whenever feasible and
costs must be proportionate to likely outcomes. The CA shall not finance any
media campaign using Department-administered funding without prior written
approval by the Department.
12. Notice of Excess or Insufficient Funds (NEIF)
Coordinating agencies must notify the Department in writing and upload the
notice to the Electronic Grants Administration and Management System
(EGrAMS) by June 1 if the amount of State Agreement funding may not be used
in its entirety or appears to be insufficient.
The contract requires that the CA expend all allocated funds per the
requirements of the SUD contract within the contract year OR notify the
Department via the NEIF that spending by year-end will be less than the
amount(s) allocated. This requirement applies to individual allocations, earmarks
and to the total CA allocation. Of particular importance are allocations for
Prevention services and Women's Specialty Services (WSS), including the
Att A Statement of Work Initial FY2012.doc PAgP 7 nf f;9
ATTACHMENT A
earmarked allocations for the Odyssey programs. The State must closely
monitor these expenditures to ensure compliance with the Maintenance of Effort
requirement in the federal SAPT Block Grant.
When it has been determined that a CA will not expend all of its allocated, WSS
State Agreement funds (including the earmarked allocations for the Odyssey
programs), these unspent funds must be returned to the Department for
reallocation to other CAs who can appropriately use these funds for WSS
programs within their CA regions within the current fiscal year. A CA's failure to
expend these funds for the purposes for which they are allocated and/or its
failure to notify the Department of projected expenditures at levels less than
allocated may result in reduced allocations to the CA in the subsequent contract
year.
13. Subcontractor Information to be Retained at the CA
a. Budgeting Information for Each Service.
b. Documentation of How Fixed Unit Rates Were Established:
The CA shall maintain documentation regarding how each of the unit rates
used in its agreements was established. The process of establishing and
adopting rates must be consistent with criteria in OMB Circular A-87 or A-
122, whichever is applicable, and with the requirements of individual fund
sources.
c. Indirect Cost Documentation:
The CA shall review subcontractor indirect cost documentation in
accordance with OMB Circular A-87 or A-122, as applicable.
d. Equipment Inventories:
The CA must apply the following to all subcontractors that have budgeted
equipment purchases in their contracts with the CA:
Any contractor equipment purchases supported in whole or in part through
this agreement must be listed in the supporting Equipment Inventory
Schedule. Equipment means tangible, non-expendable, personal property
having useful life of more than one (1) year and an acquisition cost of
$5,000 or more per unit. Title to items having a unit acquisition cost of
less than $5,000 shall vest with the Contractor upon acquisition. The
Department reserves the right to retain or transfer the title to all items of
equipment having a unit acquisition cost of $5,000 or more, to the extent
that the Department's proportionate interest in such equipment supports
such retention or transfer of title.
e. Fidelity Bonding Documentation:
The CA shall maintain fidelity bonding documentation.
Att A Statement of Work Initial FY2012.doc Page 8 of 32
ATTACHMENT A
14. Reporting Requirements
a. General Requirements
Requirements concerning specific reports are contained elsewhere in the
Agreement, including in Attachment C. The following requirements
generally pertain:
1. Each report must be submitted by the specified due date. Reports
successfully e-mailed or uploaded to the EGrAMS by the due date
are considered timely.
2. Reports must be sent to the addressee and via the submission
route (e.g., uploaded, e-mailed, etc.) specified in this Agreement.
Reports that are not sent to the specified addressee are subject to
being determined not timely or not received.
3. Reports must be submitted on the form and in the format specified
in this Agreement (if form and format are specified).
b. Legislative Reports (LRs) and Financial Reports
If the contractor does not submit the LR, or the final RER (which includes
the ABW and MIChild Year-end Balance Worksheets and Administration/
Service Coordination Report) within fifteen (15) calendar days of the due
date, the Department may withhold from the current year funding an
amount equal to five (5) percent of that funding (not to exceed $100,000)
until the Department receives the required report. The Department may
retain the amount withheld if the contractor is more than forty-five (45)
calendar days delinquent in meeting the filing requirements.
The contractor must assure that the financial data in these reports are
consistent and reconcile between the reports; otherwise, the reports will
be considered as not submitted and will be subject to financial penalty, as
mentioned above. Additional financial penalties are applicable to the
Notice of Excess and Insufficient Funds.
The Department may choose to withhold payment when any financial
report is delinquent by thirty (30) calendar days or more and may retain
the amount withheld if the report is sixty (60) or more calendar days
delinquent. This does not apply to the LR and final RER, as stated above.
Financial reports are:
1. FASD Prevention and Intervention Project: Revenues and
Expenditures Report—MONTHLY and FINAL;
2. Financial Status Report-1 st thru 3rd quarter;
Alt A Statement of Work Initial FY2012.doo Page 9 of 32
ATTACHMENT A
3. Financial Status Report-4 th quarter;
4. Notice of Excess or Insufficient Funds; and
5. Prevention Expenditures by Strategy Report.
c. Data Reporting Timeliness and Completeness Standards
DCH monitors the timeliness of submission for all required reports.
Reports that arrive after the established due date are recorded as late. If
the submission arrives more than five (5) calendar days past due, a letter
will be sent to the CA Director to notify the CA of the lack of compliance
with the published due date. Sanctions for noncompliance (depending on
the severity and frequency) may include a requirement for a corrective
action plan or may include an adjustment in prepayments.
For data transactions that are submitted via the Date Exchange Gateway
(DEG), including admission, discharge, and encounter batches, the
processing system logs the dates and times the batches were transferred
and processed. When the system is in production, monthly submissions
by the CAs are required. Data submissions are monitored daily by MDCH
staff.
d. Data Completeness
The CA is responsible for submitting 100% of required records. Initial
submissions combined with error corrections and resubmissions must
result in an accuracy rate of 100%.
e. National Outcome Measures (NOMS)
Complete, accurate, and timely reporting of treatment and prevention data
are necessary for the Department to meet its federal reporting
requirements. For the SUD Treatment NOMS, it is the CA's responsibility
to ensure that the client information reported on these records accurately
describes each client's status at admission first date of service (admission)
and on the last day of service (discharge).
Michigan Prevention Data System (MPDS)
CAs are required to collect and report the state-required prevention data
elements throughout the prevention provider network either through
participation in the MPDS or through an upload of the state-required
prevention data records to MPDS on a monthly basis.
CAs must assure that all records submitted to the state system are
consistent with the MPDS Reference Manual. (See SUD Services Policy
Manual.)
Att A Statement of Work Initial FY2012.doc Page 10 of 32
ATTACHMENT A
It is the responsibility of the CAs to ensure that the services reported to
the system accurately reflects staff service provision and participant
information for all CA-administered fund sources.
It is the responsibility of the CAs to monitor provider completeness,
timeliness and accuracy of provider data maintained in the system in a
manner which will ensure a minimum of 90 percent accuracy.
15. Critical Incidents and Sentinel Events
The CA must require all of its residential treatment providers to prepare and file
critical incident reports and sentinel event reports that include the following
components:
1. Provider determination whether critical incidents are sentinel events.
2. Following identification as a sentinel event, the provider must ensure that
a root cause analysis or investigation takes place.
3. Based on the outcome of the analysis or investigation, the provider must
ensure that a plan of action is developed and implemented to prevent
further occurrence of the sentinel event. The plan must identify who is
responsible for implementing the plan, and how implementation will be
monitored. Alternatively, the provider may prepare a rationale for not
pursuing a preventive plan.
The CA is responsible for oversight of the above processes.
Requirements for reporting data on Sentinel Events are contained in Attachment
E. These reporting requirements are narrower in scope than the responsibility to
identify and follow up on critical incidents and sentinel events.
A Critical Incident is any of the following that should be reviewed to determine
whether it meets the criteria for a sentinel event below:
1. Death of a recipient.
2. Serious illness requiring admission to hospital.
3. Alleged cause of abuse or neglect.
4. Accident resulting in injury to recipient requiring emergency room visit or
hospital admission.
5. Behavioral episode.
6. Arrest and/or conviction.
7. Medication error.
Att A Statement of Work Initial FY2012.doc Page 11 of 32
ATTACHMENT A
A Sentinel Event is an "unexpected occurrence involving death or serious
physical or psychological injury", or the risk thereof. Serious injury specifically
includes loss of limb or function. The phrase, "or risk thereof" includes any
process variation for which a recurrence would carry a significant chance of a
serious adverse outcome." (JCAHO, 1998)
16. Claims Management System
The CA shall make timely payments to all providers for clean claims. This
includes payment at 90% or higher of clean claims from network providers within
60 days of receipt, and 99% or higher of all clean claims within 90 days of
receipt.
A clean claim is a valid claim completed in the format and time frames specified
by the CA and that can be processed without obtaining additional information
from the provider. It does not include a claim from a provider who is under
investigation for fraud or abuse, or a claim under review for medical necessity. A
valid claim is a claim for services that the CA is responsible for under this
Agreement. It includes services authorized by the CA.
The CA must have a provider appeal process to promptly and fairly resolve
provider-billing disputes.
17. Care Management
The CA may pay for care management as a service designed to support CA
resource allocation as well as service utilization. Care management is in
recognition that some clients represent such service or financial risk that closer
monitoring of individual cases is warranted. Care management must be
purchased and reported consistent with the instructions for the Administrative
Expenditures Report in Attachment B to this agreement.
18. Purchasing Drug Screens
This item does not apply to medication-assisted services.
Department-administered treatment funds can be used to pay for drug screens, if
all of the following criteria are met:
(a) No other responsible payment source will pay for the screens. This
includes self pay, Medicaid, and private insurance. Documentation must
be placed in the client file;
(b) The screens are justified by specific medical necessity criteria as having
clinical or therapeutic benefit; and
Att A Statement of Work Initial FY2012xioc Page 12 of 32
ATTACHMENT A
(c) Screens performed by professional laboratories can be paid for one time
per admission to residential or detoxification services, if specifically
justified. Other than these one-time purchases, Department funds may
only be used for in house "dip stick" screens.
The code(s) to use when submitting the encounter data to MDCH is as follows:
H0003 is a lab test (sent out for analysis); or
H80100 is for in house screens (dip stick tests).
19. Purchasing HIV Early Intervention Services
Department-administered Community Grant funds (blended SAPT Block Grant
and General Fund) cannot be used to pay for HIV Early Intervention Services
because Michigan is not a Designated State for HIV.
Per 45 CFR, Part 96, Substance Abuse Prevention and Treatment Block Grant,
the definition of Early Intervention Services relating to HIV means:
(a) appropriate pretest counseling for HIV and AIDS;
(b) testing individuals with respect to such disease, including tests to confirm
the presence of the disease, tests to diagnose the extent of the deficiency
in the immune system, and tests to provide information on appropriate
therapeutic measures for preventing and treating the deterioration of the
immune system and for preventing and treating conditions arising from the
disease;
(c) appropriate post-test counseling; and
(d) providing the therapeutic measures described in Paragraph (b) of this
definition.
To review the full document, go to: htt: • ://lam iustia.com/usle
1 All 1 51 -1 2.html
Services
1. General Services
a. 12-Month Availability of Services
The CA shall assure that, for any subcontracted treatment or prevention
service, each subcontractor maintains service availability throughout the
fiscal year for persons who do not have the ability to pay.
Att A Statement of Work Initial FY2012.doc Page 13 of 32
ATTACHMENT A
The CA is required to manage its authorizations for services and its
expenditures in light of known available resources in such a manner as to
avoid the need for imposing arbitrary caps on authorizations or spending.
"Arbitrary caps" are those that are not adjusted according to individualized
determinations of the needs of clients. This requirement is consistent with
Medical Necessity Criterion 1.4.3, which may be found elsewhere in
Attachment A.
b. Persons Associated with the Corrections System
When the CA or its AMS services receives referrals from the Michigan
Department of Corrections (MDOC), the CA shall handle such referrals as
per all applicable requirements in this agreement. This would include
determining financial and clinical eligibility, authorizing care as
appropriate, applying admissions preferences, and other steps. MDOC
referrals may come from probation or parole agents, or from MDOC
Central Office staff. In situations where persons have been referred from
MDOC and are under their supervision, state-administered funds should
be used as the payment of last resort.
When persons who are on parole or probation seek treatment on a
voluntary basis from the CA's AMS services or from a panel provider,
these self-referrals must be handled like any other self-referral to the
MDCH-funded network. AMS or provider staff may seek to obtain
releases to communicate with a person's probation or parole agent but in
no instance may this be demanded as a condition for admission or
continued stay.
The CA may collaborate with MDOC, and with the Office of Community
Alternatives (OCA) within MDOC, on the purchase of substance use
disorders services and supports. This may include collaborative
purchasing from the same providers, and for the same clients. In such
situations, the CA must assure that:
1. All collaborative purchasing is supported by written agreements
among the participants.
2. Rates paid to providers, whether by a single purchaser or two or
more purchasers, do not exceed provider costs.
3. Rates paid to providers are documented and are developed
consistent with applicable OMB Circular(s).
4. No duplication of payment occurs.
Aft A Statement of Work Initial FY20 1 P.dnn Page 14 of 32
ATTACHMENT A
c. State Disability Assistance (SDA)
(Applies Only to Agencies Who Have Allocations for this Program)
MDCH continues to allocate SDA funding and to delegate management of
this funding to the CA. The SDA funding is identified in the CA's allocation
letter. The CA is responsible for allocating these funds to qualified
providers. Minimum provider qualifications are MDCH licensure as a
residential treatment provider and accreditation by one of the approved
accreditation bodies (identified elsewhere in this Agreement). A provider
may be located within the CA's region or outside of the region. SDA funds
shall not be used to pay for room and board in conjunction with sub-acute
detoxification services.
When a client is determined to be eligible for SDA funding, the CA must
arrange for assessment and authorization for SDA room and board
funding and must reimburse for SDA expenditures based on billings from
providers, consistent with CA/provider agreements. In addition, the CA
may authorize such services for its own residents at providers within or
outside its region.
The CA shall not refuse to authorize SDA funds for support of an
individual's treatment solely on the basis of the individual's current or past
involvement with the criminal justice system. For those individuals
currently involved with MDOC and receiving services as part of MDOC
programming, SDA funds shall only be used as the payment of last resort.
Qualified providers may be reimbursed up to twenty-seven ($27) per day
for room and board costs for SDA-eligible persons during their stays in
Residential treatment.
To be eligible for MDCH-administered SDA funding for room and board
services in a substance use disorder treatment program, a person must be
determined to meet Michigan Department of Human Services' (MDHS)
eligibility criteria; determined by the CA or its designee to be in need of
residential treatment services; authorized by the CA for residential
treatment when the CA expects to reimburse the provider for the
treatment; at least 18 years of age or an emancipated minor, and in
residence in a residential treatment program each day that SDA payments
are made.
The CA may employ either of two methods for determining whether an
individual meets MDHS eligibility criteria:
1. The CA may refer the individual to the local MDHS office. This
method must be employed when there is a desire to qualify the
individual for an incidental allowance under the SDA program.
Att A Statement of Work Initial FY2012.doc Page 15 of 32
ATTACHMENT A
Or,
2. The CA may make its own determination of eligibility by applying
the essential MDHS eligibility criteria. See this DHS link for details:
6'07,7- 1 3
For present purposes only, these criteria are:
• Residency in substance use disorders residential treatment.
O Michigan residency and not receiving cash assistance from
another state.
• U.S. citizenship or have an acceptable alien status.
• Asset limit of S3,000 (cash assets only are counted).
Regardless of the method used, the CA must retain documentation
sufficient to justify determinations of eligibility.
The CA must have a written agreement with a provider in order to provide
SDA funds.
d. Persons Involved with the Michigan Department of Human Services
(MDHS)
The CA must work with the MDHS office(s) in its region to facilitate access
to prevention, assessment and treatment services for persons involved
with MDHS, including families in the child welfare system and public
assistance recipients. The CA must develop written agreements with
MDHS offices that specify payment and eligibility for services, access-to-
services priority, information sharing (including confidentiality
considerations), and other factors as may be of local importance.
e. Primary Care Coordination
The CA must take all appropriate steps to assure that substance use
disorder treatment services are coordinated with primary health care. In
the case of CAs that are under contract with PIHPs for the Medicaid
substance abuse program, CAs are reminded that coordination efforts
must be consistent with these contracts.
Treatment case files must include, at minimum, the primary care
physician's name and address, a signed release of information for
purposes of coordination, or a statement that the client has refused to sign
a release.
Care coordination agreements or joint referral agreements, by themselves,
are not sufficient to show that the CA has taken all appropriate steps
Att A Statement of Work Initial FY2012.doc Page 16 of 32
g.
ATTACHMENT A
related to coordination of care. Client case file documentation is also
necessary.
f. Cultural Competence
CA must have a written cultural competency plan implemented in practice
at their agency and at all provider agencies. The plan must include:
1. The CA's identification and assessment of the cultural needs of
potential and active clients based on population served.
2. The CA's identification standards for the recruitment and hiring of
culturally competent staff members.
3. The CA's identification of how ongoing staff training needs in
cultural competency will be assessed and met and the evidence
that staff members receive training.
4. The CA's process for ensuring that panel providers comply with all
applicable requirements concerning the provision of culturally
competent services.
5. The CA's process for annually assessing its compliance with the
CA's cultural competence plan.
Charitable Choice
The September 30, 2003 Federal Register (45 CFR part 96) contains
federal Charitable Choice SAPT block grant regulations, which apply to
both prevention and treatment providers/programs. In summary, the
regulations require: 1) that the designation of religious (or faith-based)
organizations as such be based on the organization's self-identification as
religious (or faith based), 2) that these organizations are eligible to
participate as providers—e.g. a "level playing field" with regard to
participating in the CA provider panel, 3) that a program beneficiary
receiving services from such an organization who objects to the religious
character of a program has a right to notice, referral, and alternative
services which meet standards of timeliness, capacity, accessibility and
equivalency—and ensuring contact to this alternative provider, and 4)
other requirements, including-exclusion of inherently religious activities
and non-discrimination.
The CA is required to comply with all applicable requirements of the
Charitable Choice regulations. The CA must ensure that treatment clients
and prevention service recipients are notified of their right to request
alternative services. Notice may be provided by the AMS or by providers
Att A Statement of Work Initial FY2012.doc Page 17 of 32
ATTACHMENT A
that are faith-based. The CA must assign responsibility for providing the
notice to the AMS, to providers, or both. Notification must be in the form of
the model notice contained in the final regulations, or the CA may request
written approval from MDCH of an equivalent notice.
The CA must also ensure that its AMS administer the processing of
requests for alternative services. This is applicable to all face-to-face
services funded in whole or part by SAPT Block Grant funds, including
prevention and treatment services. The CA must submit an annual report
on the number of such requests for alternative services made by the
agency during the fiscal year, per Attachment C-Required Reports.
The model notice contained in the federal regulations is:
No provider of substance abuse services receiving
Federal funds from the U.S. Substance Abuse and
Mental Health Services Administration, including this
organization, may discriminate against you on the basis
of religion, a religious belief, a refusal to hold a religious
belief, or a refusal to actively participate in a religious
practice.
If you object to the religious character of this
organization, Federal law gives you the right to a referral
to another provider of substance abuse services. The
referral, and your receipt of alternative services, must
occur within a reasonable period of time after you request
them. The alternative provider must be accessible to you
and have the capacity to provide substance abuse
services. The services provided to you by the alternative
provider must be of a value not less than the value of the
services you would have received from this organization.
11, Americans with Disabilities Act
The CA and its contractors must comply with applicable provisions of the
Americans with Disabilities Act (the ADA). Further information may be
found at:
Nondiscrimination on the Basis of Disability in State and Local
Government Services: United States Code of Federal Regulations, Title
28, Part 35, Washington, D.C. (1991).
i. Limited English Proficiency
The CAs must ensure a current Limited English Proficiency
(LEP) policy is in place and in practice. The CA must also have
Att A Statement of Work Initial FY2012‘doc Page 18 of 32
ATTACHMENT A
documentation that all providers have implemented the required LEP
policy and procedures and are in compliance with related Federal and
State requirements. The LEP policies and procedures must include the
following, as required by the Office of Civil Rights.
1. Procedures for identifying and assessing the language needs of the
CA, individual provider and the geographic area served. Needs
must be based on current local and regional census data, as well
as other state and regional data.
2. Identified range of oral language assistance options appropriate to
the CAs circumstances.
3. How the CA provides notice to LEP persons, in their primary
language, of the right to free language assistance.
4. What staff training and program monitoring is performed related to
LEP policies and procedures.
5. Provisions for written materials in language other than English
where a significant number or percentage of the affected population
needs services or information in a language other than English, to
communicate effectively.
6. Provisions for language interpreters who are trained and
competent.
7. Statements explaining timely assistance.
8. Statements explaining there will be no charge to the LEP recipient
for these services.
9. Provisions regarding use of family member and/or friend as a
language interpreter must not be required. Should the consumer
choose to use family or friend as an interpreter, both the offering of
other resources, and the consumer's choice, must be documented
in writing. Availability of consumer family and friends as
translator/interpreter will not waive other LEP requirements herein
described.
2. Treatment Services
a. Medical Necessity Criteria for Substance Use Disorders Supports
and Services
Att A Statement of Work Initial FY2012,doc Page 19 of 32
ATTACHMENT A
The CA must assure that treatment service authorization and
reauthorization decisions are consistent with the following Medical
Necessity Criteria. These criteria are substantively the same as the
applicable criteria for substance use disorders Medicaid services.
1.0 Medical Necessity Criteria
"Medically necessary" substance abuse services are
supports, services, and treatment:
1.1.1 Necessary for screening and assessing the presence
of substance use disorder; and/or
1.1.2 Required to identify and evaluate a substance use
disorder; and/or
1.1.3 Intended to treat, ameliorate, diminish or stabilize the
symptoms of a substance use disorder; and/or
1.1.4 Expected to arrest or delay the progression of a
substance use disorder; and/or
1.1.5 Designed to assist the individual to attain or maintain
a sufficient level of functioning in order to achieve
his/her goals of community inclusion and participation,
independence, recovery or productivity.
1.2 The determination of a medically necessary support, service
or treatment must be:
1.2.1 Based on information provided by the individual,
individual's family, and/or other individuals (e.g.,
friends, personal assistants/aide) who know the
individual; and
1.2.2 Based on clinical information from the individual's
primary care physician or clinicians with relevant
qualifications who have evaluated the individual; and
1.2.3 Based on individualized treatment planning; and
1.2.4 Made by appropriately trained substance abuse
professionals with sufficient clinical experience; and
1.2.5 Made within federal and state standards for
timeliness; and
1.2.6 Sufficient in amount, scope and duration of the
service(s) to reasonably achieve its/their purpose.
1.3 Supports, services and treatment authorized by the CA must
be:
1.3.1 Delivered in accordance with federal and state
standards for timeliness in a location that is
accessible to the individual; and
1.1
Att A Statement of Work Initial FY2012,doc Page 20 of 32
ATTACHMENT A
1.3.2 Responsive to particular needs of multi-cultural
populations and furnished in a culturally relevant
manner; and
1.3.3 Provided in the least restrictive, most integrated
setting. Residential or other segregated settings shall
be used only when less restrictive levels of treatment,
service or support have been, for that beneficiary,
unsuccessful or cannot be safely provided; and
1.3.4 Delivered consistent with, where they exist, available
research findings, health care practice guidelines and
standards of practice issued by professionally
recognized organizations or government agencies.
1.4 Using criteria for medical necessity, a CA may:
1.4.1 Deny services a) that are deemed ineffective for a
given condition based upon professionally and
scientifically recognized and accepted standards of
care; b) that are experimental or investigational in
nature; or c) for which there exists another
appropriate, efficacious, less-restrictive and cost-
effective service, setting or support, that otherwise
satisfies the standards for medically-necessary
services; and/or
1.4.2 Employ various methods to determine amount, scope
and duration of services, including prior authorization
for certain services, concurrent utilization reviews,
centralized assessment and referral, gate-keeping
arrangements, protocols, and guidelines.
1.4.3 A CA may not deny services solely based on
PRESET limits of the cost, amount, scope, and
duration of services; but instead determination of the
need for services shall be conducted on an
individualized basis. This does not preclude the
establishment of quantitative benefit limits that are
based on industry standards and consistent with 1.3.4
above, and that are provisional and subject to
modification based on individual clinical needs and
clinical progress.
b. Clinical Eligibility: DSM IV-TR Diagnosis
in order to be eligible for treatment services purchased in whole or part by
state-administered funds under the agreement, an individual must be
found to meet the criteria for one or more selected substance use
disorders found in the Diagnostic and Statistical Manual of Mental
Disorders (DSM IV-TR). These disorders are listed below. This
Att A Statement of Work Initial FY2012.doc Page 21 of 32
ATTACHMENT A
requirement is not intended to prohibit use of these funds for family
therapy. It is recognized that persons receiving family therapy do not
necessarily have substance use disorders.
303.90
305.00
303.00
291.80
291.90
304.40
305.70
292.89
292.00
292.90
304.30
305.20
292.89
292.90
304.20
305.60
292.89
292.00
292.90
304.50
305.30
292.89
292.90
304.60
305.90
292.89
292.90
304.00
305.50
292.89
292.00
292.90
304.60
305.90
292.89
292.90
304.80
304.10
305.40
292.89
Alcohol Dependence
Alcohol Abuse
Alcohol Intoxication
Alcohol Withdrawal
Alcohol-Related Disorder, Not Otherwise Specified
Amphetamine Dependence
Amphetamine Abuse
Amphetamine Intoxication
Amphetamine Withdrawal
Amphetamine-Related Disorder, Not Otherwise
Specified
Cannabis Dependence
Cannabis Abuse
Cannabis Intoxication
Cannabis-Related Disorder, Not Otherwise Specified
Cocaine Dependence
Cocaine Abuse
Cocaine Intoxication
Cocaine Withdrawal
Cocaine-Related Disorder, Not Otherwise Specified
Hallucinogen Dependence
Hallucinogen Abuse
Hallucinogen Intoxication
Hallucinogen-Related Disorder, Not Otherwise Specified
Inhalant Dependence
Inhalant Abuse
Inhalant Intoxication
Inhalant-Related Disorder, Not Otherwise Specified
Opioid Dependence
Opioid Abuse
Opioid Intoxication
Opioid Withdrawal
Opioid-Related Disorder, Not Otherwise Specified
Phencyclidine Dependence
Phencyclidine Abuse
Phencyclidine Intoxication
Phencyclidine-Related Disorder, Not Otherwise
Specified
Polysubstance Dependence
Sedative, Hypnotic, or Anxiolytic Dependence
Sedative, Hypnotic, or Anxiolytic Abuse
Sedative, Hypnotic, or Anxiolytic Intoxication
At! A Statement of Work Initial FY2012,doc Page 22 of 32
ATTACHMENT A
292.00
292.90
304.90
305.90
292.89
292.00
Sedative, Hypnotic, or Anxiolytic Withdrawal
Sedative, Hypnotic, or Anxiolytic-Related Disorder, Not
Otherwise Specified
Other (or Unknown) Substance Dependence
Other (or Unknown) Substance Abuse
Other (or Unknown) Substance Intoxication
Other (or Unknown) Substance Withdrawal
c. Satisfaction Surveys
The CA shall assure that all network subcontractors providing treatment
conduct satisfaction surveys of persons receiving treatment at least once
a year. Surveys may be conducted by individual providers or may be
conducted centrally by the CA. Clients may be active clients or clients
discharged up to 12 months prior to their participation in the survey.
Surveys may be conducted by mail, telephone, or face-to-face. The CA
must compile findings and results of client satisfaction surveys for all
providers, and must make findings and results, by provider, available to
the public.
d. MIChild
MIChild Covered Services
The CA must assure use of a standardized assessment process, including
the American Society of Addiction Medicine (ASAM) Patient Placement
Criteria, to determine clinical eligibility for services based on medical
necessity.
Substance use disorder services are covered when medically necessary
as determined by the CA. This benefit should be construed the same as
are medical benefits in a managed care program. Inpatient (hospital-
based) services are covered, but the CA is permitted to substitute less
costly services outside the hospital if they meet the medical needs of the
patient. In the same way, the CA may substitute services for inpatient or
residential services if they meet the child's needs and they are more cost
effective.
Covered services are as follows:
1. Outpatient Treatment
2. Residential Treatment
3. Inpatient Treatment
4. Laboratory and Pharmacy
Att A Statement of Work Initial FY2012.doc Page 23 of 32
ATTACHMENT A
These benefits apply only when a CA's employed or contracted physician
writes a prescription for pharmacy items or lab.
EligibilitY
Eligible persons are persons of age 18 or less who are determined eligible
for the MIChild program by the MDCH and enrolled by the Department's
administrative vendor and live in the region covered by the CA. The CA is
responsible for determining eligibility and for charging all authorized and
allowable services to the MIChild program up to the CA's annual MIChild
revenues.
Per Enrolled Child Per Month
On a monthly basis, MDCH will provide the CA with the federal share of
MIChild funds as a per capita payment based upon a Per Enrolled Child
Per Month (PECPM) methodology for MIChild covered services. In
consideration for accepting the federal funding pushed to the CA, the CA
agrees to redirect existing state general fund dollars to match the MIChild
federal FMAP funds (Title XXI State Children's Health Insurance Program)
and carry out the associated substance use disorders program
requirements.
The PECPM rate and the federal fund source are updated, as needed, by
the Department on an annual basis or as rates change.
The PECPM funding is a per capita payment for medically necessary
MIChild-covered services including outpatient, residential and inpatient
services as authorized by the CA. If the MIChild capitation is not sufficient
to serve the MIChild enrollees, use of state-allocated General funds is
allowed. Federal SAPT Block Grant funds may not be used for inpatient
care.
Data Collection and Reporting
The CA must account separately for expenses related to MIChild
enrollees. Reporting of MIChild revenues and expenditures will be
through the RER as indicated in Attachment B to this Agreement and via
the Financial Status Report (FSR) as indicated in Attachment D to this
Agreement.
In the event that program costs are less than PECPM revenues and the
state match amounts, the CA may retain the balances as Local funds. In
the event that program costs are greater than the federal PECPM and
state match amounts, the CA may use other State Agreement funds
budgeted for treatment in this Agreement
Att A Statement of Work Initial FY2012,doc Page 24 of 32
ATTACHMENT A
The MIChild balances, as reported on the MIChild Year-end Balance
Worksheet, are the Actual Revenues minus the Actual Expenditures. If
reporting year-end unspent fund balances on this Worksheet, the agency
must report BOTH the state match balance and the federal PECPM
balance.
The state match fund balance, along with the federal PEG PM fund
balance, cannot be expended in the same fiscal year as earned. These
unexpended funds must be carried forward into the next fiscal year and
reported as Local funds. The funds become Local funds only after
Department acceptance of the final RER.
The funds must be expended consistent with requirements in this
Agreement, pertaining to State Agreement funds, to support the CA's
substance use disorder programs.
Enrollees who receive substance use disorder services must be entered
into the Substance Use Disorder Statewide Client Data System following
the instructions in the data reporting specifications.
For the required reporting of encounters for MIChild eligible clients, the CA
will report these encounters via the 837 as follows:
2000B Subscriber Hierarchical Level
SBR Subscriber Information
SBRO4 Insured Group Name: Use "MIChild" for the group name.
Access Timeliness
Access timeliness requirements are the same as those applicable to
Medicaid substance use disorders services, as specified in the agreement
between MDCH and the PIHPs. Access must be expedited when
appropriate based on the presenting characteristics of individuals.
e. Adult Benefit Waiver
Withholds of State Share Amounts
ABW per member per month gross payments for ABW SUD will be paid to
PIHPs. The state portion of the gross will be calculated as a projection
based on an estimate of annual member months per CA. The CA's fiscal
year State Agreement allocation will be reduced by this projected amount
and then paid to the PIHPs by the Department. The amount of the
reduction may be adjusted during the fiscal year, if warranted, based on
unanticipated changes in enrollment. The amount of each CA's reduction
will be determined by the Department based on:
Att A Statement of Work Initial FY2012.doc Page 25 of 32
g.
ATTACHMENT A
O the projected annual beneficiary count per county (or city, in the case
of Detroit) that is within a CA region and also within a PIHP region,
multiplied by
e the state share of the gross rate including use tax, multiplied by
O the PIHP's geographic factor.
How to Report ABW Revenues and Expenditures
If the CA has ABW expenditures, if any, in the General Administration
(GA) or Access Management System (AMS) categories, these
expenditures should be reported in the GA and/or AMS columns on Page
3 of the RER.
For ABW expenditures reported in Row C (gross expenditures), state
share does not have to be reflected in the Community Grant row, because
the state share in included in the gross.
On Page 4 of the RER, the ABW column label reads "ABW Treatment."
This is to clarify that only ABW expenditures for treatment services should
be reported in this column, given that there may be ABW expenditures
reported also for GA and AMS.
Use of State-Administered Funds for ABW Enrollees
ABW funds are first source for all services, both covered and optional,
provided to ABW beneficiaries. Other funds provided through the
MDCH/CA contract cannot be used for any services to ABW beneficiaries
if ABW funds are available. "Available" includes ABW gross revenues
(federal share and state share) received and not expended during FY
2011.
f. Intensive Outpatient Treatment — Weekly Format
The CA may purchase Intensive outpatient treatment (10P) only if the
treatment consists of regularly scheduled treatment, usually group
therapy, within a structured program, for at least three days and at least
nine hours per week.
Services for Pregnant Women, Primary Caregiver with Dependent
Children, Primary Caregiver Attempting to Regain Custody and Their
Children
The CA must assure that providers screen and/or assess pregnant
women, primary caregivers with dependent children, and primary
Att A Statement of Work Initial FY7012.rloc Page 26 of 32
ATTACHMENT A
caregivers attempting to regain custody of their children to determine
whether these individuals need and request the defined federal services
that are listed below. All federally mandated services must be made
available within each CA region.
Federal Requirements
Federal requirements are contained in 45 CRF (Part 96) section 96.124,
and may be summarized as:
Providers receiving funding from the state-administered funds set aside for
pregnant women and women with dependent children must provide or
arrange for the 5 types of services, as listed below. Use of state-
administered funds to purchase primary medical care and primary
pediatric care must be approved, in writing, in advance, by the Department
contract manager.
1. Primary medical care for women, including referral for prenatal care
if pregnant, and while the women are receiving such treatment,
child care;
2. Primary pediatric care for their children, including immunizations;
3. Gender specific substance use disorders treatment and other
therapeutic interventions for women, which may address issues of
relationships, sexual and physical abuse, parenting, and childcare
while the women are receiving these services;
4. Therapeutic interventions for children in custody of women in
treatment, which may, among other things, address their
developmental needs, issues of sexual and physical abuse, and
neglect; and
5. Sufficient case management and transportation to ensure that
women and their dependent children have access to the above
mentioned services.
The above five types of services may be provided through the MDCH/CA
agreement only when no other source of support is available and when no
other source is financially responsible.
MDCH extends the federal requirements above to primary caregivers
attempting to regain custody of their children or at risk of losing custody of
their children due to a substance use disorder. These individuals are a
priority service population in Michigan and; therefore, the five federal
requirements listed above shall be made available to them.
Aft A Statement of Work Initial FY2012.doo Page 27 of 32
ATTACHMENT A
Requirements Regarding Providers
VVomen's Specialty Services may only be provided by providers that are
designated as gender-responsive by the Department's or as gender-
competent by the CA and that meet standard panel eligibility
requirements. The provider may be designated by the Department as
Women's Specialty providers, but such designation is not required. The
CA must continue to provide choice from a list of providers who offer
gender-competent treatment and identify providers that provide the
additional services specified in the federal requirements.
Financial Requirements on Initial and Final RERs
The CA has been assigned an expenditure target for Women's Specialty
Services in the CA's initial allocation letter. State general fund dollars and
the state share of Medicaid dollars, as well as SAPT Block Grant dollars,
can be counted toward the expenditure target. CAs must report on their
RERs, in the Women's Specialty column, all allowable expenditures for
Women's Specialty Services, and only allowable expenditures.
Financial Requirements on Quarterly FSRs
On each quarterly FSR, the CA must report all allowable Women's
Specialty Services expenditures that utilize State Agreement funds.
Those funds are Community Grant and/or State Disability Assistance.
Treatment Episode Data Set (TEDS) and Encounter Reporting
Requirements
For TEDS reporting purposes, the Agency must code 'yes' for all women
eligible for and receiving qualified women's specialty services. At
admission, this can be coded based on eligibility. To qualify, the women
must be either pregnant, have custody of a minor child, or be seeking to
regain custody of a minor child. At minimum, the provider must be
certified by the agency as gender competent.
For all services that qualify based on qualifying characteristics both of the
women and of the provider, the HD modifier must be used (See
Attachment E/Section I Data Requirements: Substance Abuse Encounter
Reporting HCPCS and Revenue Codes Chart).
h. Admission Preference and Interim Services
The Code of Federal Regulations and the Michigan Public Health Code
define priority population clients. The priority populations are identified as
At A Statement of Work Initial FY2012.doc Page 28 of 32
ATTACHMENT A
follows and in the order of importance:
1. Pregnant injecting drug user.
2. Pregnant.
3. Injecting drug user.
4. Parent at risk of losing their child(ren) due to substance use.
5. All others.
Access timeliness standards and interim services requirements for these
populations are provided in the next section.
i. Access Timeliness Standards
The following chart indicates the current admission priority standards for
each population along with the current interim service requirements.
Suggested additional interim services are in italics:
Admission Priority Reauirements
Population Admission Requirement Interim Service Requirement Authority
1) Screened and referred Begin within 48 hours: CFR 96.121; 1. Counseling and education on: CFR 96.131; within 24 hours a) HIV and TB 2) Detoxification, Treatment
Methadone or b) Risks of needle sharing Policy #04 Pregnant Residential — Offer c) Risks of transmission to
Injecting sexual partners and infants Admission within 24 Drug User business hours d) Effects of alcohol and drug
Other Levels or Care — use on the fetus
Offer Admission within 48 2' Referral for pre-natal care
3. Early Intervention Clinical Business hours Services Recommended
1) Screened and referred Begin within 48 hours
within 24 hours 1. Counseling and education on: CFR 96.121;
2) Detoxification, a) HIV and TB CFR 96.131;
Pregnant Methadone or b) Risks of transmission to
Substance Residential — Offer sexual partners and infants
Use admission within 24 c) Effects of alcohol and drug
Disorders business hours use on the fetus
2. Referral for pre-natal care Other Levels or Care — 3 Early Intervention Clinical Offer Admission within 48 '
Business hours Services Recommended
Begin within 48 hours — CFR 96.121;
Injecting Screened and referred
Drug User within 24 hours; Offer maximum waiting time 120 CFR 96.126
Admission within 14 days days 1. Counseling and education on:
Att A Statement of Work Initial FY2012.doc Page 99 of 39
ATTACHMENT A
Population Admission Requirement Interim Service Requirement Authority
a) HIV and TB
b) Risks of needle sharing
c) Risks of transmission to
sexual partners and infants Recommended
2. Early Intervention Clinical
Services
Parent at Begin within 48 business hours Michigan Public
Screened and referred Health Code Risk of within 24 hours. Offer Section 6232 Losing Admission within 14 days Early Intervention Clinical Children Services Recommended
-
Screened and referred CFR 96.131(a) — sets the order within seven calendar All Others days. Capacity to offer Not Required of priority;
MDCH and CA Admission within 14 days contract
Earmark-funded Special Projects: Reporting Requirements
This reporting requirement applies to only four CAs:
• Genesee County CMH, with respect to Flint Odyssey House
• Macomb County CMH, with respect to Sacred Heart Rehabilitation
Center
e network180, with respect to Hispanic Services program
• Saginaw County Health Department, with respect to Saginaw Odyssey
House
These four CAs must submit an annual Earmark-funded Special Projects
Report by November 30, 2012 that contains the following information:
1. The name of the CA whose residents were served through the
earmarked funds during the year;
2. The number of persons served by that CA, through those funds;
and
3. The total amount of earmarked funds paid to the provider for those
services.
See Attachment E-Other Requirements for this annual report form and
form instructions. This report will be submitted via EGrAMS, as an
'Attachment' Report.
J.
Att A Statement of Work Initial FY2012.doc Page M of 39
ATTACHMENT A
Prevention Services
a. Prevention Requirements
Prevention funds may be used for needs assessment and related
activities. All prevention services must be based on a formal local needs
assessment.
The Department's intent is to move toward a community-based,
consequence-driven model of prevention. In the meantime, based on
needs assessment, prevention activities must be targeted to high-risk
groups and must be directed to those at greatest risk of substance use
disorders and/or most in need of services within these high-risk groups.
CAs are not required to implement prevention programming for all high-
risk groups. The CA may also provide targeted prevention services to the
general population.
The high risk subgroups include but are not limited to: children of
substance abusers; pregnant women/teens; drop-outs; violent and
delinquent youth; persons with mental health problems; economically
disadvantaged citizens; persons who are disabled; victims of abuse;
persons already using substances; and homeless and/or runaway youth.
Additionally, children exposed prenatally to ATOD are identified as a high-
risk subgroup.
Prevention services must be provided through strategies identified by
CSAP. These strategies are: information dissemination; education;
alternatives; problem identification and referral; community based
processes; and environmental change.
Prevention-related funding limitations the CA must adhere to are: 1) CA
expenditure requirements for prevention, including Synar, as stipulated in
the CA's allocation letter; 2) 90% of prevention expenditures are expected
to be directed to programs which are implemented as a result of an
evidence-based decision making process; 3) Alternative strategy activities,
if provided must reflect evidence-based approaches and best practices
such as multi-generational and adult to youth mentoring; and 4) state-
administered funds used for information dissemination must be part of a
multi-faceted regional prevention strategy, rather than independent, stand-
alone activity.
The CA must monitor and evaluate prevention programs at least annually
to determine if the program outcomes, milestones and other indicators are
achieved, as well as compliance with state and federal requirements.
Indicators may include integrity to prevention best practice models
including those related to planning prevention interventions such as
Att A Statement of Work Initial FY2012.doc Page 31 of 32
ATTACHMENT A
risk/protective factor assessment, community assets/resource
assessment, levels of community support, evaluation, etc. A written
monitoring procedure, which includes requirements for corrective action
plans to address issues of concern with a provider, is required.
b. Fetal Alcohol Spectrum Disorders (FASD) Prevention Project/
Parent Child Assistance Program (PCAP)—Grant Ends May 31, 2012
(Applies Only to Agencies Who Have Allocations for This Program)
• The funds are to support allowable project expenditures during the
current fiscal year period;
• Expenditures must be reported in a separate column on the CA's initial
and final RERs, utilizing one of the 'Other' columns. Title the column
"Fetal Alcohol Spectrum Disorders (FASD) Prevention Project;"
• Expenditures must be reported on the coordinating agency's quarterly
FSRs.
• Funds may not be used to pay for anything other than those within the
budget detail;
• The CA must supply its own computer equipment; and
• Data must be entered into the web-based system provided by Northrop
Grumman as required by the PCAP model design.
Att A Statement of Work Initial FY2012.doc Page 32 of 32
Contract # 20120862-00 Date: 10/13/2011
Contract #: 20120862-00
Grant Agreement Between
Michigan Department of Community Health
herinafter referred to as the "Department"
and
County of Oakland
1200 N. Telegraph Road
Pontiac Ml 48341 1050
Federal I.D.#: 38-6004876, DUNS #: 136200362
hereinafter referred to as the "Contractor"
for
Substance Use Disorder Services FY12
Part I
1. Period of Agreement:
This agreement shall commence on October 1, 2011 and continue through September
30, 2012. This agreement is in full force and effect for the period specified.
2. Program Budget and Agreement Amount
A. Agreement Amount
This total amount of this agreement is $4,403,645.00. The Department under terms of this
agreement will provide funding not to exceed $4,403,645.00. The federal funding provided by the
Department: is $3,598,186.00, as follows:
Federal Catalog of CFDA # Federal Federal Grant Amount
Program Federal Agency Grant Phase
Title Domestic Name Award
Assistance Number
(C FDA) Title
SAPT Block Block Grant 93.959 Department 10 B1 MI 12 3,598,186.00
Grant for Prevention of Health and SAPT
& Treatment Human
of Substance Services
Abuse
SAMHSA Federal 93.000 Substance PCN #283- 0.00
Fetal Alcohol Contract Abuse and 07-3001
Spectrum Award Mental Health
Disorders Services Adm
(FASD)
Center for
lExcellence
Total for 3,598,186.00
Federal
Funding
County of Oakland, Substance Use Disorder Services FY12 Page: 1 of 24
Contract #20120862-00 Date: 10/13/2011
The grant agreement is designated as a:
X subrecipient relationship or
vendor relationship
The grant agreement is designated as:
Research and Development Project; or
X Not a Research and Development Project.
B. Equipment Purchases and Title
Part I, Section 2, Paragraph B, is not applicable to this Agreement. Any
contractor equipment purchases supported in whole or in part through this
agreement must be listed in the supporting Equipment Inventory Schedule.
Equipment means tangible, non-expendable, personal property having useful life
of more than one (1) year and an acquisition cost of $5,000 or more per unit.
Title to items having a unit acquisition cost of less than $5,000 shall vest with the
Contractor upon acquisition. The Department reserves the right to retain or
transfer the title to all items of equipment having a unit acquisition cost of $5,000
or more, to the extent that the Department's proportionate interest in such
equipment supports such retention or transfer of title.
C. Deviation Allowance
Part I, Section 2, Paragraph C, is not applicable to this Agreement. A
deviation allowance modifying an established budget category by $10,000 or
15%, whichever is greater, is permissible without prior written approval of the
Department. Any modification or deviations in excess of this provision, including
any adjustment to the total amount of this agreement, must be made in writing
and executed by all parties to this agreement before the modifications can be
implemented. This deviation allowance does not authorize new categories,
subcontracts, equipment items or positions not shown in the attached Program
Budget Summary and supporting detail schedules.
3. Purpose
The focus of the program is to provide for the administration and coordination of
substance use disorder (SUD) services within the designated coordinating agency
region, consisting of Oakland County County(ies).
4. Statement of Work
The Contractor agrees to undertake, perform and complete the services described in
Attachment A, which is part of this agreement through reference.
5. Financial Requirements
The financial requirements shall be followed as described in Part II of this agreement
and Attachments B which are part of this agreement through reference. The
Contractor's fiscal year allocation letter is incorporated by reference into this
agreement.
County of Oakland, Substance Use Disorder Services FY12 Page: 2 of 24
Contract # 20120862-00 Date: 10/13/2011
6. Performance/Progress Report Requirements
The progress reporting methods, as applicable, shall be followed as described in
Attachment C, which is part of this agreement through reference.
7. General Provisions
The Contractor agrees to comply with the General Provisions outlined in Part II, which
is part of this agreement through reference. The Contractor agrees to comply with the
requirements described in Attachment D: Reporting Requirements. The Contractor
also agrees to comply with the requirements described in the SUD Services Policy
Manual, which is part of this agreement through reference.
The Parties agree that the MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY
11/12 AGREEMENT ADDENDUM A is incorporated and made part of this agreement.
8. Administration of the Agreement
The person acting for the Department in administering this agreement (hereinafter
referred to as the Contract Manager) is:
Deborah J. Hollis, Director
Bureau of Substance Abuse and Addiction Services (BSAAS)
320 S. Walnut Street, Lewis Cass Bldg, 5th floor
Lansing, MI 48913
(517) 335-6572
HollisD@michigan.gov
9. Contractor's Financial Contact for the Agreement
The person acting for the Contractor on the financial reporting for this agreement is:
Thomas Hensel Financial Officer
Name Title
henselt@oakgov.com (248) 452 9281
E-Mail Address Telephone No.
10. Special Conditions
A. This agreement is valid upon approval by the State Administrative Board as
appropriate and approval and execution by the Department.
B. This agreement is conditionally approved subject to and contingent upon the
availability of funds.
C. The Department will not assume any responsibility or liability for costs incurred by
the Contractor prior to the signing of this agreement.
D. The Contractor is required by PA 533 of 2004 to receive payments by electronic
funds transfer.
County of Oakland, Substance Use Disorder Services FY12 Page: 3 of 24
Contract #20120862-00 Date: 10/1312011
11. 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.
12. Signature Section
FOR County of Oakland
Christina Nicholas Director
Name Title
For the Michigan Department of Community Health
Kim Stephen 10/13/2011
Kim Stephen, Director Date
Bureau of Budget and Audit
County of Oakland, Substance Use Disorder Services FY12 Page: 4 of 24
Contract # 20120862-00 Date: 10/13/2011
Part II
General Provisions
I. Responsibilities - Contractor
The Contractor in accordance with the general purposes and objectives of this
agreement will:
A. Publication Rights
1. Where the Contractor exclusively develops books, films, or other such
copyrightable materials through activities supported by this agreement, the
Contractor may copyright those materials. The materials that the Contractor
copyrights cannot include service recipient information or personal
identification data. Contractor grants the Department a royalty-free, non-
exclusive and irrevocable license to reproduce, publish and use such
materials and authorizes others to reproduce and use such materials.
2. Any materials copyrighted by the Contractor or modifications bearing
acknowledgment of the Department's name must be approved by the
Department before reproduction and use of such materials. The State of
Michigan may modify the material copyrighted by the Contractor and may
combine it with other copyrightable intellectual property to form a derivative
work. The State of Michigan will own and hold all copyright and other
intellectual property rights in any such derivative work, excluding any rights or
interest granted in this agreement to the Contractor. If the Contractor ceases
to conduct business for any reason, or ceases to support the copyrightable
materials developed under this agreement, the State of Michigan has the right
to convert its licenses into transferable licenses to the extent consistent with
any applicable obligations the Contractor has to the federal government.
3. The Contractor shall give recognition to the Department in any and all
publications papers and presentations arising from the program and service
contract herein; the Department will do likewise.
4. The Contractor must notify the Department's Grants and Purchasing Division
30 days before applying to register a copyright with the U.S. Copyright Office.
The Contractor must submit an annual report for all copyrighted materials
developed by the Contractor through activities supported by this agreement
and must submit a final invention statement and certification within 90 days of
the end of the agreement period.
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.
County of Oakland, Substance Use Disorder Services FY12 Page: 5 of 24
Contract # 20120862-00 Date: 10/13/2011
C. Program Operation
Provide the necessary administrative, professional, and technical staff for
operation of the program.
D. Reporting
Utilize all report forms and reporting formats required by the Department at the
effective date of this agreement, and provide the Department with timely review
and commentary on any new report forms and reporting formats proposed for
issuance thereafter.
E. Record Maintenance/Retention
Maintain adequate program and fiscal records and files, including source
documentation to support program activities and all expenditures made under the
terms of this agreement, as required. Assure that all terms of the agreement will
be appropriately adhered to and that records and detailed documentation for the
project or program identified in this agreement will be maintained for a period of
not less than three (3) years from the date of termination, the date of submission
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.
G. Audits
This section only applies to Contractors designated as subrecipients. Contractors
designated as vendors are exempt from the provisions of this section.
1. Required Audit or Notification Letter
Contractors must submit to the Department either a Single Audit, Financial
Statement Audit, or Audit Status Notification Letter as described below. If
submitting a Single Audit or Financial Statement Audit, Contractors must also
submit a Corrective Action Plan for any audit findings that impact MDCH-
funded programs, and management letter (if issued) with a response.
a. Single Audit
Contractors that are a state, local government, or non-profit
organization that expend $500,000 or more in federal awards during
the Contractor's fiscal year must submit a Single Audit to the
Department, regardless of the amount of funding received from the
Department. The Single Audit must comply with the requirements of
the Single Audit Act Amendments of 1996, and Office of Management
and Budget (OMB) Circular A-133, "Audits of States, Local
Governments, and Non-Profit Organizations," as revised.
County of Oakland, Substance Use Disorder Services FY12 Page: 6 of 24
Contract #20120862-00 Date: 10/13/2011
The Contractor must comply with all requirements in the MDCH
Substance Abuse Prevention and Treatment Audit Guidelines,
current edition, as issued by the MDCH Office of Audit.
b. Financial Statement Audit
Contractors exempt from the Single Audit requirements that receive
$500,000 or more in total funding from the Department in State and
Federal grant funding must submit to the Department a Financial
Statement Audit prepared in accordance with generally accepted
auditing standards (GAAS). Contractors exempt from the Single
Audit requirements that receive less than $500,000 of total
Department grant funding must submit to the Department a
Financial Statement Audit prepared in accordance with GAAS if the
audit includes disclosures that may negatively impact MDCH-funded
programs including, but not limited to fraud, going concern
uncertainties, financial statement misstatements, and violations of
contract and grant provisions.
c. Audit Status Notification Letter
Contractors exempt from both the Single Audit and Financial
Statement Audit requirements (a. and b. above) must submit an Audit
Status Notification Letter that certifies these exemptions. The
template Audit Status Notification Letter and further instructions are
available at http://www.michigan.gov/mdch by selecting Inside
Community Health — MDCH Audit.
2. Due Date and Where to Send
The required audit and any other required submissions (i.e. Corrective
Action Plan and management letter with a response), or audit Status
Notification Letter must be submitted to the Department within nine months
after the end of the Contractor's fiscal year by e-mail to the Department at
MDCH-AuditReports@michigan.gov . The required materials must be
assembled as one document in a PDF file compatible with Adobe Acrobat
(read only). The subject line must state the agency name and fiscal year
end. The Department reserves the right to request a hard copy of the audit
materials if for any reason the electronic submission process is not
successful.
County of Oakland, Substance Use Disorder Services FY12 Page: 7 of 24
Contract # 20120862-00 Date: 10/13/2011
3. Penalty
a. Delinquent Single Audit or Financial Statement Audit
If the Contractor does not submit the required Single Audit reporting
package, management letter (if issued) with a response, and
Corrective Action Plan; or the Financial Statement Audit and
management letter (if issued) with a response within nine months
after the end of the Contractor's fiscal year and an extension has not
been approved by the cognizant or oversight agency for audit, the
Department may withhold from the current funding an amount equal
to five percent of the audit year's grant funding (not to exceed
$200,000) until the required filing is received by the Department. The
Department may retain the amount withheld if the Contractor is more
than 120 days delinquent in meeting the filing requirements and an
extension has not been approved by the cognizant or oversight
agency for audit. The Department may terminate the current grant if
the Contractor is more than 180 days delinquent in meeting the filing
requirements and an extension has not been approved by the
cognizant or oversight agency for audit.
b. Delinquent Audit Status Notification Letter
Failure to submit the Audit Status Notification Letter, when required,
may result in withholding from the current funding an amount equal to
one percent of the audit year's grant funding until the Audit Status
Notification Letter is received.
4. Other Audits
The Department or federal agencies may also conduct or arrange for "agreed
iinnn procedures" or additional audits to meet their needs.
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 subrecipient administers Federal awards in compliance with laws,
I egulations, 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.
County of Oakland, Substance Use Disorder Services FY12 Page: 8 of 24
Contract #23120862-03 Date: 10/13/2011
The Contractor must establish requirements to ensure compliance for 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).
I. Notification of Modifications
Provide timely notification to the Department, in writing, of any action by its
governing board or any other funding source that would require or result in
significant modification in the provision of services, funding or compliance with
operational procedures.
J. Software Compliance
The Contractor must ensure 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 1RB application
and approval materials for acceptance of the review of another IRB. All such
research must be approved by a federally assured IRB, 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 1RB Chairperson and the Contractor's IRB
Chairperson or Executive Officer(s).
II. Responsibilities - Department
The Department in accordance with the general purposes and objectives of this
agreement will:
A. Reimbursement
Provide reimbursement in accordance with the terms and conditions of this
agreement based upon appropriate reports, records, and documentation
maintained by the Contractor.
County of Oakland, Substance Use Disorder Services FY12 Page: 9 of 24
Contract 20120862-00 Date: 10/13/2011
B. Report Forms
Provide any report forms and reporting formats required by the Department at the
effective date of this agreement, and provide to the Contractor any new report
forms and reporting formats proposed for issuance thereafter at least ninety (90)
days prior to their required usage in order to afford the Contractor an opportunity
to review and offer comment.
Ill. Assurances
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. For purposes of this Agreement, OMB
Circular A-87 is applicable to Contractors that are local government entities, and
OMB Circular A-122 is applicable to Contractors that are non-profit entities.
B. Anti-Lobbying Act
The Contractor will comply with the Anti-Lobbying Act, 31 USC 1352 as revised by
the Lobbying Disclosure Act of 1995, 2 USC 1601 et seq, and Section 503 of the
Departments of Labor, Health and Human Services, and Education, and Related
Agencies section of the FY 1997 Omnibus Consolidated Appropriations Act (Public
Law 104-209). Further, the Contractor shall require that the language of this
assurance be included in the award documents of all subawards at all tiers
(including subcontracts, subgrants, and contracts under grants, loans and
cooperative agreements) and that all subrecipients shall certify and disclose
accordingly.
County of Oakland, Substance Use Disorder Services FY12 Page: 10 of 24
Contract # 20120862-00 Date: 10/13/2011
C. Non-Discrimination
1. 1. In the performance of any contract or purchase order resulting herefrom, 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;
e. the Drug Abuse Office and Treatment Act of 1972 (P.L. 92-255), as
amended, relating to nondiscrimination on the basis of drug abuse;
f. the Comprehensive Alcohol Abuse and Alcoholism Prevention,
Treatment and Rehabilitation Act of 1970 (P.L. 91-616) as amended,
relating to nondiscrimination on the basis of alcohol abuse or
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.
County of Oakland, Substance Use Disorder Services FY12 Page: 11 of 24
Contract # 20120862-00 Date: 10/13/2011
3. Additionally, assurance is given to the Department that proactive 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 it, its employees and its 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.
County of Oakland, Substance Use Disorder Services FY12 Page: 12 of 24
Contract #20120862-00 Date: 10/13/2011
E. Federal Requirement: Pro-Children Act
1. Assurance is hereby given to the Department that the Contractor will comply
with Public Law 103-227, also known as the Pro-Children Act of 1994, 20
USC 6091 et seq, which requires that smoking not be permitted in any portion
of any indoor facility owned or leased or contracted by and used routinely or
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.
F. Hatch Political Activity Act and Intergovernmental Personnel Act
The Contractor will comply with the Hatch Political Activity Act, 5 USC 1501-1509
and 7324-7328, and the Intergovernmental Personnel Act of 1970, as amended by
Title VI of the Civil Service Reform Act, Public Law 95-454, 42 USC 4728 - 4763.
Federal funds cannot be used for partisan political purposes of any kind by any
person or organization involved in the administration of federally-assisted
programs.
G. 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 within 30 days of execution
of the agreement.
County of Oakland, Substance Use Disorder Services FY12 Page: 13 of 24
Contract # 20120862-00 Date: 10/13,2011
2. That any executed subcontract to this agreement shall require the
subcontractor to comply with all applicable terms and conditions of this
agreement. In the event of a conflict between this agreement and the
provisions of the subcontract, the provisions of this agreement shall prevail.
A conflict between this agreement and a subcontract, however, shall not be
deemed to exist where the subcontract:
a. Contains additional non-conflicting provisions not set forth in this
agreement;
b. Restates provisions of this agreement to afford the Contractor the
same or substantially the same rights and privileges as the
Department; or
c. Requires the subcontractor to perform duties and/or services in less
time than that afforded the Contractor in this agreement.
3. That the subcontract does not affect the Contractor's accountability to the
Department for the subcontracted activity.
4. That any billing or request for reimbursement for subcontract costs is
supported by a valid subcontract and adequate source documentation on
costs and services.
5. That the Contractor will submit a copy of the executed subcontract if
requested by the Department.
H. 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.
I. 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 as
permitted or required by applicable law; or to a subcontractor as appropriate
under this agreement.
County of Oakland, Substance Use Disorder Services FY12 Page: 14 of 24
Contract #20120862-00 Date: 10113/2011
2. The Contractor will ensure that any subcontractor will have the same
obligations as the Contractor 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 this agreement.
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 immediately report to the
Department any suspected or confirmed unauthorized use or disclosure of
protected health data and information that falls under the HIPAA requirements
of which the Contractor becomes aware. The Contractor will work with the
Department to mitigate the breach, and will provide assurances to the
Department of corrective actions to prevent further unauthorized uses or
disclosures.
Failure to comply with any of these contractual requirements may result in
the termination of this agreement in accordance with Part II, Section V.
Agreement 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 by the Contractor received 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.
IV. Financial Requirements
A. Operating Advance
The Department will not issue an operating advance under this agreement.
B. Reimbursement Method
The Department will make prepayments equal to the Contractor's prepayment
schedule that has been approved by the Department and the Contractor. The
prepayments will be monthly, paid up to the total Department allocation as agreed
to in the approved budget. Prepayments may be adjusted quarterly based upon
expenditure reports.
6.
County of Oakland, Substance Use Disorder Services FY12 Page: 15 of 24
P.
Contract # 20120862-00 Date: 10/13/2011
C. Revenues and Expenditures Report Submission - Initial and Final
Revenues and Expenditures Reports (RERs) shall be prepared as indicated in
Attachment B. and submitted via the Electronic Grants Administration and
Management System (EGrAMS).
RERs shall be submitted twice per agreement year. One will be submitted with
the agency's initial fiscal year EGrAMS application and one will be submitted as
the final RER for the fiscal year. The final RER will be an Attachment report and
due November 30 following the end of the fiscal year.
The final RER must reflect total actual program expenditures, regardless of the
source of funds.
To access EGrAMS, log in at: http://egrams-mi.com/dch
Failure to meet financial reporting responsibilities as identified in this agreement
may result in withholding future payments.
D. Financial Status Report Submissions
Financial Status Reports (FSRs) shall be prepared and submitted electronically
through MI E-Grants.
FSRs must be submitted on a quarterly basis, no later than thirty (30) days after
the close of each calendar quarterly. The quarterly FSRs must reflect total actual
program expenditures, regardless of the source of funds.
Failure to meet financial reporting responsibilities as identified in this agreement
may result in withholding future payments.
FSRs must reflect total actual program expenditures. Expenditures are reported
only for State Agreement funds.
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, as mandated by PA 533 of 2004. Vendor registration information is
available through the Department of Management and Budget's web site:
http://michigan.gov/cpexpress
County of Oakland, Substance Use Disorder Services FY12 Page: 16 of 24
Contract # 20120862-00 Date: 10/13/2011
F. Final Obligations and Financial Status Reporting Requirements
1, Obligations Report
A Obligation Report, based on annual guidelines, must be submitted by the due
date using the format provided by the Department's Accounting Division. The
Contractor must provide an estimate of total expenditures for the entire agreement
period. The information on the report will be used to record the Department's
year-end accounts payables and receivables for this agreement.
2- Final RER
The final RER is due as stated in Attachment C to this agreement and must be
submitted via EGrAMS as an Attachment Report. The final RER must be clearly
marked "Final". Final RERs not received by the due date may result in the loss of
funding requested on the Obligation Report and may result in the potential
reduction in the subsequent year's agreement amount.
3- 4th Quarter FSR
The 4th quarter FSRs are due sixty (60) days following the end of the fiscal year or
agreement period and must be submitted electronically through MI E-Grants.
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.
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 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 or an official of
the Contractor or an owner is convicted of any activity referenced in Section 111.0.
of this agreement during the term of this agreement or any extension thereof.
County of Oakland, Substance Use Disorder Services FY12 Page: 17 of 24
Contract #20120862-00 Dale: 10/13/2011
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 this agreement. The Department will make
payments to the Contractor for allowable reimbursable costs not covered by previous
payments or other state or federal programs. The Contractor shall immediately refund
to the Department any funds not authorized for use and any payments or funds
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. Any change proposed by the Contractor which would affect
the Department funding of any project, in whole or in part in Part I, Section 2.0. of the
agreement, must be submitted in writing to the Department for approval immediately
upon determining the need for such change.
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, or 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.
County of Oakland, Substance Use Disorder Services FY12 Page: 18 of 24
Contract #20120862-DO Date: 10/13/2011
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
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 permitted or required by applicable state or
federal law or regulation. Such information may be disclosed in summary, statistical, or
other form, which does not directly or indirectly identify particular individuals.
County of Oakland, Substance Use Disorder Services FY12 Page: 19 of 24
Contract # 20120862-00 Date: 10/13/2011
Attachments
Al Att A - Oakland County Addendum
:
A Att A - Statement of Work
.t,qt.ement .
B1 Att B - Financial Reporting Requirements
-Financial Reporting
B2 Att B - Revenues and Expenditures Rpt
E-Revenues- and Expenditures Rpt
B3 Att B - Equipment Inventory
Attacranent E2 Equip inventory
County of Oakland, Substance Use Disorder Services FY12 Page: 20 of 24
Local Total State
Amount
Activity lnkind
0.00 0.00
0.00 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
3,388,416.00
873,346.00
0.00
141,883.00
0.00
0.00
3,388,416.00
873,346.00
0.00
141,883.00
0.00
0.00
Total State Agreements
Totals
4,403,645.00
4,403,645.00
4,403,645.00
4,403,645.00
0.00 0.00
0.00 0.00
Contract #20120862-00 Date: 10113/2011
B6 Att B - Source of Funds
SOURCE OF FUNDS
State Agreements
Community Grant
Prevention
FASD Award
State Disability Assistance
Gambling, State Restricted
Strategic Prevention
Enhancement Project
County of Oakland, Substance Use Disorder Services FY12 Page: 21 of 24
CONTRACTOR NAME
County of Oakland
BUDGET PERIOD
From : 10/1/2011 To :9/30/2012
BUDGET AGREEMENT
W' Original 7 Amendment
AMENDMENT #
0
lnkind Local Total Activity
DIRECT EXPENSES
State Agreements
State Amount
Community Grant
Prevention
FASD Award
4 'State Disability Assistance
3,388,416.00
873,346.00
0.00
141,883.00
3,388,416.00
873.346.00
0.00
141,883.00
0.00 0.00
0.00 0.00
0.00 0.00
0.00 0.00
1
2
5
6
0.00 0.00 0.00 0.00
0.00 0.00 0.00 0.00
0.00 0.00 Total State Agreements 4,403,645.00 4,403,645.00
TOTAL DIRECT EXPENSES 4,403,645.00 4,403,645.00 0.00 0.00
0.00 0.00 TOTAL EXPENDITURES 4,403,645.00 4,403,645.00
Contract 4 20120862-00 Date: 10/13/2011
B7 Att B - Program Budget - Summary
PROGRAM I DATE PREPARED
Substance Use Disorder Services FY12 110/13/2011
MAILING ADDRESS (Number and Street)
1200 N. Telegraph Road
Bldg. 34 East
CITY
Pontiac
STATE
MI
ZIP CODE
48341-
1050
FEDERAL ID NUMBER
38-6004876
Gambling, State Restricted
Strategic Prevention
Enhancement Project
County of Oakland, Substance Use Disorder Services FY12 Page: 22 of 24
Total In kind Local Activity
DIRECT EXPENSES
State Agreements
State Amount
Treatment Services
Women's Specialty
MI Child
General Adminstration
Access Management System
Outreach to Injecting Drug
Users
2,304,503.001 0.00
85,000.001 0.00
8,000.001 0.00
270,258.001 0.00
485,058.001 0.00
235,597.001 0.00
Total for Community Grant I 3,388,416.00 0.00
2,304,503.00
85,000.00
8,000.00
270,258.00
485,058.00
235,597.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00 3,388,416.00
0.00 0.00
0.00
0.00
0.00
0.00
Prevention Services
General Adminstration
Total for Prevention
751,398.00
121,948.00
873,346.00
751,398.00
121,948.00
873,346.00
A
5
0.00 0.00 141,883.00 141,883.00
0.00 Total State Agreements 0.001 4,403,645.00 4,403,645.00
TOTAL DIRECT EXPENSES
TOTAL EXPENDITURES
4,403,645.00
4,403,645.00
0.00
0.00
Contract #20120862-00 Date: 10/13/2011
B8 Att B - Program Budget - Cost Detail
1 Community Grant
Prevention
FASD Award
State Disability Assistance
Treatment
Gambling, State Restricted
7 Strategic Prevention Enhancement Project
County of Oakland, Substance Use Disorder Services FY12 Page: 23 of 24
Contract #20120862-DO Date: 10/13/2011
C Att C - Reporting Requirements
D1 Att D - Other Requirements
D - Other Requirements
D2 Att 0 - Sentinel Event Reporting Guidance
Att.a;1,(neirit •..: Eve , .t T.- • Y1 •: • ane
D3 Att D- lob Retailer Master List Updates and Instructions
Attachment D-Tobacoo Retailer .rviaster Lf•:: & Instructions.
D4 Att D - Injecting Drug Users 90 Percent Capacity Treatment Report
D9DU 90 Percent Capacity Treatment Rpt Form-rev. 08,08
D4 Att D - Injecting Drug Users 90 Capacity Treatment Instructions
Attachment D-injecting Drug Urte,s 90 Fernent 'Tana-cit.,: Treatment
D5 Att D - Prevention Expenditures by Strategy Instructions
Attachment D-Prevention Strq•teg.,- teport instructions
D5 Att D- Prevention Expenditures by Stragety Rpt
0-Prevention Exbenditures by Strategy Report 8,05
D6 Att D - Prevention Report for SAPT Block Grant Instructions
Attachment 9)-Prevention Re.port for SAFI Block Grant Instructions
D6 Att D - Prey Rpt for SAPT Block Grant Rpt
Attachment 0-Prevention Report for SAFI - Block Grant
D7 Att D - Priority Populations Waiting List Deficiencies Instructions
Attachment 9)-Priority Fop. Waiting List Deficiencies Instructions
07 Att D - Priority Pop Waiting List Deficiencies Rpt
Attachment 9)-Priority Pop. Waiting List. Deficiencies Report 8.05
08 Att D - Special Projects Rpt Earmarked Funded, for applicable agencies only
Attachment 9)-Special Pmj Rpt Earmarked Funded off. 10.01.07
D9 Att D- Women's Specialty Services Instructions
Attachment 0-instructions for Womens Spec Services Report
D9 Att D - Womens Specialty Svcs Rpt
Attachment D-Women's Specialty Services Report
D10 Aft D- Youth Access to Tobacco Activity Annual Rpt
Attachment 0-Youth Access to Tobacco Acti.;ity Annual Report 8,05
D11 Att D - Instructions for SUD Entity Inventory Report
Attachment D-instructions for SUD Entity inventory Report
D11 Att D - SUD Entity Inventory Report
Attachment 0- SUD Entity Inventory Report
D12 Att D 7 Charitable Choice Report
Charitable Choice Report
D13 Att D - SUD Services Policy Manual
SUD Services Policy Manual
County of Oakland, Substance Use Disorder Services FY12 Page: 24 of 24
Attachment B.1
Michigan Department of Community Health
Financial Reporting Requirements
Fiscal Year (FY) 2012
The reporting of revenues and expenditures will be accomplished via two avenues. For
revenues and expenditures: an initial and a final Revenues and Expenditures Report
(RER). For expenditures only: quarterly and final Financial Status Reports (FSRs).
See Attachment D-FSR Instructions.
1. REPORTING REVENUES AND EXPENDITURES
Revenues and Expenditures Report
The main purposes and applications of the RER include the following:
• Display revenue sources and expected amounts, and how these are
budgeted at the start of a fiscal year;
• Enable management and monitoring of federal and state spending
requirements; and
• Enable reconciliation of prepayments and expenditures on an annual basis.
The initial RER and the final RER will be used to provide a standardized format
for reporting the financial status of individual programs. All actual expenditures
and revenues (including Medicaid, Adult Benefits Waiver [ABM, MI Child, Local,
Fees and Collections, and Other Contracts and Sources) for the particular
program are reported on the final RER.
The initial RER is submitted with the initial, fiscal year application in EGrAMS and
the final RER is submitted as an 'Attachment' reports in EGrAMS. The
Coordinating Agency (CA) will be responsible for assuring that its budgets and
expenditures, as reported on the RER detail pages, correctly total to the RER
Composite Page.
Reporting of revenues and expenditures must be consistent with Generally
Accepted Accounting Principles (GAAP).
All amounts entered on the RERs must be whole dollars.
2. ADMINISTRATIVE BUDGETS AND EXPENDITURES
CA budgets and expenditures for Administration must be reasonable, prudent,
and commensurate with meeting the requirements of this agreement, consistent
with 2 CFR Part 225 (previously OMB Circular A-87) or 2 CFR Part 230
(previously OMB Circular A-122), as applicable.
The CA's Access Management System (AMS) is considered an administrative
operation, and cannot be a direct service operation. To assure accurate
Att B1 Financial Rpting Req FY2012 Initial.doc Page 1 of 15
Attachment B.1
classification of AMS expenditures, and in the interest of reporting consistency,
AMS expenditures must be reported separately on the initial and final RER, on
Page 3, in the indicated column.
All of the CA's administrative costs must be entered in the General
Administration or the AMS column on page 3 of the RER. This includes costs for
all CA personnel (Prevention Coordinators, Treatment Coordinators, etc.),
information and data systems, financial audits, and other administrative costs.
The CA must enter the dollar amount of General Administration expenditures that
is attributable to the costs of administering treatment services on the RER, page
3, in the section at the lower portion of the page, labeled "SUD Treatment
Administration." Any generally accepted method may be used to determine this
amount. This information is needed to meet reporting requirements for the
Substance Abuse Prevention and Treatment (SART) Block Grant.
If the Administration budget contains a central cost allocation amount or rate, this
allocation must have been developed consistent with 2 CFR Part 225 (OMB
Circular A-87, Attachment C). Payments are subject to recovery, based on audit
findings.
When there is a central cost allocation, the CA must also submit via EGrAMS, on
CA letterhead, a Certificate of Cost Allocation Plan whenever a central cost
allocation is introduced or is revised, or every two years, whichever is sooner.
This Certificate of Cost Allocation Plan form is available electronically (in WORD)
from the MDCH contract manager or use the format shown below:
Att B1 Financial Rptina Rea, FY2012 Initial.doc Page 2 of
Attachment B.1
(Printed On CA Letterhead)
Certificate of Cost Allocation Plan
This is to certify that I have reviewed the Cost Allocation Plan and to the best of my
knowledge and belief:
(1) All costs included in this proposal to establish cost allocations or billings for October
1, 2011 through September 30, 2012 are allowable in accordance with the
requirements of 2 CFR Part 225, "Cost Principles for State, Local, and Indian Tribal
Governments", and the Federal award(s) to which they apply. Unallowable costs
have been adjusted for in allocating costs as indicated in the Cost Allocation Plan.
2 CFR Part 225 can be found at the following link:
ciov/sitLL,Ai -.::.:,:,•,;tifiles/ombilassetsioniblfedreQ/2005/083105
7, pfif
(2) All costs included in this proposal are properly allocable to Federal awards on the
basis of a beneficial or causal relationship between the expenses incurred and the
awards to which they are allocated in accordance with applicable requirements.
Further, the same costs that have been treated as indirect costs have not been
claimed as direct costs. Similar types of costs have been accounted for consistently.
I declare that the foregoing is true and correct.
CA Name:
Signature:
Name of Official:
Title:
Date of Execution:
This Certificate of Cost Allocation Plan should be used for certification of the CA's Cost
Allocation Plan. This form must be signed by the Executive Director or Finance Director
of the CA.
Att 51 Financial Rptina Reg FY2012 Initial.don 1"g," 3 of 15
Attachment B.1
ALLOCATION REVISION REQUESTS
An Allocation Revision Request is a request to move State Agreement funds
between allocated categories during the amendment application process. MDCH
must approve or deny the request in EGrAMS before the amendment application
process will continue.
The MDCH must allocate and manage state-administered funds in a way that
assures compliance with all federal and state requirements, including SAPT
Block Grant expenditure requirements. The initial allocations for each fiscal year
are in compliance with these requirements. During the amendment application
process, a CA may propose to increase or reduce its allocation for Prevention,
within the limits of its total allocation. Though there is no separate allocation for
Treatment, this flexibility applies to Treatment as well. The MDCH will be
receptive to approving allocation revisions during amendments, when 1) the CA
can demonstrate that all applicable planning and agreement requirements can be
achieved, perhaps through the use of other available resources, for all affected
program and budget areas and 2) the MDCH can maintain compliance with
federal and state requirements. With regard to redirection of Treatment funds,
the CA must be able to demonstrate that treatment needs within the catchment
area are fully met and that there is adequate capacity to meet drug court and
offender re-entry initiatives as well.
4. BUDGET AMENDMENTS
A budget amendment is required when there is either an increase or decrease to
the CA's State Agreement amount.
Requests for budget amendments must be submitted via EGrAMS.
5. BUDGET REVISIONS
A Budget Revision involves moving state-administered funds between
expenditure budgets (Prevention, Treatment, etc.) without changing the total
budgeted amount of state-administered funds. A Budget Revision may be
requested in an amendment(s) and in the final RER.
CA Discretionary Revisions
The CA is granted limited discretion to revise the budgeted amounts of state-
administered funds without prior approval by MDCH. This discretion is applicable
only to the budget categories of combined CA General Administration and
Access Management System (treated as one category for this purpose only), and
Treatment, and it is applicable only to Community Grant funds. It is not
applicable to the WSS' Target.
Atf B1 Financial Rpting FRea, FY2012 Initial.doc Page 4 of 15
Attachment B.1
The CA may decrease or increase each of the above two budget categories by
up to $50,000 annually through the transfer of Community Grant funds among
these budget categories. Under this discretion, $50,000 is the annual, maximum
net change, up or down, that may be effected in either of the two budget
categories.
On the final RER, Community Grant row, expenditures for AMS, Treatment,
Women's Specialty Services (WSS), Adult Benefits Waiver (ABW) and MIChild
are fungible, once required targets and match requirements are met.
Expenditures in excess of the WSS target and MIChild match requirements can
be moved across these five budget categories as needed and as is consistent
with this agreement without invoking the $50,000 Deviation Allowance.
Community Grant earmarked funding for certain programs, as identified in the
CA's initial FY allocation letter and subsequent allocation amendments, can only
be used for that particular program. Such programs include, but not limited to,
both Odyssey Houses, Hispanic Services Program, and Sacred Heart.
Reducing the amount of budgeted Community Grant funds does not reduce or
amend any requirements stated elsewhere in this agreement, with respect to
either of the two budget categories. For example, reducing the Treatment budget
does not reduce the CA's program or performance responsibilities regarding
Treatment.
All Discretionary Revisions must be reported on the final RER.
NOTE - Prevention Discretionary Revisions: This $50,000 Discretionary
Revision option does NOT apply to Prevention. The CA may request to transfer
funds from or to Prevention via an email to the CA's MDCH contract manager.
The rationale for the transfer must be included in the email. Written MDCH
approval is required before the transfer takes place.
CLARIFICATION – Discretionary Revisions, as outlined above, are applicable to
the processing of the SUD agreement, as follows: 1) during each amendment
application process; and 2) at the final RER submission.
6. NOTICE OF EXCESS OR INSUFFICIENT FUNDS (NEIF)—DUE JUNE 1
Coordinating agencies must notify the Department in writing and upload the
notice to EGrAMS by June 1 if the amount of State Agreement funding may not
be used in its entirety or appears to be insufficient.
The contract requires that the CA expend all allocated funds per the
requirements of the SUD contract within the contract year OR notify the
Department via the NEIF that spending by year-end will be less than the
amount(s) allocated. This requirement applies to individual allocations, earmarks
Alt B1 Financial Rptina Reg FY2012 Initial.doc Page 5 of 15
Attachment B.1
and to the total CA allocation. Of particular importance are allocations for
Prevention services and Women's Specialty Services (VVSS), including the
earmarked allocations for the Odyssey programs. The State must closely
monitor these expenditures to ensure compliance with the Maintenance of Effort
requirement in the federal SAPT Block Grant.
When it has been determined that a CA will not expend all of its allocated, WSS
State Agreement funds (including the earmarked allocations for the Odyssey
programs), these unspent funds must be returned to the Department for
reallocation to other CAs who can appropriately use these funds for WSS
programs within their CA regions within the current fiscal year. A CA's failure to
expend these funds for the purposes for which they are allocated and/or its
failure to notify the Department of projected expenditures at levels less than
allocated may result in reduced allocations to the CA in the subsequent contract
year.
7. REVENUES
For State Agreement fund sources, Revenues are as listed in the CA's initial
allocation letter and subsequent amendments in EGrAMS.
For most other funds sources, Revenues are estimates. In some cases, the CA
may not be planning to expend all fiscal year Revenues.
On the final RER for the fiscal year, revenues and expenditures must be actual.
It is understood that, for non-State Agreement fund sources, total actual
expenditures may be less than total Revenues.
8. INITIAL OR FINAL ANNUAL BUDGET PLAN AND AGGREGATE PLANNED
(BUDGETED) EXPENDITURES
For State Agreement fund sources, planned (budgeted) expenditures, added
together, must equal the Initial Annual Budget Plan or the Final Annual Budget
Plan, as applicable, as entered on the RER-Composite.
For most other fund sources, planned (budgeted) expenditures are estimates. In
some cases, the CA may not be planning to expend all fiscal year revenues. It is
not necessary that aggregate planned (budgeted) expenditures equal the Initial
Annual Budget Plan or the Final Annual Budget Plan, as applicable, as entered
on the RER-Composite. That is, planned (budgeted) expenditures in each row
do not necessarily add to the total planned budget.
On the final RER for the fiscal year, 1) Revenues and expenditures must be
actual; and 2) Budgets must be the same as those presented in the final fiscal
year amendment. It is understood that, for non-State Agreement sources, total
All B1 Financial Rpting Req FY2012 Initial.doc Page 6 of 15
Attachment B.1
actual expenditures may be less than total planned (budgeted) expenditures.
Exception: Local Match.
9. REPORTING FEES AND COLLECTIONS
The MDCH/CA agreement requires agencies to report actual fees and collections
associated with services that the CA purchases. Expected revenues from fees
and collections must be reported on the initial annual RER. The final RER for the
fiscal year must report actual revenues.
Some agencies reimburse providers net of co-pay amounts, whether or not the
co-pays are actually collected by providers. Please do not report uncollected co-
pay revenues. Report only the revenues actually earned.
Food stamp revenue, in conjunction with residency, should be reported in Fees
and Collections—Section F on the initial and final RERs.
10. LOCAL MATCH—HOW TO BUDGET FEES/COLLECTIONS AND LOCAL
FUNDS
Amounts for Local Match are reported in the initial and final RERs. Please be
sure that the amounts entered meet Local Match criteria. The substance use
disorders agreement (Attachment A) clarifies which fees and collections may
count toward Local Match.
Please use the following worksheet to assist in computing the CA's Local Match
percentage:
MATCH COMPUTATION - MUST BE AT LEAST 10%
a. GRAND TOTAL
(Last row of initial RER, page 2, Initial Annual Budget Plan, Column C (budgets only, OR
last row of final, year-end RER, page 2, Expenditures for Agreement Period, Column E)
b. LESS:
Section B. Medicaid subtotal
Section C. ABW Gross subtotal
Section D. MIChild subtotal
Section G. Other Contracts & Sources (incl. direct Federal) S
c. TOTAL (Subtotal of b.)
d. FUNDS SUBJECT TO MATCH (a. minus c.)
e. MATCH FUNDS:
Section E. Local Subtotal
Section F. Fees & Collections Subtotal
f. TOTAL MATCH FUNDS (Subtotal of e.)
Att B1 Financial Rpting Req FY2012 Initiql_flon Page 7 of 15
Attachment B.1
g. MATCH PERCENTAGE (f/d * 100 = 00.00%)
NOTE: At the beginning of the fiscal year, the CA will use the Initial Annual Budget
Plan amounts from Column C of the initial RER, when completing the Match
Computation Table.
At the end of the fiscal year, the CA will use final, year-end expenditures from
Column E of the RER, when completing the Match Computation Table.
11. MICHILD AND ABW SAVINGS
MIChild savings become Local funds in the fiscal year following the year in which
the savings were earned. Savings should be entered in Section E. Local, Row 3-
Other Local in the initial and final RER of the fiscal year following the year in
which the savings were earned.
The MIChild savings must be expended consistent with requirements in this
Agreement, pertaining to State Agreement funds, to support the CA's substance
use disorders program.
The ABW savings should be treated according to the CA/Prepaid Inpatient
Health Plan(s)' (P1HP) agreement(s).
12. POSTING MEDICAID REVENUES THAT ARE TRANSFERS FROM A PIHP
Some CAs receive increased Medicaid revenues in the form of transfers from a
PIHP, usually late in the fiscal year. Assuming these are current year PEPM
funds, these revenues and associated expenditures should be entered on the
final RER-Composite.
13. ADULT BENEFITS WAIVER
Withholds of State Share Amounts
ABW per member per month gross payments for ABW SUD will be paid to
PIHPs. The state portion of the gross will be calculated as a projection based on
an estimate of annual member months per CA. The CA's fiscal year State
Agreement allocation will be reduced by this projected amount and then paid to
the PIHPs by the Department. The amount of the reduction may be adjusted
during the fiscal year, if warranted, based on unanticipated changes in
enrollment. The amount of each CA's reduction will be determined by the
Department based on:
• the projected annual beneficiary count per county (or city, in the case of
Detroit) that is within a CA region and also within a PIHP region, multiplied by
Att B1 Financial Rpting Reg FY2012 Initial.doc Page 8 of
Attachment B.1
• the state share of the gross rate including use tax, multiplied by
• the PIHP's geographic factor.
How to Report ABW Revenues and Expenditures
If the CA has ABW expenditures, if any, in the General Administration (GA) or
Access Management System (AMS) categories, these expenditures should be
reported in the GA and/or AMS columns on Page 3 of the RER.
For ABW expenditures reported in Row C (gross expenditures), state share does
not have to be reflected in the Community Grant row, because the state share is
included in the gross.
On Page 4 of the RER, the ABW column label reads "ABW Treatment." This is
to clarify that only ABW expenditures for treatment services should be reported in
this column, given that there may be ABW expenditures reported also for GA and
AMS.
How to Report Expenditures for WSS- and ABW-Eligible Women
When a woman is eligible for both ABW and WSS funds, the woman's
expenditures must be paid for with ABW funds.
Report these expenditures in the Women's Specialty column, Section C. ABW,
Rows 2 and 3—federal and state share respectively (see Page 3). This also
applies to the Odyssey House WSS expenditures (see Page 6).
Use of State-Administered Funds for ABW Enrollees
ABW funds are first source for all services, both covered and optional, provided
to ABW beneficiaries. Other funds provided through the MDCH/CA contract
cannot be used for any services to ABW beneficiaries if ABW funds are available.
"Available" includes ABW gross revenues (federal share and state share)
received and not expended during FY 2012.
14. MIChild
On a monthly basis, MDCH will provide the CA with the federal share of MIChild
funds as a per capita payment based upon a Per Enrolled Child Per Month
(PECPM) methodology for MIChild covered services. In consideration for
accepting the federal funding pushed to the CA, the CA agrees to redirect
existing State General fund dollars to match the MiChild federal FMAP funds
(Title XXI State Children's Health Insurance Program) and carry out the
associated substance use disorder program requirements. The PEPCM rate is
$0.33 (33 cents) per month.
The Federal and State MIChild percentages for each fiscal year will be updated,
as needed, by MDCH on an annual basis or as rates change.
Aft B1 Financial Retina Rea, FY2012 Initialxioc Page 9 of
Attachment B.1
The PECPM funding is a per capita payment for medically necessary MIChild-
covered services including outpatient, residential and inpatient services as
authorized by the CA. If the MIChild capitation is not sufficient to serve the
MIChild enrollees, use of state-allocated General Funds is allowed. Federal
SAPT Block Grant funds may not be used for inpatient care.
15. EARMARKED FUNDS
Special, earmarked funds will be identified in the CA's initial fiscal year allocation,
as shown in EGrAMS. Earmarked funds may include Odyssey House, Hispanic
Services Program, Sacred Heart, or other identified programs. The CA must
budget separately these special earmarked funds in the initial fiscal year
agreement application, the initial RER, subsequent amendments, and the final
RER. When it has been determined that a CA will not expend all of its special,
earmarked State Agreement funds (including the earmarked allocations for the
Odyssey programs), these unspent funds must be returned to the Department.
If those unspent funds are Odyssey House (WSS) funds, the Department will
reallocate the funds to other CAs who can appropriately use these funds for WSS
programs within their CA regions within the current fiscal year.
16. WOMEN'S SPECIALTY SERVICES—REQUIRED TARGET
Each CA's Women's Specialty Services (WSS) funds are combined with the
Community Grant allocation. For the purpose of assuring statewide compliance
with the SAPT Block Grant minimum expenditure requirement for Women's
Specialty Services, each CA is given a minimum expenditure target for these
services, as stated in its initial allocation letter in EGrAMS. All program/services
objectives related to Women's Specialty Services remain in place.
The expenditure target can be reached through the expenditure of a combination
of SAPT Block Grant and state funds for specialty treatment services for eligible
individuals. Eligible individuals are pregnant women, primary caregivers with
dependent children, or primary caregivers attempting to regain custody of their
children. State funds include SDA funds as well as the state share amounts of
Medicaid and ABW funds. Use of federal and state funds must be consistent
with applicable agreement requirements.
MDCH extends the five federal requirements to primary caregivers attempting to
regain custody of their children or at risk of losing custody of their children due to
a substance use disorder. These individuals are a priority service population in
Michigan and; therefore, the five federal requirements shall be made available to
them.
Attainment of the expenditure target and program/services objectives is a
contract performance requirement. The target can be amended by mutual
Att B1 Financial Rptina Rea FY2012 Initial.doc Rag', 10 of 15
Attachment B.1
agreement. MDCH will not approve budget revisions or amendments that appear
to create risk of failing to meet the Women's Specialty Maintenance of Effort.
If an CA reports Medicaid and ABW funds for VVSS on the initial and final RERs,
the CA must post both Medicaid and ABW federal and state shares for WSS-
not just the Medicaid and ABW state shares.
The federal and state Medicaid and ABW percentages for each fiscal year will be
updated, as needed, by MDCH on an annual basis or as rates change.
As a check, when adding both Medicaid and ABW federal and state shares for
WSS (budgets or expenditures), the total amount multiplied by the current-year
state or federal Medicaid and ABW Federal Medical Assistance Program (FMAP)
percent must be the amount posted in the CA's RER budget and final HER
expenditures.
EXAMPLE:
FINAL FUND SOURCE BUDGET EXPENDITURES
B. Medicaid
1. Current Year PEPM (Federal & State)
2. Federal share only for WSS $87,107 $69,383
3. State share only for WSS $44,594 $35,520
4. Reinvestment Savings
B. Subtotal $131,701 $104,903
$131,701 x .3386 = $44,594 (state share for WSS)
17. PREVENTION ALLOCATION
There are no separate allocations for Tobacco Vendor Education or Non-Synar
Tobacco Retailers Inspections. CAs are expected to use their Prevention
allocations to meet tobacco-related performance objectives and to accomplish
other Prevention plans developed through the Annual Plan Guidelines.
18. HOW TO COMPLETE THE SUD TREATMENT ADMINISTRATION MINI
REPORT (Bottom of Page 3)
On the bottom of Page 3 is a mini report labeled "SUD Treatment
Administration." The information provided here is needed by the Department in
order to complete the annual SAPT Block Grant application.
In Column 1, enter Community Grant expenditures for General Administration
which are attributed to SUD treatment services. That is, how much of the
expenditures entered in Row A.1, Column C, can be considered treatment
Att B1 Financial Rptina Rea FY2012 Initial.doc Page 11 of 15
Attachment B.1
administration expenditures? There is NO formula in this cell. An estimate is
acceptable.
In Column 2, there is a formula in this cell. The Community Grant expenditures
for AMS, from Row A.1/Column E, will populate automatically to this cell.
In Column 3, there is a formula in this cell which totals expenditures in Columns 1
and 2.
19. HOW TO REPORT GENERAL ADMINISTRATION
On Page 3, in Column C, enter expenditures charged to CA General
Administration for each of the applicable funding sources (Column A).
"Administration" includes the seven administrative functions listed and defined in
the document entitled, "Establishing Administrative Costs Within and Across the
CA System" (Attachment B.3). General Administration does not include AMS.
(See below.)
The Administrative Rules for the Substance Use Disorders Service Program
prohibit CAs from providing services. Any activity or function that is carried out
within the CA or that is allocated to the CA is considered an administrative
activity or function, and expenditures must be reported as such. For example, all
CA personnel expenditures for employees and contractors are administrative
expenditures, including expenditures for Prevention Coordinators, Treatment
Coordinators, and others.
If a CA purchases administrative functions from a vendor or subrecipient, these
contractual expenditures must be reported as CA administration. This would
include audit services, data reporting functions, building maintenance, and so
forth. Refer to the document entitled, "Establishing Administrative Costs Within
and Across the CA System" (Attachment B.3). The administrative costs of service
providers, whether vendors or subrecipients, are not counted as CA
administrative costs.
20. HOW TO REPORT ACCESS MANAGEMENT SYSTEM (AMS)
On Page 3, in Column E, enter expenditures charged to AMS functions for each
applicable fund source (Column A). AMS functions are as described in
Treatment Policy yLO_Z net7tSstem, which may be found in the
SUD Services Policy Manual. All AMS functions are administrative. The AMS
column (category) can be considered a subcategory of Administration, for RER
purposes.
AMS budget and expenditures must be reported in AMS/Column E, whether the
functions are carried out within the CA, by another entity, by a contractor, or by a
combination of these.
Att B1 Financial Rptina Rea FY2012 Initial.doc Page l2 of 1
Attachment B.1
If a CA purchases AMS functions through a contractor, and if the contractor also
provides direct services under the contract, expenditures associated with AMS
functions are to be reported in AMS/Column E on the RER. Expenditures
associated with services are to be reported in the appropriate services category
column(s).
21. HOW TO COMPLETE THE MDCH ADMINISTRATION AND SERVICE
COORDINATION REPORT
This report has a sub-category of Administration called "Service Coordination."
This captures the work and funds that CAs apply to activities that are
administrative, but that may engender more direct benefit to the community.
Service Coordination does not involve the delivery of direct services. Service
Coordination may include activities conducted by CA employees or by
contractors, but only includes activities that otherwise would be categorized as
administration_
Examples of Service Coordination:
• collaborative planning with community stakeholders;
e work with community coalitions;
• development of new services and supports (such as recovery services);
• developing media campaigns;
* sustaining and expanding promising practices and methods; and
• providing consultation and technical assistance regarding services.
22. DISTRIBUTION
The initial RER (submitted with initial FY EGrAMS application) and final RER
(submitted as an attachment in EGrAMS) should be prepared and distributed as
follows:
One Copy - An electronic or printed copy of each RER should be retained by CA.
One Copy - Submitted electronically via EGrAMS at http:liegrams-m; 1.
Submission of the RERs shall be in accordance with the instructions in
Attachment C-Required Reports.
23. RETENTION
All RERs should be retained for a period complying with the retention policies
established in the agreement.
Att B1 Financial Rptina Reg FY2012 Initial.doc PAgP nf 1
Attachment B.1
hhiCHIGAN DEPARTMENT OF COMMUNITY HEALTH
Final Year-end Reporting
Revenues and Expenditures Renal
The final RER is due by November 30 following the end of the fiscal year. The form
must be marked "FINAL" on the Face Page.
The final RER will be used for final cost settlement purposes.
Budgets on the final RER must be the same as those presented on the final amendment
for the year.
Final, year-end expenditures can be more than the corresponding budget, within the
$50,000 Deviation Allowance.
Within these final reports, financial information must be consistent and reconcile
between the following reports:
1) Legislative Report;
2) Prevention Expenditures by Strategy Report; and
3) Revenues and Expenditures Report (Final), including:
a) ABW Year-end Balance Worksheet;
b) MIChild Year-end Balance Worksheet; and
c) Administration and Service Coordination Expenditures Report.
The CA is required to liquidate all accounts payable and encumbrances by December
31 (see definitions below).
Exceptions may be granted for one-time obligations that cannot be liquidated within this
time period. However, should this be the case, an additional fifteen (15) days may be
provided if a written request for an extension, with the reason why additional time is
needed, is submitted by the due date of the final RER. Please submit such requests to
the CA's contract manager.
Failure to meet these final reporting deadlines may result in the State's inability to
reimburse the full amount of the State's share of the gross expenditures.
In addition to submitting initial and final RERs, other financial information will be
requested to assist MDCH in properly closing the State's fiscal year (September 30).
This information will help ensure sufficient funds have been reserved by the State to
make reimbursement for the agreement in the State's upcoming fiscal year. The
additional financial information required will include an estimate of open commitments
and obligations incurred as of September 30, but not yet paid. The MDCH/Accounting
Att B1 Financial Rptina Rea FY2012 Initial.doc Page l4 of 15
Attachment B.1
Division will provide detailed instructions for reporting additional financial information by
mid-August of each year.
DEFINITIONS:
• Accounts Payable - Obligations for goods or services received, which have not been
paid for as of the end of the agreement period.
• Encumbrances - Commitments at the end of the agreement period related to
unperformed (executory) contracts for goods and services.
Note: If an agreement does not end on September 30, it is still necessary to estimate
accounts payable as of September 30.
All inquiries regarding financial reporting issues should be directed to the Expenditure
Operations Section of the MDCH/Accounting Division.
References:
Michigan Department of Management and Budget
• Guide to State Government (1210.27).
• Year-End Closing Guide.
Federal OMB Circular A-102 (Revised & DHHS Common Rule).
Att B1 Financial Rpting Reg FY2012 Initial.doc Page 15 of 15
Version: Substance Abuse
Services
MICHIGAN DEPARTMENT OF COMMUNITY HEALTH
FY 11/12 AGREEMENT ADDENDUM A
1. This addendum adds the following section to Part I and Renumbers existing 11
Special Certification to 12 and existing 12 Signature Section to 13:
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.
Oakland CA Addendum to FY2012 aareement.doc Page 1 of 3
Version: Substance Abuse
Services
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.
Assurances
A. Compliance with Applicable Laws. This first sentence of this
paragraph will be stricken in its entirety and replace 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.
I. Health Insurance Portabilit and Accountabilit 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 there under.
IX. Liability. Paragraph A. will be deleted in its entirety and replaced with the
following language.
A. Except as otherwise provided by law neither Party shall be
obligated to the other, or indemnify the other for any third party
claims, demands, costs, or judgments arising out of activities to be
carried out pursuant to the obligations of either party under this
Contract, nothing herein shall be construed as a waiver of any
governmental immunity for either party or its agencies, or officers
and employees as provided by statute or modified by court
decisions.
Oakland CA Addendum to FY2012 aareement.doc Page 2 of 3
Version: Substance Abuse
Services
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
Oakland CA Addendum to FY2012 aareement.doc Pane 3 of 3
FISCAL NOTE (MISC . #11309) December 15, 2011
BY: FINANCE COMMITTEE, TOM MIDDLETON, CHAIRPERSON
IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2011/2012
SUBSTANCE USE DISORDER GRANT ACCEPTANCE
TO THE OAKLAND COUNTY BOARD OF COMMISSIONERS
Chairperson, Ladies and Gentlemen:
Pursuant to Rule XII-C of this Board, the Finance Committee has reviewed the above-referenced
resolution and finds:
1. The Michigan Department of Community Health (MDCH) has awarded the Oakland County
Department of Health and Human Services/Health Division funding in the amount of
$4,403,645.
2. The previous year's 2010/2011 award was $4,293,323, for a total increase of $110,322 in
funding.
3. A grant match estimated at $656,060 is required based on the entire FY 2012 Substance
Abuse services program budget. Specialty Substance Abuse Medicaid Services, Substance
Abuse Adult Benefit Waiver, and MI Child will be accepted by separate resolution and are not
subject to a required match.
4. Total funding for this program amounts to $5,059,705.
5. Funds will be used to subcontract with agencies to prevent and reduce the incidence of drug
and alcohol abuse and dependency.
6. The grant period extends from October 1, 2011 through September 30, 2012.
7, The Fiscal Year 2012 Special Revenue Budget is amended as follows:
HEALTH MDPH OSAS (Fund 28249)
Budget Reference 2012 / GR0000000203
FY2012
FY2012 FY2012 Amended
Adopted Adjustment Budget
Revenues
1060261-134790-610313 Federal $4,792,578 ($1,194,392) $3,598,186
1060261-134790-615571 State 0 805,459 805,459
Total Revenues $4,792,578 $ (388,933) $4,403,645
Expenses
1060261-133405-730373
1060261-133685-730373
1060261-133950-702010
1060261-133950-722740
1060261-133950-730366
1060261-133950-730926
1060261-133960-702010
1060261-133960-722740
1060261-133960-730366
1060261-133960-730926
1060261-134790-702010
1060261-134790-722740
1060261-134790-730366
1060261-134790-730373
1060261-134790-730926
1060261-134795-702010
1060261-134795-722740
1060261-134796-702010
1060261-134796-722740
1060261-134796-730366
1060261-134796-730926
Contract Svs.
Contract Svs.
Salaries
Fringe Benefits
Contract Adm.
Indirect Costs
Salaries
Fringe Benefits
Contract Adm.
Indirect Costs
Salaries
Fringe Benefits
Contract Adm.
Contract Svs.
Indirect Costs
Salaries
Fringe Benefits
Salaries
Fringe Benefits
Contract Adm.
Indirect Costs
$ 630,700 $ 120,698 $ 751,398
150,333 (150,333) 0
110,801 ( 49,748) 61,053
75,003 ( 41,235) 33,768
239,498 (231,864) 7,634
0 9,256 9,256
86,557 ( 20,990) 65,567
78,708 ( 38,300) 40,408
0 7,972 7,972
0 9,940 9,940
163,989 ( 13,506) 150,483
95,227 ( 34,079) 61,148
337,754 (301,940) 35,814
1,238,809 1,300,577 2,539,386
22,221 592 22,813
122,457 (122,457) 0
79,830 ( 79,830) 0
61,913 0 61,913
46,532 0 46,532
0 4,116 4,116
0 9,386 9,386
FINANCE COMMITTEE
Motion carried unanimously on a roll call vote with Greimel absent.
FINANCE CQMMITTEE
e"—
1060261-134800-702010 Salaries 410,750 (184,992) 225,758
1060261-134800-722740 Fringe Benefits 310,971 (135,259) 175,712
1060261-134800-730366 Contract Adm, 522,720 (473,357) 49,363
1060261-134800-730373 Contract Svs, 7,805 ( 7,805) 0
1060261-134800-730926 Indirect Costs 0 34,225 34,225
Total Expenses $4,792,578 $ (388,933) $4,403,645
Resolution #11309 December 15, 2011
Moved by Long supported by Zack the resolutions (with fiscal notes attached) on the amended Consent
Agenda be adopted (with accompanying reports being accepted).
AYES: Covey, Crawford, Dwyer, Gershenson, Gingell, Gosselin, Greimel, Hatchett, Hoffman,
Jackson, Long, Matis, McGillivray, Middleton, Nash, Nuccio, Potts, Quarles, Runestad, Scott, Taub,
Weipert, Woodward, Zack, Bosnic. (25)
NAYS: None. (0)
A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the amended Consent
Agenda were adopted (with accompanying reports being accepted).
Y APP..3VE THE FOHEGC:NG PEFOLUTION
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 December 15,
2011, with the original record thereof now remaining in my office.
In Testimony Whereof, I have hereunto set my hand and affixed the seal of the County of Oakland at Pontiac,
Michigan this 15th day of December, 2011.
PLu-- ,94
Bill Bullard Jr., Oakland County