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HomeMy WebLinkAboutResolutions - 2015.01.29 - 21662MISCELLANEOUS RESOLUTION #15007 January 29, 2014 BY: General Government Committee, Christine Long, Chairperson IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION - 2014/2015 COMPREHENSIVE PLANNING, BUDGETING AND CONTRACTING (CPBC) AGREEMENT ACCEPTANCE To the Oakland County Board of Commissioners Chairperson, Ladies and Gentlemen: WHEREAS the Michigan Department of Community Health (MDCH) has awarded the Oakland County Health Division funding via the Comprehensive Planning, Budgeting, and Contracting Agreement for the period October 1, 2014 through September 30, 2015; and WHEREAS the 2013/2014 Comprehensive Planning, Budgeting, and Contracting Agreement award included a total funding amount of $9,681,849 in grant revenue and expenditures; and WHEREAS the 2014/2015 Comprehensive Planning, Budgeting, and Contracting Agreement award reflects grant funding in the amount of $10,188,437, an increase of $506,588 (5.2%) from the previous year; and WHEREAS additional funding is expected in future contract amendments this fiscal year; and WHEREAS the budget detail for the various programs is a matter of negotiation between the Health Division and MDCH; amendments will be recommended to the FY 2015 Budget when details are finalized; and WHEREAS the CPBC Agreement has been submitted through the County Executive Review Process and is recommended for approval. NOW THEREFORE BE IT RESOLVED that the Oakland County Board of Commissioners hereby accepts the 2014/2015 Comprehensive Planning, Budgeting, and Contracting (OPEC) agreement for funding in the amount of $10,188,437 for the period of October 1, 2014 through September 30, 2015. BE IT FURTHER RESOLVED that the future level of service, including personnel, be contingent upon the level of funding for this program. BE IT FURTHER RESOLVED that the Board Chairperson is authorized to execute this agreement, any changes and extensions to the agreement not to exceed fifteen percent (15.%), which is consistent with the agreement as originally approved. BE IT FURTHER RESOLVED that the Oakland County Board of Commissioners authorizes its Chairperson to execute this Agreement subject to the following additional condition: That the County's approval for entering into this Agreement is specifically conditioned and premised upon the acceptance, approval and execution of the Agreement containing Addendum A, by the Michigan Department of Community Health, and that the failure of the Michigan Department of Community Health to execute the Agreement as specified shall, without any further act of the Oakland County Board of Commissioners, automatically negate and void the County's approval and/or acceptance of this agreement as provided for in this resolution. Chairperson, on behalf of the General Government Committee, I move the adoption of the foregoing resolution. GENERAL GOVERNMENT COMMITTEE GENERAL GOVERNMENT COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Matis and Quarles absent. GRANT REVIEW SIGN OFF — Health Division GRANT NAME: FY 2015 Comprehensive Planning, Budgeting, and Contracting Agreement FUNDING AGENCY: Michigan Department of Community Health DEPARTMENT CONTACT PERSON: Rachel Shymkiw / 452-2151 STATUS: Grant Acceptance DATE: December 22, 2014 Pursuant to Misc. Resolution #13180, 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 (12/9/2014) Department of Human Resources: HR Approved (No Committee) — Lori Taylor (12/9/2014) Risk Management and Safety: Approved by Risk Management. — Robert Erlenbeck (12/10/2014) Corporation Counsel: Approved. — Bradley G. Beim (12/22/2014) COMPLIANCE The grant agreement and attachments reference an extensive number of federal and state regulations. Please refer to the documents for specifically cited compliance requirements for this grant. COUNTY OF OAKLAND DEPARTMENT OF HEALTH AND HUMAN SERVICES HEALTH DIVISION FY 2014/2015 COMPREHENSIVE PLANNING, BUDGETING, AND CONTRACTING AGREEMENT (CPBC) ACCEPTANCE • The Oakland County Health Division (OCHD) is accepting funding through the CPBC Agreement from the Michigan Department of Community Health (MDCH) in the total amount of $10,188,437. • The Agreement is for the period October 1, 2014 through September 30, 2015. • The Agreement provides for categorical grant funding and partial reimbursement for services provided in accordance with the Public Health Code (PA. 368 of 1978, as amended). • Funding has been added in FY15 for the Gonococcal Isolate Surveillance Project. From: Van Pelt, Laurie To: "West„ Catherine"; "Jube Secontine"; "Loll Taylor"; 'Pat Davis" Cc: "Shvmkiw, Lacher; "Foreey, Kathy"; "Pisacreta. Antonio"; "Lane, Kathy" Subject: RE: GRANT REVIEW: Health Si Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance Date: Tuesday, December 09, 2014 3:53:41 PM Approved. From: West, Catherine [mailto:westca@oakgov.com] Sent: Tuesday, December 09, 2014 3:09 PM To Julie Secontine; Laurie VanPelt; Lori Taylor; Pat Davis Cc: Shymkiw, Rachel; Forzley, Kathy; `Pisacreta, Antonio'; Lane, Kathy Subject: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS Laurie Van Pelt — Lori Taylor —Julie Secontine — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division- FY 2015 Comprehensive Nanning, Budgeting, and Contracting (CPBC) Agreement Michigan Department of Community Health Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: December 23, 2014 GRANT INFORMATION Date: December 9, 2014 Operating Department: Health and Human Services/Health Division Department Contact: Rachel Shymkiw Contact Phone: 2-2151 Document Identification Number: 20151753-00 REVIEW STATUS: Acceptance - Resolution Required Funding Period: 10/1/14 through 9/30/15 New Facility/Additional Office Space Needs: N/A IT Resources (New Computer Hardware / Software Needs or Purchases): N/A M/WBE Requirements: Yes, Compliance with OMB Circular A-102 Funding Continuation/New: Continuation Application Total Project Amount: $10,188,437.00 From: Taylor. Led. To: 'West, Catherine'; "Julie 5econtine"; "Laurie VanPelt"; "Pat Davis" Cc: "Shvmkim Rachel"; "Forzley, Kathy"; "Pisacreta, Antonio"; "Lane. Kathy" Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance Date: Tuesday, December 09, 2014 3:35:14 PM HR Approved (No Committee) Lori Taylor Manager-Human Resources Recruitment & Workforce Planning Oakland County Michigan 2100 Pontiac Lake Road Waterford, MI 48328 taylorlo@oakgov.com www,oakgov.cornijoha Phone: 248-858-0548 Fax: 248-858-8391 From: West, Catherine [mailto:westca@oakgov.com] Sent: Tuesday, December 09, 2014 3:09 PM To: Julie Secontine; Laurie VanPelt; Lori Taylor; Pat Davis Cc: Shymkiw, Rachel; Forzley, Kathy; 'Pisacreta, Antonio'; Lane, Kathy Subject: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS — Laurie Van Pelt — Lori Taylor —Julie Secontine — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE — Health & Human Services/Health Division- FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement Michigan Department of Community Health Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email. Time Frame for Returned Comments: December 23, 2014 GRANT INFORMATION Date: December 9, 2014 Operating Department: Health and Human Services/Health Division Department Contact: Rachel Shymkiw From: To: Cc: Subject: Date: Etedaethaele< "West, Catherine"; "Julie Secontine"; "Laurie VanPelt"; "Lori Taylor"; "Pat Davis" "Shyrnkiw, Rachel"; "Forzley. Kathy"; "Pisacreta Antonio"; 'Lane. Kathy" RE: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance Wednesday, December 10, 2014 12:38:10 PM Approved by Risk Management. R.E. 12-1044. Robert Erlenbeck, Risk Management Office: 248-8584694 Cot: 248-421-9121 Office schedule: Monday through Thursday 7:00 to 8:30 From: Easterling, Terri [mailto:easterlingt©oakgov.com ] Sent: Wednesday, December 10, 2014 9:26 AM To: 'West, Catherine'; 'Julie Secontine 1 ; 'Laurie VanPelt; 'Lori Taylor'; 'Pat Davis' Cc: 'Shyrnkiw, Rachel'; 'Forzley, Kathy'; rPisacreta, Antonio'; 'Lane, Kathy' Subject: RE: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance Please be advised that your request for Risk Management's assistance has been assigned to Bob Erlenbeck, (ext. 8-1694). if you have not done so already, please forward all related information, documentation, and correspondence. Also, please include Risk Management's assignment number, RM14-11420, regarding this matter. Thank you. From: West, Catherine [mailto:westca(aoa gov.com ] Sent: Tuesday, December 09, 2014 3:09 PM To: Julie Secontine; Laurie VanPelt; Lori Taylor; Pat Davis Cc: Shymkiw, Rachel; Forzley, Kathy; 'Pisacreta, Antonio'; Lane, Kathy Subject: GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Grant - Acceptance GRANT REVIEW FORM TO: REVIEW DEPARTMENTS Laurie Van Pelt — Lori Taylor —Julie Secontine — Pat Davis RE: GRANT CONTRACT REVIEW RESPONSE Health & Human Services/Health Division- FY 2015 Comprehensive Planning, Budgeting, and Contracting (CPBC) Agreement Michigan Department of Community Health Attached to this email please find the grant document(s) to be reviewed. Please provide your review stating your APPROVAL, APPROVAL WITH MODIFICATION, or DISAPPROVAL, with supporting comments, via reply (to all) of this email, From: To: Subject: Date: Benn, Bradley G West. Catherine 2014-1256 GRANT REVIEW: Health & Human Services/Health Division - FY 2015 Comprehensive Planning, Budgeting, and Contracting Monday, December 22, 2014 7:32:06 AM Approved. Bradley G. Benn Assistant Corporation Counsel Department of Corporation Counsel 1200 N. Telegraph Road Bldg 14 East Courthouse West Wing Extension, 3rd Floor Pontiac, MI 48341-0419 Phone: (248) 858-0558 Fax: (248) 858-1003 Email: iMalabaDaliggY..x.Om PRIVILEGED AND CONFIDENTIAL — ATTORNEY CLIENT COMMUNICATION This e-mail is intended only for those persons to whom it is specifically addressed. It is confidential and is protected by the attorney-client privilege and work product doctrine. This privilege belongs to the County of Oakland, and individual addressees are not authorized to waive or modify this privilege in any way. Individuals are advised that any dissemination, reproduction or unauthorized review of this information by persons other than those listed above may constitute a waiver of this privilege and is therefore prohibited. If you have received this message in error, please notify the sender immediately. If you have any questions, please contact the Department of Corporation Counsel at (248) 858-0550. Thank you for your cooperation. FISCAL NOTE MSC. #15007) January 29, 2015 BY: FINANCE COMMITTEE, TOM MIDDLETON, CHAIRPERSON IN RE: DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION —2014/2015 COMPREHENSIVE PLANNING, BUDGETING, AND CONTRACTING (CPBC) AGREEMENT 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 Oakland County Health Division funding in the amount of $10,188,437 for the period October 1,2014, through September 30, 2015. 2. The initial FY 2015 award reflects an increase in the amount of $506,588 from the initial Fiscal Year 2013/2014 award amount of $9,681,849 (Please note that the Adopted Budget does not reflect the latest FY 2015 award). 3. The current FY 2015 General Fund Revenue Budget (Fund 10100) is $4,349,877. The FY 2015 award amount for the General Fund Revenue is $4,512,391. 4. The current FY 2015 Grant Fund Revenue Budget is $6,155,589, which includes all fees and collections along with a Transfer In from Non Departmental Operations. The FY 2015 award amount for the Grant Fund Revenue is $5,976,308, which includes all fees and collections along with a Transfer In from Non Departmental Operations. 5. The Grant Fund Revenue Budget is expected to balance with the award amount through anticipated additional State funding awards. 6. If funding from the anticipated future awards fail to be realized, the Health Division will address this matter by way of submitting a separate resolution to amend the Budget through a reduction in expenditures. 7. Details of the total General Fund Revenue are as follows: Michigan Dept. of Community Health Food Protection MDEQ Drinking Water MDEQ On-Site Sewage Hearing Vision Sexually Transmitted Disease Total General Fund $2,251,290 859,213 514,301 372,426 219,078 213,433 82,650 $4,512,391 8. Details of the total Grant Fund Revenue are as follows: Adolescent Screening $ 73,000 Snap-Ed 49,958 Health & Wellness (4x4) 10,000 Immunization Action Plan 491,881 Fetal Infant Mortality 5,400 Gonococcal Isolate 8,000 WIC 2,476,239 WIC Breastfeeding Peer Council 141,259 TB Control 73,413 Aids Prevention 497,900 HIV Surveillance 35,000 Vaccine Replacement/Handling 106,137 Maternal and Infant Support 321,457 CSHCS Outreach and Advocacy 285,000 Infant Safe Sleep 22,500 Bioterrorism Coordinator 236,124 BT Lab Program 57,447 Cities Readiness Initiative 157,540 EPI Planner Workplace 7,500 Nurse Family Partnership 620,291 Total Grants $5,676,046 Total Program $10 188 437 FINANCE COMMITTEE VOTE: Motion carried unanimously on a roll call vote with Woodward and Quarles absent. 9. The General and Grant Fund Revenue Budgets are amended per the attached Schedule A, to reflect the FY 2015 award. 10. Schedule A also includes budget amendments totaling $300,262 to recognize generated program fees and collections for CSHCS Outreach and Advocacy - $256,622 and Immunization Action Plan - $35,000 as well as Transfers In from Non Departmental Operations of $8,640 from a lease agreement with Walled Lake Consolidated School District for office space as approved per M.R. #11257. FINANCE COMI7ETE,E Resolution #15007 January 29, 2015 Moved by Fleming supported by Quarles the resolutions (with fiscal notes attached) on the Consent Agenda be adopted. AYES: Fleming, Gershenson, Gingell, Gosselin, Hoffman, Jackson, KowaII, Long, Matis, McGillivray, Middleton, Quarles, Scott, Spisz, Taub, Weipert, Woodward, Zack, Bowman, Crawford. (20) NAYS: None. (0) A sufficient majority having voted in favor, the resolutions (with fiscal notes attached) on the Consent Agenda were adopted. 51e, (-- HEREBY APPROVE MI RESOLUTION CHEF DEPUTY COUNTY EXECUTIVE ACTING PURSUANT TO MCL 45.559A (7) STATE OF MICHIGAN) COUNTY OF OAKLAND) I, Lisa Brown, Clerk of the County of Oakland, do hereby certify that the foregoing resolution is a true and accurate copy of a resolution adopted by the Oakland County Board of Commissioners on January 29, 2015, 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 29th day of January, 2015, A4Prz Contract #: 20151753-00 Agreement Between Michigan Department of Community Health hereinafter referred to as the "Department" and County of Oakland hereinafter referred to as the "Local Governing Entity" on Behalf of Health Department Oakland County Department of Health and Human Services! Health Division 1200 N. Telegraph Rd. 34 East Pontiac MI 48341 0432 Federal I.D.#: 38-6004876, DUNS #: 136200362 hereinafter referred to as the "Grantee" for The Delivery of Public Health Services under the Comprehensive Agreement Part I 1. Purpose This agreement is entered into for the purpose of setting forth a joint and cooperative Grantee/Department relationship and basis for facilitating the delivery of public health services to the citizens of Michigan under their jurisdiction, as described in the attached Annual Budget, established Minimum Program Requirements, and all other applicable Federal, State and Local laws and regulations pertaining to the Grantee and the Department. Public health services to be delivered under this agreement include Essential Local Public Health Services (ELPHS) and Categorical Programs as specified in the attachments to this agreement. 2. Period of Agreement: This agreement shall commence on October 1, 2014 and continue through September 30, 2015. This agreement is full force and effect for the period specified. The Department has the option to assume no responsibility for costs incurred by the Grantee prior to the signing of this agreement. 3. Program Budget and Agreement Amount A. Agreement Amount In accordance with Attachment IV - Funding/Reimbursement Matrix, the total State budget and amount committed for this period for the program elements covered by this agreement is $10,188,437.00. Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 1 of 184 Health Division, Comprehensive Agreement - 2015 B. Equipment Purchases and Title Any equipment purchases supported in whole or in part by the Department with categorical funding must be specified in an attachment to the Program Budget Summary. 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 equipment having a unit acquisition cost of less than $5,000 shall vest with the Grantee 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. Budget Transfers and Adjustments 1. Transfers between categories within any program element budget supported in whole or in part by state/federal categorical sources of funding shall be limited to increases in an expenditure budget category by $10,000 or fifteen percent (15%) whichever is greater. This transfer authority does not authorize purchase of additional equipment items or new subcontracts with state/federal categorical funds without prior written approval of the Department. 2. Any transfers or adjustments involving State/Federal categorical funds, other than those covered by Cl, including any related adjustment to the total state amount of the budget, must be made in writing through a formal amendment executed by all parties to this agreement in accordance with Section VIII. A. of Part II. 3. The C.1 and C.2 provisions authorizing transfers or changes in local funds apply also to the Family Planning program, provided statewide local maintenance of effort is not diminished in total. Any statewide diminishing of total local effort for family planning and/or any related funding penalty experienced by the Department shall be recovered proportionately from each local Grantee that, during the course of the agreement period, chose to reduce or transfer local funds from the Family Planning program. 4. Agreement Attachments A. The following documents are attachments to this Agreement Part I and Part II - General Provisions, which are part of this agreement through reference: 1. Attachment I - Annual Budget 2. Attachment III - Program Specific Assurances and Requirements 3. Attachment IV - Funding/Reimbursement Matrix 4. Attachment V - FY14/15 Agreement Addendum A B. The attachments are added into this Agreement as follows: 1. Original Agreement (Part land Part II) - Attachment I, Ill, IV Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 2 of 184 Health Division, Comprehensive Agreement -2015 5. Statement of Work The Grantee agrees to undertake, perform and complete the services described in Attachment III - Program Specific Assurances and Requirements and the other applicable attachments to this agreement which are part of this agreement through reference. 6. Method of Payments and Financial Reports The payment procedures shall be followed as described in Part ll and Attachment I - Annual Budget and Attachment IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 7. Performance/Progress Report Requirements The progress reporting methods, as applicable, shall be followed as described in IV - Funding/Reimbursement Matrix, which are part of this agreement through reference. 8. General Provisions The Grantee agrees to comply with the General Provisions outlined in Part II, which are part of this agreement through reference. 9 Administration of the Agreement The person acting for the Department in administering this agreement (hereinafter referred to as the Contract Consultant) is: Name: Brenda Roys, COMP Liaison Location/Building: 4th Floor, Lewis Cass Building Telephone No.: 517-373-1207 Email Address: roysb@michigan.gov 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. The Department and Grantee, under the terms of this agreement shall, subject to availability of funding and other applicable conditions, provide resources and continuous services throughout the period of this agreement as shown in Attachment I - Annual Budget. C. The Department will not assume any responsibility or liability for costs incurred by the Grantee prior to the signing of this agreement. D. The Grantee is required by PA 533 of 2004 to receive payments by electronic funds transfer. Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 3 of 184 Health Division, Comprehensive Agreement -2015 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 Grantee. 12. Signature Section For Oakland County Department of Health and Human Services/ Health Division Michael J Gingell Chairperson Name Title For the Michigan Department of Community Health Kim Stephen Kim Stephen, Director Bureau of Budget and Purchasing 12/03/2014 Date Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 4 of 184 Health Division, Comprehensive Agreement - 2015 Part II General Provisions I. Responsibilities - Grantee The Grantee in accordance with the general purposes and objectives of this agreement will: A. Publication Rights 1. Where the Grantee exclusively develops books, films, or other such copyrightable materials through activities supported by this agreement, the Grantee may copyright those materials. The materials that the Grantee copyrights cannot include service recipient information or personal identification data. Grantee 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 Grantee 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 Grantee 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 Grantee. If the Grantee 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 Grantee has to the federal government. 3. The Grantee 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 Grantee must notify the Department's Grants and Purchasing Division 30 days before applying to register a copyright with the U.S. Copyright Office. The Grantee must submit an annual report for all copyrighted materials developed by the Grantee 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 Financial Status Report Instructions. Any underrecoveries of otherwise available fees resulting from failure to bill for eligible services will be excluded from reimbursable expenditures. Date: 12103/2014 Contract # 20161753-00, Oakland County Department of Health and Human Services/ Page: 5 of 184 Health Division, Comprehensive Agreement - 2015 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 1. Single Audit Provide, consistent with the regulations set forth in the Single Audit Act Amendments of 1996, P.L. 104-156, and Section .320 of the Office of Management and Budget (OMB) Circular A-133, "Audits of States, Local Governments, and Non-Profit Organizations," a copy of the Grantee's annual Single Audit reporting package, including the Corrective Action Plan, and management letter (if one is issued) with a response to the Department. The Grantee must assure that the Schedule of Expenditures of Federal Awards includes expenditures for all federally-funded grants. 2. Other Audits The Department or federal agencies, may also conduct or arrange for "agreed upon procedures" or additional audits to meet their needs. Dale: 1210312014 Contract # 20161753-00, Oakland County Department of Health and Human Services/ Page: 6 of 184 Health Division, Comprehensive Agreement - 2015 Due Date The Single Audit reporting package, management letter (if one is issued) with a response and Corrective Action Plan shall be submitted to the Department within nine months after the end of the Grantee's fiscal year. The Single Audit reporting package, management letter, and Corrective Action Plan shall be filed with the Department even if there are no findings or disclosures reported in the audit pertaining to Department programs. 4. Penalty If the Grantee does not submit the required Single Audit reporting package, management letter (if one is issued) with a response, and Corrective Action Plan within nine months after the end of the Grantee'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 Grantee 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 Grantee 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. 5. Where to Send A copy of the Single Audit reporting package, management letter (if one is issued) with a response, and Corrective Action Plan must be forwarded 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. H. Subrecipient/Vendor Monitoring The Grantee must ensure that each of its subrecipients comply with the Single Audit Act requirements. The Grantee must issue management decisions on audit findings of their subrecipients as required by OMB Circular A-133. The Grantee 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 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 7 of 184 Health Division, Comprehensive Agreement 2015 with laws, regulations, and the provisions of contracts, and that performance goals are achieved. The subrecipient monitoring plan should include a risk- based assessment to determine the level of oversight, and monitoring activities such as reviewing financial and performance reports, performing site visits, and maintaining regular contact with subrecipients. The Grantee must establish requirements to ensure compliance by for-profit subrecipients as required by OMB Circular A-133, Section 210(e). The Grantee 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 the Grantee, its governing board or any other funding source which would require or result in significant modification in the provision of services, funding or compliance with operational procedures. J. Software Compliance The Grantee 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 Grantee's business operations for processing date/time data. K. Human Subjects The Grantee will comply with Protection of Human Subjects Act, 45 CFR, Part 46. The Grantee agrees that prior to the initiation of the research, the Grantee 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 Grantee's IRB Chairperson or Executive Officer(s). L. Terms To abide by the terms of this agreement including all attachments. Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 8 of 184 Health Disision, Comprehensive Agreement - 2015 M. Minimum Program Requirements To comply with Minimum Program Requirements established in accordance with Section 2472.3 of 1978 PA 368 as amended, MCL 333.2472.3, MSA 14.15 (2472.3), for each applicable program element funded under this agreement. N. Annual Budget and Plan Submission To submit an Annual Budget and Plan request to the Department, in accordance with instructions established by the Department, to serve as the basis for completion of specific details for Attachments I and IV of this agreement via Grantee/Department negotiated amendment(s). Failure to submit a complete Annual Budget and Plan by the due date through MI E- Grants will result in the deferral of Department payments until these documents are submitted. 0. Maintenance of Effort All agencies shall comply with maintenance of effort requirements for ELPHS, as defined in the current Department appropriation act, and Family Planning in accordance with federal requirements, except as noted in Section 3.C.3 of Part P. Accreditation 1. All Grantees shall comply with the local public health accreditation standards and follow the accreditation process and schedule established by the Department to achieve full accreditation status. Grantees that fail to meet all accreditation requirements and/or implement corrective plans of action within the prescribed time period will receive the status of "Not Accredited." Grantees designated as "Not Accredited" may have their Department allocations reduced for costs incurred in the assurance of service delivery. Grantees that disagree with on-site review findings or their accreditation status may request an inquiry through written request to the Department. The request must identify the disagreement and resolution sought. The inquiry participants will be comprised of Grantee staff, Department staff, the Accreditation Commission Chair, and the Accreditation Coordinator as needed. Participants will clarify facts, verify information and seek resolution. 2. Consent Agreements/Administrative Compliance Orders/Administrative Hearings for "Not Accredited" Grantees: a. Grantees designated as "Not Accredited", will receive a Consent Agreement Package from the Department. Grantees and their local governing entities shall be given 75 days to review the package, meet with the Department, and sign/return the Consent Agreement. b. Fulfillment of the terms and conditions of the Consent Agreement Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 9 of 184 Health Division, Comprehensive Agreement - 2015 will not affect accreditation status, but impacts the Grantees' ability to fulfill its contractual obligations under the Comprehensive Planning, Budgeting and Contracting Agreement. Grantees designated as Not Accredited", will retain this designation until the subsequent accreditation cycle. c. Grantee failure to fulfill the terms and conditions of the Consent Agreement within the prescribed time period will result in the issuance of an Administrative Compliance Order by the Department. d. Within 60 working days after receipt of an Administrative Compliance Order and proposed compliance period, a local governing entity may petition the Department for an administrative hearing. If the local governing entity does not petition the Department for a hearing within 60 days after receipt of an Administrative Compliance Order, the order and proposed compliance date shall be final. After a hearing, the Department may reaffirm, modify, or revoke the order or modify the time permitted for compliance. e. If the local governing entity fails to correct a deficiency for which a final order has been issued within the period permitted for compliance, the Department may petition the appropriate circuit court for a writ of mandamus to compel correction. Q. Medicaid Outreach Activities Reimbursement The Grantee agrees to report allowable costs and request reimbursement for the Medicaid Outreach activities it provides in accordance with 2 CFR, Part 225 (OMB Circular A-87) and the requirements in Medicaid Bulletin number: MSA 05-29. The Grantee agrees to submit a Cost Allocation Plan Certification to the Department to bill for the Medicaid Outreach Activities. The Cost Allocation Plan Certification is valid until a change is made to the cost allocation plan or the Department determines it is invalid. The Grantee will submit quarterly FSRs for the Medicaid Outreach activities and an annual FSR for the Children with Special Health Care Services Medicaid Outreach activities in accordance with the instructions contained in Attachment In accordance with the Medicaid Bulletin, MSA 05-29, the Grantee agrees to target their Medicaid outreach effort toward Department established priorities. For FY 13/14, the Department priorities are: lead testing, outreach and enrollment for the Family Planning waiver, and outreach for pregnant women, mothers and infants for the Maternal and Infant Health Program. The Grantee will submit a report using the MDCH Local Health Department Medicaid Outreach form describing their outreach activities targeting the priorities 30 Date: 1210312014 Contract # 20151753-00, Oakland County Department e Health and Human Services/ Page: 10 of 184 Health Division, Comprehensive Agreement - 2015 days after the end of a fiscal year quarter and at the same time as the final COMPREHENSIVE FSR is due into the Department. The Local Health Department Medicaid Outreach report are to be sent through MI E-Grants as an attachment report. II. Responsibilities - Department The Department in accordance with the general purposes and objectives of this agreement will: A. Payment Provide payment in accordance with the terms and conditions of this agreement based upon appropriate reports, records, and documentation maintained by the Grantee. 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 Grantee 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 Grantee an opportunity to review and offer comment. C. Terms Abide by the terms of this agreement including all attachments. 13. Notification of Modifications To notify the Grantee in writing of modifications to Federal or State laws, rules and regulations affecting this agreement. E. Identification of Laws To identify for the Grantee relevant laws, rules, regulations, policies, procedures, guidelines and State and Federal manuals, and provide the Grantee with copies of these documents to the extent they are not otherwise available to the Grantee. F. Modification of Funding To notify the Grantee in writing within thirty (30) calendar days of becoming aware of the need for any modifications in agreement funding commitments made necessary by action of the Federal Government, the Governor, the Legislature or the Department of Management and Budget on behalf of the Governor or the Legislature. Implementation of the modifications will be determined jointly by the Grantee and the Department. G. Monitor Compliance To monitor compliance with all applicable provisions contained in federal grant awards and their attendant rules, regulations and requirements pertaining to program elements covered by this agreement. Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 11 of 184 Health Division, Comprehensive Agreement - 2015 H. Reimbursement To reimburse local agencies for costs based upon timely, accurately completed Financial Status Reports in accordance with Section IV. I. Technical Assistance To make technical assistance available to the Grantee for the implementation of this agreement. J. Health Insurance Portability and Accountability The Department assures that it will be in compliance with the Health Insurance Portability and Accountability Act. K. Accreditation The Department agrees to adhere to the accreditation requirements including the process for "Not Accredited" Grantees. The process includes developing and monitoring consent agreements, issuing and monitoring administrative compliance orders, participating in administrative hearings and petitioning appropriate circuit courts. L. Medicaid Outreach Activities Reimbursement The Department agrees to reimburse the Grantee for all allowable Medicaid Outreach activities that meet the standards of the Medicaid Bulletin: MSA 05-29 including the cost allocation plan certification and that are billed in accordance with the requirements in Attachment I. In accordance with the Medicaid Bulletin, MSA 05-29, the Department will identify each fiscal year the Medicaid Outreach priorities and establish a reporting requirement for the Grantee. III. Assurances The following assurances are hereby given to the Department: A. Compliance with Applicable Laws The Grantee will comply with applicable federal and state laws, guidelines, rules and regulations in carrying out the terms of this agreement. The Grantee 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. B. Anti-Lobbying Act The Grantee 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 104-208). Further, the Grantee 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. Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 12 of 184 Health DIvIsion, Comprehensive Agreement - 2015 C. Non-Discrimination 1 In the performance of any contract or purchase order resulting herefrom, the Grantee 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 Grantee 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 Grantee 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 (Pl. 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 disabilities; 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 Date: 12/0312014 Contract 420151753-00, Oakland County Department of Health and Human Services/ Page: 13 of 184 Health Division, Comprehensive Agreement - 2015 h. any other nondiscrimination provisions in the specific statute(s) under which application for Federal assistance is being made; and, i. the requirements of any other nondiscrimination statute(s) which may apply to the application. 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 Grantee 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 Grantee 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. E. Federal Requirement: Pro-Children Act 1. Assurance is hereby given to the Department that the Grantee 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 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 14 of 184 Health Division, Comprehensive Agreement -2015 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 Grantee also assures that this language will be included in any subawards which contain provisions for children's services. 2. The Grantee 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 Grantee. If activities or services are delivered in facilities or areas that are not under the control of the Grantee (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 Grantee 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. National Defense Authoriation Act Employee Whistleblower Protections The Grantee will comply with the National Defense Authorization Act "Pilot Program for Enhancement of Grantee Employee Whistleblower Protections". 1. This agreement and employees working on this agreement will be subject to the whistleblower rights and remedies in the pilot program on Grantee employee whistleblower protections established at 41 U.S.C. 4712 by section 828 of the National Defense Authorization Act for Fiscal Year 2012 and FAR 3.908. 2. The Grantee shall inform its employees in writing, in the predominant language of the workforce, of employee whistleblower rights and protections under 41 U.S.C. 4712, as described in section 3.908 of the Federal Acquisition Regulation. 3. The Grantee shall insert the substance of this clause, including this paragraph (3), in all subcontracts over the simplified acquisition Date: 1210312014 Contract 4 20151753-00, Oakland County Department of Health and Human Services/ Page: 15 of 184 Health Division, Comprehensive Agreement - 2015 threshold. H. Home Health Services If the Grantee provides Home Health Services (as defined in Medicare Part B), the following requirements apply: 1. The Grantee shall not use State ELPHS or categorical grant funds provided under this agreement to unfairly compete for home health services available from private providers of the same type of services in the Grantee's service area. 2. For purposes of this agreement, the term "unfair competition" shall be defined as offering of home health services at fees substantially less than those generally charged by private providers of the same type of services in the Grantee's area, except as allowed under Medicare customary charge regulations involving sliding fee scale discounts for low-income clients based upon their ability to pay. 3. If the Department finds that the Grantee is not in compliance with its assurance not to use state ELPHS and categorical grant funds to unfairly compete, the Department shall follow the procedure required for failure by local health departments to adequately provide required services set forth in Sections 2497 and 2498 of 1978 PA 368 as amended (Public Health Code), MCL 333.2497 and 2498, MSA 14.15 (2497) and (2498). Subcontracts Assure for any subcontracted service, activity or product: 1. That a written subcontract is executed by all affected parties prior to the initiation of any new subcontract activity. Exceptions to this policy may be granted by the Department upon written request. 2. That any executed subcontract shall require the subcontractor to comply with all applicable terms and conditions of this agreement. In the event of a conflict 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; or b. Restates provisions of this agreement to afford the Grantee 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 Grantee in this agreement. 3. That the subcontract does not affect the Grantee's accountability to the Department for the subcontracted activity. 4. That any billing or request for reimbursement for subcontract costs is Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 16 of 184 Health Division, Comprehensive Agreement -2015 supported by a valid subcontract and adequate source documentation on costs and services. 5. That the Grantee will submit a copy of the executed subcontract if requested by the Department. 6. That subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $10,000 shall contain provisions or conditions that will: a. Allow the Grantee or Department to seek administrative, contractual or legal remedies in instances in which the Contractor violates or breaches contract terms, and provide for such remedial action as may be appropriate. b. Provide for termination by the Grantee, including the manner by which termination will be effected and the basis for settlement. 7. That all subcontracts in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government of amounts in excess of $100,000 shall contain a provision that requires compliance with all applicable standards, orders or regulations issued pursuant to the Clean Air Act of 1970 (42 USC 1857(h)), Section 508 of the Clean Water Act (33 USC 1368), Executive Order 11738 and Environmental Protection Agency regulations (40 CFR Part 15). 8. That ail subcontracts and subgrants in support of programs or elements utilizing funds provided by the Department, the State of Michigan or the federal government in excess of $2,000 for construction or repair, awarded by the Grantee shall include a provision: a. For compliance with the Copeland "Anti-Kickback" Act (18 USC 874) as supplemented in Department of Labor regulations (29 CFR, Part 3). b. For compliance with the Davis-Bacon Act (40 USC 276a to a-7) and as supplemented by Department of Labor regulations (29 CFR, Part 5) (if required by Federal Program Legislation). c. For compliance with Section 103 and 107 of the Contract Work Hours and Safety Standards Act (40 USC 327-330) as supplemented by Department of Labor regulations (29 CFR, Part 5). This provision also applies to all other contracts in excess of $2,500 that involve the employment of mechanics or laborers. J. 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 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 17 of 184 Health Division, Comprehensive Agreement - 2315 responsible federal contractor(s), or 2 CFR, Part 2 (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. K. Health Insurance Portability and Accountability Act To the extent that this act is pertinent to the services that the Grantee provides to the Department under this agreement, the Grantee assures that it is in compliance with the Health Insurance Portability and Accountability Act (HIPAA) requirements including the following: 1. The Grantee 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. 2. The Grantee will ensure that any subcontractor will have the same obligations as the Grantee 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 Grantee must only use the protected health data and information for the purposes of this agreement. 4. The Grantee 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 Grantee's employees. 5. The Grantee 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 Grantee becomes aware. The Grantee 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. 6. Failure to comply with any of these contractual requirements may result in the termination of this agreement in accordance with Part II, Section V. Agreement Termination. 7. In accordance with HIPAA requirements, the Grantee is liable for any claim, loss or damage relating to unauthorized use or disclosure of protected health data and information by the Grantee received from the Department or any other source. 8. The Grantee will enter into a business associate agreement should the Department determine such an agreement is required under HIPAA. Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 18o1 184 Health Division, Comprehensive Agreement - 2015 IV. Payment and Reporting Procedures A. Operating Advance Under the pre-payment reimbursement method, no additional operating advances will be issued. B. Comprehensive Prepayments The Department will make monthly prepayments equal to 1/12th of the agreement amount for each non-fee-for-service program contained in Attachment IV of this agreement. One single payment covering all non-fee-for- service programs will be made within the first week of each month. The Department will send to the Grantee a worksheet itemizing the individual program amounts included in the monthly prepayment within five working days of processing the monthly prepayment. Prepayments for the months of October thru January will be based upon the initial agreement amounts in Attachment IV. Subsequent monthly prepayments may be adjusted based upon agreement amendments and/or Grantee adjustment requests per Department approval. C. Prepayment Adjustments If the sum of the prepayments do not equal at least 90% of the Grantee's expenditures for a quarter of the contract period, the Grantee may submit documentation for an adjustment to the monthly prepayment amount via the following process: 1. Submit a written request for the adjustment to the Department's Accounting Division, Expenditure Operations Section. 2. The adjustment request must be itemized by program and must list the amount received from the Department, the expenditure amount reported per the quarterly Financial Status Report (FSR), and the difference. The amount received from the Department and the expenditures must be for the same reporting quarterly FSR period. 3. The Department will review the requests and if an adjustment is approved, it will be included in the next scheduled monthly prepayment. 4. Adjustment requests will not be accepted prior to submission of the FSR for the quarter ending December 31. No adjustments will be made prior to the February monthly prepayment. 5. The ability of the Department to approve adjustments may be limited by the quarterly allotments of spending authority in the Department's appropriation account mandated by the Office of the State Budget Director. The quarterly allotment limits the amount of each account (program) that the Department may expend during each fiscal quarter. D. Financial Status Report Submission A Financial Status Report (FSR) must be submitted for all programs listed on Attachment IV. All FSR's must be prepared in accordance with the Date; 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 19 of 184 Health Division, Comprehensive Agreement 2015 Department's FSR instructions and submitted electronically not later than thirty (30) days after the close of the fiscal quarters through MI E-Grants. Reports are due 1/30, 4/30, and 7/30. FSR's must report total actual program expenditures regardless of the source of funds. The Department will reimburse the Grantee for expenditures in accordance with the terms and conditions of this agreement. Failure to comply with the reporting due dates will result in the deferral of the Grantee's monthly prepayment. E. Reimbursement Method The Grantee will be reimbursed in accordance with the reimbursement methods for applicable program elements described as follows: 1. Performance Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of State funds. Any local funds used to support program elements operated under such provisions of this agreement may be transferred by the Grantee within, among, to or from the affected elements without Department approval, subject to applicable provisions of Sections 3.B. and 3.0.3 of Part I and Section XIV of Part II. If local health department performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the State maximum allocation will be reduced equivalent to actual performance in relation to the minimum performance. 2. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total State allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable as a source before any local funding requirement unless a specific local match condition exists. 3. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 4. Essential Local Public Health Services (ELPHS) - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required services, as noted in the current Appropriations Act. Date: 1210312014 Contract # 20151763-00, OaXiand County Department of Health and Human Services/ Page: 20 of 184 Health Division, Comprehensive Agreement - 2015 F. Reimbursement Mechanism All Grantees must sign up through the on-line vendor registration process to receive all State of Michigan payments as Electronic Funds Transfers (EFT)/Direct Deposits. Vendor registration information is available through the Department of Management and Budget's web site: http://www.cpexpress.state.mi. us/ G. Unobligated Funds Any unobligated balance of funds held by the Grantee at the end of the agreement period will be returned to the Department or treated in accordance with instructions provided by the Department. H. Fiscal Year-End Reporting An Obligation Report is based on annual guidelines and due date using the format provided by the Department through MI E-Grants. The Grantee must provide, by program, an estimate of total expenditures for the entire agreement period (October 1 through September 30). This report must represent the Grantee's best estimate of total program expenditures for the agreement period. The information on the report will be used to record the Department's year-end accounts payables and receivables by program for this Agreement. The report assists the Department in reserving sufficient funding to reimburse the final expenditures that will be reported on the Final FSR without materially overstating or understating the year-end obligations for this agreement. The Department compares the total estimated expenditures from this report to the total amount reimbursed to the Grantee in the monthly prepayments and quarterly fee-for-service payments to establish accounts payable and accounts receivable entries at fiscal year-end. The Department recognizes that based upon payment adjustments and timing of agreement amendments, the Grantee may owe the Department funding for overpayment of a program and may be due funds from the Department for underpayment of a program at fiscal year- end. Within 75 days after the agreement fiscal year-end, the Grantee must liquidate any unpaid year-end commitments and obligations. Any obligation remaining unliquidated after 75 days from the end of the agreement period shall revert to the Department for disposition in accordance with applicable state and/or federal requirements, except as specifically authorized in writing by the Department. Final Total Grantee FSR Project Final FSR Due Date Bioterrorism 11/15/XX WIC 11/30/XX All Remaining Projects 12/15/XX The final total Grantee FSR is due December 15, after the agreement period Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 21 of 184 Health Division, Comprehensive Agreement -2015 end date. WIC financial data reporting and final FSR must be received by November 30. Upon receipt of the final FSR electronically through MI E- Grants, the Department will determine by program, if funds are owed to the Grantee or if the Grantee owes funds to the Department. If funds are owed to the Grantee, payment will be processed. However, if the Grantee underestimated their year-end obligations in the Obligation Report as compared to the final FSR and the total reimbursement requested does not exceed the agreement amount that is due to the Grantee, the Department will make every effort to process full reimbursement to the Grantee per the final FSR. Final payment may be delayed pending final disposition of the Department's year-end obligations. If funds are owed to the Department, it will generally not be necessary for Grantee to send in a payment. Instead the Department will make the necessary entries to offset other payments and as a result the Grantee will receive a net monthly prepayment. When this does occur, clarifying documentation will be provided to the Grantee by the Department's Accounting Division. J. Penalties for Reporting Noncompliance For failure to submit the final total Grantee FSR report by December 15, through MI E-Grants after the agreement period end date, the Grantee may be penalized with a one-time reduction in their current ELPHS allocation for noncompliance with the fiscal year-end reporting deadlines. Any penalty funds will be reallocated to other Comprehensive Grantees (local health departments). Reductions will be one-time only and will not carryforward to the next fiscal year as an ongoing reduction to a Grantee's ELPHS allocation. Penalties will be assessed based upon the submitted date in MI E-Grants: ELPHS Penalties for Noncompliance with Reporting Requirements: 1. 1% - 1 day to 30 days late; 2. 2% - 31 days to 60 days late; 3. 3% - over 60 days late with a maximum of 3% reduction in the Grantee's ELPHS allocation. V. Agreement Termination The Department may cancel this agreement without further liability or penalty to the Department for any of the following reasons: A. This agreement may be terminated by either party by giving thirty (30) days written notice to the other party stating the reasons for termination and the effective date. B. This agreement may also be terminated on thirty (30) days prior written notice upon the failure of either party to carry out the terms and conditions of this agreement, provided the alleged defaulting party is given notice of the alleged breach and fails to cure the default within the thirty (30) day period. C. This agreement may be terminated immediately if the Grantee's local health Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 22 of 184 Health DIvIsion, Comprehensive Agreement - 2015 department, or an official of the Grantee's local health department, is convicted of any activity referenced in Part II, Section lIl.D, of this agreement during the term of this agreement or any extension thereof. VI. Final Reporting upon Termination Should this agreement be terminated by either party, within thirty (30) days after the termination, the Grantee 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 Grantee for allowable reimbursable costs not covered by previous payments or other state or federal programs. The Grantee shall immediately refund to the Department any funds not authorized for use and any payments or funds advanced to the Grantee 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. V1II. Amendments Any changes to this agreement will be valid only if made in writing and accepted by all parties to this agreement. A. This agreement, including attachments, may be amended by mutual written consent of the Grantee and the Department. When submitting a proposed agreement/budget amendment, the Grantee must submit copies of the revised sheets and a summary description of the changes. B. In the event that circumstances occur that are not reasonably foreseeable, or are beyond the Grantee's or Department's control, which reduce or otherwise interfere with the Grantee's or Department's ability to provide or maintain specified services or operational procedures, immediate written notification must be provided to the other party and an amendment to this agreement negotiated. C. Amendments to this agreement shall be made as follows: 1. Any change proposed by the Grantee which would affect the State funding of any element funded in whole or in part by funds provided by the Department, subject to Part I, Section 3.C, of the agreement, must be submitted in writing to the Department immediately upon determining the need for such change. The proposed change may be implemented upon receipt of written notification from the Department. Within thirty (30) days after receipt of the proposed change, the Department shall advise the Grantee in writing of its determination. Subsequently the Department will initiate any necessary formal amendment to the agreement for execution by all parties to the agreement. Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 23 of 184 Health Division, Comprehensive Agreement - 2015 Any changes proposed by the Department must be agreed to in writing by the Grantee and upon such written agreement, the Department shall initiate any necessary formal amendment as above. 2. Other amendments of a routine nature including applicable changes in budget categories, modified indirect rates, and similar conditions which do not modify the agreement scope, amount of funding to be provided by the Department or, the total amount of the budget may be submitted by the Grantee at any time prior to June 2nd. The Department will provide a written response within thirty (30) calendar days. All amendments must be submitted to the Department by June 15 through MI E-Grants to assure the amendment can be executed prior to the end of the agreement period. IX. Liability A. All liability to third parties, loss, or damage as a result of claims, demands, costs, or judgments arising out of activities, such as direct service delivery, to be carried out by the Grantee in the performance of this agreement shall be the responsibility of the Grantee, 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 Grantee, any subcontractor, anyone directly or indirectly employed by the Grantee, provided that nothing herein shall be construed as a waiver of any governmental immunity that has been provided to the Grantee or its employees by statute or court decisions. 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 Grantee, if the liability, loss, or damage is caused by, or arises out of, the action or failure to act on the part of any Department employee or agent, provided that nothing herein shall be construed as a waiver of any governmental immunity by the State, its agencies (the Department) or employees as provided by statute or court decisions. C. In the event that liability to third parties, loss, or damage arises as a result of activities conducted jointly by the Grantee and the Department in fulfillment of their responsibilities under this agreement, such liability, loss, or damage shall be borne by the Grantee 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 Grantee, the State, its agencies (the Department) or their employees, respectively, as provided by statute or court decisions. Date: 12103/2014 Contract #20151753-00, Oak/and County Department of Health and Human Services/ Page: 24 of 184 Health Division, Comprehensive Agreement - 2015 X. Conflict of Interest The Grantee and the Department are subject to the provisions of 1968 PA 317, as amended, MCL 15.321 et seq, and 1973 PA 196, as amended, MCL 15.341 et seq. XI. 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 Grantee 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. XIII. Waiver Any clause or condition of this agreement found to be an impediment to the intended and effective operation of this agreement may be waived in writing by the Department or the Grantee, upon presentation of written justification by the requesting party. Such waiver may be temporary or for the life of the agreement and may affect any or all program elements covered by this agreement. XIV. Funding A. State funding for this agreement shall be provided from the applicable and available Department appropriations for the current fiscal year. The Department provided funds shall be as stated in the approved Annual Budget - Attachment I, the Program Specific Assurances and Requirements - Attachment Ill, and as outlined in the Funding/Reimbursement Matrix - Attachment IV. B. The funding provided through the Department for this agreement shall not exceed the amount shown for each federal and state categorical program element except as adjusted by amendment. The Grantee must advise the Department in writing by May 1, if the amount of Department funding may not be used in its entirety or appears to be insufficient for any program element. ELPHS transfer requests between MDCH, MDA and MDEQ must also be requested in writing by May 1. All ELPHS required services must be maintained throughout the entire period of the agreement. C. The Department may periodically redistribute funds between agencies during the agreement period in order to ensure that funds are expended to meet the varying needs for services. Such redistributions will be based upon projections obtained in consultation with the Grantee. Any redistributions will be effected through the established amendment process. Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 25 of 184 Health Division, Comprehensive Agreement - 2015 AA Attachments Al Attachment I - Instructions for the Annual Budget Attachment I - Instructions for the Annual Budget A2 Attachment II - FY 14/15 Agreement Addendum A Oakland County FY Agreement Addendum A A3 Attachment III - Program Specific Assurances and Requirements Attachment III - Program Specific Assurances and Requirements Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 26 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - 2015 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDCH Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Vendor / Subrecepient (0 Adolescent STD Screening Reg. Alloc. F 73,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Bioterrorism Regional EPI Reg. Alloc. F 7,500 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Support Body Art Fixed Fee Calc. Amt. 250.00/Numb Fixed Unit Rate (2) N/A N/A N/A N/A N/A Vendor ers Childrens Special Hlth Care Calc. Amt. 150.00Nario Fixed Unit Rate (1), N/A N/A N/A N/A N/A Vendor Services (CSHCS) Care us (7) Coordination . Chilcirens Special Hlth Care Reg. Affix. F 142,500 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Services (CSHCS) Outreach & Advocacy Reg. Alloc. S 142,500 Fetal Infant Mortality Review Reg. Alloc. F 5,400 Staffing (6) N/A N/A N/A N/A N/A Subrecepient (FIMR) Case Abstraction Food ELPHS ELPHS Food S 859,213 ELPHS (3), (4) N/A N/A N/A N/A N/A Vendor General Communicable Disease ELPHS S 385,566 ELPHS (3), (4) N/A N/A N/A N/A N/A Vendor ELPHS MDCH Other Gonococcal Isolate Surveillance Reg. Alloc. F 8,000 Staffing (6) NIA N/A N/A N/A N/A Subrecepient Project Hearing ELPHS ELPHS S 219,078 ELPHS (3), (4) N/A N/A N/A N/A N/A Subrecepient Hearing HIV ELPHS ELPHS S 347,565 LPHO (3), (4) N/A N/A N/A N/A N/A Vendor MDCH Other HIV Prevention Reg. Alloc. F 367,351 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Reg. Alloc. S 130,549 HIV Surveillance Support Reg. Alloc. F 7,000 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Reg. All oc. F 17,500 Reg. Alloc. F 10,500 Immunization Action Plan (IAP) Reg. Mix. F 491,881 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Immunization ELPHS ELPHS S 670,232 ELPHS (3), (4) N/A N/A N/A N/A N/A Vendor MDCH Other Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 27 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - 2015 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDCH Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Vendor! Subrecepient (f) Immunization Fixed Fees Cale. Amt. 300.00/Numb Fixed Unit Rate (2), N/A N/A N/A N/A N/A Vendor ers (7) Immunization Vaccine Quality Reg. Alloc, S 106,137 Staffing (6) N/A N/A N/A N/A N/A Vendor Assurance Infant Safe Sleep Reg. Alloc. S 22,500 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Laboratory Services Bio Reg_ Alloc. F 57,447 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Local Health Department SNAP- Reg. Moe. F 49,958 Staffing (6), (18) N/A N/A N/A N/A N/A Subrecepient ED MDEQ Drinking Water ELPHS S 514,301 ELPHS (3), (4) N/A N/A N/A N/A N/A Vendor Drinking Water MDEQ On-site Sewage ELPHS S 372,426 ELPHS (3), (4) N/A N/A N/A N/A N/A Vendor Onsite Sewage MI Health and Wellness 4 X 4 Reg. Alloc. S 10,000 Staffing (6) N/A NIA N/A N/A N/A Subrecepient Plan Nurse Family Partnership -MCH Local MCH F 107,151 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Nurse Family Partnership Reg. Alloc. F 31,945 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Services Reg. Moe. S 588,346 Other-MCH-Children Local MCH F 66,252 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Other-MCH-Varied Local MCH F 81,802 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Other-MCH-Women Local MCH F 66,252 Staffing (6) N/A N/A N/A N/A N/A Subrecepient Public Health Emergency Preparedness (PHEP) 10/1/14— Reg. Alloc. F 236,124 Staffing (6), (14), (18) N/A N/A N/A N/A N/A Subrecepient 6/30/15 Public Health Emergency Preparedness (PHEP) CRI Reg. Alloc. F 157,540 Staffing (6), (14), (18) N/A N/A N/A N/A N/A Subrecepient 10/1/14 — 6/30/15 Sexually Transmitted Disease Reg. Alloc. F 82,650 Staffing (6) N/A N/A N/A N/A N/A Subrecepient (STD) Control Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Service,s/ Page: 28 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 MICHIGAN DEPARTMENT OF COMMUNITY HEALTH ATTACHMENT IV - Comprehensive Agreement - 2015 CONTRACT MANAGEMENT SECTION Oakland County Department of Health and Human Services/ Health Division Program Element/Funding Source (a) MDCH Source Fed/St Funding Amount Reimbursement Method (b) Performance Target Output Measurement Total (c) Perform Expect State (d) Funded Target Perform State Funded Minimum Performance Percent Number (e) Vendor / Subrecepient (t) Sexually Transmitted Disease Reg. Moo. S 0 Staffing (6) N/A N/A N/A N/A N/A Subreceoient (STD) Control Sexually Transmitted Disease ELPHS S 847,927 ELPHS(3), (4) N/A N/A N/A N/A N/A Vendor (STD-ELPHS) MDCH Other SIDS Calc. Amt. 85.00/Numbe is Fixed Unit Rate (2), (11) N/A N/A N/A N/A N/A Vendor TB Control Reg. Alloc. F 73,413 Staffing (6) N/A N/A N/A N/A N/A Vendor Vision ELPHS ELPHS S 213,433 ELPHS (3), (4) N/A N/A N/A N/A N/A Subrecepient Vision WIC Breastfeeding Reg. Alloc. F 141,259 Staffing (6) N/A N/A N/A N/A N/A Subrecepient WIC Resident Services Reg. Alloc. F 2,476,239 Performance (8) # Average N/A 15450 97 14986 Subrecepient Monthly Participation TOTAL MDCH FUNDING 10,188,437 *SPECIFIC OUTPUT PERFORMANCE MEASURES WILL BE INCORPORATED VIA AMENDMENT Attachment IV Notes Attachment IV Notes Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 29 01184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Administration DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT PI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount I Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,639,249.00 0.00 0.00 4,639,249.00 2 Fringe Benefits 3,105,304.00 0.00 0.00 3,105,304.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 142,384.00 0.00 0.00 142,384.00 5 Supplies and Materials 388,687.00 0.00 0.00 388,687.00 6 Travel 56,047.00 0.00 0.00 56,047.00 7 Communication 52,125.00 0.00 0.00 52,125.00 8 County-City Central Services 702,846.00 0.00 0.00 702,846.00 9 Space Costs 1,133,390.00 0.00 0.00 1,133,390.00 10 All Others (ADP, Con. Employees, Misc.) 1,285,838.00 0.00 0.00 1,285,838.00 Total Program Expenses 11,505,870.00 0.00 0.00 11,505,870.00 TOTAL DIRECT EXPENSES 11,505,870.00 0.00 0.00 11,505,870.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs -6,889,422.00 0.00 0.00 -6,889,422.00 2 Other Costs Distributions -2,525,030.00 0.00 0.00 -2,525,030.00 Total Indirect Costs -9,414,452.00 0.00 0.00 -9,414,452.00 TOTAL INDIRECT EXPENSES -9,414,452.00 0.00 0.00 -9,414,452.00 TOTAL EXPENDITURES 2,091,418.00 0.00 0.00 2,091,418.90 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 30 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total '1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 297,467.00 0.00 297,467,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 11,783,00 0,00 11,783.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MOCK Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0,00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0,00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0,00 1,782,168.00 0.00 1,782,168.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0,00 2,091,418.00 0.00 2,091,418.00 Totals 0.00 2,091,418.00 0.00 2,091,418.00 Date: 12/03/2014 Contract !2015753-00, Oakland County Department of Health and Human Services/ Page: 31 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail 'Line Item Amount' Cash[ Inkindl Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,639,249.00 0.00 0.00 4,639,249.00 2 Fringe Benefits 3,105,304.00 0.00 0.00 3,105,304.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 142,384.00 0.00 0.00 142,384.00 5 Supplies and Materials 388,687.00 0.00 0.00 388,687.00 6 Travel 56,047.00 0.00 0.00 56,047.00 7 Communication 52,125.00 0.00 0.00 52,125.00 8 County-City Central Services 702,846.00 0.00 0.00 702,846.00 9 Space Costs 1,133,390.00 0,00 0.00 1,133,390.00 10 All Others (ADP, Con. Employees, Misc.) 1,285,838.00 0.00 0.00 1,285,838.00 Total Program Expenses 11,505,870.00 0.00 0.00 11,505,870,00 TOTAL DIRECT EXPENSES 11,505,870.00 0.00 0.00 11,505,870.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs -6,889,422,00 0.001 0.001 -6,889,422.00 2 Other Costs Distributions Other Cost Distributions-Non- Community W -1,249,262.00 0.00 0.00 -1,249,262.00 Other Cost Distributions-Misc Distributi -1,273,768.00 0.00 0.00 -1,273,768.00 Other Cost Distributions-SIDS fee -2,000.00 0.00 0,00 -2,000,00 Total for Other Costs Distributions -2,525,030.00 0.00 0.00 -2,525,030.00 Total Indirect Costs -9,414,452.00 0.00 0.00 -9,414,452.00 TOTAL INDIRECT EXPENSES -9,414,452.00 0.00 0.00 -9,414,452,00 TOTAL EXPENDITURES 2,091,418.00 0.00 0.00 2,091,418.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 32 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015/ Environmental Administration DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pl Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount] Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,534,242.00 0.00 0.00 3,534,242.00 2 Fringe Benefits 2,249,513.00 0.00 0.00 2,249,513.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 71,742.00 0,00 0.00 71,742.00 6 Travel 231,575.00 0.00 0.00 231,575.00 7 Communication 100,664.00 0.00 0.00 100,664.00 8 County-City Central Services 535,438.00 0.00 0.00 535,438.00 9 Space Costs 106,872.00 0.00 0.00 106,872.00 10 All Others (ADP, Con. Employees, Misc.) 565,712.00 0.00 0.00 565,712.00 Total Program Expenses 7,395,758.00 0.00 0.00 7,395,758.00 TOTAL DIRECT EXPENSES 7,395,758.00 0.00 0.00 7,395,758.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs t 1,838,652.00 0.00 0.00 1,838,652.00 2 Other Costs Distributions -6,448,393.00 0.00 0.00 -6,448,393.00 Total Indirect Costs -4,609,741.00 0.00 0.00 -4,609,741.00 TOTAL INDIRECT EXPENSES -4,609,741.00 0.00 0.00 -4,609,741.00 TOTAL EXPENDITURES 2,786,017.00 0.00 0.00 2,786,017.00 Date: 12/0312014 Contract If 20151753-00, Oakland County Department of Health and Human Services/ Page: 33 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS - Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 596,250.00 0.00 596,250.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 1,922,472.00 0.00 1,922,472.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 14,236.00 0.00 14,236.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MUCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 253,059.00 0.00 253,059.00 inkind Match 0.00 0.00 0.00 0.00 MOCK Fixed Unit Rate 0.00 0.00 0.00 0.00 Total Source of Funds 0.00 2,786,017.00 0.00 2,786,017.00 Totals 0.00 2,786,017.00 0.00 2,786,017.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 34o1 184 Health Division, Comprehensive Agreement .2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail 'Line Item I Amount Cash Inkind, Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,534,242.00 0.00 0.00 3,534,242.00 2 Fringe Benefits 2,249,513.00 0.00 0.00 2,249,513.00 3 Cap. Exp. for Equip & Fac, 4 Contractual 5 Supplies and Materials 71,742.00 0.00 0.00 71,742.00 6 Travel 231,575.00 0.00 0.00 231,575.00 7 Communication 100,664.00 0.00 0.00 100,664.00 8 County-City Central Services 535,438.00 0.00 0.00 535,438.00 9 Space Costs 106,872.00 0.00 0.00 106,872.00 10 All Others (ADP, Con. Employees, Misc.) 565,712.00 0.00 0.00 565,712.00 Total Program Expenses 7,395,758.00 0.00 0.00 7,395,758.00 TOTAL DIRECT EXPENSES 7,395,758.00 0.00 0.00 7,395,758.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 1,838,652.00 0.001 0.00 1,838,652.00 2 Other Costs Distributions EH Adm Distribtions -6,433,393.00 0.00 0.00 -6,433,393.00 Other Cost Distributions-Body Art Fees -15,000.00 0.00 0,00 -15,000.00 Total for Other Costs Distributions -6,448,393.00 0.00 0.00 -6,448,393.00 Total Indirect Costs -4,609,741.00 0.00 0.00 -4,609,741.00 TOTAL INDIRECT EXPENSES -4,609,741.00 0.00 0.00 -4,609,741.00 TOTAL EXPENDITURES 2,786,017.00 0.00 0.00 2,786,017.00 Date: 12/0312014 Contract// 20151753-00, Oakland County Department of Health and Human Services/ Page: 35 of 184 Health DIvisfon, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/0312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Adolescent STD Screening DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT WI Original r Amendment AMENDMENT # 0 CITY Pontiac , STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category I Amount] Cash 1 Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 33,429,00 0.00 0.00 33,429.00 2 Fringe Benefits 14,406.00 0.00 0.00 14,406.00 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 5,692.00 0.00 0.00 5,692.00 6 Travel 560.00 0.00 0.00 560.00 7 Communication 336.00 0.00 0.00 336.00 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 13,513.00 0.00 0.00 13,513.00 Total Program Expenses 67,936.00 0.00 0.00 67,936.00 TOTAL DIRECT EXPENSES 67,936.00 0.00 0.00 67,936.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 5,064.00 0.00 0.00 5,064.00 2 Other Costs Distributions 9,350.00 0.00 0.00 9,350.00 Total Indirect Costs 14,414.00 0.00 0.00 14,414.00 TOTAL INDIRECT EXPENSES 14,414.00 0.00 0.00 14,414.00 TOTAL EXPENDITURES 82,350.00 0.00 0.00 82,350.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 36 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 73,000.00 0.00 0.00 73,000.00 ELPHS - MDCH Hearing 0.00 0.00 0,00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 9,350.00 0.00 9,350.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 73,000.00 9,350.00 0.00 82,350.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 37 o1184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 1210312014 3 Program Budget - Cost Detail Line item I Qty Rate UOM Amount' Cash Inkindl Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse Notes : Public Health Nurse II 1.0000 10409.000 FTE 10,409.00 0.00 0.00 10,409.00 Assistant Notes : Office Assistant 1.0000 2195.000 FTE 2,195.00 0.00 0.00 2,195.00• Technician Notes : Medical Technologist 1.0000 5925.000 FTE 5,925.00 0.00 0.00 5,925.00 Coordinator Notes : Health Program Coordinator 1.0000 4878.000 FIE 4,878.00 0.00 0.00 4,878.00 Public Health Nurse Notes : PHN III 1.0000 10022.000 FTE 10,022.00 0.00 0.00 10,022.00 Total for Salary & Wages 33,429.00 0.00 0.00 33,429.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 43.091 14,406.00 0.00 0.00 14,406.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 392.00 0.00 0.00 392.00 Medical Supplies 0.0000 0.000 50.00 0.00 0.00 50.00 Printing 0.0000 0.000 250.00 0.00 0.00 250.00 Educational Supplies 0.0000 0.000 5,000.00 0.00 0.00 5,000.00 Total for Supplies and Materials 5,692.00 0.00 0.00 5,692.00 6 Travel Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 38 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 Line Item Qty Rate UOM Amount Cash Inkind Total Mileage Notes : 177 miles @ .565 0.0000 0.000 560.00 0.00 0.00 560.00 7 Communication Telephone 0.0000, 0.000 336.00 0.00 0.00 336.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 180.00 0.00 0.00 180.00 Information Technology 0.0000 0.000 2,800.00 0.00 0.00 2,800.00 Advertising 0.0000 0.000 10,533.00 0.00 0.00 10,533.00 Total for All Others (ADP, Con. Employee 13,513.00 0.00 0.00 13,513.00 Total Program Expenses 67,936.00 0.00 0.00 67,936.00 TOTAL DIRECT EXPENSES 67,936.00 0.00 0.00 67,936.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs , Fiscal Year Rate 1 0.0000 15.1501 5,064.00 0.00 0.00 5,064.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 9,350.00 0.00 0.00 9,350.00 Total Indirect Costs 14,414.00 0.00 0.00 14,414.00 TOTAL INDIRECT EXPENSES 14,414.00 0.00 0.00 14,414.00 TOTAL EXPENDITURES _ 82,350.00 0.00 0.00 82,350.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 39 of 184 Health DIvIsion, Comprehensive Agreement -2015 Contract #20151753-00 Date: 1210312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Local Health Department SNAP-ED DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2014 To :9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p. n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 24,451.00 0.00 0.00 24,451.00 2 Fringe Benefits 4,148.00 0.00 0.00 4,148.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 19,541.00 0.00 0.00 19,541.00 6 Travel 2,036.00 0.00 0.00 2,036.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 8,568.00 0.00 0.00 8,568.00 Total Program Expenses 58,744.00 0.00 0.00 58,744.00 TOTAL DIRECT EXPENSES 58,744.00 0.00 0.00 58,744.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,704.00 0.00 0.00 3,704.00 Other Costs Distributions 7,998.00 0.00 0.00 7,998.00 Total Indirect Costs 11,702.00 0.00 0.00 11,702.00 TOTAL INDIRECT EXPENSES 11,702.00 0.00 0.00 11,702.00 TOTAL EXPENDITURES 70,446.00 0.00 0.00 70,446.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 40 of 184 Health Division, Comprehensive Agreement - 2015 Contract 4 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.40 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 4.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 49,958.00 0.00 0.00 49,958.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 7,998.00 0.00 7,998.00 lnkind Match 0.00 0.00 12,490.00 12,490.00 MDCH Fixed Unit Rate Totals 49,958.00 7,998.00 12,490.00 70,446.00 Date: 12/0312014 Contract 4 20151753-00, Oakland County Department of Health and Human Services/ Page: 41 of 184 Health DIvision, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/0312014 3 Program Budget - Cost Detail ILine Item 1 Qty RatelUOM I Amount Cash' Inkindl Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor Notes : MATCH 41.0000 34.854 FTE 1,429.00 0.00 0.00 1,429.00 Health Educator Notes : MATCH 1065.00 00 18.157 FTE 19,337.00 0.00 0.00 19,337.00 Outreach Worker Notes : MATCH 21.0000 19.238 FTE 404.00 0.00 0.00 404.00 Epidemiologist Notes : MATCH 21.0000 29.905 FTE 628.00 0.00 0.00 628.00 Health Educator 104.000 0 25.510 FTE 2,653.00 0.00 0.00 2,653.00 Total for Salary & Wages 24,451.00 0.00 0.00 24,451.00 2 Fringe Benefits All Composite Rate Notes : MATCH $3,034 FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 16.965 4,148.00 0.00 0.00 4,148.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Provisions - Food 0.0000 0.000 2,710.00 0.00 0.00 2,710.00 Postage 0.0000 0.000 4,008.00 0.00 0.00 4,008.00 Printing 0.0000 0.000 10,421.00 0.00 0.00 10,421.00 Supplies - Food Demo 0.0000 0.000 1,386.00 0.00 0.00 1,386.00 Educational Supplies 0.0000 0.000 1,016.00 0.00 0.00 1,016.00 Total for Supplies and Materials 19,541.00 0.00 0.00 19,541.00 6 Travel Mileage 0.0000 0.000 908.00 0.00 0.00 908.00 Date: 2/03/2014 Contract #20151753 00, Oakland County Department of Health and Human Services/ Page: 42 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Notes : 1622 @ .56 Conferences 0.0000 0.000 1,128.00 0.00 0.00 1,128.00 Total for Travel 2,036.00 0.00 0.00 2,036.00 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 180.00 0.00 0.00 180.00 Interpretation 0.0000 0.000 1,976.00 0.00 0.00 1,976.00 Advertising 0.0000 0.000 4,060.00 0.00 0.00 4,060.00 Licenses & Permits Notes : MATCH 0.0000 0.000 648.00 0.00 0.00 648.00 Info Tech Operations Notes : MATCH 0.0000 0.000 1,360.00 0.00 0.00 1,360.00 Staff Training 0.0000 _ 0.000 344.00 \._ 0.00 0.00 344.00 Total for All Others (ADP, Con. Employee 8,568.00 0.00 0.00 8,568.00 Total Program Expenses 58,744.00 0.00 0.00 58,744.00 TOTAL DIRECT EXPENSES 58,744.00 0.00 0.00 58,744.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate Notes : MATCH $2982 0.0000 15.150 3,704.00 0.00 0.00 3,704.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 7,998.00 0.00 0.00 7,998.00 Total Indirect Costs 11,702.00 0.00 0.00 11,702.00 TOTAL INDIRECT EXPENSES 11,702.00 0.00 0.00 11,702.00 TOTAL EXPENDITURES 70,446.00 0.00 0.00 70,446.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 43 of 184 Health Division, Comprehensive Agreement -2015 Contract 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM 1 PROJECT Comprehensive Agreement - 2015 / Public Health Emergency Preparedness (PHEP) 10/1/14 -6/30115 DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To :6/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount Cash Inkind 1 Total DIRECT EXPENSES Program Expenses Salary & Wages 123,924.00 0.00 0.00 123,924.00 2 Fringe Benefits 78,072.00 0.00 0.00 78,072.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 2,263.00 0.00 0.00 2,263.00 6 Travel 8,448.00 0.00 0.00 8,448.00 7 Communication 3,269.00 0.00 0.00 3,269.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 8,381.00 0.00 0.00 8,381.00 10 All Others (ADP, Con. Employees, Misc.) 16,043.00 0.00 0.00 16,043.00 Total Program Expenses 240,400.00 0.00 0.00 240,400.00 TOTAL DIRECT EXPENSES 240,400.00 0.00 0.00 240,400.00 INDIRECT EXPENSES Indirect Costs i Indirect Costs 18,774.00 0.00 0.00 18,774.00 2 Other Costs Distributions 33,195.00 0.00 0.00 33,195.00 Total Indirect Costs 51,969.00 0.00 0.00 51,969.00 TOTAL INDIRECT EXPENSES 51,969.00 0.00 0.00 51,969.00 TOTAL EXPENDITURES 292,369.00 0.00 0.00 292,369.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 44 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash I lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS , 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 236,124.00 0.00 0.00 236,124.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 100 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 33,195.00 0.00 33,195.00 Inkind Match 0.00 0.00 23,050.00 23,050.00 MDCH Fixed Unit Rate Totals 236,124.00 33,195.00 23,050.00 292,369.00 Date: 12103/2014 Contract #2015175:3-00, Oakland County Department of Health and Human Services/ Page: 45 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty Rate UOM I Amount' Cash! inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator Notes : Health Program Coordinator 0.7500 67636.000 FTE 50,727.00 0.00 0.00 50,727.00 Assistant Notes : Office Assistant 11 0.3750 30974.000 FTE 11,615.00 0.00 0.00 11,615.00 Health Educator Notes : Public Health Educator II 0.3750 43896.000 FTE 16,461.00 0.00 0.00 16,461.00 Assistant Notes : Technical Assistant 0.3750 35618.000 FTE 13,357.00 0.00 0.00 13,357.00 Specialist Notes : Public Health Emer Prep Specialist 0.3750 50200.000 FTE 18,825.00 0.00 0.00 18,825.00 Manager Notes : MATCH FUNDS - K FORZLEY HEALTH MANAGER 0.1202 107642.000 FTE 12,939.00 0.00 0.00 12,939.00 Total for Salary & Wages 123,924.00 0.00 0.00 2 Fringe Benefits ALI Composite Rate Notes : MATCH $7,757 FICA Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Short/Long Term Disability Dental Ins Work Comp 0.0000 62.999 78,072.00 0.00 0.00 78,072.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 1,263.00 0.00 0.00 1,263.00 Disaster Supplies 0.0000 0.000 1,000.00 0.00 0.00 1,000.00 Date: 12/03/2014 Contract #20151753-00 Oakland County Department of FleaAh and Human Services/ Page: 46 of 184 Health Division, Comprehensive Agreement 2015 Contract # 20151753-00 Date: 1210312014 1Line Item i Qtyl RatelUOM Amount Cash Inkind Total Total for Supplies and Materials 2,263.00 0.00_ 0.00 2,263.00 6 Travel Mileage Notes : 6000 miles @ .56 0.0000 0.000 3,360.00 0.00 0.00 3,360.00 Conferences 0.0000 0.000 5,088.00 0.00 0.00 5,088.00 Total for Travel 8,448.00 0.00 0.00 8,448.00 7 Communication Telephone Communications 0.0000 0.000 3,269.00 0.00 0.00 3,269.00 8 County-City Central Services Space Costs Building Space Rental I 0.00001 0.000 8,381.00 0.00 0.00 8,381.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 627.00 0.00 0.00 627.00 Copier 0.0000 0.000 3,825.00 0.00 0.00 3,825.00 IT Operations 0.0000 0.000 10,075.00 0.00 0.00 10,075.00 Software support 0.0000 0.000 1,516.00 0.00 0.00 1,516.00 Total for All Others (ADP, Con. Employee 16,043.00 0.00 0.00 16,043.00 Total Program Expenses 240,400.00 0.00 0.00 240,400.00 TOTAL DIRECT EXPENSES 240,400.00 0.00 0.00 240,400.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate Notes : MATCH $1959 0.0000 15.150 18,774.00 0.00 0.00 18,774.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 33,195.00 0.00 0.00 33,195.00 Total indirect Costs 51,969.00 0.00 0.00 51,969.00 TOTAL INDIRECT EXPENSES 51,969.00 0.00 0.00 51,969.00 TOTAL EXPENDITURES 292,369.00 0.00 0.00 292,369.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 47 of 184 Health DivIsion, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM 1 PROJECT Comprehensive Agreement - 2015 / Body Art Fixed Fee DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/3012015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT WI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount I Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 16,000.00 0.00 0.00 15,000.00 Total Indirect Costs 15,000.00 0.00 0.00 15,000.00 TOTAL INDIRECT EXPENSES 15,000.00 0.00 0.00 15,000.00 TOTAL EXPENDITURES 15,000.00 0.00 0.00 15,000.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 48 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Body Art Fee 15,000.00 0.00 0.00 15,000.00 Totals 15,000.00 0.00 0.00 15,000.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 49 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty Rate UOM Amount' Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees-from Environ 0.0000 0.000 15,000.00 0.00 0.00 15,000.00 Total Indirect Costs 15,000.00 0.00 0.00 15,000.00 TOTAL INDIRECT EXPENSES 15,000.00 0.00 0.00 15,000.00 TOTAL EXPENDITURES 15,000.00 0.00 0.00 15,000.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 50 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12103/2014 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Childrens Special 1-11th Care Services (CSHCS) Care Coordination DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT FA Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category Amount I Cash I Inkind Total DIRECT EXPENSES Program Expenses Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 256,622.00 0.00 0.00 256,622.00 Total Indirect Costs 256,622.00 0.00 0.00 256,622.00 TOTAL INDIRECT EXPENSES 256,622.00 0.00 0.00 256,622.00 TOTAL EXPENDITURES 256,622.00 0.00 0.00 256,622.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department e Health and Human Services/ Page: 51 of 184 Health DivIslon, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0,00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate CSHCS Care Coordination 256,622.00 0.00 0.00 256,622.00 Totals 256,622.00 0.00 0.00 256,622.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Serviced Page: 52 of 184 Health DIvision, Gomprehensive Agreement - 2015 Contract 4 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty RatelUOM I Amount Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees-from CSHCS 0 0.0000 0.000 256,622.00 0.00 0.00 256,622.00 Total Indirect Costs 256,622.00 0.00 0.00 256,622.00 TOTAL INDIRECT EXPENSES 256,622.00 0.00 0.00 256,622.00 TOTAL EXPENDITURES 256,622.00 0.00 0.00 256,622.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 53 of 184 Health Division, Comprehensive Agreement - 2015 Contract if 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / CSHCS Medicaid Outreach DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To :9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 732,816.00 0.00 0.00 732,816.00 Total Indirect Costs 732,816.00 0.00 0.00 732,816.00 TOTAL INDIRECT EXPENSES 732,816.00 0.00 0.00 732,816.00 TOTAL EXPENDITURES 732,816.00 0.00 0.00 732,816.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 54 of 184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 234,025.00 0.00 0.00 234,025.00 Required Match - Local 0.00 234,025.00 0.00 234,025.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 264,766.00 0.00 264,766.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 234,025.00 498,791.00 0.00 732,816.00 Date*, 12/0312014 Contract #201517S3-00, Oakland County Department of Health and Human Services/ Page: 55 01184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty RatelUOM Amount Cash lnkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Distributions for Medicaid 0.0000 0.000 732,816.00 0.00 0.00 732,816.00 Total indirect Costs 732,816.00 0.00 0.00 732,816.00 TOTAL INDIRECT EXPENSES 732,816.00 0.00 0.00 732,816.00 TOTAL EXPENDITURES 732,816.00 0.00 0.00 732,816.00 Date: 12/0312014 Contact #20151753-00, Oakland County Department of Health aticl Human Services/ Page: 56 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Public Health Emergency Preparedness (PHEP) CRI 10/1/14 - 6/30/15 DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To :6/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT .17 Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category I Amount Cash I Inkind I Total DIRECT EXPENSES Program Expenses Salary & Wages 69,101.00 0,00 0.00 69,101.00 2 Fringe Benefits 43,534.00 0.00 0.00 43,534.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 6,996.00 0.00 0.00 6,996.00 6 Travel 2,824.00 0.00 0.00 2,824.00 7 Communication 8,088.00 0.00 0.00 8,088.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 4,203.00 0.00 0.00 4,203.00 10 All Others (ADP, Con. Employees, Misc.) 28,079.00 0.00 0.00 28,079.00 Total Program Expenses 162,825.00 0.00 0.00 162,825.00 TOTAL DIRECT EXPENSES 162,825.00 0.00 0.00 162,825.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 10,469.00 0.00 0.00 10,469.00 2 Other Costs Distributions 22,195.00 0.00 0.00 22,195.00 Total Indirect Costs 32,664.00 0.00 0.00 32,664.00 TOTAL INDIRECT EXPENSES 32,664.00 0.00 0.00 32,664.00 TOTAL EXPENDITURES 195,489.00 0.00 0.00 195,489.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Heaith and Human Services/ Page: 57 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 L 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 157,540.00 0.00 0.00 157,540.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 , 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 22,195.00 0.00 22,195.00 Inkind Match 0.00 0.00 15,754.00 15,754.00 MDCH Fixed Unit Rate Totals 157,540.00 22,195.00 15,754.00 195,489.00 Date: 12/03/2014 Contract 4 20161753.00, Oakland County Department of Health and Human Services/ Page: 58 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 1210312014 3 Program Budget - Cost Detail Line Item 1 Qty RatelUOM ' Amount! Cash! Inkindl Total DIRECT EXPENSES Program Expenses i Salary & Wages Specialist Notes : PH Emer Prep Specialist 780.000 0 24.135 FTE 18,825.00 0,00 0.00 18,825.00 Assistant Notes : Office Assistant 2 780.000 0 14,891 FTE 11,615.00 0.00 0.00 11,615.00 Health Educator Notes : PH Educator 1 780.000 0 21.104 FTE 16,461.00 0.00 0.00 16,461,00 Assistant Notes : Tech Assistant 780.000 0 17.124 FTE 13,357.00 0,00 0.00 13,357.00 Administrator Notes : Administration - MATCH FUNDS 205.000 0 43.137 FTE 8,843.00 0.00 0.00 8,843.00 ,Total for Salary & Wages 69,101.00 0.00 0.00 69,101.00 2 Fringe Benefits Composite Rate Notes : MATCH $5571 FICA Unemp Ins Retirement Hospital Insurance Life Insurance Vision Ins. Short/Long Term Disability Dental Insurance Work Comp 0.0000 63.000 43,534.00 0.00 0.00 43,534.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 350.00 0.00 0.00 350.00 Printing 0.0000 0.000 3,000.00 0.00 0.00 3,000.00 Disaster Supplies 0.0000 0.000 3,646.00 0.00 0.00 3,646.00 Total for Supplies and Materials 6,996.00 0.00 0.00 6,996.00 Travel Mileage Notes : 500 miles @ .56 0.0000 0.000 280.00 0.00 0.00 280.00 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Health Division, Comprehensive Agreement - 2015 Date: 12/03/2014 Page: 59 of 184 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Conferences 0.0000_ 0.000 2,544.00 0.00 0.00 2,544.00 Total for Travel 2,824.00 0.00 0.00 2,824.00 7 Communication Telephone Communications 0.0000 0.000 8,088.00 0.00 0.00 8,088.00 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 1 4,203.00 0.00 0.00 4,203.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 441.00 0.00 0.00 441.00 IT Operations 0.0000 0.000 10,926.00 0.00 0.00 10,926.00 Professional Services 0.0000 0.000 11,122.00 0.00 0.00 11,122.00 Software support - Barcode Inc 0.0000 0.000 5,590.00 0.00 0.00 5,590.00 Total for All Others (ADP, Con. Employee 28,079.00 0.00 0.00 28,079.00 Total Program Expenses 162,825.00 0.00 0.00 162,825.00 TOTAL DIRECT EXPENSES 162,825.00 0.00 0.00 162,825.00 INDIRECT EXPENSES Indirect Costs H 1 Indirect Costs Fiscal Year Rate Notes : MATCH $1,448 0.0000 - 15.150 10,469.00 0.00 0.00 10,469.00 2 Other Costs Distributions Health Adm Distribution 0,0000 0.000 22,195.00 0.00 0.00 22,195.00 Total Indirect Costs 32,664.00 0.00 0.00 32,664.00 TOTAL INDIRECT EXPENSES 32,664.00 0.00 0.00 32,664.00 TOTAL EXPENDITURES 195,489.00 0.00 0.00 195,489.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services! Page: 60 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 ) Childrens Special 111th Care Services (CSHCS) Outreach & Advocacy DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F71 Original rr Amendment AMENDMENT # 0 CITY Ponttac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 294,656.00 0.00 0.00 294,656.00 2 Fringe Benefits 110,632.00 0.00 0.00 110,632.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 10,897.00 0.00 0.00 10,897,00 6 Travel 1,784.00 0.00 0.00 1,784.00 7 Communication 12,500.00 0.00 0.00 12,500.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 24,398.00 0.00 0.00 24,398.00 10 All Others (ADP, Con. Employees, Misc.) 42,115,00 0.00 0.00 42,115.00 Total Program Expenses 496,982.00 0.00 0.00 496,982.00 TOTAL DIRECT EXPENSES 496,982.00 0.00 0.00 496,982.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 44,640.00 0.00 0.00 44,640.00 2 Other Costs Distributions -256,622.00 0.00 0.00 -256,622.00 Total Indirect Costs :211,982.00 0.00 0.00 -211,982.00 TOTAL INDIRECT EXPENSES -211,982.00 0.00 0.00 -211,982.00 TOTAL EXPENDITURES 285,000.00 0.00 0.00 285,000.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 61 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 285,000.00 0.00 0.00 285,000.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals LI 285,000.00 0.00 0.00 285,000.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 62 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty RatolUOM Amount' Cash Inkind Total DIRECT EXPENSES Program Expenses Salary & Wages Supervisor 1.0000 72489.000 FTE 72,489.00 0.00 0.00 72,489.00 Public Health Nurse 0.4808 54125.000 FTE 26,022.00 0.00 0.00 26,022.00 Public Health Nurse 0.4807 48720.000 FTE 23,420.00 0.00 0.00 23,420.00 Assistant 0.4808 38043.000 FTE 18,291.00 0.00 0.00 18,291.00 Outreach Worker 0.4808 40060.000 FTE 19,260.00 0.00 0.00 19,260.00 Assistant 0.3365 29899.500 FTE 10,062.00 0.00 0.00 10,062.00 Assistant 0.4808 29899.000 FTE 14,375.00 0.00 0.00 14,375.00 Assistant 0.1683 26613.000 FTE 4,478.00 0.00 0.00 4,478,00 Assistant 1.0000 29210.000 FTE 29,210.00 0.00 0.00 29,210.00 Assistant 1.0000 38046.000 FTE 38,046.00 0.00 0.00 38,046.00 Public Health Nurse 0.2885 64140.000 FTE 18,503.00 0.00 0.00 18,503.00 Public Health Nurse 0.2885 64140.000 FTE 18,503.00 0.00 0.00 18,503.00 OVERTIME 0.0668 29889,000 FTE 1,997.00 0.00 0.00 1,997.00 Total for Salary & Wages 294,656.00 0.00 0.00 294,656.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 37.546 _ 110,632.00 0.00 0.00 110,632.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 3,886.00 0.00 0.00 3,886.00 Postage 0.0000 0.000 3,500.00 0,00 0.00 3,500.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 63 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Printing 0.0000 0.000 3,511.00 0.00 0.00 3,511.00 Total for Supplies and Materials 10,897.00 0.00 0.00 10,897.00 6 Travel Mileage Notes : 1400 miles @.56 0.0000 0.000 784.00 0.00 0.00 784.00 Conferences 0.0000 0.000 500.00 0.00 0.00 500.00 client transportation 0.0000 0.000 500.00 0.00 0.00 500.00 Total for Travel 1,784.00 0.00 0.00 1,784.00 7 Communication Telephone 0.0000 0,000 12,500.00 0.00 0.00 12,500.00 8 County.City Central Services Space Costs Building Space Rental 0.0000 0.000 24,398.00 0.00 0.00 24,398.00 10 All Others (ADP, Con. Employees, Misc.) Convenience Copier 0.0000 0.000 2,350,00 0.00 0.00 2,350.00 Insurance 0.0000 0.000 765.00 0.00 0.00 765.00 IT Operations 0.0000 0.000 39,000.00 0.00 0.00 39,000.00 Total for All Others (ADP, Con. Employee 42,115.00 0.00 0.00 42,115.00 Total Program Expenses 496,982.00 0.00 0.00 496,982.00 TOTAL DIRECT EXPENSES 496,982.00 0.00 0.00 496,982.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate I 0.0000 15.150 44,640.00 0.00 0.00 44,640.00 2 Other Costs Distributions Other Cost Distributions-CSHCS Care Coor 0.0000 0.000 -256,622.00 0.00 0.00 -256,622.00 Health Adm Distribution 0.0000 0.000 69,371.00 0.00 0.00 69,371.00 Other Cost Distributions-Nursing Staff 0.0000 0.000 646,695.00 0.00 0.00 646,695.00 Nursing Adm Distribution 0.0000 0.000 16,750.00 0.00 0.00 16,750.00 Other Cost Distributions-CSHCS - Medical 0.0000 0.000 _. .1 -732,816.00 0.00 0.00 -732,816.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 64 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Total for Other Costs Distributions -256,622.00 0.00 0.00 -256,622.00 Total Indirect Costs -211,982.00 0.00 0.00 -211,982.00 TOTAL INDIRECT EXPENSES -211,982.00 0.00 0.00 -211,982.00 TOTAL EXPENDITURES 285,000.00 0.00 0.00 285,000.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 65 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -20151 Bioterrorism Regional EPI Support DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F7, Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category i Amount Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 2,513.00 0.00 0.00 2,513.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 344.00 0.00 0.00 344.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 1,818.00 0.00 0.00 1,818.00 10 All Others (ADP, Con. Employees, Misc.) 2,825.00 0.00 0.00 2,825.00 Total Program Expenses 7,500.00 0.00 0.00 7,500.00 TOTAL DIRECT EXPENSES 7,500.00 0.00 0.00 7,500.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 961.00 0.00 0.00 961.00 Total Indirect Costs 961.00 0.00 0.00 961.00 TOTAL INDIRECT EXPENSES 961.00 0.00 0.00 961.00 TOTAL EXPENDITURES 8,461.00 0.00 0.00 8,461.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 56 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 7,500.00 0.00 0.00 7,500.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 961.00 0.00 961.00 lnkind Match 0.00 ., 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 7,500.00 961.00 0.00 8,461.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 67 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail tLine Item I Qty Rate UOM ! Amount! Cashl Inkind Total DIRECT EXPENSES Program Expenses Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0.00001 0.0001 2,513.00 0.00 0.00 2,513.00 Travel 7 Communication phones 0.0000 0.000 344.00 0.00 0.00 344.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.0001 1,818.00 0.00 0.00 1,818.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 25.00 0.00 0.00 25.00 IT Operations 0.0000 0.000 2,800.00 0.00 0.00 2,800.00 Total for All Others (ADP, Con. Employee 2,825.00 0.00 0.00 2,825.00 Total Program Expenses 7,500.00 0.00 0.00 7,500.00 TOTAL DIRECT EXPENSES 7,500.00 0.00 0.00 7,500.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 961.00 0.00 0.00 961.00 Total Indirect Costs 961.00 0.00 0.00 961.00 TOTAL INDIRECT EXPENSES 961.00 0.00 0.00 961.00 TOTAL EXPENDITURES 8,461.00 0.00 0.00 8,461.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Homan Services/ Page: 68 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015! Fetal Infant Mortality Review (FIMR) Case Abstraction DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To :9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT PI Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category I Amount i Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,441.00 0.00 0.00 4,441.00 Fringe Benefits 263.00 0.00 0.00 263.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 23.00 0.00 0.00 23.00 Total Program Expenses 4,727.00 0.00 0.00 4,727,00 TOTAL DIRECT EXPENSES 4,727.00 0.00 4,727.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 673.00 0.00 0.00 673.00 2 Other Costs Distributions 859,00 0.00 0.00 859.00 Total Indirect Costs 1,532.00 0.00 0.00 1,532,00 TOTAL INDIRECT EXPENSES 1,532.00 0.00 0.00 1,532.00 TOTAL EXPENDITURES 6,259.00 0.00 0.00 6,259.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 69 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 D.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 5,400.00 0.00 0.00 5,400.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0,00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0,00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 859.00 0.00 859.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 5,400.00 859.00 0.00 6,259.00 Date: 12/03/2014 Contract tk 20151753-00, Oakland County Department of Health and Human Services/ Page: 70 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qtyl Rate UOM Amount' Cash I inkind , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse Notes : PH Nurse 3 0.0692 64170.000 FTE 4,441.00 0.00 0.00 4,441.00 2 Fringe Benefits All Composite Rate Notes : Social Security (FICA) Unemp Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.920 263.00 0.00 0.00 263.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 23.00 0.00 0.00 23.00 Total Program Expenses 4,727.00 0.00 0.00 4,727.00 TOTAL DIRECT EXPENSES 4,727.00 0.00 0.00 4,727.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Fiscal Year Rate 0.0000 15.150 673.00 0.00 0.00 673.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 692.00 0.00 0.00 692.00 Nursing Adm Distribution 0.0000 0.000 167.00 0,00 0.00 167,00 Total for Other Costs Distributions 859.00 0.00 0.00 859.00 Total Indirect Costs 1,532.00 0.00 0.00 1,532.00 TOTAL INDIRECT EXPENSES 1,532.00 0.00 0.00 1,532.00 Dale: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 71 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 ILine Item ! Qty RatelUOM Amount Cash Inkind Total TOTAL EXPENDITURES 6,259.00 0.00 0.00 6,259.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 72 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Food ELPHS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT )7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category 1 Amount I Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 3,953,856.00 0.00 0.00 3,953,856.00 Total Indirect Costs 3,953,856.00 0.00 0.00 3,953,856.00 TOTAL INDIRECT EXPENSES 3,953,856.00 0.00 0.00 3,953,856.00 TOTAL EXPENDITURES 3,953,856.00 0.00 0.00 3,953,856.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 73 of 184 Health Division, Comprehensive Agreement - 2015 Contract ft 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS _ Category Amount 1 Cash , Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 1,160,000.00 0.00 1,160,000.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 l.. Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0,00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,934,643.00 0.00 1,934,643.00 Inkind Match 0,00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals L 859,213.00 3,094,643.00 0.00 [ 3,953,856.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 74 of 184 Health Division, Comprehensive Agreement- 2015 Contract # 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item I Qty RatelUOM Amount' Cash I inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 3,963,856.00 0.00 0.00 3,953,856.00 Total Indirect Costs 3,953,856.00 0.00 0.00 3,953,856.00 TOTAL INDIRECT EXPENSES 3,953,856,00 0.00 0.00 3,953,856.00 TOTAL EXPENDITURES 3,953,856.00 0.00 0.00 3,953,856.00 Date 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 75 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / General Communicable Disease ELPHS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category Amount I Cash lnkind I Total DIRECT EXPENSES Program Expenses Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0,00 10 All Others (ADP, Con, Employees, Misc.) 0.00 0,00 0,00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 1,645,649.00 0.00 0.00 1,645,649.00 Total Indirect Costs 1,645,649.00 0,00 0.00 1,645,649.00 TOTAL INDIRECT EXPENSES 1,645,649,00 0.00 0.00 1,645,649.00 TOTAL EXPENDITURES 1,645,649.00 0.00 0.00 1,645,649.00 Date: 12/03/2014 Contract # 20151753-0D, Oakland County Department of Health and Human Services/ Page: 76 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind I Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines D.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 385,566.00 0.00 0.00 385,566.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,260,083.00 0.00 1,260,083.00 lnkind Match 0,00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 385,566.00 1,260,083.00 0.00 1,645,649.00 Date: 12103/2014 Contract # 20151753.00, Oakland County Department of Health and Human Services/ Page: 77 of 184 Health Division, Comprehensive Agreement - 2016 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item I Qty RatelUOM Amount Cashl Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Other Costs Distributions Other Cost Distributions-CD Unit Staff Notes : 50% of FTE Medical Director's salary and fringes 100% of CD Staff Unit time includes,Epidemiologist s, PHN's, PHN Supervisor, Office Assistants 0.0000 0.000 1,249,262.00 0.00 0.00 1,249,262.00 Other Cost Distributions-Misc Cost disti Notes : 1% of total Health Division Clinic Expenses (based on a workload management program that tracks Clinic Nursing time) 0.0000 0.000 63,274.00 0.00 0.00 63,274.00 Health Adm Distribution Notes : 4.25 % of Central Support Unit Staff expenses 0.0000 0.000 333,113.00 0.00 0.00 333,113.00 Date: 12103/2014 Contract # 20151753 00, 0aWand County Department of Health and Human Services/ Page: 78 of 184 Hearth Division, Comprehensive Agreement- 2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UONI Amount Cash lnkind Total 0.3 % of Lab Support staff expenses 0.13 % of Health Division Administration Expenses Total for Other Costs Distributions 1,645,649.00 0.00 0.00 1,645,649.00 Total Indirect Costs 1,645,649.00 0.00 0.00 1,645,649.00 TOTAL INDIRECT EXPENSES 1,645,649.00 0.00 0.00 1,645,649.00 TOTAL EXPENDITURES 1,645,649.00 0.00 0.00 1,645,649.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 79 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM I PROJECT Comprehensive Agreement - 2015 / Gonococcal Isolate Surveillance Project DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT F. 1 , Original [7 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category 1 Amount I Cash Inkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 8,000.00 0.00 0.00 8,000.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 Total Program Expenses 8,000.00 0.00 0.00 8,000.00 TOTAL DIRECT EXPENSES 8,000.00 0.00 0.00 8,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 1,025.00 0.00 0.00 1,025.00 Total Indirect Costs 1,026.00 0.00 0.00 1,025.00 TOTAL INDIRECT EXPENSES 1,025.00 0.00 0.00 1,025.00 TOTAL EXPENDITURES 9,025.00 0.00 0.00 9,025.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 80 of 184 Health Division, Comprehensive Agreement - 2015 Contract #2015l753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I lnkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MUCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 , Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0.00 0.00 MUCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 8,000.00 0.00 0.00 8,000.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MUCH Vision 0.00 0.00 0.00 0.00 ELPHS - MUCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0,00 0,00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0,00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other L. 0.00 1,025.00 0.00 1,025,00 lnkind Match 0.00 0.00 0,00 0.00 IVIDCH Fixed Unit Rate Totals 8,000.00 1,025.00 0.00 9,025.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 81 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 1210312014 3 Program Budget - Cost Detail JLine Item ' Qty I Ratell.101V1 1 Amount Cash' Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials SupplieS & materials 0.0000 0.0001 8,000,00 0.001 0.00 8,000.00 6 Travel 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 8,000.00 0.00 0.00 8,000.00 TOTAL DIRECT EXPENSES 8,000.00 0,00 0.00 8,000.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Other Costs Distributions Health Adm Distribution 0.0000 0.000 1,026.00 0.00 0.00 1,025.00 Total Indirect Costs 1,025.00 0.00 0.00 1,025.00 TOTAL INDIRECT EXPENSES 1,025.00 0.00 0.00 1,025.00 TOTAL EXPENDITURES 9,025.00 0.00 0.00 9,025.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human ServIces/ Page: 82 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12)03/2014 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015/ Hearing ELPHS DATE PREPARED 12/312014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F7. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category Amount' Cash . Inkind , Total DIRECT EXPENSES Program Expenses Salary & Wages 262,662.00 0.00 0.00 262,662.00 2 Fringe Benefits 78,650.00 0.00 0.00 78,650.00 Cap. Exp. for Equip & Fac, 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 3,706.00 0.00 0.00 3,706.00 Travel 6,127.00 0.00 0.00 6,127.00 7 Communication 698.00 0.00 0.00 698.00 8 , County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 18,073.00 0.00 0.00 18,073.00 10 All Others (ADP, Con. Employees, Misc.) 5,368.00 0.00 0.00 5,368.00 Total Program Expenses 375,284.00 0.00 0.00 375,284.00 TOTAL DIRECT EXPENSES 375,284.00 0.00 0.00 375,284.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 39,793.00 0.00 0.00 39,793.00 2 Other Costs Distributions 129,320.00 0.00 0.00 129,320.00 Total Indirect Costs 169,113.00 0.00 0.00 169,113.00 TOTAL INDIRECT EXPENSES 169,113.00 0.00 0.00 169,113.00 TOTAL EXPENDITURES 544,397.00 0.00 0.00 544,397.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 83 of 184 Health Division, Comprehensive Agreement -2015 Contract if 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind I Total 1 Source of Funds Fees and Collections - let and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.0D 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 219,078.00 0.00 0.00 219,078.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.0D ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 325,319.00 0.00 325,319.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 219,078.00 325,319.00 0.00 544,397.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 84 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail 'Line Item I Qty Ratel UOM Amount' Cash' Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 1.0000 46378.000 FTE 46,378.00 0.00 0.00 46,378.00 Technician 1.0000 40061.000 FTE 40,061.00 0.00 0.00 40,061.00 Technician 1.0000 35617.000 FTE 35,617.00 0.00 0.00 35,617.00 Technician 1.0000 35617.000 FTE 35,617.00 0.00 0.00 35,617.00 Technician 1.0000 18471,000 FTE 18,471.00 0.00 0.00 18,471.00 Technician 1.0000 18547.000 FTE 18,547.00 0.00 0.00 18,547.00 Technician 1.0000 18471.000 FTE 18,471.00 0.00 0.00 18,471.00 Outreach Worker 1.0000 15682.000 FTE 15,682.00 0.00 0.00 15,682.00 Coordinator 1.0000 33818.000 FTE 33,818.00 0.00 0.00 33,818.00 Total for Salary & Wages 262,662.00 0.00 0.00 262,662.00 2 Fringe Benefits Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 29.943 78,650.00 0.00 0.00 78,650.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office/Educ/Medical, Postage, Prin 0.0000 0.000 3,706.00 0.00 0.00 3,706.00 6 Travel Travel-terms not specified 0.0000 0.000 6,127.00 0.00 0.00 6,127.00 Communication Telephone 0.0000 0.000 698.00 0.00 0.00 698.00 8 County-City Central Services 9 Space Costs Date: 1210312014 Contract It 20151753-00, Oakland County Department of Health ad Human Services/ Page: 85 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 1210312014 Line Item Qty Rate UOM Amount Cash Inkind Total Bldg Space Costs 0.0000 0.000 18,073.00, 0.00 0.00 18,073.00 10 All Others (ADP, Con. Employees, Misc.) Copier, Equip Maint, Exp Equip, Tr 0.0000 0.000 5,368.00 0.00 0.00 5,368.00 Total Program Expenses 375,284.00 0.00 0.00 375,284.00 TOTAL DIRECT EXPENSES 375,284.00 0.00 0.00 375,284.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 1 0.0000 15.150 39,793.00 0.00 0.00 39,793.00 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 12,837.00 0.00 0.00 12,837.00 Other Cost Distributions-Misc. 0.0000 0.000 63,320.00 0.00 0.00 63,320.00 Health Adm Distribution 0.0000 0.000 53,163.00 0.00 0.00 53,163.00 Total for Other Costs Distributions 129,320.00 0.00 0.00 129,320.00 Total Indirect Costs 169,113.00 0.00 0.00 169,113.00 TOTAL INDIRECT EXPENSES 169,113.00 0.00 0.00 169,113.00 TOTAL EXPENDITURES 544,397.00 0.00 0.00 544,397.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 86 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / HIV ELPHS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT p-, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount 1 Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 Fringe Benefits 0.00 0,00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0,00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0,00 0.00 7 Communication 0.00 0.00 0.00 0,00 8 County-City Central Services 0.00 0.00 0.00 0.00 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0,00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 747,049.00 0,00 0,00 747,049.00 Total Indirect Costs 747,049.00 0.00 0.00 747,049.00 TOTAL INDIRECT EXPENSES 747,049.00 0.00 0.00 747,049.00 TOTAL EXPENDITURES 747,049.00 0.00 0.00 747,049.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Servicedi Page: 87 01184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category 1 Amount Cash lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 347,566.00 0.00 0.00 347,565.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 399,484.00 0.00 399,484,00 inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals I 347,565.00 399,484.00 0.00 747,049.00 Date: 12103/2014 Contract tt 20151753,-00, Oakland County Department of Health and Human Services/ Page: 88 of 184 Health Division, Comprehensive Agreement -2016 Contract #20151753-00 Date: 12/03(2014 Program Budget - Cost Detail 'Line Item 1 City Rate I UOM I Amount' Cash lnkind Total DIRECT EXPENSES Program Expenses Salary & Wages Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 15,398.00 0.00 0.00 15,398.00 Other Cost Distributions-Miso 0.0000 0.000 731,651.00 0.00 0.00 731,651.00 Total for Other Costs Distributions 747,049.00 0.00 0.00 747,049.00 Total Indirect Costs 747,049.00 0.00 0.00 747,049.00 TOTAL INDIRECT EXPENSES 747,049.00 0.00 0.00 747,049.00 TOTAL EXPENDITURES 747,049.00 0.00 0.00 747,049.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 89 of 184 Health Division, Comprehensive Agreement - 2010 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / HIV Prevention DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERioD From : 10/1/2014 To: 9130/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT l7, Original r Amendment AMENDMENT # 0 CITY Pontiac _. STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 i Category I Amount 1 Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 267,609.00 0.00 0.00 267,609.00 2 Fringe Benefits 125,397.00 0.00 0.00 125,397.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 7,908.00 0.00 0.00 7,908.00 6 Travel 8,243.00 0.00 0.00 8,243.00 7 Communication 4,200.00 0,00 0.00 4,200.00 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 6,730.00 0.00 0.00 6,730.00 10 All Others (ADP, Con, Employees, Misc.) 37,270.00 0.00 0.00 37,270.00 Total Program Expenses 457,357.00 0.00 0.00 457,357.00 TOTAL DIRECT EXPENSES 457,357.00 0.00 0.00 457,357.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 40,543.00 0.00 0.00 40,543.00 2 Other Costs Distributions 63,771.00 0.00 0.00 63,771.00 Total Indirect Costs 104,314.00 0.00 0.00 104,314.00 TOTAL INDIRECT EXPENSES 104,314.00 0.00 0.00 104,314.00 TOTAL EXPENDITURES 561,671.00 0.00 0.00 561,671.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 90 of 184 Health Divtsion, Comprehensive Agreement - 2015 Contract #20161763-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 497,900.00 0.00 0.00 497,900.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 1100 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 1100 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 63,771.00 0.00 63,771.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 497,900.00 63,771.00 0.00 561,671.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 91 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail Line Item Qty Rate UOM Amount' Cash I Inking Total DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nurse Notes : Public Health Nurse II 1.0000 24615.000 FTE 24,615.00 0.00 0.00 24,615.00 Coordinator Notes : Health Program Coordinator 1.0000 62758.000 FTE 62,758.00 0.00 0.00 62,758.00 Assistant Notes : Office Assistant 1.0000 35851.000 FTE 35,851.00 0.00 0.00 35,851.00 Public Health Nurse Notes : Public Health Nurse II 1.0000 26022.000 FTE 26,022.00 0.00 0.00 26,022.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 64142.000 FTE 64,142.00 0.00 0.00 64,142.00 Overtime Notes : 120 Hrs Overtime 1.0000 3049.000 FTE 3,049.00 0.00 0.00 3,049.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 26557.000 FTE 26,557.00 0.00 0.00 26,557.00 Public Health Nurse Notes : PHN II 1.0000 24615,000 FTE 24,615.00 0.00 0.00 24,615.00 Total for Salary & Wages 267,609.00 0.00 0.00 267,609.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 46.858 125,397.00 0.00 0.00 125,397.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 92 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/0312014 Line Item 1 Qty Rate 'UOM Amount[ Cash [ lnkind Total 5 Supplies and Materials Office Supplies 0.0000 0.000 950.00 0.00 0.00 950.00 Medical Supplies 0.0000 0.000 3,358.00 0.00 0.00 3,358.00 Postage 0.0000 0.000 300.00 0.00 0.00 300.00 Printing 0.0000 0.000 2,500.00 0.00 0.00 2,500.0-0 Lab Supplies _ 0.0000 0.000 800.00 0.00 0.00 800.00 Total for Supplies and Materials 7,908.00 0.00 0.00 7,908.00 6 Travel Mileage Notes : 10,970 miles @ .56 0.0000 0.000 6,143.00 0.00 0.00 6,143.00 Client Transportation 0.0000 0.000 600.00 0.00 0.00 600.00 Conferences 0.0000 0.000 1,500.00 0.00 0.00 1,500.00 Total for Travel 8,243.00 0.00 0.00 8,243.00 7 Communication .- Telephone I 0.0000 0.000 4,200.00 0.00 0.00 4,200.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 6,730.00 0.00 0.00 6,730.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations Notes : it operations 0.0000 0.000 11,200.00 0,00 0.00 11,200.00 Convenience Copier Notes : copier 0.0000 0.000 685.00 0.00 0.00 685.00 Interpretation Notes : printing 0.0000 0.000 1,750.00 0.00, 0.00 1,750.00 Insurance 0.0000 0.000 1,385.00 0.00 0.00 1,385.00 Advertising Notes : interpretation 0.0000 0.000 18,500.00 0.00 0.00 18,500.00 Lab Fees 0.0000 0.000 3,750.00 0.00 0.00 3,750.00 Total for All Others (ADP, Con. Employee 37,270.00 0.00 0.00 37,270.00 Total Program Expenses 457,357.00 0.00 0.00 457,357.00 TOTAL DIRECT EXPENSES _ 457,357.00 0.00 0.00 457,357.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 40,543.00 0,00 0.00 40,543.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 93 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Line Item 1 Qty Rate UOM Amount! Cashl Inkind I Total 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 63,771.00 0.00 0.00 63,771.00 Total Indirect Costs 104,314.00 0.00 0.00 104,314.00 TOTAL INDIRECT EXPENSES 104,314.00 0.00 0.00 104,314.00 TOTAL EXPENDITURES 561,671.00 0.00 0.00 561,671.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 94 of 184 Health Division, Comprehensive ATeement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / HiV Surveillance Support DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 101112014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 3,089.00 0.00 0.00 3,089.00 2 Fringe Benefits 178.00 0.00 0.00 178.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0,00 7 Communication 6,731.00 0.00 0,00 6,731.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 23,874.00 0.00 0.00 23,874.00 10 All Others (ADP, Con. Employees, Misc.) 660.00 0.00 0.00 660.00 Total Program Expenses 34,532.00 0.00 0.00 34,532.00 TOTAL DIRECT EXPENSES 34,532.00 0.00 0.00 34,532.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 468.00 0.00 0.00 468.00 2 Other Costs Distributions 4,483.00 0.00 0.00 4,483.00 Total Indirect Costs 4,951.00 0.00 0.00 4,951.00 TOTAL INDIRECT EXPENSES 4,951.00 0.00 0.00 4,951.00 TOTAL EXPENDITURES 39,483.00 0.00 0.00 39,483.00 Date: 1210312014 Contract ff 20151753-00, Oakland County Department of Health and Human Services/ Page: 95 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/0312014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 1 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MOCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 35,000.00 0.00 0.00 35,000.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0,00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 4,483.00 0.00 4,483.00 lnkind Match 0.00 0.00 0.00 0.00 NIDCH Fixed Unit Rate Totals 35,000.00 4,483.00 0.00 39,483.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 96 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail !Line Item Qty[ Rate UOM Amount Cash! Inkind , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 128.000 0 24.133 FTE 3,089.00 0.00 - 0.00 3,089.00 2 Fringe Benefits All Composite Rate Notes : FICA, UNEMP INS, RETIREMENT, HOSP INS, LIFE INS, VISION INS, HEARING INS, S/L-TERM DISABILITY, DENTAL INS, WORK COMP 0.0000 5.760 178.00 0.00 0.00 178.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication Telephone Communications 0.0000 0.000 6,731.00 0.00 0.00 6,731.00 8 County-City Central Services 9 Space Costs Building Space 0.0000 0.000 23,874.00 0.00 0.00 23,874.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0.000 660.00 0.00 0.00 660.00 Total Program Expenses 34,532.00 0.00 0.00 34,532.00 TOTAL DIRECT EXPENSES 34,532,00 0.00 0.00 34,532.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 468.00 0.00 0.00 468.00 2 Other Costs Distributions _ Health Adm Distribution 0.0000 0.0001 4,483.00 0.00 0.00 4,483.00 Total Indirect Costs 4,951.00 0.00 0.00 4,951.00 TOTAL INDIRECT EXPENSES 4,951.00 0.00 0.00 4,951.00 TOTAL EXPENDITURES 39,483.00 0.00 0.00 39,483.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 97 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Immunization Action Plan (lAP) DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/3012015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT ri, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Cash I lnkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages , 242,635.00 0.00 0.00 242,635.00 2 Fringe Benefits 169,205.00 0.00 0.00 169,205.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0,00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 25,532.00 0.00 0.00 25,532.00 6 Travel 6,674.00 0.00 0.00 6,674.00 7 Communication 4,632.00 0.00 0.00 4,632.00 8 County-City Central Services 0.00 0.00 0,00 0.00 9 Space Costs 14,597.00 0.00 0.00 14,597.00 10 All Others (ADP, Con. Employees, Misc.) 26,847.00 0.00 0.00 26,847.00 Total Program Expanses 490,122.00 0.00 0.00 490,122.00 TOTAL DIRECT EXPENSES 490,122.00 0.00 0.00 490,122.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 36,759.00 0.00 0.00 36,759.00 2 Other Costs Distributions 48,778.00 0.00 0.00 48,778.00 Total Indirect Costs 85,537.00 0.00 0.00 85,537.00 TOTAL INDIRECT EXPENSES 85,537.00 0.00 0.00 85,537.00 TOTAL EXPENDITURES _ 575,659.00 0.00 0.00 575,659.00 Date: 12/0312014 Contract #20151753410, Oakland County Department of Health and Human Services/ Page: 98 of 184 Health DiVsion, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS _ Category Amount r Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 491,881.00 0.00 0.00 491,881.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 l 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0,00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 83,778.00 0.00 83,778.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 491,881,00 83 ,778.001 0.00 575,659.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 99 of 184 Health Division, comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty RatelUOM Amount Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator Notes : Health Program Coordinator 1.0000 67636.000 FTE 67,636.00 0.00 0.00 67,636.00 Public Health Nurse Notes : Public Health Nurse Ill 1.0000 64142,000 FTE 64,142.00 0.00 0.00 64,142.00 Assistant Notes : Office Assistant II 1.0000 38046.000 FTE 38,046.00 0.00 0.00 38,046.00 Clerk Notes : Vaccine Supply Clerk 1.0000 30431.000 FIE 30,431,00 0.00 0.00 30,431.00 Assistant Notes : Office Assistant II 1.0000 38046.000 FTE 38,046.00 0.00 0.00 38,046.00 Overtime 1.0000 4334.000 FTE 4,334.00 0.00 0.00 4,334.00 Total for Salary & Wages 242,635.00 0.00 0.00 242,635.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 69.737 169,205.00 0.00 0.00 169,205.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials Office Supplies 0.0000 0.000 2,500.00 0.00 0.00 2,500.00 Postage 0.0000 0.000 17,000.00 0.00 0.00 17,000.00 Printing 0.0000 0,000 5,032,00 0.00 0.00 5,032.00 Educational Supplies 0.0000 0.000 1,000.00 0.00 0.00 1,000.00 Total for Supplies and Materials 25,532.00 0.00 0.00 25,632.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 100 o 184 Health Division, Comprehensive Agreement - 2016 Contract #20151753-00 Date: 12103/2014 Line Item I Qtyl RatejUOM Amount! Cashi Inkindl Total 6 Travel Mileage Notes : 6250 miles @ .56 0.0000 0.000 3,500.00 0.00 0.00 3,500.00 Conferences 0.0000 0,000 3,174.00 0.00 0.00 3,174.00 Total for Travel 6,674.00 0.00 0.00 6,674.00 7 Communication Telephone i 0.0000 0.000 4,632.001 0.001 0.00 4,632.00 8 County-City Central Services Space Costs Building Space Rental 0.0000 0.000 14,597,00 0.00 0.00 14,597.00 10 All Others (ADP, Con. Employees, Misc.) _ Equipment Repair 0.0000 0.000 200.00 0.00 0.00 200.00 Convenience Copier Notes : copier 0.0000 0.000 2,400.00 0.00 0.00 2,400.00 IT Operation Notes : printing 0.0000 0.000 23,047.00 0.00 0.00 23,047.00 Insurance 0.0000 0.000 1,200.00 0.00 0.00 1,200.00 Total for All Others (ADP, Con. Employee 26,847.00 0.00 0.00 26,847.00 Total Program Expenses 490,122.00 0.00 0.00 490,122.00 TOTAL DIRECT EXPENSES 490,122,00 0.00 0.00 490,122.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 r 15.150 . 36,759.00 0.001 0.00 36,759.00 2 Other Costs Distributions Other Cost Distributions-Nurse TrainNFC 0.0000 0,000 -35,000.00 0.00 0.00 -35,000.00 Health Adm Distribution 0.0000 0.000 67,483.00 0.00 0.00 67,483.00 Nursing Adm Distribution 0.0000 0.000 16,295.00 0.00 0.00 16,295.00 Total for Other Costs Distributions 48,778.00 0.00 0.00 48,778.00 Total Indirect Costs 85,637.00 0.00 - 0.00 85,637.00 TOTAL INDIRECT EXPENSES 85,537.00 0.00 0.00 85,537.00 TOTAL EXPENDITURES 575,659.00 0.00 0.00 575,659.00 Date: 12/03/2014 Contract #20151753-00 Oakland County Department of Health and Human Services/ Page: 101 of 184 Health Division, Comprehensive Agreement - 2015 Contract /f 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM I PROJECT Com erehensive A*reement - 2015 / Immunization ELPHS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Pl Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 1 Category Amount Cash , Inkind Total DIRECT EXPENSES Program Expenses , 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0,00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 4,996,013.00 0.00 0.00 4,996,013.00 Total Indirect Costs 4,996,013,00 0.00 0.00 4,996,013.00 TOTAL INDIRECT EXPENSES 4,996,013.00 0.00 0.00 4,996,013.00 TOTAL EXPENDITURES 4,996,013.00 0.00 0.00 4,996,013.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department cf Health and Human Services/ Page: 102 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12103/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category , Amount Cash Inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0,00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 2,317,412.00 0.00 2,317,412.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0,00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0,00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 670,232.00 0.00 0.00 670,232.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,008,369.00 0.00 2,008,369.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 670,232.00 4,325,781.00 1 0.00 4,996,013.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human ServIces/ Page: 103 of 184 Health Division, Comprehensive Agreement - 2016 Contract #20151753-00 Date: 1210312014 3 Program Budget - Cost Detail Line Item • QtyI RatelUOM 1 Amounti Cash! Inkindi Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits Cap. Exp. for Equip & Fat. Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Other Cost Distributions-Field Nursing 0.0000 0.000 727,532.00 0.00 0.00 727,532.00 Other Cost Distributions-Clinic 0.0000 0.000 1,951,069.00 0.00 0.00 1,951,069.00 Federally Provided Vaccines Notes : Used 2012-13 budgetary figure/current not available yet. 0.0000 0.000 2,317,412.00 0.00 0.00 2,317,412.00 Total for Other Costs Distributions 4,996,013.00 0.00 0.00 4,996,013.00 Total Indirect Costs 4,996,013.00 0.00 0.00 4,996,013.00 TOTAL INDIRECT EXPENSES 4,996,013.00 0.00 0.00 4,996,013.00 TOTAL EXPENDITURES 4,996,013.00 0.00 0.00 4,996,013.00 Date: 12/0312014 Contract #20151753-00 Oakland County Department of Health and Human Services/ Page: 104 of 184 Health Division, Comprehensive Agreement- 2016 Contract #20151753-00 Date: 12J03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Infant Safe Sleep DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9130/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT W. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount 1 Cash _ lnkind r1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,060.00 0.00 0.00 4,060.00 2 Fringe Benefits 2,779.00 0.00 0.00 2,779.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 9,421.00 0.00 0.00 9,421.00 6 Travel 0.00 0.00 0.00 0.00 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 5,625.00 0.00 0.00 5,625.00 Total Program Expenses 21,885.00 0.00 0.00 21,885.00 TOTAL DIRECT EXPENSES 21,885.00 0.00 0.00 21,885.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 615.00 0.00 0.00 615.00 2 Other Costs Distributions 2,882.00 0.00 0.00 2,882.00 Total Indirect Costs 3,497.00 0.00 0.00 3,497.00 TOTAL INDIRECT EXPENSES 3,497.00 0.00 0.00 3,497.00 TOTAL EXPENDITURES 25,382.00 0.00 0.00 25,382.00 Date: 12103/2014 Contract tt 20151753-00, Oakland County Department of Health and Human Services/ Page: 105 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I lnkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0,00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 22,500.00 0.00 0.00 22,500.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0,00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,882.00 0.00 2,882.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 22,500.00 2,882.00 0.00 25,382.00 Date: 1210312014 Contract # 20161753-00, Oakland County Department of Health and Human Services/ Page: 106 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail Line Item I Qtyl , RateIUOM i Amount Cash' Inkind Total DIRECT EXPENSES Program Expenses I Salary & Wages Health Educator 0.0615 50206.000 FTE 3,089.00 0.00 0.00 3,089.00 Chief Nursing 0.0120 80825.000 FTE 971.00 0.00 0.00 971.00 Total for Salary & Wages 4,060.00 0.00 0.00 4,060.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins Retirement Ins Hospital Ins Life Ins Vision Ins Dental Ins Workers Comp Short/Long Terms Disability Ins 0.0000 68.450 2,779.00 0.00 0.00 2,779.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials Printing 0.0000 0.000 3,551.00 0.00 0.00 3,551.00 Educational Supplies 0.0000 0.000 2,495.00 0.00 0.00 2,495.00 Client Support Materials 0.0000 0.000 3,375.00 0.00 0.00 3,375.00 Total for Supplies and Materials 9,421.00 0.00 0.00 9,421.00 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Advertising 0.0000 0.000 5,625.00 0.00 0.00 5,625.00 Total Program Expenses 21,885.00 0.00 0.00 21,885.00 TOTAL DIRECT EXPENSES 21,885.00 0.00 0.00 21,885.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs Fiscal Year Rate 0.0000L 15.150 615.00_ 0.00 0.00 615.00 Date: 12/03/2014 Contract 20151753-00, Oakland County Department of Health and Human Services/ Page: 107 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 1210312014 Line Item I Qty RatelUOM Amount' Cash' lnkind Total 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 2,882.00 0.00 0.00 2,882.00 Total Indirect Costs 3,497.00 0.00 0.00 3,497.00 TOTAL INDIRECT EXPENSES 3,497.00 0.00 0.00 3,497.00 TOTAL EXPENDITURES 25,382.00 0.00 0.00 25,382.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 108 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Laboratory Services Bio DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT PI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE ,48341-0432 FEDERAL ID NUMBER 38-6004876 [ Category Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 28,084.00 0.00 0.00 28,084.00 2 Fringe Benefits 3,180.00 0.00 0.00 3,180,00 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 4,165.00 0.00 0.00 4,165.00 6 Travel 1,800.00 0.00 0.00 1,800.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0,00 0.00 10 All Others (ADP, Con. Employees, Misc.) 15,963.00 0.00 0.00 15,963.00 Total Program Expenses 53,192.00 0.00 0.00 53,192.00 TOTAL DIRECT EXPENSES 53,192.00 0.00 0.00 53,192.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 4,255.00 0.00 0.00 4,255.00 2 Other Costs Distributions 7,358.00 0.00 0.00 7,358.00 Total Indirect Costs 11,613.00 0.00 0.00 11,613.00 TOTAL INDIRECT EXPENSES 11,613.00 0.00 0.00 11,613.00 TOTAL EXPENDITURES 64,805.00 0.00 0.00 64,805.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 109 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MUCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELP HS 0.00 0.00 0.00 0.00 Local Non-ELP HS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 57,447.00 0.00 0.00 57,447.00 ELPHS - MUCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 7,358.00 0.00 7,358.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 57,447.00 7,358.00 0.00 64,805.00 Date: 12/03/2014 Contract #20151753-00 Oakland County Department of Health and Human Services/ Page: 110 of 184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail , Line Item I Qty RateltiOM Amount Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Technician Notes : Medical Technologist 1000.00 00 25.509 FTE 25,509.00 0.00 0.00 25,509.00 Supervisor 78.0000 33.013 FTE 2,575.00 0.00 0.00 2,575.00 Total for Salary & Wages 28,084.00 0.00 0.00 28,084.00 Fringe Benefits All Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 11.323 3,180.00 0.00 0.00 3,180.00 Cap, Exp. for Equip & Fac. Contractual 5 Supplies and Materials Lab Supplies 0.0000 0.000 4,165.00 0.00 0.00 4,165.00 Travel Mileage Notes : 250 miles @ .56 0.0000 0.000 300.00 0.00 0.00 300.00 ,Conferences 0.0000 0.000 1,500.00 0.00 0,00 1,500.00 Total for Travel 1,800.00 0.00 0.00 1,800.00 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 225.00 0.00 0.00 225.00 CLIA License 0.0000 0.000 1,100.00 0.00 0.00 1,100.00 Equipment Rental 0.0000 0.000 11,838.00 0.00 0.00 11,838.00 IT Operations 0.0000 0.000 2,800.00 0.00 0.00 2,800.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Serviced Page: 111 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 -7 Line Item L Qtyi RatelUOM Amount Cash lnkind Total Total for All Others (ADP, Con. Employee 15,963.00 0.00 0.00 15,963,00 Total Program Expenses 53,192.00 0.00 0.00 53,192.00 TOTAL DIRECT EXPENSES 53,192.00 0.00_ 0.00 53,192.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 4,255.00 0.00 0.00 4,255.00 2 Other Costs Distributions Health Aclm Distribution' 0.0000 0.000 7,358.00 0.00 0.00 7,358.00 Total Indirect Costs 11,613.00 0.00 0.00 11,613.00 TOTAL iNDIRECT EXPENSES 11,613.00 0.00 0.00 11,613.00 TOTAL EXPENDITURES 64,805.00 9.00 0,00 64,805.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 112 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM I PROJECT Comprehensive Agreement -2015 / MI Health and Wellness 4 X 4 Plan DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fi, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amounts Cash , Inkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,996.00 0.00 0.00 4,996.00 2 Fringe Benefits 1,119.00 0,00 0.00 1,119.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 2,585.00 0.00 0.00 2,585,00 5 Supplies and Materials 2,504.00 0.00 0.00 2,504.00 6 Travel 56.00 0.00 0.00 56.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services J 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 483.00 0.00 0.00 483.00 Total Program Expenses 11,743.00 0.00 0.00 11,743.00 TOTAL DIRECT EXPENSES 11,743.00 0.00 0.00 11,743.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 757.00 0,00 0.00 757.00 2 Other Costs Distributions 1,601.00 0.00 0.00 1,601.00 Total Indirect Costs 2,368.00 0,00 0.00 2,358.00 TOTAL INDIRECT EXPENSES 2,358.00 0.00 0.00 2,358,00 TOTAL EXPENDITURES 14,101.00 0.00 0.00 14,101.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 113 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 10,000.00 0.00 0.00 10,000.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 i 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 ._ 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,601.00 0.00 1,601.00 lnkind Match 0.00_ 0.00 2,500.00 2,500.00 MDCH Fixed Unit Rate Totals 10,000.00 1,601.00 2,500.00 14,101.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 114 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail , Line Item I Qty RateIUOM I Amount! Cash' lnkind 1 Total DIRECT EXPENSES Program Expenses Salary & Wages Health Educator Notes : PINE - Public Health Educator II 192.000 0 18.833 FTE 3,616.00 0.00 0.00 3,616.00 Supervisor Notes : Health Education Supervisor - MATCH 20.0000 34.850 FTE 697.00 0.00 0.00 697.00 Health Educator Notes : Health Educator III - MATCH 20.0000 25.500 FIE 510.00 0.00 0.00 510.00 Outreach Worker Notes : Auxiliary Health Worker - MATCH 9.0000 19.222 _ FTE 173.00 0.00 0.00 173.00 Total for Salary & Wages 4,996.00 0.00 0.00 4,996.00 2 Fringe Benefits All Composite Rate Notes : MATCH $1,119 FICA Unemp Ins Retirement Hosp Ins Life Ins Vision Ins Dental Ins Work Comp Short/Long Term Disability 0.0000 22.400 1,119.00 0.00 0.00 1,119.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Oakland University 0.0000 0.000 _ 2,585.00 0.00 0,00 2,585.00 Supplies and Materials Printing 0.0000 0.000 750.00 0.00 0.00 750.00 Materials & Supplies 0.0000 0.000 1,283.00 0.00 0.00 1,283.00 Food Provisions 0.0000 0.000 71.00 0.00 0.00 71.00 Postage 0.0000 0.0013 150.00 0.00 0,00 150.00 Incentives 0.0000 0.000 250.00 0.00 0.00 250.00 Total for Supplies and Materials 2,504.00 0.00 0.00 2,504.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 115 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 Line Item I Qty i Rate UOM Amount[ Cash' Inkind Total 6 Travel Mileage Notes : 100 miles @ .56 0.0000 0.000 56.00 0,00 0.00 56.00 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 28.00 0.00 0.00 28.00 Interpreter Fees, EdLIC Programs 0.0000 0.000 85.00 0.00 0.00 85.00 Professional Svcs 0.0000 0.000 270.00 0,00 0.00 270.00 Licenses & Permits 0,0000 0.000 100.00 0.00 0.00 100.00 Total for All Others (ADP, Con. Employee 483.00 0.00 0.00 483.00 Total Program Expenses 11,743.00 0.00 0.00 11,743.00 TOTAL DIRECT EXPENSES _ 11,743.00 0.00 0.00 11,743.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate Notes : Portion MATCH on salaries of $1,380 = $209 0.0000 15.150 757.00 0.00 0.00 757.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 1,601.00 0.00 0.00 1,601.00 Total Indirect Costs 2,358.00 0.00 0.00 2,358.00 TOTAL INDIRECT EXPENSES 2,358.00 0.00 0.00 2,358.00 TOTAL EXPENDITURES 14,101.00 0.00 0.00 14,101.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 116 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015! Nurse Family Partnership -MCH DATE PREPARED 12/312014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT fv, Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Cash Inkind 1 Total DIRECT EXPENSES Program Expenses 1 -I Salary & Wages 58,580.00 .._ 0.00 0.00 56,580.00 2 Fringe Benefits 37,269.00 0.00 0.00 37,269.00 Cap. Exp. for Equip & Fac. 0.00 0,00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 954.00 0.00 0.00 954.00 7 Communication 1,032.00 0.00 0.00 1,032.00 8 County-City Central Services 0.00 0.00 0.00 0.00 r- Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 2,744.00 0.00 0.00 2,744,00 Total Program Expenses 98,579.00 0.00 0.00 98,579.00 TOTAL DIRECT EXPENSES 98,579,00 0.00 0.00 98,579.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 8,572,00 0.00 0.00 8,572.00 2 Other Costs Distributions 13,360.00 0.00 0.00 13,360.00 Total Indirect Costs 21,932.00 0.00 0.00 21,932.00 TOTAL INDIRECT EXPENSES 21,932.00 0.00 0.00 21,932.00 TOTAL EXPENDITURES 120,511.00 0.00 0.00 120,511.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 117 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12103/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total i Source of Funds Fees and Collections - 1 st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0,00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0,00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0,00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 IVICH Funding 107,151.00 0.00 0.00 107,151.00 Local Funds - Other 0.00 13,360.00 0.00 13,360.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 107,151.00 13,360,00 i 0.00 _ 120,511.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 118 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail Line Item Qtyl Rate UOM Amount Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 1 0.8365 67640.000 FTE 56,580.00 0.00 0.00 56,580.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 65.870 J. 37,269.00 0.00 0.00 37,269.00 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials 6 Travel Mileage Notes : 1,703 MILES @ .56 0.0000 0.000 954.00 0.00 0.00 954.00 7 Communication TELEPHONE 0.0000 0.000 1,032.00 0.00 _ 0.00 1,032.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT IOPERATIONS 0.0000 0.000 2,744.00 0.00 0.00 2,744.00 Total Program Expenses 98,579.00 0.00 0.00 98,579.00 TOTAL DIRECT EXPENSES 98,579.00_ 0.00 0.00 98,579.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Fiscal Year Rate _ 0.0000, 15.150 8,572.00 0.00 0.00 8,572.00 Other Costs Distributions , Health Adm Distribution 0.0000 0.000 13,360.00 0.00 0.00 13,360.00 Total Indirect Costs 21,932.00 0.00 0.00 21,932.00 TOTAL INDIRECT EXPENSES 21,932.00 0.00 0.00 21,932.00 Date: 1210312014 Contract # 20151753-.00, Oakland County Department of Health and Human Services/ Page: 119 of 184 Health Division, comprehensive Agreement -2015 Contract #20151753-00 Date: 12103/2014 'Line Item Qty Rate UOM Amount Cash Inkind Total TOTAL EXPENDITURES 120,511.00 0.00 0.00 120,511.00 Date: 12/03/2014 Contract # 20151753-00, °Wand County Department of Health and Human Services/ Page: 120 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Nurse Family Partnership Medicaid Outreach DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r07 Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0,00 0.00 0.00 0.00 7 Communication 0.00 0.00 0,00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0,00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 0.00 0.00 0.00 0.00 Total Indirect Costs 0.00 0.00 0.00 0.00 TOTAL INDIRECT EXPENSES 0.00 0.00 0,00 0.00 TOTAL EXPENDITURES 0.00 0.00 0.00 0.00 Date: 12/03/2014 Contract #20151753-00 Oakland County Department of Health and Human Services/ Page: 121 o1184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0,00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0,00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0,00 0.00 0.00 MDCH Fixed Unit Rate Totals 1 0.00 0.00 0.00 0.00 Date: 12/03/2014 Contract 20151753-00, Oakland County Department of Health and Human Services/ Page: 122 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item i Qty Rate UOIVI Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Total Indirect Costs 0.00 , 0.00 0.00 0.00 TOTAL INDIRECT EXPENSES 0.00 0.00 0,00 0.00 TOTAL EXPENDITURES 0.00 0.00 0.00 0.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 123 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 1210312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Nurse Family Partnership Services - DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT lv, Original r Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 1 Category i Amount 1 Cash .1 Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 345,513.00 0.00 0.00 345,513.00 2 Fringe Benefits 223,216.00 0.00 , 0,00 223,216.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 5,454.00 0.00 0.00 5,454.00 5 Supplies and Materials 9,100.00 0.00 0.00 9,100.00 6 Travel 8,600.00 0,00 0.00 9,600.00 7 Communication 5,863,00 0.00 0.00 5,963.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 4,100.00 0.00 0.00 4,100.00 10 All Others (ADP, Con. Employees, Misc.) 18,445.00 0,00 0,00 18,445.00 Total Program Expenses 620,291.00 0.00 0,00 620,291,00 TOTAL DIRECT EXPENSES 620,291.00 0.00 0.00 620,291.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 77,340.00 0.00 0.00 77,340.00 Total Indirect Costs 77,340.00 0.00 0.00 77,340.00 TOTAL INDIRECT EXPENSES 77,340.00 0.00 0.00 77,340.00 TOTAL EXPENDITURES r 697,631.00 _ 0.00 0.00 697,631.00 Date: 12/03/2014 Contract # 20151753-00, Oakiand County Department of Health and Human Services/ Page: 124 of 184 Health Division, Comvehensive Agreement -2015 Contract #20151753-00 Date: 12/0312014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0,00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 1100 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0,00 MDCH Comprehensive 620,291.00 0.00 0.00 620,291.00 ELPHS - MDCH Hearing 0,00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 7 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 77,340.00 0.00 77,340.00 lnkind Match 0.00 0.00 _ 0.00 0.00 MDCH Fixed Unit Rate Totals 620,291.00 77,340.00 0.00 697,631.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 125 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20161753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty RatelUOM Amount' Cash Inkind Total DIRECT EXPENSES Program Expenses Salary & Wages Public Health Nurse Notes : Public Health Nurse ill 1.0000 64141.000 FTE 64,141.00 0.00 0.00 64,141.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 64141.000 FTE 64,141.00 0.00 0.00 64,141.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 64141.000 FTE 64,141.00 0.00 0.00 64,141.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 58203.000 FTE 58,203.00 0.00 0.00 58,203.00 Public Health Nurse Notes : Public Health Nurse II 1.0000 51199.000 FTE 51,199.00 0.00 0.00 51,199.00 Assistant Notes : Office Assistant It - PTNE 0.4808 38045.000 FIE 18,292.00 0.00 0.00 18,292.00 Assistant 0,4808 26612.000 FTE 12,795.00 0.00 0.00 12,795.00 Coordinator 0,1635 67640.000 FTE 11,059.00 0.00 0.00 11,059.00 , Overtime 0.0265 58203.000 FTE 1,542.00 0.00 0,00 1,542.00 Total for Salary & Wages 345,513.00 0.00 0.00 345,513.00 2 Fringe Benefits Composite Rate Notes : Fica Unemp Ins Retirement Hosp Ins Life Ins Vision Ins Dental Ins Work Comp Short/Long Term Disability 0.0000 64.604 223,216,00 0.00 0.00 223,216.00 3 j Cap. Exp. for Equip & Fac. 4 - Contractual NFP National Office Program Suppo 0.0000 0.000 1,652.00 0.00 0.00 1,652.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Heaith and Human Services/ Page: 126 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total NFP Consultation 0.0000 0.000 3,802.00 0.00 0.00 3,802.00 Total for Contractual 5,454.00 0.00 0.00 5,454.00 5 Supplies and Materials Office Supplies 0.0000 0.000 2,200.00 0.00 0.00 2,200,00 Postage 0,0000 0,000 250.00 0.00 0.00 250.00 Printing 0.0000 0.000 3,000.00 0.00 0.00 3,000.00 Incentives supplies 0.0000 0.000 3,000.00 0.00 0.00 3,000.00 Educational Supplies 0.0000 0.000 650.00 0.00 0.00 650.00 Total for Supplies and Materials 9,100.00 0.00 0.00 9,100.00 6 Travel Conferences 0.0000 0.000 400.00 0.00 0.00 400.00 Client Transportation 0.0000 0.000 200.00 0.00 0.00 200.00 Mileage Notes : 14,285 miles @ .56 0.0000 0.000 8,000.00 0.00 0.00 8,000.00 Total for Travel _ 8,600.00 0.00 0.00 8,600.00 7 Communication Telephone Communications 0.0000 0,000 5,863.00 0.00 0.00 5,863.00 8 County-City Central Services Space Costs Building Space Rental 0.0000 0.000 4,100.00 0.00 0.00 4,100.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 1,338.00 0.00 0.00 1,338.00 Info Tech Operations 0.0000 0.000 12,544.00 0.00 0.00 12,544.00 Translation & Interpretation 0.0000 0.000 2,043.00 0.00 0.00 2,043.00 Staff Training 0.0000 0.000 - 2,520.00 0.00 0.00 2,520.00 Total for All Others (ADP, Con. Employee 18,445.00 0.00 0.00 18,445.00 Total Program Expenses 620,291,00 0.00 0.00 620,291.00 TOTAL DIRECT EXPENSES 620,291.00 0.00 0.00 620,291.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Other Costs Distributions Health Adm Distribution 0.0000 0.000 77,340.00 0.00 0.00 77,340.00 Total Indirect Costs 77,340.00 0.00 0.00 77,340.00 Date; 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 127 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Line Item I Qty Rate UOM Amount Cash Inkind Total TOTAL INDIRECT EXPENSES 77,340.00 0.00 0.00 77,340.00 TOTAL EXPENDITURES 697,631.00 0.00 0.00 697,631.00 Date; 12/03/2014 Contract # 20151753.00, Oakland County Department of Health and Human Services/ Page: 128 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Medicaid Outreach DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount I Cash Inkind 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.40 0,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00. 0.00 0.00 4 _., Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0,00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0,00 10 All Others (ADP, Con. Employees, Misc.) 1.00 0.00 0.00 1.00 Total Program Expenses 1.00 0.00 0.00 1.00 TOTAL DIRECT EXPENSES 1.00 0.00 0.00 1.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 0.00 0.00 0.00 0.00 Total Indirect Costs 0.00 0.00 0.00 0.00 TOTAL INDIRECT EXPENSES 0,00 0.00 0.00 0.00 TOTAL EXPENDITURES . 1.00 0.00 0.00 1.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 129 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category _ Amount Cash Inkind Total '1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 1.00 0.00 0.00 1.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0,00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 1.00 0.00 0.00 1.00 Date: 12/05/2014 Contract #20151753-00, Oakland County Department of Heaith and Human Services/ Page: 130 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item .1 QtY1- RatelUOM I AmountI Cash I Inkind Total DIRECT EXPENSES Program Expenses Salary S, Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Supporting Services I 0.0000 0.000i 1.00 0.00 0.00 1.00 Total Program Expenses 1.00 0.00 0.00 1.00 TOTAL DIRECT EXPENSES 1.00 0.00 0.00 1.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Total Indirect Costs 0.00 0.00 0.00 0.00 TOTAL INDIRECT EXPENSES 0.00 0.00 0.00 0.00 TOTAL EXPENDITURES 1.00 0.00 0.00 1.00 Contract #20151753-00, Oakland County Department of Health and Human Services/ Health Division, Comprehensive Agreement -2010 Date: 12/03/2014 Page: 131 of 184 Contract #20151753-00 Date: 12/03/2014 Program Budget Summary PROGRAM I PROJECT Comprehensive Agreement - 2015 / Other-MCH-Children DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p-, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1_ Amount Cash lnkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 37,197.00 0,00 0.00 37,197.00 2 Fringe Benefits 23,420.00 0.00 0.00 23,420,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0,00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 Total Program Expenses 60,617.00 0.00 0.00 60,617,00 TOTAL DIRECT EXPENSES 60,617.00 0.00 0.00 60,617.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 5,635.00 0.00 0.00 5,635.00 2 Other Costs Distributions 8,261.00 0.00 0.00 8,261.00 Total Indirect Costs 13,896.00 0.00 0.00 13,896.00 TOTAL INDIRECT EXPENSES 13,896.00 0.00 0.00 13,896.00 TOTAL EXPENDITURES 74,513.00 0.00 0.00 74,513.00 Date: 12/0312014 Contract #20101753-00, Oakland County Department of Health and Human Services/ Page: 132 01184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0,00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0,00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0,00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0,00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0,00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 66,252.00 0.00 0.00 66,252.00 Local Funds - Other 0.00 8,261,00 0.00 8,261.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 66,252.00 8,261.00 0.00 74,513.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 133 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 3 Program Budget - Cost Detail Line Item Qty Rate UOM Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Nutritionist/Dietician 0.1803 50863.000 FTE 9,170.00 0.00 0.00 9,170.00 Nutritionist/Dietician 0.5000 56054.000 FTE 28,027.00 0.00 0.00 28,027.00 Total for Salary & Wages 37,197.00 0.00 0.00 37,197.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 62.962 23,420.00 0.00 0.00 23,420.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 60,617.00 0.00 0.00 60,617.00 TOTAL DIRECT EXPENSES 60,617.00 0.00 0.00 60,617.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 5,635.00 0.00 0.00 5,635.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 8,261.00 0.00 0.00 8,261.00 Total Indirect Costs 13,896.00 0.00 0.00 13,896.00 TOTAL INDIRECT EXPENSES 13,896.00 0.00 0.00 13,896.00 TOTAL EXPENDITURES 74,513.00 0.00 0.00 74,513.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 134 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Other-MCH-Varied DATE PREPARED 12/3/2014 _ CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT PI Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount .1 Cash I lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 36,881.00 0.00 0.00 36,881.00 2 Fringe Benefits 2,124.00 0.00 0.00 2,124.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 9,057.00 0,00 0.00 9,057.00 6 Travel 6,302.00 0.00 0.00 6,302.00 7 Communication 2,640.00 0.00 0.00 2,640.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 19,211.00 0.00 0.00 19,211.00 Total Program Expenses 76,215.00 0.00 0.00 76,215.00 TOTAL DIRECT EXPENSES 76,215.00 0.00 0.00 76,215.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 5,587.00 0.00 0.00 5,587.00 2 Other Costs Distributions 6,415,464.00 0.00 0.00 6,415,464.00 Total Indirect Costs 6,421,051.00 0.00 0.00 6,421,051.00 TOTAL INDIRECT EXPENSES 6,421,051.00 0.00 0.00 6,421,051.00 TOTAL EXPENDITURES 6,497,266.00 0.00 0.00 6,497,266.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services? Page: 135 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 81,802.00 0.00 0.00 81,802.00 Local Funds - Other 0.00 6,415,464.00 0.00 6,415,464.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 81,802.00 6,415,464.00, 0.00 6,497,266.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 136 of 184 Heatth Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item Qty Rate UOM I Amount' Cash lnkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse 0.2385 64132.000 FTE 15,295.00 0.00 0.00 15,295.00 Public Health Nurse 0.3365 64148.000 FTE 21,586.00 0.00 0.00 21,586.00 Total for Salary & Wages 36,881.00 0.00 0.00 36,881.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 5.760 2,124.00 0.00 0.00 2,124.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0.0000 0.000 3,500.00 0.00 0.00 3,500.00 Educational Supplies 0.0000 0.000 5,557.00 0.00 0.00 5,557.00 Total for Supplies and Materials 9,057.00 0.00 0.00 9,057.00 Travel Mileage Notes : 8,575 miles @ .56 0.0000 0.000 4,802.00 0.00 0.00 4,802.00 Client Transportation 0.0000 0.000 500.00 0.00 0.00 500.00 Conferences 0.0000 0.000 1,000.00 0.00 0.00 1,000.00 Total for Travel 6,302.00 0.00 0.00 6,302.00 7 Communication Telephone 0.0000 0.000 2,640.00 0.00 0.00 2,640.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 8,400.00 0.00 0.00 8,400.00 Workshops & Meetings 0.0000 0.000 400.00 0.00 0.00 400.00 Insurance 0.0000 0.000 789.00 0.00 0.00 789.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 137 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Line item Qty Rate UOIVI Amount Cash lnkind Total Translation & Interpretation 0.0000 0.000 9,122.00 0.00 0.00 9,122.00 Periodicals Boods Pub! Sub 0.0000 0.000 500.00 0.00 0.00 500.00 Total for All Others (ADP, Con. Employee 19,211.00 0.00 0.00 19,211.00 Total Program Expenses 76,215.00 0.00 0.00 76,215.00 TOTAL DIRECT EXPENSES _ 76,216.00 0.00 0.00 76,215.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0,0000 15.150 5,587.00 0.00 0.00 5,587.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 10,199.00 0.00 0.00 10,199.00 Other Cost Distributions-Nursing Notes : This distribution takes total costs of Field Nursing and allocates them back to various cost centers by a time study. The % back to MCH is 76.5%. Health is in the process of updating their time study to "random moment in time" for FY 2014-15 0.0000 0.000 6,161,992.00 0.00 0.00 6,161,992.00 Nursing Adm Distribution 0.0000 0.000 2,476.00 0.00 0.00 2,476.00 Other Cost Distributions- Clinic/Educatio Notes : This distribution takes total costs of Clinic & Education and allocates them back to various cost centers by a time study. The % back to MCH for Clinic is 3% and the °A, back to MCH for Education is 2.855%. Health is in the process of updating their time study to "random moment in 0.0000 0.000 240,797.00 0.00 0,00 240,797,00 Date: 12/03/2014 Contract #20151753 00, Oakland County Department of Health and Human Services/ Page: 138 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total time for FY 2014-15 Total for Other Costs Distributions 6,415,464.00 0.00 0.00 6,415,464.00 Total Indirect Costs 6,421,051.00 0.00 0.00 6,421,051.00 TOTAL INDIRECT EXPENSES 6,421,051.00 0.00 0.00 6,421,051.00 TOTAL EXPENDITURES 6,497,266.00 0.00 0.00 6,497,266.00 Date: 12/0312014 Contract #20101753-00, Oakland County Department of Health and Human Services/ Page: 139 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 1210312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Other-MCH-Women DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rv-1 Original n Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category I Amount I Cash Inkind f Total DIRECT EXPENSES Program Expenses Salary & Wages 37,197.00 0.00 0.00 37,197.00 2 Fringe Benefits 23,420.00 0.00 0.00 23,420.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 000 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 Total Program Expenses 60,617.00 0.00 0.00 60,617.00 TOTAL DIRECT EXPENSES 60,617.00 0.00 0.00 60,617.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 5,635.00 0.00 0.00 5,635.00 2 Other Costs Distributions 8,261.00 0.00 0.00 8,261.00 Total Indirect Costs 13,896.00 0.00 0.00 13,896.00 TOTAL INDIRECT EXPENSES 13,896.00 0.00 0.00 13,896.00 TOTAL EXPENDITURES 74,513.00 0.00 0.00 74,513.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 140 of 184 Health Division, Comprehensive Agreement- 2016 Contract # 20151763-00 Date: 12/0312014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total 1 Source of Funds Fees and Collections - lot and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cast Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 66,252.00 0.00 0.00 66,252.00 Local Funds - Other 0.00 8,261.00 0.00 8,261.00 lnkind Match 0.00 0.00 0,00 0.00 MDCH Fixed Unit Rate Totals 66,252.00 , 8,261.00 1 0.00 74,513.00 Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services] Page: 141 of 184 Health Division, Comprehensive Agreement 2015 Contract # 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail I Line Item I Qtyl Rate UOM Amount Cash Inkindi Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Nutritionist/Dietician 0.1803 50863.000 FTE 9,170.00 0.00 0.00 9,170.00 Nutritionist/Dietician 0.5000 56054.000 FIE 28,027.00 0.00 0.00 28,027.00 Total for Salary & Wages 37,197.00 0.00 0.00 37,197.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 62.962 23,420,00 0.00 0.00 23,420.00 3 Cap. Exp. for Equip & Fac. Contractual 5 Supplies and Materials 6 Travel 7 Communication County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 60,617.00 0.00 0.00 60,617.00 TOTAL DIRECT EXPENSES 60,617.00 0.00 0,00 60,617.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 5,635.00 0.00 0.00 5,635.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 8,261.00 0.00 0.00 8,261,00 Total Indirect Costs 13,896.00 0.00 0.00 13,896.00 TOTAL INDIRECT EXPENSES 13,896.00 0.00 0.00 13,896.00 TOTAL EXPENDITURES 74,513.00 0.00 0.00 74,513.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Serviced Page: 142 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / MDEQ On-site Sewage DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rv7 Original n Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount I Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0,00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 1,407,305.00 0.00 0.00 1407,305.00 Total Indirect Costs 1,407,305.00 0.00 0.00 1,407,305.00 TOTAL INDIRECT EXPENSES 1,407,305.00 0.00 0.00 1,407,305.00 TOTAL EXPENDITURES 1,407,305.00 0.00 0.00 1,407,305.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 143 of 184 Health Division, Comprehensive Agreement - 2010 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount, Cash I inkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MOCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 372,426.00 0.00 0.00 372,426.00 MOH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,034,879.00 0.00 1,034,879.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 372,426.00 1,034,879.00 0.00 1,407,305.00 Date: 1210312014 Contract ft 20151753-00, Oakland County Department of Health and Human Services/ Page: 144 of 184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item 1 Cityr- Rate UOM Amount! Cash i Inkind r Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 1,407,305,00 0.00 0.00 1,407,305.00 Total Indirect Costs 1,407,305.00 0.00 0.00 1,407,305.00 TOTAL INDIRECT EXPENSES 1,407,305.00 0.00 0.00 1,407,305.00 TOTAL EXPENDITURES 1,407,305.00 0.00 0.00 1,407,305.00j Date: 12/0312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 145 a 184 Health Division, Comprehensive Agreement - 2010 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM i PROJECT Comprehensive Agreement - 2015/ SIDS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT WI Original r Amendment AMENDMENT # 0 CITY Pontiac STATE NH ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 Category Amount 1 Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con, Employees, Misc.) 0.00 0.00 0.00 0,00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 Other Costs Distributions 2,000.00 0.00 0.00 2,000.00 Total Indirect Costs 2,000.00 0.00 0.00 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 0.00 0.00 2,000.00 TOTAL EXPENDITURES 2,000.00 0.00 _ 0.00 2,000.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 146 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12103/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount 1 Cash Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0,00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MUCH Non Comprehensive 0.00 0.00 0.00 0.00 MUCH Comprehensive 0.00 , 0.00 0.00 0.00 ELPHS - MUCH Hearing 0.00 0.00 0.00 0.00 ELPHS -MUCH Vision 0.00 0.00 0.00 0.00 ELPHS - MUCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Sudden Infant Death Syndrome Fees 2,000,00 0.00 0.00 2,000,00 Totals 2,000.00 0.00 0.00 2,000.00 Date; 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 147 of 184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail Line Item [ Qty RatetUOM Amount[ Cash! Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Fringe Benefits 3 Cap. Exp. for Equip & Fee, 4 Contractual 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Health Adm Distribution Notes : Cost Distributions for SIDS Fees from Health Adminstration 0.0000 0.000 2,000.00 0.00 0.00 2,000.00 Total Indirect Costs 2,000.00 0.00 0.00 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 0.00 0.00 2,000.00 TOTAL EXPENDITURES 2,000.00 0.00 0.00 2,000.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 148 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -2015 / Sexually Transmitted Disease (STD) Control DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2014 To : 9/3012015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT TV, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category Amount I Cash Inkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 47,787.00 0.00 0.00 47,787.00 2 Fringe Benefits 34,806.00 0.00 0.00 34,806.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 57.00 0.00 0.00 57.00 Total Program Expenses 82,650.00 0.00 0.00 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 0.00 0.00 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 10,586.00 0.00 0.00 10,586.00 Total Indirect Costs 10,586.00 0.00 0.00 10,586.00 TOTAL INDIRECT EXPENSES 10,586.00 0.00 0.00 10,586.00 TOTAL EXPENDITURES 93,236.00 0.00 0.00 93,236.00 Date: 12)0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 149 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount _ Cash _ Inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0,00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0,00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0,00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0,00 0,00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 82,650.00 0.00 0,00 82,650.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0,00 0.00 ELPHS - MUCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0,00 ELPHS - Drinking Water 0.00 0.00 0,00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 10,586.00 0.00 10,586.00 Inkind Match 0.00 0.00 0.00 0.00 MUCH Fixed Unit Rate Totals 82,650.00 10,586.00 0.00 93,236.00 Contract #20151753-00, Oakland County Department of Health and Human Services/ Health Division, Comprehensive Agreement - 2010 Date: 12/03/2014 Page: 150 of 184 Contract #20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail Line Item I Qty Rate UOM Amount Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 1.0000 47787.000 FTE 47,787.00 0.00 0.00 47,787.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment insurance Retirement insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 72.836 34,806.00 0.00 0.00 34,806.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 57.00 0.00 0.00 57.00 Total Program Expenses 82,650.00 0.00 , 0.00 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 0.00 0.00 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Health Adm Distribution I 0.0000 0.000 10,586.00 0.00 0.00 10,586.00 Total Indirect Costs 10,586.00 0.00 0.00 10,586.00 TOTAL INDIRECT EXPENSES 10,586.00 0.00 0.00 10,586.00 TOTAL EXPENDITURES 93,236.00 0.00 0.00 93,236.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Haman Services/ Page: 151 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12)03/2014 1 Program Budget Summary PROGRAM I PROJECT Comprehensive Agreement - 20151 Sexually Transmitted Disease (STD-ELPHS) DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To :9130/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT W Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category 1 Amount I Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 2,922,845.00 0.00 0.00 2,922,845.00 Total Indirect Costs 2,922,845.00 0.00 0.00 2,922,845.00 TOTAL INDIRECT EXPENSES 2,922,845.00 0.00 0.00 2,922,845.00 TOTAL EXPENDITURES 2,922,845.00 0.00 0.00 2,922,845.00 Date: 1210312014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 152 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 847,927.00 0.00 0.00 847,927,00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,074,918.00 0.00 2,074,918.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 847,927.00 2,074,918.00 0.00 2,922,845.00 Date: 1210312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 153 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 Program Budget - Cost Detaii Line Item I Qty Rate UOIVI Amount Cash inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 13,776.00 0.00 0.00 13,776.00 Other Cost Distributions-Clinic & Lab di 0.0000 0.000 2,909,069.00 0.00 0.00 2,909,069.00 Total for Other Costs Distributions 2,922,845.00 0.00 0.00 2,922,845.00 Total Indirect Costs 2,922,845.00 0.00 0.00 2,922,845.00 TOTAL INDIRECT EXPENSES 2,922,845.00 0.00 0.00 2,922,845.00 TOTAL EXPENDITURES 2,922,845.00 0.00 0.00 2,922,845.00 Date: 12/03/2014 Contract 4 20151753-00, Oakland County Department of Health and Human Services/ Page: 154 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 1 Program Budget Summary PROGRAM i PROJECT Comprehensive Agreement - 2015 / TB Control DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/112014 To : 913012015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category Amount [ Cash Inkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 14,788.00 0.00 0.00 14,788.00 2 Fringe Benefits 852.00 0.00 0.00 852.00 3 Cap. Exp. for Equip & Fac. 0.0D 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 45,554.00 0.00 0.00 45,554.00 6 Travel 16,500.00 0.00 0.00 16,500.00 7 Communication 731.00 0.00 0.00 731.00 8 County-City Central Services 0.00 0,00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 68,811.00 0.00 0.00 68,811.00 Total Program Expenses 147,236.00 0.00 0.00 147,236.00 TOTAL DIRECT EXPENSES 147,236.00 0.00 0.00 147,236,00 INDIRECT EXPENSES Indirect Costs Indirect Costs 2,240.00 0.00 0.00 2,240.00 2 Other Costs Distributions 810,232.00 0.00 0.00 810,232.00 Total Indirect Costs 812,472.00 0.00 0.00 812,472.00 TOTAL INDIRECT EXPENSES 812,472.00 0.00 0.00 812,472.00 TOTAL EXPENDITURES 959,708.00 0.00 0.00 959,708.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 155 of 184 Health Division, Comprehensive Agreement -2010 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash !Wild Total i Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 , 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0,00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 73,413.00 0.00 0.00 73,413.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0,00 ELPHS - MDCH Other 0.00 0,00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0,00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0,00 0,00 Local Funds - Other 0.00 886,295.00 0.00 886,295.00 Inkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 73,413.00 886,295.00] 0.00 959,708.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 156 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail !Line item 1 Qty! Rate i UOM I Amount! Cash] Inkincir Total DIRECT EXPENSES Program Expenses Salary & Wages Outreach Worker Notes : Auxiliary Health Worker 1.0000 14788.000 FTE 14,788.00 0.00 0.00 14,788.00 2 Fringe Benefits All Composite Rate Notes : Social Security Unemployment Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.760 852.00 0.00 0.00 852.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies 0.0000 0.000 2,500.00 0.00 0.00 2,500.00 Postage 0.0000 0.000 100.00 0.00 0.00 100.00 Incentives supplies 0.0000 0.000 1,000.00 0.00 0.00 1,000.00 County TB meclical,office,drugs, et 0.0000 0.000 41,954.00 0.00 0.00 41,954.00 Total for Supplies and Materials 45,554.00 0.00 0.00 45,554.00 6 Travel Mileage Notes : 17,858 miles @ .56 0.0000 0.000 10,000.00 0.00 0.00 10,000.00 Conferences 0.0000 0.000 6,500.00 0.00 0.00 6,500.00 Total for Travel 16,500,00 0.00 0.00 16,500.00 7 Communication Communication 731.00 0.00 0.00 731.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 200.00 0.00 0.00 200.00 Lab Fees 0.0000 0.000 33,933.00 0.00 0.00 33,933.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 157 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Professional Svcs, Translation/It 0.0000 0.000 450.00 0.00 0.00 450.00 Equipment Repair 0.0000 0.000 250.00 0.00 0.00 250.00 County TB, prof svcs, interpretati 0.0000 0.000 33,978.00 0.00 0.00 33,978.00 Total for All Others (ADP, Con. Employee 68,811.00 0.00 0.00 68,811.00 Total Program Expenses 147,236.00 0.00 0.00 147,236.00 TOTAL DIRECT EXPENSES 147,236,00 0,00 0.00 147,236.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs Fiscal Year Rate 0.0000 15.150 2,240.00 0.00 0.001 2,240.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 19,145.00 0.00 0.00 19,145.00 Other Cost Distributions-Field Nursing d 0.0000 0.000 40,418.00 0.00 0.00 40,418.00 Nursing Adm Distribution 0.0000 0.000 6,634.00 0.00 0.00 6,634.00 Other Cost Distributions-Misc 0.0000 0.000 744,035.00 0.00 0.00 744,035.00 Total for Other Costs Distributions 810,232.00 0.00 0.00 810,232.00 Total Indirect Costs 812,472.00 0.00 0.00 812,472.00 TOTAL INDIRECT EXPENSES 812,472.00 0.00 0.00 812,472.00 TOTAL EXPENDITURES 959,708.00 0.00 0.00 959,708.00 Contract #20151753-00, Oakland County Department of Health and Human Services/ Health Division, Comprehensive Agreement -2015 Date: 12/03/2014 Page: 158 0/ 184 Contract #20151753-00 Date: 12/03/2014 Program Budget Summary PROGRAM I PROJECT Comprehensive Agreement -2015 / Immunization Fixed Fees DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount 1 Cash 1 Inkind i Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0,00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00_ 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 7 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs 0.00 0.00 0.00 0.00 2 Other Costs Distributions 35,000.00 0.00 0.00 35,000.00 Total Indirect Costs 35,000.00 0.00 0.00 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 0.00 0.00 35,000.00 TOTAL EXPENDITURES 35,000.00 0.00 0.00 35,000.00 Date: 121030014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 159 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total -I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0,00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0,00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MI3CH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0,00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 inkind Match - 0.00 _ 0.00 0.00 0.00 MDCH Fixed Unit Rate 1MM: VFC - AFIX Visits 35,000.00 0.00 0.00 35,000.00 Totals 35,000.00 _ 0.00 0.00 35,000.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 160 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12103/2014 3 Program Budget - Cost Detail Line Item I Qty Rate UOM Amount' Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap, Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs Indirect Costs 2 Other Costs Distributions Cost Distributions for Fees-from LAP 0.0000 0.000 35,000.00 0.00 0.00 35,000.00 Total Indirect Costs 35,000.00 0.00 0.00 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 0.00 0.00 35,000.00 TOTAL EXPENDITURES 35,000.00 0.00 0.00 35,000.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 161 of 184 Health Division, Comprehensive Agreement 2015 Contract # 20151753-00 Date: 12/03/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / Vision ELPHS DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To: 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT .17 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount Cash 1 lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 244,090.00 0.00 0.00 244,090.00 2 Fringe Benefits 73,089.00 0.00 0.00 73,089.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 Supplies and Materials 3,444.00 0.00 0.00 3,444.00 6 Travel 5,693.00 0.00 0.00 5,693.00 7 Communication 648.00 0.00 0.00 648.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 16,795.00 0.00 0.00 16,795.00 10 All Others (ADP, Con. Employees, Misc.) 4,989.00 0.00 0.00 4,989.00 Total Program Expenses 348,748.00 0.00 0.00 348,748.00 TOTAL DIRECT EXPENSES 348,748.00 0.00 0.00 348,748.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 36,980.00 0.00 0.00 36,980.00 2 Other Costs Distributions 124,653.00 0.00 0.00 124,653.00 Total Indirect Costs 161,633.00 0.00 0.00 161,633.00 TOTAL INDIRECT EXPENSES 161,633.00 0.00 0.00 161,633.00 TOTAL EXPENDITURES 510,381.00 0.00 0.00 510,381.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 162 of 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 213,433.00 0.00 0.00 213,433.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 296,948.00 0.00 296,948.00 Inkind Match 0.00 _ 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 213,433.00 296,948.00 0.00 510,381.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 163 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail 'Line Item Qty Rate UOM Amount' Cash Inkindl Total DIRECT EXPENSES Program Expenses I Salary & Wages Supervisor 1.0000 37767.000 FTE 37,767.00 0.00 0.00 37,767.00 Technician 1.0000 15055.000 FIE 15,055.00 0.00 0.00 15,055.00 Technician 1.0000 15055.000 FTE 15,055.00 0.00 0,00 15,055.00 Technician 1.0000 24036.000 FTE 24,036.00 0.00 0.00 24,036.00 Technician 1.0000 18365.000 FTE 18,365.00 0.00 0.00 18,365.00 Outreach Worker 1.0000 31364.000 FTE 31,364.00 0.00 0.00 31,364.00 Technician 1.0000 14788.000 FTE 14,788.00 0.00 0.00 14,788.00 Technician 1.0000 14788.000 FTE 14,788.00 0.00 0.00 14,788.00 Technician 1.0000 24036.000 FTE 24,036.00 0.00 0.00 24,036.00 Technician 1.0000 19260.000 FTE 19,260.00 0.00 0.00 19,260.00 Technician 1.0000 14788.000 FTE 14,788.00 0.00 0.00 14,788.00 Technician 1.0000 14788.000 FTE 14,788.00 0.00 0.00 14,788.00 Total for Salary & Wages 244,090.00 0.00 0.00 244,090.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOYMENT INS RETIREMENT HOSPITAL INS LIFE INS VISION INS HEARING INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 29.944 73,089.00 0.00 0.00 73,089.00 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials Office,Medical,Educ, Postage, Prin 0.0000 0.000 3,444.00 0.00 0.00 3,444.00 6 Travel Travel-terms not specified 0.0000 0.000 5,693.00 0.00 0.00 5,693.00 7 Communication Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Serv]ces/ Page: 164 of 184 Health Dfvision, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash lnkind Total Telephone 0.0000 0.000 648.00 0.00 0.00 648.00 8 County-City Central Services 9 Space Costs Bldg Space Costs 0.0000 0.000 16,795.00 0.00 0.00 16,795.00 10 All Others (ADP, Con. Employees, Misc.) Gaper, Equip Maint, Exp Equip, Tra 0.0000 0.000 4,989.00 0.00 0.00 4,989,00 Total Program Expenses 348,748.00 0.00 0.00 348,748.00 TOTAL DIRECT EXPENSES 348,748.00 0.00 0.00 348,748.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 36,980.00 0.00 0.00 36,980.00 2 Other Costs Distributions Nursing Adm Distribution 0.0000 0.000 11,929.00 0.00 0.00 11,929.00 Other Cost Distributions-Misc Distributi 0.0000 0.000 63,320.00 0.00 0.00 63,320.00 Health Adm Distribution 0.0000 0.000 49,404.00 0.00 0.00 49,404.00 Total for Other Costs Distributions 124,653.00 0.00 0.00 124,653.00 Total Indirect Costs 161,633.00 0.00 0.00 161,633.00 TOTAL INDIRECT EXPENSES 161,633.00 0.00 0.00 161,633.00 TOTAL EXPENDITURES 510,381.00 0.00 0.00 510,381.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 165 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement -20151 Immunization Vaccine Quality Assurance DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rv... Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Cash Inkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 1,913,001.00 0.00 0.00 1,913,001.00 2 Fringe Benefits 1,165,176.00 0.00 0.00 1,165,176.00 3 Cap. Exp. for Equip & Fac. 0.00 0,00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 874,465.00 0.00 0.00 874,465.00 6 Travel 7,742.00 0,00 0.00 7,742.00 Communication 35,070.00 0.00 0.00 35,070.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 171,410.00 0.00 0.00 171,410.00 10 All Others (ADP, Con. Employees, Misc.) 334,936.00 0.00 0.00 334,936.00 Total Program Expenses 4,501,800.00 0.00 0.00 4,501,800.00 TOTAL DIRECT EXPENSES 4,501,800.00 0.00 0.00 4,501,800.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 289,820.00 0.00 0.00 289,820.00 2 Other Costs Distributions -3,768,110.00 0.00 0.00 -3,768,110.00 Total Indirect Costs -3,478,290.00 0,00 0.00 -3,478,290.00 TOTAL INDIRECT EXPENSES -3,478,290.00 0.00 0.00 -3,478,290.00 TOTAL EXPENDITURES 1,023,510.00 0.00 0.00 1,023,510.00 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Health Division, Comprehensive Agreement - 2015 Date: 12/03/2014 Page: 166 of 184 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category I Amount Cash Inkind Total _ I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 825,025.00 0.00 825,025.00 Fees and Collections - 3rd Party 0.00 85,000.00 0.00 85,000.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 7,348.00 0.00 7,348.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 106,137.00 0.00 0.00 106,137.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 0.00 0.00 0.00 Inkind Match 0.00 0.00 0.00 0,00 MDCH Fixed Unit Rate Totals 1 106,137.00 917,373.00 0.00 1,023,510.00 Date: 12103/2014 Contract #201517-53-00, Oakiand County Department of Health and Human Services/ Page: 167 of 184 Health Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 1210312014 3 Program Budget - Cost Detail Line item I Qty I Rate UOM Amount Cash! lnkind I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Clerk Notes ; Vaccine Supply Clerk 1.0000 40061.000 FTE 40,061.00 0.00 0.00 40,061,00 Clerk Notes : Vaccine Supply Clerk 500,000 0 19.260 FTE 9,630.00 0.00 0.00 9,630.00 Overtime Notes : Various Clinic Public Health Nurses 1,0000 5200.000 FTE 5,200.00 0.00 0.00 5,200.00 County PH Clinic Nurses-various 1.0000 1858110.000 FTE 1,858,110.00 0.00 0.00 1,858,110.00 Total for Salary & Wages 1,913,001.00 0.00 0.00 1,913,001.00 2 Fringe Benefits All Composite Rate Notes : RCA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 69.510 38,155,00 0.00 0.00 38,155,00 Composite Rate Notes : FICA Unemployment Insurance Retirement Insurance Hospital Insurance Life Insurance Vision Insurance Dental Insurance Workers Comp Short and Long Term Disability Insurance 0.0000 100.000 1,127,021.00 0.00 0.00 1,127,021.00 Total for Fringe Benefits 1,165,176.00 0.00 0.00 1,165,176.00 Cap. Exp. for Equip & Fac. 4 Contractual Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 168 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Line Item Qty i Rate ILIOM Amount! Cash lnkind 1 Total Supplies and Materials Medical, Office, Ethic, Postage, at Notes : Clinic 0.0000 0.000 871,761.00 0.00 0.00 871,761.00 Office Supplies Notes : VQA 0.0000 0.000 300.00 0.00 0.00 300.00 Materials & Supplies - Smart Temps Notes : VQA 0.0000 0.000 2,404.00 0.00 0.00 2,404.00 Total for Supplies and Materials 874,465.00 0.00 0.00 874,465.00 6 Travel Mileage Notes : 1511 miles @ .56 VOA 0.0000 0.000 846.00 0.00 0.00 846.00 Conferences Notes : VQA 0.0000 0.000 200.00 0.00 0.00 200.00 Mileage Notes : 11,096 miles @ .56 Clinic 0.0000 0.000 6,214.00 0.00 0.00 6,214.00 Conferences Notes : Clinic 0.0000 0.000 482.00 0.00 0.00 482.00 Total for Travel 7,742.00 0.00 0.00 7,742.00 7 Communication Telephone 0.0000 0.000 35,070.00 0.00 0.00 35,070.00 8 County-City Central Services 9 Space Costs Bldg Space Cost 0.0000 0.0001 171,410.00 0.00 0.00 171,410.00 10 All Others (ADP, Con. Employees, Misc.) Laundry, lT Oper, Memberships, Pro Notes : Clinic 0.0000 0.000 333,911.00 0.00 0.00 333,911.00 Insurance Notes : VOA 0.0000 0.000 325.00 0.00 0.00 325.00 Prof Svcs - Smart Temps 0.0000 0.000 700.00 0.00 0.00 700.00 Total for All Others (ADP, Con. Employee 334,936.00 0.00 0.00 334,936.00 Total Program Expenses 4,501,800.00 0.00 0.00 4,501,800.00 TOTAL DIRECT EXPENSES 4,501 ,800.00 0.00 0.00 4,501,800.00 INDIRECT EXPENSES Indirect Costs Date: 12103/2014 Contract // 20151753,00, Oakland County Department of Health and Human Services/ Page: 169 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Line Item I Qty Rate!UOM Amount! Cash Inkind p Total i indirect Costs Fiscal Year Rate 0.0000 15.150 8,316.00 0.00 0.00 8,316.00 Indirect Costs - Other- General Fund 0.0000 15.150 281,504.00 0.00 0.00 281,504.00 Total for Indirect Costs 289,820.00 0.00 0.00 289,820.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 2,138,977.00 0.00 0,00 2,138,977.00 Nursing Adm Distribution 0.0000 0.000 190,003.00 0.00 0.00 190,003.00 Other Cost Distributions-misc 0.0000 0.000 -6,097,090,00 0.00 0,00 -6,097,090.00 Total for Other Costs Distributions -3,768,110.00 0.00 0.00 -3,768,110.00 Total Indirect Costs -3,478,290.00 0.00 0.00 -3,478,290.00 TOTAL INDIRECT EXPENSES -3,478,290.00 0.00 0.00 -3,478,290.00 TOTAL EXPENDITURES 1,023,510.00 0.00 0.00 1,023,610.00 Date: 12103/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 170 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12(0312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / WIC Breastfeeding DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Serviced Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F,7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38 6004876 I Category Amount! Cash Inkind , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 27,040.00 0.00 0.00 27,040.00 Fringe Benefits 25,606.00 0.00 0.00 25,606.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 Contractual 71,259.00 0,00 0.00 71,259.00 5 Supplies and Materials 3,551.00 0.00 0.00 3,551.00 6 Travel 1,510.00 0.00 0.00 1,510.00 7 Communication 594.00 0.00 0.00 594.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 1,550.00 0.00 0.00 1,550.00 10 All Others (ADP, Con. Employees, Misc.) 6,052.00 0.00 0.00 6,052.00 Total Program Expenses 137,162.00 0.00 0.00 137,162.00 TOTAL DIRECT EXPENSES 137,162.00 0.00 0.00 137,162.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 4,097.00 0.00 0,00 4,097.00 2 Other Costs Distributions 18,092.00 0.00 0.00 18,092.00 Total Indirect Costs 22,189.00 0.00 0.00 22,189.00 TOTAL INDIRECT EXPENSES 22,189.00 0.00 0.00 22,189.00 TOTAL EXPENDITURES 159,351.00 0.00 0.00 159,351.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 171 01184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inland Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0,00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0,00 0.00 Required Match - Local 0.00 , 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 141,259,00 0.00 0.00 141,259.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0,00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 18,092,00 0.00 18,092.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 141,259.00 18,092.00 0.00 159,351.00 Date: 12103/2014 Contract #20151763-00, Oakland County Department of Health and Human Services/ Page: 172 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/03/2014 3 Program Budget - Cost Detail 'Line Item QtY I Rate UOM Amount Cash I Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Lactation Specialist 1.0000 27040.000 FTE 27,040.00 0.00 0.00 27,040.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMP INS RETIREMENT HOSPITAL INS LIFE INS VISION INS DENTAL INS WORK COMP SHORT/LONG TERM DISABILITY 0.0000 94.697 25,606.00 0.00 0.00 25,606.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency- OLSHA 0.0000 0.000 71,259.00 0.00 0.00 71,259.00 5 Supplies and Materials Office Supplies 0.0000 0.000 750.00 0.00 0.00 750.00 Postage 0.0000 0.000 500.00 0.00 0.00 500.00 Printing 0.0000 0.000 500.00 0.00 0.00 500.00 Medical Supplies 0.0000 0.000 1,110.00 0.00 0.00 1,110.00 Educational Supplies 0.0000 0.000 541.00 0.00 0.00 541.00 Materials & Supplies 0.0000 0.000 150.00 0.00 0.00 150.00 Total for Supplies and Materials 3,551.00 0.00 0.00 3,551.00 6 Travel Mileage Notes : 1000 miles @ .56 0.0000 0.000 560.00 0.00 0.00 560.00 Conferences 0.0000 0.000 950.00 0.00 0.00 950.00 Total for Travel 1,510.00 0.00 0.00 1,510.00 7 Communication Telephone Communications 0.0000 0.000 594.00 0.00 0.00 594.00 8 County-City Central Services Date: 12/0312014 Contract # 20151753-00, Oaklard County Department of Health and Human Services/ Page: 173 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 Line Item Qty RatelUOM _ Amount[ Cash! inkindi Total 9 Space Costs Rent 0.0000 0.000 1,550.00_ 0,00 0.00 1,550.00 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 2,720.00 0.00 0.00 2,720.00 Interpretation 0.0000 0.000 800.00 0.00 0.00 800.00 Advertising 0.0000 0.000 755.00 0.00 0.00 755.00 Insurance 0.0000 0.000 382.00 0.00 0.00 382.00 Staff Training 0.0000 0,000 1,395,00 0.00 0.00 1,395.00 Total for All Others (ADP, Con. Employee 6,052.00 0.00 0.00 6,052.00 Total Program Expenses 137,162.00 , 0.00 0.00 137,162.00 TOTAL DIRECT EXPENSES 137,162.00 0.00 0.00 137,162.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate 0.0000 15.150 _ 4,097.00 0.00 0.00 4,097.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 18,092.00 0.00 0.00 18,092.00 Total Indirect Costs 22,189.00 0.00 0.00 22,189.00 TOTAL INDIRECT EXPENSES 22,189.00 0,00 0.00 22,189.00 TOTAL EXPENDITURES 159,351.00_ 0.00_ 0.00 159,351.00 Date: 12/03/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 174 of 184 Health Division, Comprehensive Agreement - 2015 Contract #20151753-00 Date: 12/0312014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015 / WIC Resident Services DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT FA Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category .1 .Amount Cash inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 1,007,862.00 0.00 0.00 1,007,862.00 2 Fringe Benefits 651,653.00 0.00 0.00 651,653.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 0.00 0.00 4 Contractual 414,000.00 0.00 0.00 414,000.00 5 Supplies and Materials 46,631.00 0.00 0,00 46,631.00 6 Travel 5,581,00 0.00 0.00 5,581.00 7 Communication 15,030.00 0.00 0.00 15,030.00 8 County-City Central Services 0.00 0.00 0.00 0.00 9 Space Costs 91,147.00 0.00 0.00 91,147.00 10 All Others (ADP, Con. Employees, Misc.) 91,644.00 0.00 0.00 91,644.00 Total Program Expenses 2,323,548.00 0.00 0.00 2,323,548.00 TOTAL DIRECT EXPENSES 2,323,548,00 0.00 0.00 2,323,548.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 152,691.00 0.00 0.00 152,691.00 2 Other Costs Distributions 346,241.00 0.00 0.00 346,241,00 Total Indirect Costs 498,932.00 0.00 0.00 498,932.00 TOTAL INDIRECT EXPENSES 498,932.00 0.00 0.00 498,932.00 TOTAL EXPENDITURES 2,822,480.00 0.00 0.00 2,822,480.00 Date: 12/03/2014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 175 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash lnkind Total I Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0.00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 2,476,239.00 0.00 0.00 2,476,239.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 0.00 0.00 0.00 0.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 346,241.00 0.00 346,241.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals I 2,476,239.00 346,241.00 0.00 2,822,480.00 Date: 12/0312014 Contract /I 20161753-00, Oakland County Department of Health and Human Services/ Page: 176 of 184 Health Div/don, Comprehensive Agreement -2015 Contract # 20161753-00 Date: 1210312014 3 Program Budget - Cost Detail [Line item I Qty Rate UOM Amount Cash Inkind Total DIRECT EXPENSES Program Expenses I Salary & Wages Assistant 2.0000 22932.500 FTE 45,865.00 0.00 0.00 45,865.00 Assistant 1,0000 13585,000 FTE 13,585.00 0.00 0,00 13,585.00 Auxilliary Health Worker 10.0000 28820,200 FTE 288,202.00 0.00 0.00 288,202.00 Technician Notes : Dietetic Tech 6.0000 40889.166 FTE 245,335.00 0.00 0.00 245,335.00 Supervisor Notes : WIC Supervisor 1.0000 65598.000 FTE 65,598.00 0.00 0.00 65,598,00 Supervisor Notes : Office Supervisor 1 1.0000 46378.000 FTE 46,378.00 0,00 0.00 46,378.00 Supervisor Notes : Office Supervisor 2 1.0000 56055.000 FTE 56,055.00 0.00 0.00 66,055.00 Nutritionist/Dietician Notes : PH Nutritionist 2 3.0000 67923.330 FTE 173,770.00 0.00 0.00 173,770.00 Nutritionist/Dietician Notes : PH Nutritionist 3 1.0000 61623.000 FTE 61,623.00 0.00 0.00 61,623.00 Overtime 1.0000 11451.000_ FTE 11,451.00 0.00 0.00 11,451.00 Total for Salary & Wages 1,007,862.00 0.00 0.00 1,007,862.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins. Retirement Hospital Ins. Life Ins. Vision Ins. Hearing Ins. Dental Ins. Work Comp Short/Long Term Disability 0.0000 64.657 - 651,653.00 0,00 0.00 651,653.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency- OLSHA to pilot WIC 0.0000 0.000 .. 414,000.00 0.00 0.00 414,000.00 5 Supplies and Materials Date: 12/03/2014 Contract #20151753-00. Oakland County Department of Health and Human Services/ Page; 177 or 184 Health Division, Comprehensive Agreement -2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash inkind Total Office Supplies 0.0000 0.000 11,461.00 0.00 0.00 11,461.00 Medical Supplies 0.0000 0.000 14,665,00 0.00 0.00 14,665.00 Educational Supplies 0.0000 0.000 10,500.00 0.00 0.00 10,500.00 computer supplies 0.0000 0.000 150.00 0.00 0.00 150.00 Postage 0.0000 0.000 2,058.00 0.00 0.00 2,058.00 Printing 0.0000 0,000_ 7,797.00 0.00 0.00 7,797,00 Total for Supplies and Materials 46,631.00 0.00 0.00 46,631.00 6 Travel Mileage Notes : 6,750 miles @ .56 0.0000 0.000 3,780.00 0.00 0.00 3,780.00 Conferences 0.0000 0.000 1,801.00 0,00 0.00 1,801.00 Total for Travel 5,581.00 0.00 0.00 5,581.00 7 Communication Telephone 0.0000 0.000 15,030,00 0.00 0.00 15,030.00 8 County-City Central Services Space Costs Bldg Space Cost Rental 0.0000 0.0001 91,147.00 0.00 0.00 91,147.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0,000 6,690.00 0.00 0.00 6,690.00 Equipment Repair 0.0000 0.000 1,200.00 0.00 0.00 1,200.00 Convenience Copier 0,0000 0,000 4,500.00 0,00 0.00 4,500,00 IT Operatons 0.0000 0.000 57,210.00 0.00 0.00 57,210.00 Advertising 0.0000 0.000 15,044.00 0.00 0.00 15,044.00 Staff Training 0.0000 0.000 2,500.00 0.00 0.00 2,500.00 Prof svcs, interpretation, laundry 0.0000 0.000 4,500.00 0.00 0.00 4,500.00 Total for All Others (ADP, Con. Employee 91,644.00 0.00 0.00 91,644.00 Total Program Expenses 2,323,548.00 0.00 0.00 2,323,548.00 TOTAL DIRECT EXPENSES 2,323,548.00 0.00 0.00, 2,323,548.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Fiscal Year Rate f 0.0000 15.150 _ 152,691.00 0.00 0.00 152,691.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0,000 317,156.00 0.001 0.00 317,156.00 Date: 12/03/2014 Contract 420151753-00, Oakland County Department of Health and Human Services/ Page: 178 of 184 Health [Division, Comprehensive Agreement 2015 Contract #20151753-00 Date: 12/03/2014 Line Item Qty Rate UOM Amount Cash Inkind Total Other Cost Distributions-Health Educatio 0.0000 0.000 29,085.00 0.00 0.00 29,085.00 Total for Other Costs Distributions 346,241.00 0.00 0.00 346,241.00 Total Indirect Costs 498,932.00 0.00 0.00 498,932.00 TOTAL INDIRECT EXPENSES 498,932.00 0.00 0.00 498,932.00 TOTAL EXPENDITURES 2,822,480.00 0.00 0.00 2,822,480.00 Date: 12/03/2014 Contract If 20151753-00, Oakland County Department of Health and Human Services/ Page: 179 of 184 Health Division, ComprehensIve Agreement - 2015 Contract # 20151753-00 Date: 12413/2014 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2015/ MDEQ Drinking Water DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : W30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd, 34 East BUDGET AGREEMENT Fel Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category I Amount 1 Cash lnkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 0.00 0.00 2 Fringe Benefits 0.00 0.00 0.00 0.00 3 Cap. Exp. for Equip & Fac, 0.00 0.00 0.00 0.00 4 Contractual 0.00 0.00 0.00 0.00 5 Supplies and Materials 0.00 0.00 0.00 0.00 6 Travel 0.00 0.00 0.00 0.00 Communication 0.00 0.00 0.00 0.00 8 County-City Central Services 0.00 0.00 0,00 0.00 9 Space Costs 0.00 0.00 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 0.00 0.00 Other Costs Distributions 793,000.00 0.00 0.00 793,000.00 Total Indirect Costs 793,000.00 0.00 0.00 793,000.00 TOTAL INDIRECT EXPENSES 793,000.00 0,00 0.00 793,000.00 TOTAL EXPENDITURES 793,000.00 0.00 0.00 793,000.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Serviced/ Page: 180 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 1210312014 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 0.00 0.00 0.00 0.00 Fees and Collections - 3rd Party 0.00 0.00 0.00 0.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 Federally Provided Vaccines 0.00 0.00 0.00 0.00 Federal Medicaid Outreach 0.00 0.00 0.00 0.00 Required Match - Local 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0,00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Local Non-ELPHS 0.00 0.00 0.00 0.00 Other Non-ELPHS 0.00 0.00 0,00 0.00 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 MDCH Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MDCH Vision 0.00 0.00 0.00 0.00 ELPHS - MDCH Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Drinking Water 514,301.00 0.00 0,00 514,301.00 ELPHS - On-Site Sewage 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 278,699.00 0.00 278,699.00 lnkind Match 0.00 0.00 0.00 0.00 MDCH Fixed Unit Rate Totals 514,301.00 278,699.00 0.00 793,000.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 181 of 184 Health Division, Comprehensive Agreement -2015 Contract # 20151753-00 Date: 12/03/2014 Program Budget - Cost Detail Line item Qty Rate UOM I Amount! Cashl Inkindl Total] DIRECT EXPENSES Program Expenses 1 Salary & Wages 2 Fringe Benefits 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 670,145.00 0.00 0.00 670,145.00 Other Cost Distributions-Misc. Distribut 0.0000 0.000 122,855.00 0.00 0.00 122,855.00 Total for Other Costs Distributions 793,000.00 0.00 0,00 793,000.00 Total Indirect Costs 793,000.00 0.00 0.00 793,000.00 TOTAL INDIRECT EXPENSES 793,000.00 0.00 0.00 793,000.00 TOTAL EXPENDITURES 793,000.00 0.00 0.00 793,000.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 182 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20151753-00 Date: 12/03/2014 Summary of Budget PROGRAM 1 PROJECT Comprehensive Agreement -2015 / Comprehensive Agreement - 2015 DATE PREPARED 12/3/2014 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2014 To : 9/30/2015 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT pi Original Fr Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category Amount Cash Inkind Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 13,304,564.00 0.00 0.00 13,304,564.00 2 Fringe Benefits 8,247,011.00 0.00 0.00 8,247,011.00 3 Contractual 635,682.00 0.00 0.00 635,682.00 4 Supplies and Materials 1,561,369,00 0,00 0.00 1,561,369.00 5 Travel 379,056.00 0.00 0.00 379,056.00 Communication 255,195.00 0.00 0.00 255,195.00 7 County-City Central Services 1,238,284.00 0.00 0.00 1,238,284.00 8 Space Costs 1,627,338.00 0.00 0.00 1,627,338.00 9 All Others (ADP, Con. Employees, Misc.) 2,601,822.00 0.00 0.00 2,601,822.00 Total Program Expenses 29,850,321.00 0.00 0.00 29,850,321.00 TOTAL DIRECT EXPENSES 29,850,321.00 _ 0.00 0.00 29,850,321.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs -4,332,999.00 0.00 0.00 -4,332,999.00 2 Other Costs Distributions 12,675,266.00 0.00 0.00 12,675,266.00 Total Indirect Costs 8,342,267.00 0.00 0.00 8,342,267.00 TOTAL INDIRECT EXPENSES 8,342,267.00 0,00 0.00 8,342,267.00 TOTAL EXPENDITURES 38,192,588,00 0.00 0.00 38,192,588.00 SOURCE OF FUNDS Category Amount Cash Inkind Total 1 Fees and Collections - 1st and 2nd Party 0.00 2,878,742.00 0.00 2,878,742.00 2 Fees and Collections - 3rd Party 0.00 85,000.00 0.00 85,000.00 3 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 4 Federal or State (Non MDCH) 0.00 1,922,472.00 0.00 1,922,472.00 Date: 12/0312014 Contract # 20151753-00, Oakland County Department of Health and Human Services/ Page: 183 of 184 Health Division, Comprehensive Agreement - 2015 Contract # 20161763-00 Date: 12/03/2014 5 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 6 L Federally Provided Vaccines 0,00 2,317,412.00 0.00 2,317,412.00 7 Federal Medicaid Outreach 234,026.00 0.00 0.00 234,026.00 8 Required Match - Local 0.00 234,025.00 0.00 234,025.00 9 Local Non-ELPHS 0.00 33,367.00 0.00 33,367,00 10 Local Non-ELPHS 0.00 0.00 0.00 0.00 11 Local Non-ELPHS 0.00 0.00 0.00 0.00 12 Other Non-ELPHS 0.00 0.00 0.00 0.00 13 MDCH Non Comprehensive 0.00 0.00 0.00 0.00 14 MDCH Comprehensive 5,437,239,00 0,00 0.00 , 5,437,239.00 15 ELPHS - MDCH Hearing 219,078.00 0.00 0.00 219,078.00 16 ELPHS -1V1DCH Vision 213,433.00 0.00 f 0.00 213,433.00 17 ELPHS - MDCH Other 2,251,290.00 0.00 0.00 2,251,290.00 18 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 19 ELPHS - Drinking Water 514,301.00 0.00 0.00 514,301,00 20 ELPHS - On-Site Sewage 372,426.00 0.00 0.00 372,426.00 21 MCH Funding 321,457.00 0.00 0.00 321,457.00 22 Local Funds - Other 0.00 19,936,691.00 0.00 19,936,691.00 23 Inkind Match 0.00 0.00 53,794.00 53,794.00 24 MDCH Fixed Unit Rate 308,622.00 0.00 0.00 308,622.00 TOTAL 10,731,085.00 27,407,709.00 _ 53,794.00 38,192,588.00 Date: 12103/2014 Contract #20151753-00, Oakland County Department of Health and Human Services/ Page: 184 01184 Health Division, Comprehensive Agreement - 2015 ATTACHMENT I MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 14/15 Comprehensive Agreement INSTRUCTIONS FOR THE ANNUAL BUDGET INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH SERVICES TABLE OF CONTENTS Page I. INTRODUCTION 2 II. MINIMUM BUDGETING REQUIREMENTS 2 III. REIMBURSEMENT CHART 3 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES 12 V. FORM PREPARATION GENERAL 12 VI. FORM PREPARATION - EXPENDITURE CATEGORIES 12 VII. FORM PREPARATION - SOURCE OF FUNDS 13 VIII. SPECIAL BUDGET INSTRUCTIONS A. Public Health Emergency Preparedness (PHEP) 16 B. WIC 16 C. Family Planning 17 D. Breast and Cervical Cancer 19 E. CSHCS Outreach and Advocacy 21 F. Program Budget - Cost Detail Schedule (DCH-0387) Form Preparation 21 Attachment 1-Annual Budget Forms 23 G. Medicaid Outreach Activities Reimbursement Procedures 27 Attachment 2-Medicaid Outreach Activities Cost Allocation Plan Certification 32 Attachment 3-Medicaid Outreach Activities Cost Allocation Plan Sample 33 H. Michigan Colorectal Cancer-Screening Program 36 I. Immunization 317 and VFC Allowable Expenditures 37 MDCH/G&PD FY 14/15 ATTACHMENT I Page 1 of 41 7/2/14 INSTRUCTIONS FOR THE ANNUAL BUDGET FOR LOCAL HEALTH SERVICES I. INTRODUCTION The Annual Budget for Local Health Services is completed on a state fiscal year basis, and is used to establish budgets for many Department programs. In the Annual Budget, the Department consolidates many of its categorical programs' funding and Essential Local Public Health Services (ELPHS) (formerly known as the local public health operation's funding) into a single, Comprehensive Agreement for local health departments. The Department's Plan and Budget Framework serves as a principal reference point for budget development. The Annual Budget for Local Health Services must be completed in accordance with and adhere to the established requirements as specified in these instructions and submitted to the Department as required by the agreement. H. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in 2 CFR, Part 225 (OMB Circular A-87), as amended. B. Federal Block Grant Funds - Maternal & Child Health and Preventive Health Block Grant funds may not be used to: provide inpatient services; make cash payments to intended recipients of health services; purchase or improve land; purchase, contract or permanently improve (other than minor remodeling defined as work required to change the interior arrangements or other physical characteristics of any existing facility or installed equipment when the cost of the remodeling incident does not exceed $2,000) any building or other facility; or purchase major medical equipment (any item of medical equipment having a unit cost of over $10,000 and used in the diagnosis or treatment of patients, excluding equipment typically used in a laboratory); satisfy any requirement for the expenditure of non-federal funds as a condition for the receipt of Federal funds; or provide financial assistance to any entity other than a public or nonprofit private entity. C. Expenditure and Funding Source Breakdown - For purposes of development, analysis and negotiation activities must be budgeted at the individual expenditure and funding source category level on the Annual Budget for Local Health Services. D. Special Budget Requirements for Certain Categorical Program Elements - The Annual Budget for Local Health Services is completed in the MI E-Grants System through the application budget to include details for all program elements (excluding Administration and Grantee Support). MDCH/G&PD FY 14/15 ATTACHMENT I Page 2 of 41 7/2/14 E. Local MCH - Local MCH funds can be used for general Maternal Child Health (MCH) activity. These funds are to be budgeted as a funding source under any of the appropriate program element(s) (i.e., Children's Special Health Care Services (CSHCS) Outreach and Advocacy, Child Health, Family Planning, Immunization, Maternal Infant Health Program, or a locally defined program which is defined in the LMCH Community Plan). If an agency wants to utilize this funding for another purpose, approval must be obtained from the Division of Family and Community Health. These funding sources cannot be used under the WIC element except in extreme circumstances where a waiver is requested in advance of expenditures, and evidence is provided that the expenditures satisfy all funding requirements. The MCH activities should address the priorities identified in the community health assessment and improvement process. III. REIMBURSEMENT CHART A. Program Element/Funding Source The Program Element/Funding Source column provides a listing of all currently funded MDCH programs that are included in the Comprehensive Agreement. When applicable, funding sources are specified. B. Reimbursement Methods The Reimbursement Methods column specifies the type of method used for each of the program element/funding sources. Funding under the Comprehensive Agreement can generally be grouped under four (4) different methods of reimbursement. These methods are defined as follows: 1. Performance Reimbursement - A reimbursement method by which local agencies are reimbursed based upon the understanding that a certain level of performance (measured by outputs) must be met in order to receive full reimbursement of costs (net of program income and other earmarked sources) up to the contracted amount of state funds prior to any utilization of local funds. Performance targets are negotiated starting from the last year's negotiated target and the most recent year's actual numbers except for programs in which caseload targets are directly tied to funding formulas/annual allocations. Other considerations in setting performance targets include changes in state allocations from past years, local fiscal and programmatic factors requiring adjustment of caseloads, etc. Once total performance targets are negotiated, a minimum state funded performance target percentage is applied (typically 90% unless otherwise specified). If local Grantee actual performance falls short of the expectation by a factor greater than the allowed minimum performance percentage, the state maximum allocation for cost reimbursement will be reduced equivalent to actual performance in relation to the minimum performance. 2. Fixed Unit Rate Reimbursement - A reimbursement method by which local health departments are reimbursed a specific amount for each output actually delivered and reported. 3. ELPHS - A reimbursement method by which local health departments are reimbursed a share of reasonable and allowable costs incurred for required Essential Local Public Health Services (ELPHS), as noted in the current Appropriations Act. 4. Staffing Grant Reimbursement - A reimbursement method by which local health departments are reimbursed based upon the understanding that State dollars will be paid up to total costs in relation to the State's share of the total costs and up to the total state allocation as agreed to in the approved budget. This reimbursement approach is not directly dependent upon whether a specified level of performance is met by the local health department. Department funding under this reimbursement method is allocable and a source before any local funding requirements unless a special local match condition exists. MDCH/G&PD FY 14/15 ATTACHMENT 1 Page 3 of 41 7/2/14 C. Performance Level If Applicable The Performance Level column specifies the minimum state funded performance target percentage for all program elements/funding sources utilizing the performance reimbursement method (see above). If the program elements/funding source utilizes a reimbursement method other than performance or if a target is not specified, N/A (not-available) appears in the space provided. D. Performance Target Output Measures Performance Target Output Measure column specifies the output indicator that is applicable for the program elements/ funding source utilizing the performance reimbursement method. Output measures are based upon counts of services delivered. E. Subrecipient or Vendot Designation The Subrecipient or Vendor Designation column identifies the type of relationship that exists between the Department and the local health department on a program-by-program basis. Federal awards expended as a subrecipient are subject to audit or other requirements of OMB Circular A-133. Payments made to or received as a vendor are not considered Federal awards and are, therefore, not subject to such requirements. 1. Subrecipient A subrecipient is a non-Federal entity that expends Federal awards received from a pass- through entity to carry out a Federal program, but does not include an individual that is a beneficiary of such a program; or is a recipient of other Federal awards directly from a Federal Awarding agency. Subrecipient characteristics include: a. Determines who is eligible to receive what Federal assistance; b. Has its performance measured in relation to whether the objectives of a Federal program are met; c. Has responsibility for programmatic decision making; d. Is responsibility for adherence to applicable Federal program requirements specified in the Federal award; and e. In accordance with its agreements uses the Federal funds to carry out a program for a public purpose specified in authorizing status as opposed to providing goods or services for the benefit of the pass-through entity. 2. Vendor A Vendor is for the purpose of obtaining goods and services for the non-Federal entity's own user and creates a procurement relationship with the Grantee. Vendor characteristics include: a. Provides the goods and services within normal business operations; b. Provides similar goods or services to many different purchasers; c. Normally operates in a competitive environment; d. Provides goods or services that are ancillary to the operation of the Federal program; and e. Is not subject to compliance requirements of the Federal program as a result of the agreement, though similar requirements may apply for other reasons. F. Type of Project The type of project designation is indicated by footnote and is used if the project meets the Research and Development Project criteria. Research and Development Projects are defined by OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations, as: MDCH/G&PD FY 14/15 ATTACHMENT I Page 4 of 41 7/2/14 Research and development (R&D) means all research activities, both basic and applied, and all development activities that are performed by a non-Federal entity. Research is defined as a systematic study directed toward fuller scientific knowledge or understanding of the subject studied. The term research also includes activities involving the training of individuals in research techniques where such activities utilize the same facilities as other research and development activities and where such activities are not included in the instruction function. Development is the systematic use of knowledge and understanding gained from research directed toward the production of useful materials, devices, systems, or methods, including design and development of prototypes and processes. G. Reimbursement Chart The following Reimbursement Chart notes elements/funding sources, applicable payment methods, target levels, output measures for each program/element having a performance reimbursement option. In addition, the chart also provides the subrecipient/ vendor designations, as in prior years: REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Adolescent STD Screening Staffing(6) N/A Subrecipient Bed Bug Surveillance, Education and Outreach Staffing (6) N/A Vendor Biomonitoring of Persistent Toxic Substances in Michigan Urban Fisheaters Fixed Unit(2) N/A Vendor Body Art Fixed Unit(2) N/A Vendor Breast & Cervical Cancer Control Coordination Performance) 97% # Women Screened for Breast & Cervical Cancer Subrecipient Breastfeeding Support Staffing(6) N/A Subrecipient Comprehensive Cancer Control (CCC) Community Implementation Project Staffing(6) N/A Subrecipient Child Health Staffing(6) N/A Subrecipient Childhood Lead Poisoning Education & Outreach Staffingi6T N/A Subrecipient Childhood Lead Staffine N/A Subrecipient MDCH/G&PE) FY 14/15 ATTACHMENT 1 Page 5 01 41 7/2114 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method(2} Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Poisoning Intervention Childhood Lead Poisoning Prevention Staffing Subrecipient CSHCS — Case Management/Care Coordination Fixed Unit Rate(7) N/A Vendor CSHCS Medicaid Outreach Staffing (6) NA Subrecipient CSHCS - Outreach & Advocacy Staffing (6) N/A Subrecipient Eat Safe Fish Staffing{6) N/A Subrecipient ELPHS MDCH Staffing(6) N/A Vendor MDA Performance 75% °A of Food Service Licensees received required inspections Vendor MDEQ Staffing (6) N/A Vendor Hearing Program Vision Program Staffing(6) Staffing(6) N/A N/A Subrecipient Subrecipient Expanded HIV Testing Staffing(6) N/A Subrecipient Family Planning/BCCCP Joint Project Coordination Staffing(6) N/A Subrecipient Family Planning Services General Services Performance) (8) (13) 95% # Unduplicated Clinic Users Served Subrecipient FDA Tobacco Retailer (A & L) Inspections Staffing (6) N/A Subrecipient FDA Tobacco Retailer (A&L) Inspections Fixed Unit Rate(2) N/A Subrecipient MDCH/G&PD FY 14/15 ATTACHMENT Page 6 of 41 7/2/14 REIMBURSEMENT CHART Program Element/ Funding Source(1) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Fetal Alcohol Spectrum Disorder Projects Staffing(6) N/A Subrecipient Feta!Infant Mortality Review Abstractions Fixed Unit Rate(2) N/A Vendor Health Disparities Building-Organization Capacity to Adopt CLAS Staffing(6) N/A Subrecipient Highly Targeted Community Based HIV Prevention Services Staffing(6) N/A Subrecipient HIV/AIDS Care MHI Staffing(6) N/A Vendor HIV Prevention Services Categorical Non-Categorical Staffing (6) Red Unit Rate ° (12) N/A N/A , Subrecipient Vendor HIV/AIDS Provider Education Staffing (6) N/A Subrecipient , HIV Rapid Testing Project Staffing N/A , Subrecipient HIV/STD Partner Services Staffing(6) N/A Subrecipient HIV Surveillance Support Staffing(6) N/A Subrecipient HOPWA Staffing (6) N/A Subrecipient Immunization AFIX Follow-up Site Visit Immunization Billing Practice Infrastructure Enhancement Field Service Reps Immunization Action Plan Michigan Care Improvement Registry Nurse Education Fixed Unit Rate (7) Staffing(6) Staffing(6) Staffing(6) Staffing(6) Fixed Unit Rate(2)(7) Staffing(6) N/A N/A N/A N/A N/A N/A N/A Vendor Subrecipient Subrecipient Subrecipient Subrecipient Vendor Vendor MDCH/G&PD FY 14/15 ATTACHMENT1 Page 7 of 41 7/2/14 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method (2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Vaccine Quality Assurance Program VFC/AFIX Site Visit Fixed Unit Rate(2X7) N/A Vendor Informed Consent Fixed Unit Rate(2)(7) N/A Vendor Interconception Care Evaluation Project Staffing (8) N/A Subrecipient Laboratory Services PHEP ELC STD Staffing (6) Staffing (8) Staffing (6) N/A N/A N/A Subrecipient Subrecipient Subrecipient Local Health Department SNAP-ED Staffing(8)(18) N/A Subrecipient Local Tobacco Reduction Staffing(8) N/A Subrecipient Maternal Infant Health Program (MIHP) Staffing (6 ) N/A Subrecipient Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Competitive Expansion Grant Seed Funding Staffing(8) N/A Subrecipient Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Local Home Visiting Leadership Group Staffing (6) N/A Subrecipient Maternal Infant Early Childhood Home Visiting Program (MIECHVP) Healthy Families America Expansion Staffing (6) N/A Subrecipient MDCH/G&PD FY 14/15 ATTACHMENT1 Page 8 of 41 7/2/14 REIMBURSEMENT CHART Program Element/ Funding Source ) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Michigan Abstinence Program Performance (8)(18) 90% Number of unduplicated youth to be served Subrecipient Michigan Adolescent Pregnancy & Parenting Program Staffine) N/A Subrecipient Michigan Colorectal Cancer Screening Program Performance) 90% Number of women and men that complete a screening test. Subrecipient Michigan Health and Wellness 4 X 4 Plan Staffing(6) N/A Subrecipient Michigan Home Visiting initiative Rural Expansion Grant Staffine) N/A Subrecipient Nurse Family Partnership Services (NFP) Staffine) N/A Subrecipient Nurse Family Partnership Medicaid (NFP) StaffingO) N/A Subrecipient Obesity Prevention Staffine) N/A Subrecipient Practices to Reduce Infant Mortality through Equity (PRIME) Local Learning Collaborative Staffing(6) N/A Subrecipient Public Health Emergency Preparedness (PHEP) Public Health Emergency Preparedness (PHEP) Public Health Emergency Preparedness (PHEP) Public Health Emergency Preparedness (PHEP) Cities of Readiness Initiative (CRI) Public Health Staffing (6) (14) (18) Staffingo) (15) (18) Staffing N/A N/A N/A Subrecipient Subrecipient Subrecipient MDCH/G&PD FY 14/15 ATTACHMENT I Page 9 of 41 7/2/14 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation Emergency Preparedness (PHEP) Cities of Readiness Initiative (CRI) Staffing (8)(15)(18) N/A Subrecipient Subrecipient Sexual Violence Prevention Staffing(6) N/A Subrecipient Sexually Transmitted Disease (STD) Control Staffing(6) N/A Subrecipient Sudden Unexplained Infant Death (SUID) And Other infant Death Fixed Unit Rate (2)(11) N/A Vendor SEAL! Michigan Dental Sealant Program Staffing (8) N/A Subrecipient TB Control Directly Observed Therapy (DOT) Staffing (e) N/A Vendor Taking Pride in Prevention Performance (8)(") 90% Number of unduplicated youth served with intense interventions (at least 14 hours of direct service) Subrecipient Teen Pregnancy Prevention Initiative Performance(8X18) 90% Number of unduplicated youth served with intense interventions (at least 14 hours of direct service) Subrecipient Youth Suicide Prevention Staffing(8) N/A Subrecipient WIC - Resident Performance) 97% #Average Monthly Participation Subrecipient WIC - Breastfeeding Staffing (6) N/A Subrecipient MDCH/G&PD FY 14/15 ATTACHMENT 1 Page 10 of 41 7/2/14 REIMBURSEMENT CHART Program Element/ Funding Source Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Vendor Designation WIC - Migrant Staffing (bF N/A Subrecipient WISEWOMAN Project Performance (9) Screened creened for 95% # Women Cardiovascular Disease Risk Factors Subrecipient MDCH/G&PD FY 14/15 ATTACHMENT, Page 11 of 41 7/2/14 Footnotes: (1) Program element or funding source as applicable. (2) Refer to the master Comprehensive agreement and the program and budget instructions package for further explanation of applicability of these reimbursement methods. (3) Allocation to be reflected in individual programs during budgeting process. (4) Not Applicable. (6) Subject to statewide maintenance of effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs, (8) The performance reimbursement target will be the base target caseload established by MDCH. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDCH agreement funding for coordination. (10) Fixed rate limited to contract amount. (11) Up to 6 visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Quarterly FPAR data will be used to determine total Title X users and Plan First) enrollees. (14) Public Health Emergency Preparedness funding must be expended by June 30, 2015 and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness funding for July 1, 2015- September 30, 2015 is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHD's must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development Criteria as defined by OMB Circular A-133, Audits of States, Local Governments, and Non-Profit Organizations (17) American Recovery and Reinvestment Act (ARRA) provision applies. See attached appendix for provision. (18) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. MDCH/G&PD FY 14/16 ATTACHMENT) Page 12 of 41 7/2/14 IV. LOCAL ACCOUNTING SYSTEM STRUCTURE OF ACCOUNTS/COST ALLOCATION PROCEDURES As in past years, no additional accounting system detail is being required beyond local uniform accounting procedures prescribed by the Michigan Department of Treasury, Local Financial Management System requirements, documentation requirements of categorical program funding sources and any local requirements. Some agencies may already have separate cost centers in their accounting system to directly identify costs and related funding of required services, but such breakdowns are not essential to being able to meet minimum reporting requirements if proper allocation procedures are used and adequate documentation is maintained. All allocations must have clearly measurable bases that directly apply to the amounts being allocated, must be documented with work papers that will provide an adequate audit trail and must result in a representative reporting of costs and funding for affected programs. More specific guidance can be found in 2 CFR, Part 225 (OMB Circular A-87), V. FORM PREPARATION - GENERAL The Ml E-Grants System on-line application, including the budget entry forms, are utilized to develop a budget summary for each program element administered by the local Grantee. The system is designed to accommodate any number of local program elements including those unique to a particular local Grantee. Applications, including budget forms, are completed for all program elements, regardless of the reimbursement mechanism, including Agency administration(s) fee for service program elements, categorical program elements, performance based program elements and Medicaid Outreach associated program elements. Budget entry is required for each major expenditure and source of fund categories for which costs/funds are identified. VI. FORM PREPARATION - EXPENDITURE CATEGORIES Budgeted expenditures are to be entered for each program element, project or group of services by applicable major category. A. Salaries and Wages-This category includes the compensation budgeted for all permanent and part- time employees on the payroll of the Grantee and assigned directly to the program. This does not include contractual services, professional fees or personnel hired on a private contract basis. Consulting services, vendor services, professional fees or personnel hired on a private contracting basis should be included in "Other Expenses." Contracts with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies should be included in Contractual (Sub-contract) Expenses. B. Fringe Benefits - This category is to include, for at least the specified elements, all Grantee costs for social security, retirement, insurance and other similar benefits for all permanent and part-time employees assigned to the specified elements. C. Cap EXP for Equip & Fac - This category includes expenditures for budgeted stationary and movable equipment used in carrying out the objectives of each program element, project or service group. The cost of a single unit or piece of equipment includes necessary accessories, installation costs, freight and other applicable expenses associated with the purchase of the equipment. Only budgeted equipment items costing $5,000 or more may be reported under this category. Small equipment items costing less than $5,000 are properly classified as Supplies and Materials or Other Expenses. This category also includes capital outlay for purchase or renovation of facilities. D. Contractual (Subcontracts/Subrecipient) - Use for expenditures applicable to written contracts or agreements with secondary recipient organizations such as cooperating service delivery institutions or delegate agencies. Payments to individuals for consulting or contractual services, or for vendor services are to be included under Other Expenses. Specify subcontractor(s) address, amount by subcontractor and total of all subcontractors. N1DCH/G&PD FY 14/15 ATTACHMENT I Page 13 of 41 7/2/14 E. Supplies and Materials - Use for all consumable items and materials including equipment-type items costing less than $5,000 each. This includes office, printing, janitorial, postage and educational supplies; medical supplies; contraceptives and vaccines; tape and gauze; prescriptions and other appropriate drugs and chemicals. Federal Provided Vaccine Value should be reported and identified on in Other Cost Distributions category. Do not combine with supplies. F. Travel - Travel costs of permanent and part-time employees assigned to each program element. This includes costs of mileage, per diem, lodging, meals, registration fees and other approved travel costs incurred by the employee. Travel of private, non-employee consultants should be reported under Other Expenses. G. Communication Costs - These are costs for telephone, Internet, telegraph, data lines, websites, fax, email, etc., when related directly to the operation of the program element. H. County/City Central Services - These are costs associated with central support activities of the local governing unit allocated to the local health department in accordance with 2 CFR, part 225 (OMB Circular A-87). 1. Space Costs - These are costs of building space necessary for the operation of the program. J. All Others (Line 11) - These are costs for all other items purchased exclusively for the operation of the program element and not appropriately included in any of the other categories including items such as repairs, janitorial services, consultant services, vendor services, equipment rental, insurance, Automated Data Processing (ADP) systems, etc. K. Total Direct Expenditures — The MI E-Grants System sums the direct expenditures budgeted for each program element, project or service grouping and records in the Total Direct Expenditure line of the Budget Summary. L. Admin. 0/H Expenditures - Use to distribute costs of general administrative operations that have not been directly charged to individual programs. The Administrative Overhead (0/H) expenditures distribute administrative costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate I to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. The amount of Admin. 0/H should be allocated to all appropriate program elements with the total equivalent amount reflected as a credit or minus in the column(s) for Administration. M. Other Cost Distributions — Use to distribute various contributing activity costs to appropriate program areas based upon activity counts, time study supporting data or other reasonable and equitable means. An example of Other Cost Distributions is nursing supervision. The distribution process permits costs reflected in a single program element to be subsequently distributed, perhaps only in part, to other programs or projects as appropriate. If an allocation is made, the charges must be reflected in the appropriate program columns and the offsetting credit reflected in the program column being distributed. There must be a documented, well-defined rationale and audit trail for any cost distribution or allocation based upon 2 CFR, Part 225 (OMB Circular A-87) cost principles. Federal Provided Vaccine Value should be reported on a separate line and clearly identified. N. Total Direct & Admin. Expenditures — The MI E-Grants System sums the indirect expenditures program element and records in the Total Indirect Expenditure line of the Budget Summary. 0. Total Expenditures — The MI E-Grants System sums the direct and indirect expenditures and records in the Total Expenditure line of the Budget Summary. VII. FORM PREPARATION - SOURCE OF FUNDS Source of Funds are to be entered for each program element, project or group of services by applicable major category as follows: & 2& 2nndd ppaartrtyy_ A. Fees & Collections - Fees 1s t 1st -1 party funds projected to be received from private payers, including patients, source users MDCH/G&PD FY 14/15 ATTACHMENT I Page 14 of 41 7/2/14 and any member of the general population receiving services. ii. 2nd party funds received from organizations, private or public, who might reimburse services for a group or under a special plan. iii. Any Other Collections B. Fees & Collections - 3rd Party — 3rd Party Fees - Funds projected to be received from private insurance, Medicaid, Medicare or other applicable titles of the Social Security Act directly related to the cost of providing patient care or other services (e.g., includes Early Periodic Screening, Detection and Treatment [EPSDT] Screening, Family Planning.) C. Federal/State Funding (Non-MDCH) - Funds received directly from the federal government and from any state Contractor other than MDCH, such as the Department of Natural Resources and Environment (MDNRE). This line should also be used to exclude state aid funds such as those provided through the Michigan Department of Treasury under P.A. 264 of 1987 (cigarette tax). D. Federal Cost Based Reimbursement — Funds received for Federal Cost Based Reimbursement which should be budgeted in the program in which they were earned. E. Federally Provided Vaccines — The projected value of federally provided vaccine. F. Federal Medicaid Outreach — (Please note: to be used only for Medicaid Outreach, CSHCS Medicaid Outreach or Nurse Family Partnership program elements.) Funds projected to be received from the federal government for allowable Medicaid Outreach activities. This amount represents the anticipated 50% federal administrative match of local contributions. G. Required Match - Local — Funds projected to be local contribution for programs that have a match contribution requirement (Please note: for Medicaid Outreach, CSHCS Medicaid Outreach, or Nurse Family Partnership, this amount represents the 50% matching local contribution for allocable Medicaid Outreach Activities. Federal Medicaid Outreach and Required Local match amounts should equal each other.) H. Local Non-ELPHS - Local funds budgeted for the following expenditures: 1. Expenditures for services not designated as required and allowable for ELPHS funding (e.g., medical examiner and inpatient maternity services); expenditures determined not to be reasonable; and, expenditures in excess of the maximum state share of funds available. 2. Any losses arising from uncollectible accounts and other related claims Under-recovery of reimbursable expenditures from, or failure to bill, available funding sources that would otherwise result in exclusions from ELPHS funding, if recovered. However, no exclusion is required where the local jurisdiction has made and documented a decision to have local funds underwrite: a. the cost of uncollectible accounts or bad debts incurred in support of providing required or allowable health services, An example of this condition would be for services provided to indigents who are billed as a matter of procedure with little chance for receipt of payment. b. potential recoveries or under-recoveries from other sources for the principal purpose of providing required and allowable health services at free or reduced cost to the public served by the Grantee An example would be keeping fees for services at a reduced level for the benefit of the people served by the Grantee while recognizing that to do so limits recovery from third parties for the same types of services. 3. Contributions to a contingency reserve or any similar provisions for unforeseen events. 4. Charitable contributions and donations. 5. Salaries and other incidental expenditures of the chief executive of a political subdivision (i.e., county executive and mayor). 6. Legislative expenditures; such as, salaries and other incidental expenditures of local governing MDCH/G&PD FY 14/15 ATTACHMENT I Page 15 of 41 7/2/14 bodies (i.e., county commissioners and city councils). Do not enter board of health expenses. 7. Expenditures for amusements, social activities and other incidental expenditures related thereto; such as, meals, beverages, lodging, rentals, transportation and gratuities. 8. Fines, penalties and interest on borrowings. 9. Capital Expenditures - Local capital outlay for purchase of facilities and equipment (assets) are excluded from ELPHS funding. I. Other Non- ELPHS - Funds budgeted from sources other than state, federal and local appropriations to the extent that they are not eligible for ELPHS (e.g., funding from local substance abuse coordinating grantee, local area on aging grantees). J. MDCH - NON-COMPREHENSIVE - Funds budgeted for services provided under separate MDCH agreements. Examples include: funding provided directly by the Community Services for Substance Abuse for community grants, etc. K. MDCH COMPREHENSIVE - This section includes all funding projected to be due under the Comprehensive Agreement from categorical programs and needs to equal the allocation. L. ELPHS MDCH Hearing - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDCH Hearing program and has to equal the MDCH ELPHS Hearing allocation. Additional ELPHS to be budgeted for the Hearing Program must be entered into ELPHS - MDCH Other. Hearing allocations may only be spent on the Hearing Program. M. ELPHS - MDCH Vision - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDCH Vision program and has to equal the ELPHS MDCH Vision allocation. Additional ELPHS to be budgeted for the Vision Program must be entered into ELPHS MDCH Other. Vision allocations may only be spent on the Vision Program. N. ELPHS - MDCH Other - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDCH Other program for eligible program elements. Please note: The MI E-Grants System validates the ELPHS MDCH Other budgeted funds across the applicable program elements to assure the agreement does exceed the ELPHS - MDCH Other allocation. 0. ELPHS - Food - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Food program and has to equal the ELPHS Food allocation. P. ELPHS - Drinking Water - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS Drinking Water program and has to equal the ELPHS Drinking Water allocation. Q. ELPHS On-site Sewage - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS On-site Sewage program and has to equal the ELPHS On-site Sewage allocation. R. MCH Funding - This section includes all funding projected to be due under Comprehensive Agreement specific to the MCH eligible program elements. Please note: The MI E-Grants System validates the MCH budgeted funds across applicable program elements to assure the agreement does exceed the MCH allocation. S. Local Funds - Other - Enter all local support in the appropriate element, project or service group column. This may include local property tax, and other local revenues (does not include fees). T. Inkind Match - Enter Local Support from donated time or services. U. MDCH Fixed Unit Rate - Select the type of fee-for-services from the lookup to correspond with the program element. MDCH/G&PD FY 14/15 ATTACHMENT I Page 16 of 41 7/2/14 VIII. SPECIAL BUDGET INSTRUCTIONS Certain elements are supported by federal or other categorical program funds for which special budgeting requirements are placed upon grantees and subgrantees. These include: Element Federal or Other Funding Contractor Public Health Emergency Preparedness U.S. Department of Health & Human Services, Centers for Disease Control WIC U.S. Department of Agriculture, Food & Nutrition Service Family Planning U.S. Department of Health & Human Services, Public Health Service Breast and Cervical Cancer U.S. Department of Health & Human Services, Centers for Disease Control CSHCS Outreach & Advocacy Michigan Department of Community Health Medicaid Outreach Activities Centers for Medicare and Medicaid Services In general, subgrantee budgets must provide sufficient budget detail to support grantee budget requests and be in a format consistent with grantor Contractor requirements. Certain types of costs must receive approval of the federal grantor Contractor and/or the grantee prior to being incurred. A. Public Health Emergency Preparedness (PHEP) Special Budget Requirements Local Health Departments will receive the initial FY 14/15 allocation of the CDC Public Health Emergency Preparedness (PHEP) funds in nine equal prepayments for the period October 1, 2014 through June 30, 2015. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) column for each of the following COMPREHENSIVE program elements: 1. Public Health Emergency Preparedness (PHEP) (October 1,2014 — June 30,2015) 2. Public Health Emergency Preparedness (PHEP)— Cities of Readiness (October 1, 2014 — June 30, 2015) 3. Laboratory Services - Bioterrorism (October 1, 2014 September 30, 2015) B. WIC Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill WIC grant application budget requirements each fiscal year: Salaries & Fringe Benefits Automated Management Systems Space Utilization Costs Equipment Supplies Communications & Travel All Other Direct Costs Indirect Costs All Funding Sources By Type The WIC cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget form in the MI E-Grants System. General instructions for these forms are contained at the end of this section. Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget these funds MDCH/G&PD FY 14/15 ATTACHMENT I Page 17 of 41 7/2/14 as a separate element. Agencies must track and report expenditures separately on the FSR. And comply with special reporting requirements. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of the Michigan Department of Community Health as specified by the U.S. Department of Agriculture, Food and Nutrition Service (Ref.: 7 CFR Part 246, and USDA-WIC Administrative Cost Handbook 3/86). Prior approval is accomplished by providing appropriate detail in the budget request approved by MDCH or subsequently in a written request approved in writing by MDCH. A. Automated Information Systems - which are required by a local Grantees except for those used in general management and payroll, including acquisition of automated data processing hardware or software whether by outright purchase or rental-purchase agreement or other method of acquisition. B. Capital Expenditures of $2,500 or More - such as the cost of facilities, equipment, including medical equipment, other capital assets and any repairs that materially increase the value or useful life of capital assets. C. Management Studies - performed by agencies or departments other than the local Grantee or those performed by outside consultants under contract with the local Grantee. D. Accounting and Auditing Services - performed by private sector firms under professional service contracts for purposes of preparation or audit of program and financial records/reports. E. Other Professional Services - rendered by individuals or organizations, not a part of the local Grantee, such as: 1. Contractual private physician providing certification data. 2. Contractual organization providing laboratory data. 3. Contractual translators and interpreters at the local Grantee level. F. Training and Education - provided for employee development, which directly or indirectly benefits the grant program, to the extent that such training is contracted for or involves out-of-service training over extended periods of time. G. Building Space and Related Facilities -the cost to buy, lease or rent space in privately or publicly owned buildings for the benefit of the program. H. Non-Fringe Insurance and Indemnification Costs All charges to WIC must be necessary, reasonable, allowable and allocable for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule, 2 CFR, Part 215 (OMB Circular A-110) and 7 CFR Part 3015. C. Family Planning Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill Family Planning grant application budget requirements each fiscal year: Salaries & Wages Fringe Benefits Travel Equipment Supplies Contractual Construction All Other Direct Costs MDCH/G&PD FY 14115 ATTACHMENT I Page 18 of 41 7/2/14 Indirect Costs All Funding Sources By Type The Family Planning cost/funding categories and supporting budget detail requirements are satisfied by completion of an application budget in the MI E-Grants System. General instructions for these forms are contained at the end of this section. 2. Costs Allowable Only With Prior Approval - The following costs are allowable only with prior review/approval of MDCH. Prior approval is accomplished by providing appropriate detail in the budget request approved by MDCH or subsequently in a written request approved in writing by MDCH. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented, or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more p unit. E. Insurance - contributions to a reserve for a self-insurance program. F. Public Information Service Costs — for the cost of providing public information services. G. Publication and Printing Costs - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. J. Mass Severance Pay - involving grant-supported personnel. K. Organization/Reorganization Costs - allocable to the program. L. Overtime Premium - involving grant-supported personnel. M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a change in scope). N. Professional Services - in connection with Patent/Copyright Infringement Litigation. Q. Trailers or Modular Units — for costs of trailers and modular units. P. Transfers Between Construction and Nonconstruction - for approved construction funds. Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect costs to absorb increases in direct costs. R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or any other means used for the actual performance of substantive programmatic work. All charges to Family Planning must be necessary, reasonable, allowable, and allocable, for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB Circular A-110) D. Breast and Cervical Cancer Control Program Special Budget Requirements 1. The Breast and Cervical Cancer Control Program (BCCCP) budget is to be developed in the following way: MDCH/G&PD FY 14/15 ATTACHMENT I Page 19 of 41 7/2/14 BCCCP Coordination should be used to budget costs associated with coordination of the program. Only coordination expenses will be reimbursed through the Comprehensive Agreement. All Direct Service claims including Case Management Reimbursement must be billed to the MDCH Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the MDCH Cancer Prevention and Control Section. No Direct Services or Case Management expenses will be reimbursed through the Comprehensive Agreement. The Coordination amount $97 per woman based on a target caseload established by MDCH. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 97% performance requirement for this program. There is no longer a match requirement. Match is recorded by the program and reported to MDCH. For specific billing requirements refer to the most recent Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement Rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and Other Program Instructions for the BCCCP and Family Plarining/BCCCP Joint Project issued in August of each fiscal year. The above referenced documents are available at www.michigancancer.om/BCCCP. 2. The Family Planning (FP)/BCCCP Joint Project budget is to be developed in the following way: FP/BCCCP Coordination should be used to budget costs associated with coordination of the program. Only coordination expenses will be reimbursed through the COMPREHENSIVE agreement. All Direct Service claims including Case Management Reimbursement must be billed to the MDCH Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreement with the LCA will be responsible for billing Direct Service claims to the MDCH Cancer Prevention and Control Section. No Direct Services or Case Management expenses will be reimbursed through the Comprehensive Agreement. The Coordination amount is initially established by MDCH and may be adjusted at the discretion of MDCH through the Comprehensive Amendment process. The Coordination amount will be reimbursed under the staffing grant reimbursement method. There is no performance requirement. There no longer is a match requirement. Match is recorded by the program TPA and reported to MDCH. For specific billing requirements refer to the most recent Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement Rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and Other Program Instructions for the BCCCP and Family Planning/BCCCP Joint Project issued in August of each fiscal year. The above referenced documents are available at www.michigancancer.orm/BCCCP. 3. The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Program budget is to be developed in the following way: WISEWOMAN Coordination and Screening should be used to budget costs associated with MDCH/G8PD FY 14/15 ATTACHMENT I Page 20 of 41 7/2/14 coordination of the program and delivery of the initial screening and risk reduction counseling to WISEWOMAN participants. This includes administration and interpretation of health risk instrument, WISEWOMAN screening services (height, weight, body mass index, 2 blood pressure readings, total cholesterol, HDL cholesterol, and glucose), and delivery of risk reduction counseling. All Direct Service claims must be billed to the MDCH Cancer Prevention and Control Section for claim processing. The Local Coordinating Agency (LCA) and/or direct service providers with contracts or letters of agreements with the LCA will be responsible for billing Direct Service claims to the MDCH Cancer Prevention and Control Section. This includes follow-up fasting lipid panel, fasting glucose, A1c, and one diagnostic exam. No Direct Services expenses will be reimbursed through the Comprehensive Agreement. The Coordination and Screening amount is $140 per woman based on a target caseload established by MDCH. The WISEWOMAN Coordination budget requires the following: The WISEWOMAN budget must include WISEWOMAN regional meeting travel and related costs for at a minimum the WISEWOMAN Coordinator plus at least one community navigator to attend a two day regional meeting Any remaining balance must be included in the WISEWOMAN Budget for outreach/recruitment or systems/environmental change activities (for example: WISEWOMAN advertising; WISEWOMAN community outreach and recruitment events; and activities that will enhance WISEWOMAN and community access to nutritious foods, physical activity opportunities, and smoke-free places). Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 95% caseload performance requirement for this project. In addition, there is a match requirement (hard or in-kind) of $1 for each $3 of MDCH agreement funding for coordination. For specific billing requirements refer to the most recent Billing Manual. For specific program requirements, including current fiscal year Direct Service Reimbursement rates and documentation related to the match requirement, refer to the current fiscal year Special Budgeting and other Program instructions for the WISEWOMAN Program issued in August of each fiscal year. The above referenced documents are available at www.michiqancancer.oro/BCCCP The program element titled "WISEWOMAN Community Navigation" should be used to budget costs associated with providing community navigation services to WISEWOMAN participants according to Community Navigation Protocols. The Community Navigation amount will be determined according to how the LCA performs on a set of performance measures. Initially, the LCA will receive $20 per caseload spot for 70% of the caseload and $90 per caseload spot for 30% of the caseload. Adjustments will be made during the amendment process as needed. E. Children's Special Health Care Services (CSHCS) Outreach and Advocacy - The program element, titled CSHCS Outreach and Advocacy should be used to budget costs associated with this program. F. Program Budget - Online Detail Budget Application Entry Complete the appropriate budget forms contained within the MI E-Grants System for each program element. An example of this form is attached (see Attachment 1 for reference). 1. Salary and Wages - a. Position Description - Select from the expenditure row look-up all position titles or job descriptions required to staff the program. If the position is missing from the list, please use Other and type in the position in the drop down field provided. MDCH/G&PD FY 14/15 ATTACHMENT I Page 21 of 41 7/2/14 b. Positions Required - Enter the number of positions required for the program corresponding to the specific position title or description. This entry may be expressed as a decimal (e.g., Full-Time Equivalent — FTE) when necessary. If other than a full-time position is budgeted, it is necessary to have a basis in terms of time reports to support time charged to the program. c. Amount — The MI E-Grants System calculates the salary for the position required and records it on the Budget Detail. Enter this amount in the Amount column. d. Total Salary —The MI E-Grants System totals the amount of all positions required and records it on the Budget Summary, e. Notes - Enter any explanatory information that is necessary for the position description. Include an explanation of the computation of Total Salary in those instances when the computation is not straightforward (i.e., if the employee is limited term and/or does not receive fringe benefits). 2. Fringe Benefits — Select from the expenditure row look-up applicable fringe benefits for staff working in this program. Enter the percentage for each. The MI E-Grants system updates the total amount for salary and wages in the unit field and calculates the fringe benefit amount. If the "Composite Rate" fringe benefit item is selected from the expenditure row look up, record the applicable fringe benefit items (i.e,. FICA, Life insurance, etc.) in the "Notes" tab. 3. Equipment Enter a description of the equipment being purchased (including number of units and the unit value), the total by type of equipment and total of all equipment purchases. 4. Contractual - Specify subcontractor(s)/subrecipient(s) working on this program, including the subcontractor's/subrecipient's address, amount by subcontractor/subrecipient and total of all subcontractor(s)/subrecipient(s). Multiple small subcontracts can be grouped (e.g., various worksite subcontracts), 5. Supplies and Materials - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 6. Travel - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 7. Communication - Enter amount by category. A description is required if the budget category exceeds 10% of total expenditures. 8. County-City Central Services - Enter amount by category and total for all categories. 9. Space Costs - Enter amount by category and total for all categories. 10. Other Expenses - Enter amount by category and total for all categories. A description is required if the budget category exceeds 10% of total expenditures. It Indirect Cost Calculation - Enter the base(s), rate(s) and amount(s). 12. Other Cost Distributions - Enter a description of the cost, percent distributed to this program and the amount distributed. 13. Total Exp. - MI E-grants totals the amount of all positions required and records it on the Budget Summary. MDCH/G&PD FY 14/16 ATTACHMENT I Page 22 of 41 7/2/14 Ixctceo1 SO-paw Tr ee I @0 POP IGE! copy 23,276.001 0.001 3,340.60 0.401 7,262.001 "01 ! 10,131.001 3,004,00[, 0.no[ 165,523.04 0001 165,523.0011 29,405 001 1,665,001 31 l300.0, 106,813 001 L..Ij.9,405,001! L . 1 .e85.0011 F 31,060.00i 1 310000 •, 01:. -1 1 : 196,612u4 Attachment 'I B1 Attachment B1-Program Budget Summary _..,..,;r116111010:00.1r: srf haosugari We*: Lihrto May-t4b7.13 EGrAMS Application Mrat 2D MIDN 1 Agency .i AOC Heallh Depagrnent : .Applicaltort r Family Planning San/Ices SAMPLE n Valiclato j Program Comprehensive Agreernerl -ET 20)4( Show Documents Budget_Stemmary LIEBEIM Man MIME B3,419 mil 0.001 34,20204 0001 DIRECT EXPENSES Program Expenses Salary & Wages Olga Denelas op. Exp. for Equip & Pao. Contractual Supplies and Materials -rf oval C mm R1711.111[Cation Codrity-City Central Services Space Costs All Others (ADP, Can. Employees, Mao ) Total Program Menses TOTAL DIRECT EXPERSES NDIRECT.EXPENSES inchrecl.Coiis Indireti Costs Other Costa Distributions Total Maroc:IC.0sta TOTAL INDIRECT EXPENSES TOTAL EXPENDITURES p - 83,412.0011 34,202 0011 • JI 23,27S001 3,340.00i,1 7,262.0011 10,131.04 2O9400[ 155,523.0011 .. 1 165 523 06, 0.0! L 000, :It, 0011 : 0.cc.: i 0.00 I 0.00 6.061i . 1 0.00r ATTACHMENT I Page 23 of 41 MDCH/G&PD FY 14/16 7/2/14 duet 1 Micellene.OLts .1 Index 1 [921 cppyi ... Faceatieet. I certificationa sav:e Ci I of spria 1,j OtO V.M.t. lo 0 0 She. TIFIO I IX Close 1 0,001 66,000.00 0.0D1 io,000.00 cool o.00l 014 11 0.00' 0.00 0.09 0.00 0.00 0.00 0.90; 0.001 0.00. r............. I.. 0.001, T oQoi - 0.1 44,800.00 0:4 I.. • 000 000' 0.001 65,813.00 0.00, 0.00 0,00 0,00 o.on, - (too: 0.00. -0.0011 • • • 0.0011 . 0 ir.i141 0.001 • 0.80-1 0.081i • 44,800,0011 0.1101 • o.00ll • o1.16:]:;1, o:o1o1 .IB 0_00 0.00 Source of Funds EGrAMS Appl cation t;.;,•-t,t d tyitr et Age-8cl' AOC Health Depalment Program Comptehens hie Agreement - FY 20 h0{ Application t Fan-illy Planning Sea-ices gAMPLE Show llocumenls Source.of Fund . Faile.anci•Coliectlooa-1 lot and 200 party Fees and Collections - ltd Party Federal or State (Neil .140q1-1) ••: • FeaoraT Cost Based Helmbureement Federally Prai4dad YaccineS Federal Medicaid Outreach Required Match -.Local Local Non-ELFHS 0.00; 66,000.00 0.00 19,000.00. 0.003 0.90, 0.001 0.0011 Local tion-ELPHS Other Non-ELPHS macH Nun Oompreheasive MUCH Camprthnnalve ELPHS MUCH Hearing ELPHD —MUCH Vision ELPHS —MUCH Other ELPHS— Food ELPH8 — Orfoking Water_ ELPHS %wage. McH Funding X Local Funds -Dither •• Inland Match MDCH Fixed Dna:Rale MDCH/G&PD FY 14/15 ATTACHMENT I Page 24 of 41 7/2/14 go 1.5 . . Th.t 1:14141 Ela 111111Pr 5-13 EGrA S Application Agency Application ABC Health Department Family Planning Services SAMPLE Program : Comprehensive Agreement - FY 20}0< cppy-J ":13:+e 0 0 • 111.5eve 1 I It Show True 1.21. Validate] 1 IgA pop Narrative; in; 'Type: --1Pupend. Uwe TOP', Budgei Detail Calngory: 1Pregram.6Penees- elary 84agen Classiieetien,Seg. Select the poston description. Identify-the quantity as rita. identity tie role as average ens! per PIE. lest] uctloge Faresheet I Cerlitichtlens •I Dodge'. klis-eellorraoue Melvi. Show Documents lx clone LOA Sairei fl5uye+L55 Va lidn_tej -g Eric., I LP On 1 Lk copy. 1 .BIXIget 001011 _Category,: Cleeetticatlee Seg. .7rograin Expenses -.Cap. Sap tor Equip 4Fac. 1 Iwo LF>rperuntyre• • SuliType: • • NerratIVe Show Tree I lustructlena : ligblprnent is 'defined es !he cost at singte'llein valued SIC 000 pr mar-eon Asipi useful fire orrner0 thalfanp. yew.. conic shnute.Inchnie lrhe.ttern end any lapdlicable expenses such on Lula Oaf lan 'ekes: rhaintenence fees ; etc. Heins calling less then 06,000'shoulrl be entered Nils 4ie sulpiles ard maierlan One !Contractual refers to-secondery rear:I-fent n Taril2ationS eery, Please enter lhe contact ktornietlea. I Cons Libras and supporting serilcesulx,ontracte shonld 13k budgeter., aderth e etlidiectinran line. [CM1 1 1 1 It 11:1 JD' • . IL [115 Save I I [421 coP a. 1 I 9rireoer ILElI I PI %fa hrtate I 1 to Show Tree I Narrative: ,171: warm iwzmau MI= Mod 01:11 imorill o :IioIi 7000011 I to Show Trce]] 0.0 Cub Type : o.60 acmj o:oiij 23 B2 Attachment B2-Prooram Budoet Cost Detail TEM ] 0 X Wrse Pradilioner 1=1[ c.* olon000qFTE la 17,200.001, ..1,200 0011 o.c9-' Rao! 2.3• 0 0.46L34932 43611FTE 16,069.001 16,069.00t acol .11o 16nr-dlnalor 111/ 0.4111 5-1o.361Toi: Fri I d 26426iOli 060 .6.661 x 1.9911 26729 244 FTE . 29,125.0 01 29,135 Cser 0,00 ooI a51 =MEM LEGII 65Ell ELM] GI= Budget Detail Category: program PipenseS .ISJOUlies Meier-Ws. .1 Cissiticalion Seg. : Inetructiotts =MIME D -0< !Printing n IFtstag-Le I p Save. t 1 1PrOgrerri.D0ensee i-Travai Type 1ExOendltpre Sub Type-. • 'Oiled Narrative: '01 Eirnina nEni MEEE 3,03 001 o.o0 cm! na 7.8 r 34Q.coli 15-61 Efiol ai ATTACHMENT I Page 25 of 41 • B svweoj Budget Beloit Category: Classigoatien See,: 11 Levu./ : une fern ()Category Level ; ® Line item 0 Category ger* that abet one than 114 yalidate .1=1•Eirer.3 I ILLE I1103 Copy] lostruellons; !Mileage .1ponfarentes MDCH/G&PD FY 14/15 7/2/14 •5 Saved a oao ol VoIidoti, 1 0 iior 1.X1POF I EB21 Copy.] Budget:Out:lit Category: :Piegram Expenses - Communication - Olassification'Seq: 1 _1 Level: Une Item 0 Categeni 1111 OuscritkiCei 1 111 er phones 311 1 fines Mr 11111111111=1111=== 7,262-04 7,262 KC o oo LI X :Fiscl Sear Rate 1 D Savel I lep Save .11 ra4.Vailida-To [TA I 11FD.Coey Budget boleti Category: ilrellind Costs - Other 6.0010 DisbiOotlope ClassificatiOn Seri 13 instructions-, x LNufsingAdrn Distribuuor LI I [2=1 Dmil_IMEMS e,00!: • 6.01. h • I WShpvv Tre-el (.1.7) Narrative 171 pe : LE:iPenctiture Sub Type tdirect 11.3=0.M418 I I - 1,606.007_ i,1385.01±11 • • • 1E1 =Total q" __IL L r 7 LLSkyavv.__L:_11"re- (i) (I) 10 100 NM= I EMMII 13:1=1 Vctirlatc: Livri poF P cop BudgOt NBitl : Olassili6ton ='; : (b.tinollern 0 Category Type; lExpendliib sub Iwo: lured tgurratNe leslie OS; um 11•11=1:111•1111121 11lD 6,$23.001i 6,923.4 •u_0011 3.00: 2,600.601 2,508.00 T16o, Dose-notion 1.:1112.2Life 1.15.5e2LeLlcw[S.2_0,uligtettej PJ2L1= ' oatanori '10Tog LACiF,70.7L.rePloYeee r0* Clessit cation S.cn..; J • Level: Une Item 0 Category Insuuetions : ',.Experditure Type :I0tfd wTrJ C,!„.) iI f:=13 [MO TEED ID X 'Supporting Services_ n X !Lab Fees n lithe, 1.12-2r] o j ka_tIida J L5rJ1.22L,OLI Copy Budge( Detail categufy: 'Indirect Costs riedlred.COStS ClasslfiCation See i3 kletrUctions.T 2,279.00'L 2,270.001[ODD.a.* n 300.0011 300001 0.001 .1) 1 t Inn 0[111 cool .il•5 j h0WTrOO lExpen-dlfg-re. •.Stib TyPe LItidIrool: Type: lExpendbra 8ub Type. 1Dirett 5how Tree I 0 0 tsl e1ratiVe .17 Instruct° jh5'he w Be (T) CD, 14rtative I is ,-,-,,, I 3..,.._.._ L____11 validate 0.`.LL_Ln._1•,•• tp.....19L1 f It c.PY i : nutiriet Detail . , Category: 1Progfarn'EXpenees:.Counly.CityCenlral Services .. .. ..I Type; JEPenclitufe , Classfiloation See.: Il. , .. 1.eirel : 0.Line ilern 0 Cole003, $ub Type -. r1-34-eCt InstructlenS MDCH/G&PD FY 14/15 ATTACHMENT I Page 26 of 41 7/2/14 G. Medicaid Outreach Activities Reimbursement Procedures Medicaid Outreach Activities that are funded by local dollars and meet federal requirements are eligible for reimbursement at a 50% federal administrative match rate. Local Health Departments seeking reimbursement for the provision of locally funded allowable outreach activities specific to the Medicaid program may do so by submitting appropriate documentation to MDCH in accordance with the instructions listed below. Medicaid Outreach Activities funding is a subrecipient relationship. 1. Budget Preparation A. Complete the MI E-Grants application and budget forms for the application Medicaid Outreach Activities that occur during the fiscal year: 10/1/xx-09/30/xx. Reimbursable activities included in the budget must conform to the requirements as specified in the MSA bulletin for Local Health Department Outreach Activities. Complete the MI E-Grants application and budget forms for this program. 1. Medicaid Outreach Activities: 10/01/xx-09/30/xx a. Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/xx-091301xx. Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in the MSA bulletin for Local Health Department Outreach Activities. Outreach activities must not be part of direct service. Expenditures must be reflected in the cost allocation plan. b. Source of Funds Tab Budget the amount expected from the federal government for allowable Medicaid Outreach activities. Federal Medicaid Outreach represents the anticipated 50% federal administrative match of local contributions. Budget the local contribution. Required Match - Local represents the 50% matching local contribution for Medicaid Outreach activities. These two amounts should match. c. Sources of Local Funds Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the Health Department as a source for matching funds. Other state and/or federal grant awards for Medicaid Outreach must be recorded on the appropriate line as indicated in the Comprehensive Budget Instructions - Attachment I. (Please specify the source of funds as shown in the example.) B. Complete the MI E-Grants application and budget forms for the application titled CSHCS Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx. 1. CSHCS Expenditures related to CSHCS Outreach and Advocacy should be reflected under one program element and adhere to Section IV, Special Instruction Section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period:10/1/xx-09/30/xx. a. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD CSHCS program has been applied. A table containing each health jurisdiction Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating the federal funding is as follows: MDCH/G&PD FY 14/15 ATTACHMENT I Page 27 of 41 7/2/14 Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) b. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution. Federal Medicaid Outreach and Required Match — Local should equal each other. Additional local contribution that is not eligible for the 50% federal match should be reported on the Local Funds — Other line. c. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the health department as a source for matching funds. d. Comprehensive Outreach and Advocacy and Care Coordination Funds Should be reported in a separate program element. C. Complete the Ml E-Grants application and budget forms for the application titled Nurse Family Partnership for the timeframe: 10/01/xx-09/30/xx. Complete the MI E-Grants application and budget forms for this program. 1. Nurse Family Partnership Outreach (applicable only for Berrien, Calhoun, Kalamazoo, Oakland and Kent) Expenditures related to Nurse Family Partnership Outreach should be reflected under one program element and adhere to Section IV, Special Instruction Section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period:10/1/14-09/30/15. a. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD Nurse Family Partnership program has been applied. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) b. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution in Required Match — Local. Federal Medicaid Outreach and Required Match — Local should equal each other. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds — Other. c. Sources of Local Fund Types Local Health Departments may utilize their county appropriation, funds received from local or private foundations, local contributors or donators, and from other non-state/non-federal grant agreements that are specific to Medicaid outreach or are to be used at the discretion of the Health Department as a source for matching funds. ATTACHMENT I Page 28 of 41 D. Cost Distributions Record costs distributions in the Indirect Costs Other Costs Distribution on the Application budget if costs associated with allowable Medicaid Outreach activities conducted in other Comprehensive programs (i.e., WIC, Family Planning, Immunization, etc.) are to be distributed. This may require a budget modification in the related program(s) to reflect the cost distribution movement. 2. Cost Allocation Certification This certification remains on file with the Department until no longer valid (see Attachment 2). 3, Cost Allocation Plan for Medicaid Outreach Activities LHDs seeking Medicaid Outreach reimbursement must keep on file a current cost allocation plan that reflects actual costs associated with Medicaid Outreach Activities, CSHCS Outreach and Advocacy and Nurse Family Partnership (see Attachment 3). The cost allocation plan must be supported by appropriate documentation, such as a time study, or other federally approved methodology for allocating costs, in accordance with 2 CFR, Part 225 (OMB Circular A-87). At a minimum, the cost allocation plan should contain both a narrative section and an allocation methodology section for both Medicaid Outreach activities and CSHCS Outreach and Advocacy, for the fiscal year. The narrative section should briefly describe each program for which Medicaid Outreach activity expenditures are distributed and list the expenditure categories utilized. Non-reimbursable costs should be identified. The narrative section should also state the methodology utilized for distributing costs. The allocation methodology section provides the detailed calculations for how costs are determined. A. Medicaid Outreach Activities In the example provided (see Attachment 3), costs associated with providing Medicaid Outreach activities are incurred both through dedicated staff for conducting outreach activities and through the WIC program. In the Medicaid Outreach program, staff time, fringe benefits, supplies, materials, travel, other expenses, indirect and supervision associated with providing a Medicaid Outreach program are calculated for the time period at a cost of $89,074. In addition, through a time-study conducted in the WIC clinic on a quarterly basis, it was determined that, on the average, seven minutes of each certification and re-certification appointment is spent performing Medicaid Outreach activities. Time spent conducting outreach activities is multiplied by the number of encounters to determine the total number of hours spent on Medicaid Outreach. Number of hours is multiplied by the averaged hourly wage to determine the total outreach salary costs. Fringe costs and indirect costs associated with outreach salary costs are also added for a total of $47,532. Total for Medicaid Outreach Activity expenses = $136,606. Non-reimbursable costs are subtracted from this amount. Total amount of local contribution spent for Medicaid Outreach Activities = $77,606 and the 50% federal administrative match is $38,803. B. CSHCS Outreach and Advocacy Program/Nurse Family Partnership Medicaid Outreach In the example provided (see Attachment 3), costs associated with providing Medicaid Outreach activities through the CSHCS Outreach and Advocacy program or the Nurse Family Partnership Outreach are incurred through dedicated staff responsible for delivering the program. Staff time, fringe benefits, supplies, materials, travel, other expenses, indirect and supervision associated with providing these programs are calculated for the time period at a cost of $210,912. In this example, Comprehensive Grant funding for the period is subtracted from the program's total cost to determine the MDCH/G&PD FY 14115 ATTACHMENT 1 Page 29 of 41 7/2/14 local contribution. This amount is multiplied by the program's Medicaid participation rate at 35%, which equals $38,819. The 50% federal administrative match is $19,410. 4. Financial Status Report (FSR) LHDs seeking 50% federal administrative match should request reimbursement by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through MI E-Grants. A. Medicaid Outreach Activities 1. Quarterly FSRs and Final FSR For Quarters 1-3, LHDs must reflect the actual Medicaid Outreach expenses incurred in a separate program element titled Medicaid Outreach. Actual expenses incurred for each of the listed expenditure categories are allowable, but must be specific to Medicaid Outreach as defined by the MSA bulletin for Local Health Department Outreach Activities and not part of a direct service. Expenses should be supported by a time study or other federally approved methodology. a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match for Medicaid Outreach. b. Required Match - Local Should be used to report the remaining portion of the local contribution of the Medicaid Outreach Match. Both amounts should equal. c. Other Source of Funds Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. Total Source of Funds should equal Total Expenditures. B. CSHCS Outreach and Advocacy CSHCS Outreach and Advocacy billing should occur on the final FSR through the MI E- Grants system after Comprehensive Agreement funds have been expended. 1. Billing should occur as follows: a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. b. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Additional local contribution that is not eligible for the 50% federal match should be reported in Local Funds - Other. c. Local Funds - Other Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. d. Comprehensive Outreach and Advocacy and Care Coordination Should be billed as separate program element. MDCH/G&PD FY 14/15 ATTACHMENT 1 Page 30 of 41 7/2/14 C. Nurse Family Partnership Outreach Reimbursement for Nurse Family Partnership Outreach should be requested by submitting their actual expenses for allowable Medicaid Outreach activities on their quarterly FSRs through Ml E-Grants. Should occur on the final FSR after Comprehensive funds have been expended. 1. Billing should occur as follows: a. Federal Medicaid Outreach Should be used to request the 50% federal administrative match. Match is determined by multiplying local contribution for the program by the percentage of Medicaid enrollees. This product is then multiplied by 50% in order to determine the eligible federal administrative match. b. Revired Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Both lines should equal. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds - Other. c. Local Funds - Other Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDCH grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. 5. Comprehensive Agreement Obligation Report — filed in September 20xx. The Obligation report is used to estimate the payable amount due to Local Health Departments from MDCH for each program element. A. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach Activities to be earned from Medicaid Outreach on the Federal Medicaid Outreach row. B. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from CSHSC — Medicaid Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. C. In the Estimate Column, enter the maximum projected federal administrative match earnings for allowable Medicaid Outreach activities to be earned from Nurse Family Partnership Outreach. This should reflect the local contribution multiplied by the Medicaid enrollment participation rate x 50% federal match rate. Note: CSHCS Outreach and Advocacy and CSHCS Care Coordination activities funded through the Comprehensive Agreement are recorded as separate program elements. MDCH/G&PD FY 14/15 ATTACHMENT I Page 31 of 41 7/2/14 Attachment 2 (Name of Health Department) MEDICAID OUTREACH ACTIVITIES COST ALLOCATION PLAN Certification by the Responsible Health Department Official 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 Medicaid Outreach Activities are allowable in accordance with the requirements of 2 CFR Part 225 (OMB Circular A-87), "Cost Principles for State and Local 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. All costs included in this proposal are properly allocable to the Medicaid Outreach Activities Administration award on a basis of a beneficial casual relationship between the expenses incurred and the Medicaid Outreach Administration award 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. 3. This certification will be resubmitted if a significant change occurs that impacts the Medicaid Outreach activities or upon a Department review that results in a finding of non-compliance. If neither of these conditions exists the certification remains valid in subsequent fiscal years. I, as the responsible Health Department Official, declare that the foregoing is true and correct. (Name of Health Department) Signature: Name of Official: Title: Date: Attachment 3 MDCH/G&PD FY 14115 ATTACHMENT I Page 32 of 41 7/2/14 Green County Health Department Cost Allocation Methodology For Medicaid Outreach Activities The Green County Health Department has a specific staff person assigned to qualified Medicaid Outreach Activities. The actual costs of this position have been charged to the Medicaid Outreach Activities cost center. These costs are Salary, Fringe Benefits, Supplies & Materials, Communications, Space Cost, Other Misc., Indirect Costs, and Nursing Supervision. Non-reimbursable costs have been deducted from these costs as an Exclusion Item (grant funding). The WIC program includes qualified Medicaid Outreach Activities in the initial and bi-annual recertification process. The cost of the Medicaid Outreach Activities included in the WIC Cost Center was determined by using a one-week time study (which will be repeated periodically). The result of the time study is the average number of minutes per certification or recertification involved in Medicaid Outreach Activities. The average time multiplied by the number of certifications and recertifications was converted into hours providing qualified activities. Total hours were multiplied by the average hourly salary of outreach staff to arrive at the salary costs of providing the outreach activities. Fringe benefit costs were calculated using the staff's fringe benefit/salary ratio and the indirect cost was calculated using the health department's standard indirect costs distribution allocation process. MDCH/G&PD FY 14/15 ATTACHMENT I Page 33 of 41 7/2/14 Less Federal funded grant Total Medicaid Outreach Activity Qualified Matchable Cost Projected for July 1 - Sept 30,2005 Anticipated Federal Medicaid Match at 50% GREEN COUNTY HEALTH DEPARTMENT BUDGETED COSTS FOR MEDICAID OUTREACH ACTIVITIES BUDGETED FOR 10/1/135 - 9/30/06 COSTS OF STAFF ASSIGNED TO MEDICAID Salary Fringe Benefits @ 40.% Supplies 8, Materials Travel Communications Space Cost Other Misc. Indirect 37.63% Nursing Supervision Total $89,074 COSTS OF STAFF ASSIGNED TO WIC Average time per certification or recertification (minutes) Number projected Total WIC Medicaid Outreach Activity time (minutes) Total in Hours Average Salary for positions providing outreach Total outreach salary cost Fringe at 40% Indirect Cost @ 37.53% $47,532 $38,200 $16350 $1,000 $500 $500 (indirect cost) $440 $21,207 $0,797 $89,074 7 9 200 . 64,400 1,073 $21,74 $23.336 $11,201 $12,995 Total Cost of WIC Medicaid Outreach Activities to be Distributed From WIC to Medicaid Outreach $47,532 Total Budgeted Cost for 7/1/05 - 9/30/05 $135,606 $59.000 $77,606 $38,803 MDCH/G&PD FY 14/15 7/2/14 ATTACHMENT I Page 34 of 41 H. Michigan Colorectal Cancer Screening Program — The Michigan Colorectal Cancer Early Detection program (MCRCEDP) budget is to be developed in the following ways: 1. This budget is intended to cover all staffing and coordination for the program. All allowable expenses will be reimbursed through the Comprehensive Agreement. 2. All direct service claims must be billed through the MDCH Cancer Prevention and Control Section. The LHD and/or direct service providers with contracts or letters of agreement with the LHD will be responsible for billing. a The staffing, coordination and direct service total amount is $105 per woman or man based on a target caseload established by MDCH. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 90% performance requirement for this program. The performance target output measure is the number of women and men that complete a screening test for colorectal cancer. 4. For specific program requirements, including current direct service reimbursement rates and other documentation refer to the most current MCRCEDP manual. MDCH/G&PD FY 14/15 ATTACHMENT I Page 35 of 41 7/2/14 I 1N3AHOV_LIV Allowable Uses of 317 and VFC FA Operations Funds POD developed the following table to tilSiSt Z.Veadees in preparing budgets that me in compliance with federal_ grants policies and CDC award requirements. The table was developed*ing:a conibination of OMB Circular A-87, PHS Grants Policy Statement 9505, and FOB- identified prom.= priorities. Budget Category/Expenses Allowable with S1,7 aperan'ons funds Allowable with N-FC op erntions: funds .knoWabie With NTC ordeinig funds .AiloWable With liTCIAFP:. funds. Allowable with Pan fin funds Allowable with NTC Distribation hinds (ivhere czpplicabk) P4ersoauei Salarviwa es ,i i v. e Compensationifringe benefits Tra el StatellocaliRegional cnfeience x eases Local meetings/col:dere= s(Act hoc) (excluding mealS) I ItiLstate travel costs ,i- Out Of state travei costs (restricted to IsCIC,.1-lep B Coordinators Metniag, Program MonagersTRA Meeting, ACM neeting AFDC and 1.7C trainings. and other CDC- sponsored fillnitUriZatiOn program meetings) I 1 _ i Tricilraibrip. lvlated) VFC-o site visits i AFDC-only site visits _ I Combined (..AFLX & InFC site isits) , i Perinatal hospital record reviews .70,1,1013 Sectio I The Basics p.18 £1,0Z/1,E/01. PeoeideH I INIAIFIOV_LLV BudgetCate-Ezra-FTExpenses Allowable with 317 operation funds Allowable with VEC .perations funds Allawabire with V-EC oderi lita-ds Allowable with VECIAFJX funds Allowable Allowable with VEC Distribution funds fichere a-pram*, ' 1 h Pau Eht funds Equipmene Pxmrnie for vaccine ordering Vaccine .orage equipment for VELC vaccine .tpr e-c-a7ritivonjariki., Copy machines i 1 1 1. ,./ *Equarnant an ariicle qf ranVbfe TIOPIErpayclable p-i-sctnal propeeV hawfng 11.5441 afe of more than one year and an acquisition cagt af S5;000 or it fOre per 7.171 tr_ • Supplies Vaccine administration supplies (incluglincr . but r or limited to nasal ?harm, geal swabs, syringes for emergency -vaccination clinics) Office supplies-computers„ general office (pens, paper, paper clips etc.), ink cartridges, ..-f- calculattor Personal. computers Laptops I V I I Pink Books–, Red Book", Yello, Books ,if Piiter l 1 1 LaboratorT supplies (influenza cultures and PCRs culture and molecular_ lab media ..-..et-Qtypiaz) Temperature mothrors-ThenttornetemData • Loggers i ' ...e" Vaccine dtippi-np.- mpplies (storage container ice packs, bubble wrap_ etc.) Contractual 1 7 ,01.2013 Section. I—The B-a-i --cs p_19 liNDINHOVIIV Budget CategoryiEmpenses .32.Ilowable- with 317 operations funds Allowable with VIC operations funds ABowable Allowable with VIC/MILK funds Allowable with Fan III funds Allowable with I.:"FC Distribution ftmds (where applicable) IA ith VIC ordering funds Statelocal conferences evenses (conference . site, materials panting, hotel accommodEMOns : expenses, speaker fees) Food is ,Ilt}r allowable_ ! Regionallocal meetings ..-e : General contractual ..rvices (e_g_ IAPs_ local ' health departments, contractual stall athisory coniiee media, provid . up:414'11gs) v, GSA Ciitracmal services Other ilS contractual agreements (suppon, enhancement, up_mudes) FA Non-CDC Contract vaccines . Indirect . Indirec. t cos -7 Miscellaneous Accounting services -,(- Advertisin7 (restricted to recruitment of staff or trainees_ procurement of good s and services, dis- pocAl of scrap or surplus materials) : Audit Fees BRESS Survey, Committee meetino' (room rental,. etpipnent rental, etc) 'V Communication (electronic)compoter transmittal, messenger, postage_ local and long distance telephone) i I I ,./- 77012013 Section I----The Basics p20 UNBWHOVIIV Budget CategorylExpenses Allowable with 317 operations funds Allowable with VIC operations funds Allowable with VFC ordering funds Allowable with 7.7FCAFEK funds Allowable with Pan Flu funds Allowable with vrc Distaibution funds 04,4zeze applicable) Consumer information activities Conswner I provider board participation (travel reimbursement) Data processing Laboratory services (tests conducted for immunization prop-a.ms) Local set-Vice delivery activities ../ Maintenance operationirepairs -Malpractice insurance for volunteers Membershipsisubscriptious v..- NIS Oversampling Pagersicell phones v" v.- Printinng of vaccine accountability forms ve' Professional service costs (limited terni s Attorney General Office services ,. v.- Public relations v,..- Publicatiordprinting costs (all other immunization related publication and printing expenses) ../.- i 1 ./ Rent (requires explanation of why these costs are not included in the indirect cost rate agreement or cost allocation plan) V ./.- cfor vatz;frio eti;2114.aicon ibt4712:v.b Shqyping (other thar, vacrim.) v.- Shipping (vaccine) Software license/Renewals (ORACLE_ etc) Stipend Reimbursements 11 Toll-free phone lines for vaccine ordering v• 1 1 Training costs - Statewide, staff, providers v.° vf v. Translations (translati ng materials) 7,.`0 1 /2013 Section I—The Basics p21 I 1N3 HON/11V L.17 10 017 abed Budget CategotTiErpeuses Allowable with 317 operations funds Allowable with VIC operations funds Allowable with VFC ordering funds Allowable with ITCAFEc funds Allowable with Pan Flu funds Allowable with VFC Distribution funds (where applicable) Vehicle lease (restricted to awardees with policies that prohibit local travel reimbursement) VFC enrollment materials VFC provider feedback surveys VIS camera-ready copies I 7101.'2013 Section 1—The Basics p.22 Non-Allowable Expenses with Federal Immuniz. ation Funds Expense N T allowable with federal immunization funds Honoraria 1 Advertising costs 'g. canwatithgs, di...playx„ exhibia. inthjg. •minvarabilit, ills, mgmetibrv Alcoholic *erages V • Building purchases, construction, capital improvements v Land purchases Liltive1lobbyitig activities we Boudisa, Depreciation oii use charges Research V Fundraising V Interest on loans for the acquisition andior moderr1i7ation of an existing_buitding Clinical care 4101'1410110ilffrifiniOtt servinsx) Entertainment V Payment of bad debt Dry cleaning r Vehicle rchase V Promotional Material ie_g,piagire,i, clatharg and conantworative isms sui.11 as perm,wrap 4,etp.....-, falomfolios, 1amardc, con&,ailegr ilni.-,k Purchase of food efa i frqxjiredtratra. I per dim casts] Other restrictions which must be talon. into accouiitclite writing the budget Funds may be spent only for activities' anti personnel costs that are directly related to the Immunization and Vaccines for Children Cooperatrs7e Agreement. Funding requests not directly related to imniuM7ation activities are outside the scope of this cooperative agreement program and will not be funded. Pre-award costs will not be reinabm-sed 7/01,2013 Section I—The Basics p.23 MDCH/G&PD re 14/15 ATTACHMENT I Page 41 of 41 7/2/14 ATTACHMENT II GUIDANCE TO STATE AGENCIES REGARDING THE USE OF FUNDS RECEIVED UNDER THE AMERICAN RECOVERY AND REINVESTMENT ACT (ARRA) Table of Contents BACKGROUND 4 PURPOSE 4 INTRODUCTION 5 SECTION 1 — CONTRACT AND GRANT TERMS AND REQUIREMENTS 6 - Buy Michigan Preference 6 1.2- Buy American Requirement 6 1.3 - Whistleblower Protections 7 1.4 - Wage Requirements 7 1.5 - Publicizing Contract Actions 7 1.6 - Reporting Requirements 7 1.7 - Inspection of Records 8 1.8 - Availability of Funding 8 1.9 - Non-Discrimination 8 1.10 - Prohibition on Use of Funds 8 1.11 - Publications 8 1.12 - False Claims Act 8 1.13 - Conflicting Requirement 9 1.14 - Sub-Recipient Requirements 9 1.15 - Competitive Fixed Price Contracts 9 1.16- Segregation of Funds 9 1.17 - Job Opportunity Posting Requirements 9 SECTION 2- COMPLIANCE AND CONTRACT MANAGEMENT 10 2.1 - General Planning and Process 10 2.2 - Determination of Responsibility 10 2.3 - Delegated Authority 11 2.4 - Contract Surveillance/Administration 11 2,5 - Emergency Purchases 12 2.6 Reporting 12 2.7 - Segregation of Costs 13 2.8 - Government Accountability Office/Inspector General Access 13 2.9 Ethics 14 2.10- Michigan Economic Recovery Office Notification 14 2.11 - Notice Requirements under PA 7 of 2009 14 Guidance to State Agencies Regarding Funds Received April 1(3, 2009 Under the American Recovery and Reinvestment Act (ARRA) Implement the selected model with fidelity, as established by the model developer. Program Director Oct. 1- Sept. 30 • Required high-quality supervision is in place. • Well-trained, competent staff are hired. • Data collection requirements are met. • Fully participate with the National Model Office and the Department with respect to program monitoring, assessment, support and technical assistance services. Ensure all training and technical assistance requirements are met. Program Director Oct. 1- Sept. 30 • All MIECHV Staff participate in: 1. All training and TA required by model developer, 2. Additional training and TA as identified by the HVWG, 3. Workforce development opportunities, and 4. Information sharing and learning opportunities across home visiting sites. Ensure that MIECHV grantee meetings are attended by appropriate staff. Each community must participate in three full-day grantee meetings per year, which will consist of MIECHV program updates and COI work related to improving benchmark data collection. Local MIECHV program team representation is expected and respective work plans and budgets must reflect this activity. Identify and recruit participants. Program Director Oct. 1- Sept. 30 Each community must clearly outline in their respective work plans how they will collaborate with community partners to conduct outreach and recruitment, including with their local Home Visiting HUB, if one exists. Page 92 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Minimize attrition rates for participants. • Program Director • MIECHV Staff Oct. 1- Sept. 30 Each community must clearly outline in their respective work plans how they will minimize attrition rates for their respective home visiting program participants. Address challenges to maintaining program quality and fidelity, Program Director Oct. 1- Sept. 30 Each community must clearly outline in their respective work plans how they will address challenges to maintaining program quality and fidelity. Objective: Use the evidence base to build the home visiting system infrastructure and improve the quality of the home visiting system. Collect and report data for all eligible families who receive services funded with the MIECHVI. • MIECHVI Staff • Program Director Oct. 1- Sept. 30 • Collect data regarding progress toward benchmarks in accordance with the schedule and specifications provided by the MIECHV Evaluation Grantee. • Ensure all MIECHV staff participate in trainings for purposes of using selected measurement tools. • Submit data in accordance with the schedule and specifications provided by the MlECHV Evaluation Grantee. • Assure local data safety, security and confidentiality. • Complete Annual Home Visiting Agency Survey. Engage the community and coordinate with appropriate entities/programs. Program Director Oct. 1- Sept. 30 • Participate in a broad-based community advisory committee that is providing oversight for the respective model and other home visiting efforts. This will occur collaboratively with other early childhood committees or advisory bodies, or the Local Leadership Group established to Page 93 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 work with the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program. Funding may not be used for a separate model-specific advisory body. • Build upon and maintain diverse community and target population collaboration and support. • Participate in the local home visiting leadership group (LLG) that has been designated to work with the Michigan M1ECHV Program, to effectively link the respective model with other home visiting programs and services offered in the community, and to represent the model in Continuous Quality Improvement (CQI) efforts that assess the impact of the overall home visiting effort in the community. Establish and implement a Program Oct. 1- • Establish a program CQI team. regular program Continuous quality Improvement (CQI) process. Director Sept. 30 • Ensure appropriate staff participate in trainings/TA related to CQI. • Engage in conversations with the Department regarding local CQ1 needs. • Monitor progress toward the Home Visiting Initiative objectives. • Use data to identify opportunities for improvement, develop improvement strategies and assess success of the strategies. • Participate in reporting activities, as required by the Department /HRSA. Page 94 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 • Conduct/participate in evaluation activities as required by the Department /HRSA. 3. If a subcontracting Grantee wishes to print promotional or educational materials, using contract funds, related to the MIECHV initiative, they must: A. Send draft materials electronically to the contract manager, Penny Eisfelder, at eisfelderomichigan.00v. B. Materials must be approved by the Department staff and a written approval received by the subcontracting Grantee. C. All materials must include the Michigan Home Visiting Initiative logo, which can be obtained from the contract manager, upon request. D. All materials must include the HRSA federal grant disclaimer and grant number, which can be obtained from the contract manager upon request. E. Separate approval must be obtained for each publication an Grantee wishes to print. Work Plan Requirements: Upon initiation of the agreement the subcontracting Grantee must submit a "work plan" report via email or fax to the Contract Manager, Penny Eisfelder (see cOntact information in reporting requirements). Requirements in section A and B should be reflected in each Grantee's respective work plan. Additional activities may be included in work plan, but for the purpose of this agreement, the Minimum Program Requirements must serve as the basis for the work plan. Reporting Requirements: 1. Each subcontracting Grantee shall submit the following reports: All activities in the work plan shall be implemented and quarterly narrative reports submitted by the subcontracting Grantee as specified. The narrative report should provide updates on implementation of all activities in the Work Plan. Comparative data should be included to illustrate progress. These reports are to be submitted within 30 days of the end of the quarter and either via e-mail or by fax to the Contract Manager, Penny Eisfelder (contact information below). FSRs are to be submitted quarterly through the MI-E Grants system, as well. 2. Any such other information as specified in the Work Plan shall be developed and submitted by the subcontracting Grantee, as required by the Contract Manager. 3. All other reports or information are to be submitted electronically to: Penny Eisfelder, Program Analyst Division of Family & Community Health Michigan Department of Community Health P.O. Box 30195 Page 95 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Lansing, MI 48909 Phone: 517-241-6841 Fax: 517-335-8697 eisfelderpmichipan,qov 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5.. The subcontracting Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by Contract Manager. MICHIGAN ABSTINENCE PROGRAM (MAP) SPECIAL REQUIREMENTS (DISTRICT HEALTH DEPARTMENT #2, DISTRICT HEALTH DEPARTMENT #4, JACKSON COUNTY HEALTH DEPARTMENT, TUSCOLA COUNTY HEALTH DEPARTMENT) Grantee Reauirement 1. Provide fourteen (14) or more hours of structured intervention to youth ages 10-15 (up to 21 for special education populations), spread across at least a four week period. Activities that are solely, recreational or social shall not be included. 2. Develop and/or maintain a coalition/advisory council representative of the diversity of the community (including teens and parents/guardians) who are instrumental in all phases of the program planning, implementation and evaluation. The coalition/advisory council must meet at least quarterly throughout the funding period. 3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 50 percent or more of the amount requested. 5. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. 6. In addition to those mentioned here, the Grantee must adhere to all of the Michigan Abstinence Program's Minimum Program Requirements (MPRs). Department Reauirements 1. Provide administrative professional and technical consultation to the program. 2. Provide a minimum of one MAP-sponsored coordinator meetings/trainings per year. Reporting Requirements 1. The Grantee shall submit program narrative reports on the following dates: Type of Report and Timeframe Due Date Page 96 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Quarterly Report (October 1 — December 31) January 30 Quarterly Report (January 1 — March 31) April 30 Quarterly Report (April 1 — June 30) July 30 Year-End Report (October 1 — September 30) November 30 2. Any such information as specified in the contract requirements and MAP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3. Reports and information shall be submitted to the Contract Manager at: Robyn Corey, Teen Pregnancy Prevention Consultant Michigan Department of Community Health P.O. Box 30195, 109 W. Michigan Ave.8 th Floor Lansing, MI 48909 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager. MICHIGAN ADOLESCENT PREGNANCY & PARENTING PROGRAM (MI-APPP) SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT) Grantee Requirements 1. Implement approved Adolescent Family Life Project-Positive Youth Development (AFLP-PYD) case management program for pregnant and parenting teens and fathers 15-19 years of age. Activities that are solely recreational or social shall not be included. 2. Develop and/or maintain a local steering committee representative of the diversity of the community, including pregnant/parenting mothers and fathers, who are instrumental in all phases of the program planning, implementation and evaluation. The steering committee must meet at least quarterly throughout the funding period. 3 If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 20 percent or more of the amount requested. 5. In addition to those mentioned here, the Grantee must adhere to its approved program work plan and all of the MI-APPP Minimum Program Requirements (MPRs). 6. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. Page 97 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 7. Information provided must be medically accurate, age appropriate, culturally relevant and up to date. 8. Programs must complete, following the approved implementation guidelines, the MI- APPP participant tracking database and submit to MPHI quarterly. 9. Programs must administer, following the approved implementation guidelines, the MI- APPP youth intake and exist forms and enter required information into Ml-APPP database and submit to MPHI quarterly. 10. Pregnancy prevention education must be delivered separate and apart from any religious education or promotion. MI-APPP funding cannot be used to support inherently religious activities including but not limited to, religious instruction, worship, prayer or proselytizing (45 CFR Part 87). 11. Family planning drugs and/or devices cannot be prescribed, dispense or otherwise distributed on school property as part of the pregnancy prevention education funded by MI-APPP as mandated in the Michigan School Code. 12. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under MI-APPP. 13. MI-APPP funding cannot be used to supplant funding for an existing program supported with another source of funds. 14. All program and financial reports must be submitted by the deadlines specified by the Department in the report face sheet. Department Requirements 1. Provide administrative professional and technical consultation to the program. 2. Provide two two-day MI-APPP sponsored learning collaboratives per year. Reporting Requirements 1. The Grantee shall submit program and evaluation progress reports on the following dates: Type of Report and Timeframe Due Date Quarterly Report (October 1 — December 31) January 30 Quarterly Report (January 1 — March 31) April 30 Quarterly Report (April 1 — June 30) July 30 Quarterly Report ( July 1 — September 30) October 30 2. Any such information as specified in the contract requirements and MI-APPP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3, Reports and information shall be submitted to the Contract Manager at: Hillary Turner, MI-APPP Program Coordinator Michigan Department of Community Health 109 W. Michigan Ave., 8 th Floor Page 98 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 P.O. Box 30195 Lansing, MI 48913 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager. MICHIGAN CARE IMPROVEMENT REGISTRY SPECIAL REQUIREMENTS Grantee Requirements 1. Michigan Care Improvement Registry (MCIR) responsibilities: A. Ensure that all immunizations administered to persons born after December 31, 1993 by the Grantee, or by any provider with the jurisdiction are reported to the MCIR. B. Ensure that all immunization providers within the Grantee's jurisdiction are registered through the MCIR and that all of their activities are coordinated with the regional Grantee of the Department and operated within their guidelines. MICHIGAN COLORECTAL CANCER EARLY DETECTION PROGRAM SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, DISTRICT HEALTH DEPARTMENT #4, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, HURON COUNTY HEALTH DEPARTMENT, AND MUSKEGON COUNTY HEALTH DEPARTMENT) Grantee Reauirements The Michigan Colorectal Cancer Early Detection Program (MCRCEDP) provides colorectal screening services to program eligible men and women: 1:1 Aged 50-64 years 111 Average risk for colorectal cancer — screened by Fecal Occult Blood Test (FOBT) El Increased risk for colorectal cancer— screened by colonoscopy 111 Low income (up to 250% of the Federal poverty level) El Who have inadequate or no health insurance For specific MCRCEDP requirements please refer to the most current MCRCEDP manual available at http://www.michigancancer.oro/Colorectal/. Page 99 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 NURSE FAMILY PARTNERSHIP (NFP) SERVICES SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION, AND SAGINAW COUNTY HEALTH DEPARTMENT) Grantee Requirements for All Department Funded Proiects Maintain Fidelity to the Model: Adhere to the Nurse Family Partnership (NFP) National Service Office program standards and operate the program with fidelity to the requirements of the Department and the National Service Office Application Review Team approved Implementation Plan and Annual Plan. Projects must incorporate the Department and NSO NFP requirements as required for fidelity. Staffing: NFP home visiting nursing staff will reflect the community served. If unable to obtain and maintain a staff that reflects the population served, the Grantee must document their good faith, due diligent effort to comply with this requirement. Submit a staff roster for the fiscal year and within 30 days of a change. Target Population: 1. Michigan is using NFP as a specialized home visiting service strategy for low income, first time mothers whose population group contributes to the community's excess infant deaths. This specialized service strategy is a focused way use limited resources, directing it to the most at risk populations. 2. The Provider shall develop an Outreach Plan for NFP that is consistent with the risk-based analysis identified in the Annual Kitagawa analysis county profile for excess infant death rates provided by the Department. 3. The provider shall demonstrate that enrollment reflects the use of the outreach plan and shall submit quarterly reports on outreach activities and caseload population status. 4. The provider shall refer clients not eligible for NFP to the Maternal Infant Health Program(s) in their community or another home visiting program designed for at risk pregnant women in their county. Page 100 of 121 MDCH/G&PD FY 14/15 ATTACHMEN1111 07/03/14 Program Monitoring. Assessment. Support and Technical Assistance (TA): Fully participate with National Service Office Site Developer and the Department Nurse Consultant program monitoring, assessment, support and technical assistance services. Professional Development and Training: All NFP program staff will participate in professional development and training activities, as required by NFP. They will also be required to participate in home visiting learning communities, other learning opportunities, and meetings such as grantee meetings required by the Department. Engage and Coordinate with Community Stakeholders: Assure that there is a broad-based community advisory committee that is providing oversight for NFP. This will occur collaboratively with other early childhood committees or advisory bodies, or the Local Leadership Group established to work with the Maternal, Infant and Early Childhood Home Visiting (MIECHV) Program as listed below. Coordinate with Aporo',date Entities/Programs: 1. Build upon and maintain diverse community and target population collaboration and support. 2. Participate in a local home visiting committee (or if none, at the Great Start Collaborative) that seeks to effectively align home visiting efforts across the community, and represent NFP in Continuous Quality Improvement efforts that assess the impact of the overall home visiting effort in the community. Data Collection: 1. Comply with all NFP and the Department data collection requirements. 2. Authorize Detroit Wayne Health Authority and the Michigan Public Health Institute (MPH I) to receive information from the national NFP clinical information system (CIS) known as Efforts to Outcomes (ET0). 3. Work with the MIECHV Evaluation Grantee to develop a plan to collect and report additional data beyond that required for NFP. Continuous Quality Improvement (CQI): 1. Participate in all NFP quality initiatives including: research, evaluation and continuous quality improvement. 2. Participate in all State and local Home Visiting CQI (established by the Local Leadership Group) activities as required by the Department. Nurse-Family Partnership Medicaid Outreach Reauirements For Berrien. Kalamazoo. Kent, Oakland and Calhoun Counties only: Nurse Family Partnership Medicaid Outreach Requirements are in the Annual Budget Instructions document. Page 101 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Follow Nurse-Family Partnership Medicaid Outreach Requirements in the Attachment I "Instructions for the Annual Budget." The percentage match is 50% based on the percentage of project clientele that are Medicaid enrolled beneficiaries. Match funding is only available for NFP clients who are Medicaid enrolled beneficiaries. Reportina Reauirements 1 The Grantee shall adhere to the NFP, Inc., National Office program reporting requirements. 2. The Provider shall submit all required reports in accordance with the Department reporting requirements. A. Staff Roster: within 30 days of the beginning of each fiscal year and within 30 days of a staffing change. B. NFP Community Outreach Plan: within 30 days of the beginning of each fiscal year. C. Quarterly Reports (on outreach activities and caseload population status): within 30 days of the end of each quarter. D. Medicaid Outreach Report: within 30 days of the end of each quarter. Reports and information shall be submitted to: Rosemary Fournier Division of Family and Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, Michigan 48909 or The Division of Family Community Health mail box at DFCH@michigan.gov (put "Nurse Family Partnership Reports FY 15 in the subject line). PRACTICES TO REDUCE INFANT MORTALITY THROUGH EQUITY (PRIME) LOCAL LEARNING COLLABORATIVE SPECIAL REQUIREMENTS (INGHAM COUNTY HEALTH DEPARTMENT) Project Overview: Practices to Reduce Infant Mortality through Equity (PRIME). This project received 3 years of funding from W. K. Kellogg Foundation. The project began in May 2010. The project has three goals: I. Develop a replicable workforce training and practice model that incorporates social justice and the elimination of racism in both organizational policy and practice. The Page 102 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 model is to be used as a strategy for eliminating disparities in health outcomes, related to infant mortality in Michigan; 2. Use a state/local partnership network to codify effective efforts that undo racism and improve infant health in Michigan. Share local lessons learned statewide and disseminate experience of Michigan communities that inform this work and improve effective engagement of stakeholders in policy making decisions; and 3. Identify a sustainable quality assurance process that recognizes social determinants of health in policies, program models and practices, allocation formulas and/or program accreditation review. This should include public documentation of health status data and stories of African Americans and American Indians in Michigan. The PRIME Local Learning Collaborative formed in March 2011 to accomplish the work outlined in Goal 2. The Grantee will be responsible for participating in the following: 1. Assist the PRIME Steering Team assemble, codify and share activities and experiences from and around the state that inform the work in PRIME 2. Assist in developing an Dissemination Plan to share the LLC's work in health equity, health disparities and undoing racism throughout the state 3. Gather and submit data on the agencies' work in health equity, health disparities and undoing racism 4. Participate in PRIME Local Learning Collaborative meetings Funds may be used to pay for: 1. Project staff salaries and associated payroll taxes and fringe benefits 2. Program administration (e.g. accounting, payroll) 3. Travel associated with PRIME meetings & activities 4. Communications (e.g. telephone, fax, postage, internet access) 5. Printing and copying 6. Consultant/professional fees (evaluation consultant) PHEP (PUBLIC HEALTH EMERGENCY PREPAREDNESS) SPECIAL REQUIREMENTS (INCLUDING CRI FUNDING FOR, DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, WAYNE, OAKLAND, LIVINGSTON, LAPEER, MACOMB AND ST. CLAIR COUNTY HEALTH DEPARTMENTS) OCTOBER 1, 2014 JUNE 30, 2015 Grantee Reauirements (Base/ CRI) The Public Health Emergency Preparedness section of Attachment III is effective from October 1, 2014 through June 30, 2015. Funds are provided by the Department for nine months based on the Department's fiscal year. Page 103 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 As a sub-recipient of funding provided through the Centers for Disease Control and Prevention (CDC) National Bioterrorism Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) Cooperative Agreement, each local health department (LHD) shall conduct activities to build preparedness and response capacity and capability. These activities shall be conducted in accordance with the HPP/PHEP Cooperative Agreement guidance for 2014-2015 plus any and all related guidance from the CDC and the Department that is issued for the purpose of clarifying or interpreting overall program requirements. All Grantee activities shall be consistent with all approved BP3 work plan(s) and budget(s) on file with the Department through the MI E-Grants system. In addition to these broad requirements, the Grantee will comply with the following: 1. Required one (1) full time equivalent (FTE) emergency preparedness coordinator, as a point of contact. In addition to the Grantee health officer, the emergency preparedness coordinator shall participate in collaborative capacity building activities of the HPP/PHEP Cooperative Agreement, all required reporting and exercise requirements and in regional Healthcare Coalition (HCC) initiatives. 2. There are a number of special initiatives, projects, and/or supplementals that are facilitated under this cooperative agreement. For example, the Cities Readiness Initiative (CRI) performance and evaluation initiatives. Each Grantee that is designated to participate in any "special" initiative, project, or supplemental is required to comply with all CDC and MDCH OPHP guidance, and all accompanying work plan and budgeting requirements implemented for the purpose of sub- recipient monitoring and accountability. Some or all "special" initiatives, projects, or supplementals may require separate recordkeeping of expenditures. If so, this separate accounting will be identified in separate project budgets in the MI E-Grants system. These special projects may also require additional reporting and exercise activities. 3. Grantees are required to submit a 3-month (7/112014 to 9/30/2015) and 9-month (October 1 to June 30) budget for both Base PHEP and Cities Readiness Initiative (CRI) funding, including the 10 percent (10%) MATCH for those periods (see #14 below for detail regarding Match). Submitted to OPHP PHEP(michioan.qov by May 1,2014. 4. ALL activities funded through the PHEP cooperative agreement must be completed between July 1,2014, and June 30, 2015, and all BP3 funding must be obligated by June 30, 2015 and completed by the August 15, 2015 FSR submission deadline. 5. Submit all budget amendments to the Office of Public Health Preparedness (OPHP) for review prior to submitting them in the MI E-Grants system. Budget amendments that contain line items deviating more than 15 percent from the original budgeted line item must be approved by OPHP prior to implementation (15 percent deviation rule) via email to Jolene Miller at milier139(&.michiconsiov. Note: This change reflects the removal of the $10,000 maximum deviation. Page 104 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 6. Final Financial Status for funding period ending June 30 reports MUST be submitted in the MI E-Grants system for this funding source no later than August 15, 2015. 7. Supplantation: The replacement of non-federal funds with federal funds to support the same activities. The Public Health Service Act, Title I, Section 319(c) specifically states, "SUPPLEMENT NOT SUPPLANT. — Funds appropriated under this section shall be used to supplement and not supplant other federal, state, and local public funds provided for activities under this section." This law strictly and expressly prohibits using cooperative agreement funds to supplant any current state or local expenditures. 8. Unallowable Costs: A. Recipients may not use funds for fund raising activities or lobbying. B. Recipients may not use funds for research. C. Recipients may not use funds for construction or major renovations. D. Recipient may not use funds for clinical care. E. Recipients may not use funds to purchase vehicles to be used as means of transportation for carrying people or goods, e.g., passenger cars or trucks, electrical or gas — driven motorized carts. F. Recipients may not use funds for reimbursement of pre-award costs. G. Recipients may supplement but not supplant existing state or federal funds for activities described in the budget. H. Payment or reimbursement of backfilling costs for staff is not allowed. I. None of the funds awarded to these programs may be used to pay the salary of an individual at a rate in excess of Executive Level II or $179,700 per year. 9. Exercise and Performance Measure Requirements: A. High Priority Performance Goal (HPPG): To ensure a timely and effective response to an incident, public health agencies must demonstrate their capability to immediately (with no advance notice) assemble pre-identified public health staff, with senior incident management roles, within 60 minutes of notification. The target date for reaching the 60 minute benchmark is November 1. B. All performance measures must be completed and the required data submitted to the Department — OPHP by the due dates established in the Grantees Work Plan. C. Demonstrate capability to receive stage, store, distribute, track, and dispense medical countermeasures (MCM) during a public health emergency. i. Attain a score of 89 percent or higher on the Division of Strategic National Stockpile (DSNS) Local Technical Assessment Review (TAR) tool. ii. Conduct a mass prophylaxis drill utilizing three of the eight RAND points of dispensing templates. This activity is MANDATORY for all Page 105 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 seven CRI funded LHDs and OPTIONAL (but recommended) for the remaining LHDs. iii. The CR1 Metropolitan Statistical Area (MSA) must conduct one full functional exercise in BP3 (or real event) testing key components or CAP from June exercise of their mass dispensing/prophylaxis plan (This is related to the Medical Countermeasure Distribution and Dispensing (MCMDD) guidance required by CDC). iv. All SNS assets must be tracked by using CDC's Inventory Management and Tracking System (IMATS) at the LHD Distribution Node. v. All pharmaceuticals and vaccines received from the SNS must be tracked down to the dispensing/administration level by using the Michigan Care improvement Registry (MCIR), 10. Under the alignment of the HPP and PHEP cooperative agreements, Grantee's must partner with the Regional Healthcare Coalition (HCC) and support HCC initiatives to ensure that healthcare organizations receive resources to meet medical surge demands. Working well together during a crisis, is facilitated by working together on a regular basis. To this end, Emergency Preparedness Coordinators, supported by CDC PHEP, are required to participate in, and support Regional Healthcare Coalition initiatives. In addition, the EPC or designee is required to attend IQR percent of Regional Healthcare Coalition planning or advisory board meetings; this will be confirmed through attendance registration. Each Grantee aligned with multiple regions need only align with one region to meet this requirement. 11. Maintain National Incident Management System (NIMS) compliance as detailed in the LHD work plan and submit annually to the Department — OPHP. 12. Each sub-recipient Grantee must retain program-related documentation for activities and expenditures consistent with Title 2 CFR Audits of States, Local Governments, and Non-Profit Organizations, to the standards that will pass the scrutiny of audit. 13. PHEP awardees shall, not less often than once every two years, audit their expenditures from amounts received under these awards. Such audits shall be conducted by an entity independent of the Grantee administering a funded program, in accordance with the Comptroller General's standards for auditing governmental organizations, programs, activities, and functions and using generally accepted auditing standards. Awardees may choose to include PHEP as a major program in their required A-133 audit process to fulfill the PAHPRA—required biennial audit. However, if awardees choose not to include PHEP expenditures as part of their required A-133 audit process, a separate audit must be performed to fulfill the PAHPRA—required biennial audit. This audit is required for the PHEP funds under PAHPRA without regard to funding thresholds. (Base and CRI), Page 106 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 14. Comply with required 10 percent MATCH for July 1,2014 through September 30, 2014 and October 1,2014 through June 30, 2015. Grantees are required to submit a letter (on Grantees letterhead) stating the source, calculation and narrative description of how the match was achieved, unless said match is met using local dollars. This was due with the narrative budget submission to the Department — OPHP. 15. Administrative preparedness: Grantees must work to strengthen administrative preparedness planning. Examples that such planning should address include (but are not limited to) the following: emergency use authorizations, public health and law enforcement collaboration. Improve plans to respond to emergency purchasing, staffing, and contracting. Ensure adherence to all federal circulars and all financial reporting requirements. 16. The Pandemic and All Hazards Preparedness Reauthorization Act (PAHPRA) of 2013 requires the withholding of amounts from entities that fail to achieve PHEP benchmarks. The following PHEP benchmarks have been identified by CDC for the Fiscal Year: A. Adherence to spending limits and applicability. LHDs must spend ninety-eight (98) percent of their PHEP aliocation. Failure to do so or misuse of funds will affect the amount that is allocated in subsequent budget periods. B. Demonstrated adherence to all PHEP application and reporting deadlines. Grantees must submit required PHEP program data and reports by the stated deadlines. This includes, but is not limited to, progress reports, performance measure data reports, National Incident Management System (NIMS) compliance reports, updated emergency plans, budget narratives, Financial Status Reports (FSR), etc. Failure to do so will constitute a benchmark failure. i. All deliverables must be submitted via email to OPHP using the OPHP PHEPmichigan.gov email address by the due date given for each deliverable in this work plan. Exception: SNS Plan and required documentation. Mail these to OPHP, ATTN: Mary Sharp 201 Townsend St., Lansing, MI 48913. ii. The CDC preparedness capability self-assessment is due in May 2015, documenting current preparedness status and self-identified gaps based on the CDC public health preparedness capabilities as they relate to overall jurisdictional needs. C. Demonstrated capability to receive, stage, store, distribute, and dispense Strategic National Stockpile materiel during a public health emergency. i. Public health departments must maintain the capability to plan and execute the receipt, staging, storage, distribution, and dispensing of materiel during a public health emergency. Page 107 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 A minimum of three different RAND drills (not the same drill performed three times) must be conducted within each planning/local jurisdiction within each CRI metropolitan statistical area (MSA) during BP3 2014- 2015. D. Submission of Pandemic Influenza Plan. For BP3, Grantees are required to submit an updated pandemic influenza plan to OPHP by the date identified in the program work plan. 17. LHDs that fail substantially to meet benchmarks for the immediately preceding fiscal year or who fail to submit pandemic influenza plans may have funds withheld from their awards. An awardee that fails to correct such noncompliance shall be subject to withholding in the following amounts per PAPHA: A. For the fiscal year immediately following a fiscal year in which an Grantee has failed substantially to meet performance measures/benchmarks or submit a satisfactory pandemic influenza plan, an amount equal to 10 percent (10%) of funding the Grantee was eligible to receive. B. For the fiscal year immediately following two consecutive fiscal years in which an LHD experienced such a failure, an amount equal to 15 percent (15%) of funding the Grantee was eligible to receive, taking into account the withholding of funds for the immediately preceding fiscal year. C. For the fiscal year immediately following three consecutive fiscal years in which an Grantee experienced such a failure, an amount equal to 20 percent of funding the Grantee was eligible to receive, taking into account the withholding of funds for the immediately preceding fiscal year. D. For the fiscal year immediately following four consecutive fiscal years in which an Grantee experienced such a failure, an amount equal to 25 percent of funding the Grantee was eligible to receive for such a fiscal year, taking into account the withholding of funds for the immediately preceding fiscal year. Regional Evidemioloay Support: 1. For those Grantees receiving additional funds to provide workspace for Regional Epidemiologists, the grantee must provide adequate office space, telephone connections, and high-speed Internet access. The position must also have access to fax and photocopiers. SEXUALLY TRANSMITTED DISEASE (STD) CONTROL SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT, CITY OF DETROIT HEALTH AND WELLNESS, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, Page 108 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 JACKSON COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HUMAN SERVICES DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, MUSKEGON COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) 1. For medical providers that identify 5% or more of the County's gonorrhea, chlamydia, and/or syphilis morbidity, the local STD program will visit them at least annually to review provider screening, reporting, treatment, and partner management methods. 2. Quarterly Reports: Grantee shall submit the Quarterly Clinic Activity and Medication Inventory Reports within 10 calendar days after the end of each quarter. 3. Participate in technical assistance/capacity development, quality assurance and program evaluation activities as directed by DHWDC/STD. 4. Implement program standards and practices to ensure the delivery of culturally, linguistically, and developmentally appropriate services. Standards and practices must address sexual minorities 5. Inform DHWDC/STD at least 2 weeks prior to changes in clinic operation (hours, scope of service, etc.) 6. Adhere to budgets and staffing plans submitted to and approved by DHWDC. Deviations outside of allowance must be approved by DHWDC. 7. For gonorrhea and chlamydia cases in the Michigan Disease Surveillance System, 50% shall be completed within 30 days and 60% within 60 days from the date of specimen collection. SUDDEN UNEXPLAINED INFANT DEATH (SUID1 AND OTHER FETAL INFANT DEATH SPECIAL REQUIREMENTS Grantee Reauirements 1. Grantee personnel will maintain current expertise in fetal/ infant death research, bereavement and counseling techniques through educational in-service and/or personal professional development. 2. The Grantee will update current curriculum and materials for maternal and child health programs to incorporate Sudden Unexplained Infant Death (SUID) and other fetal/infant death risk reduction information and interconception care education and/or counseling. lnterconception care, per the joint program brief issued by the CDC and HRSA in 2008, is comprised of interventions that aim to identify and modify biomedical, behavioral, and social risks to a woman's health or pregnancy outcome through prevention and management, emphasizing those factors which must be acted on before conception or early in pregnancy to have maximal impact. Thus, it is Page 109 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 more than a single visit and less than all well-woman care. It includes care before a first pregnancy or between pregnancies. 3. The Grantee will facilitate bereavement support services to families and other caretakers of infants experiencing a fetal or SUlD infant death. In communities with an active Fetal Infant Mortality Review (FIMR) team, the Grantee will facilitate bereavement support services to families and other caretakers experiencing any type of infant and perinatal death. 4. The Grantee will encourage all infant deaths to be reviewed in the local Child Death Review team process and/or Fetal-Infant Mortality Review process (if available) to improve the consistency of death scene investigation, autopsy, death certificate documentation and accurate SUID diagnosis. Department Requirements 1. Provide payment of $125 for each family support visit. A maximum of 6 visits are reimbursable per fetal/infant death. One of these visits can be utilized to conduct a FIMR Maternal Interview. 2. Provide training for certification of family support providers. 3. Provide technical assistance for bereavement support through Tomorrow's Child (Michigan SIDS). SEAL! MICHIGAN DENTAL SEALANT PROGRAM SPECIAL REQUIREMENTS (INGHAM COUNTY HEALTH DEPARTMENT AND OTTAWA COUNTY HEALTH DEPARTMENT) Grantee Requirements 1. Administer screening, fluoride and dental sealant applications to all eligible children with a signed consent form in the Department Oral Health Program designated schools, to meet goals of the priority population. 2. Provide oral health promotion of dental sealants through literature and/or presentations to parents/guardians of children that are culturally and linguistically sensitive. 3. Provide instruction on oral health and sealant placement to children targeted for the SEAL! Michigan program prior to sealant placement. 4. Measure quality control of the sealant program through SEALS data software and provide hard copy forms to the Department upon request: 5. Ensure all staff has received training in the SEAL! Michigan Program via on-line training provided by the Department, which includes SEALS training. Note: even if training has been completed by grantees in previous years, attendance for the current grant cycles is required. Page 110 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 6. Adhere to CDC, OHSA and MIOSHA Standards and the State of Michigan Administrative Rules. 7. Ensure sealant material is approved by ADA, is non-expired, and applied according to manufacturer's specifications. 8. Demonstrate activity in establishing a dental home or referral network for children referred for dental treatment. Grantees must document that personal contact via phone or letter is made to the parent/guardian of child with urgent dental care needs. (Urgent means care needed within 24 hours), Grantee must have a mechanism to track the children receiving emergency dental restorative emergency services within 20 miles of the sealant site and provide the tracking information to the Department upon request. 9. Provide details on how the program is working toward sustainability beyond the grant. Grantees must provide documentation on how sustainability is taking place, for example: Medicaid, 3rd party billing protocols or in-kind contributions. 10. Grantees must utilize experienced and competent staff to accomplish program goals. 11. Grantees must track separately the amount of schools they serve, how many children received dental sealants, and how many dental sealants have been placed separately from SEALS and be able to provide this information upon request. 12. Retention checks must be performed on 20% of children serviced and achieve 90% or better retention rates on occlusal surfaces and 65% retention rates on buccal pits. If retention is found to be less than 90% (meaning more than 10% of dental sealants are falling out) then 40% of students must be checked for sealant retention. Any dental sealants which have fallen out upon the retention check must be replaced immediately free of charge and then rechecked for retention. 13. Grantees shall be compliant with sub-recipient grantee meetings quarterly. A minimum of two on- site visits will be required yearly, remaining two will take place via conference call. 14. To be considered for the non-competitive continuation grant the following must be completed: A. Meet and/or exceed all grant requirements and priorities B. Complete the non-competitive grant application in its entirety (see RFP) C. Have the application postmarked or received by the Department by December 1, for the second year. Reporting Reauirements The Grantee shall submit the following reports within 15 days as stated on the following dates: Quarter End Date Report Due 1 st Qtr (December 31) January 15 2nd Qtr (March 31) April 15 Page 111 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 3rd Qtr (June 30) July 15 4th Qtr (September 30) October 15 1 Collect data through SEALS software so as to monitor the program effectiveness, final reporting due within two (2) weeks of the end of the year fourth quarter grant period. 2. The Grantee shall submit the following information electronically in an encrypted manner to the Department Oral Health Program or through the State of Michigan File Transfer system. A. Complete Sealant Efficiency Assessment for Locals and States (SEALS) software to include: (Exported Child Level, Exported Event Level and entire software). This should be updated weekly and sent at the end of grant year in the fourth quarter and/or upon request by the Department. B. Electronic copy of Program Level. This should be sent at the end of the 4 th quarter and prepared for each quarterly site visit. C. Demonstration of retention check of sealants of 90% or greater on occlusal surfaces and 65% on lingual and buccal pits. A sampling of 20% of the teeth sealed by new employees must be checked for retention within 3-6 weeks following sealant placement. All retention checks shall be entered into SEALS within each grant year. 3. A work plan should be submitted at the end of every quarter. The work plan should include an update on all of the Grantee requirements. 4. Provide documentation that emergency dental restorative services are tracked for children referred through the SEAL! Michigan dental sealant program within a 20 mile radius of the sealant program. 5. The Grantee shall submit an Evaluation Form to be sent at the end 4th quarter. This will be provided to grantees by September 1 by Oral Health Coordinator. Send reports to: Jill Moore, Dental Sealant Coordinator Oral Health Program SEAL! Michigan Michigan Dept. of Community Health, Div. of Family & Community Health P.O. Box 30195, Lansing MI 48909 Phone: (517)373-4943 Fax: (517)335-8697 MooreJ14Rmichiqan.qov Page 112 of 121 MDCH/G&PD FY 14/15 ATTACHMENT !II 07/03/14 TB CONTROL 3406 PROGRAM SPECIAL REQUIREMENTS (BAY COUNTY HEALTH DEPARTMENT, BERRIEN COUNTY HEALTH DEPARTMENT, BENZIE- LEELANAU DISTRICT HEALTH DEPARTMENT, CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT, CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, DICKINSON-IRON DISTRICT HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES DEPARTMENT, LIVINGSTON COUNTY DEPARTMENT OF PUBLIC HEALTH, LUCE- MACKINAC-ALGER- SCHOOLCRAFT DISTRICT HEALTH DEPARTMENT, MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, MIDLAND COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH DELTA & MENOMINEE COUNTIES, SAGINAW COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, WESTERN UPPER PENINSULA HEALTH DEPARTMENT) For those local health departments certified to participate in the 340B program to obtain reduced pricing for anti-tuberculosis medications, minimal funds are provided to offset expenses for administrative activities. Disallowed Costs: Federal (CDC) guidelines prohibit the use of these funds to purchase anti-tuberculosis medications or to pay for inpatient services. TUBERCULOSIS CONTROL AND ELIMINATION SPECIAL REQUIREMENTS (GENESEE COUNTY HEALTH DEPARTMENT, ING HAM COUNTY HEALTH DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION, OTTAWA COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, AND WAYNE COUNTY HEALTH DEPARTMENT) General Requirements Each local health department as a sub-recipient of the CDC Tuberculosis Elimination Cooperative Agreement shall conduct activities for the purposes of tuberculosis control and elimination. Funds may be used support personnel, purchase equipment and supplies, and provide services directly related to core TB control front-line activities, with a priority emphasis on DOT (Directly Observed Therapy), case management, completion of treatment and contact investigations. Funds may also be used to support incentive or enabler offerings to enhance patient adherence to treatment. Disallowed Costs: Federal (CDC) guidelines prohibit the use of these funds to purchase anti-tuberculosis medications or to pay for inpatient services. Examples of appropriate incentive/enabler offerings include retail Page 113 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 coupons, public transit tickets, food, non-alcoholic beverages, or other goods/services that may be desirable or critical to a particular patient. For more information and suggested uses of incentive/enabler options, refer to CDC's Self-Study Module #9, Enhancing Adherence to Tuberculosis Treatment at http://www.cdc.qov/tb/ed ucation/ssmod u les/mod ul e9/ss9 read i no3.htm. Contract Specific Requirements 1. Utilize DOT as the standard of care to achieve at minimum 80% of TB cases enrolled in DOT (Jan 1- Dec 31). 2. Document in MDSS all changes to treatment regimen using the Report of Verified Case of Tuberculosis (RVCT) comments field (pg. 12), and completion of therapy using RVCT Follow-Up 2 (pg. 7). 3. Maintain evidence of monthly DOT logs on site (to be made available if needed). Monthly submission of DOT logs is no longer required. 4. Achieve at least 94% completion of treatment within 12 months for eligible TB cases. The determination of treatment completion is based on the total number of doses taken, not solely on the duration of therapy. Consult the most current ATS document Treatment of Tuberculosis for guidance in the number of doses needed and the length of treatment required following any interruptions in therapy. 5. Maintain appropriate documentation on site (to be made available if needed). Document the appropriate use of expenditures for incentive and enablers for clients to best meet their needs to complete DOT and appropriate therapy. 6. Ensure >90% completion of RVTC pages 1 - 6 in MDSS within one month of diagnosis. 7 Unallowable Costs per federal guidelines: A. Funds can not be used for procurement of anti-tuberculosis medications. B. Funds can not be used for research. C. Funds can not be used for inpatient services 8. Ensure that confidential public health data, is maintained and transmitted to the Department, in compliance with applicable standards defined in the "CDC Data Security and Confidentiality Guidelines for HIV, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis Programs" http://www.cdc4ovinchhstp/proqraminteoration/docs/PCSIDataSecurityGuidelines.pdf Reporting Requirements: DOT Logs are maintained on site and available if needed. All other data must be entered into MDSS as stipulated in contract specific requirements. Page 114 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 TAKING PRIDE IN PREVENTION (TPIP) SPECIAL REQUIREMENTS (CALHOUN COUNTY PUBLIC HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT) Grantee Reauirements 1. Implement, with fidelity, the approved evidence-based intervention to youth ages 12- 19. Activities that are solely recreational or social shall not be included. 2. Develop and/or maintain a coalition/advisory council representative of the diversity of the community (including teens and parents/adults/caregivers) who are instrumental in all phases of the program planning, implementation and evaluation. The coalition/advisory council must meet at least quarterly throughout the funding period. 3. If programming will be provided by a subcontractor, a Letter of Understanding (LOU) detailing the responsibilities to which both parties agree must be completed. 4. Secure local matching funds (either cash or in-kind resources) totaling 35 percent or more of the amount requested. 5. A minimum of 90% of the proposed users must be served to access the total amount of allocated funds. 6. In addition to those mentioned here, the Grantee must adhere to its approved program work plan and all of the Teen Pregnancy Prevention Initiative's Minimum Program Requirements (MPRs). 7. Comprehensive pregnancy prevention (abstinence and contraception) education must be taught using an evidence-based intervention approved by the Department and address the following three adulthood preparation topics: healthy relationships, adolescent development, and parent-child communication. 8. Information provided must be medically accurate, age-appropriate, culturally relevant, and up- to-date. 9. Programs must complete, following the approved implementation guidelines, the TPIP/TPP1 program/participant tracking database and submit to MPH1 quarterly. 10. Programs must administer, following the approved implementation guidelines, the TPIP/TPPI youth pre/entry and post/exit surveys and subsequent entry of the survey data into ODE quarterly. 11. Pregnancy prevention education must be delivered separate and apart from any religious education or promotion. TPIP/TPPlfunding cannot not be used to support inherently religious activities including, but not limited to, religious instruction, worship, prayer, or proselytizing (45 CFR Part 87). 12. Family planning drugs and/or devices cannot be prescribed, dispensed, or otherwise distributed on school property as part of the pregnancy prevention education funded by TP1P/TPPI as mandated in the Michigan School Code. Page 115 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 13. Abortion services, counseling and/or referrals for abortion services cannot be provided as part of the pregnancy prevention education funded under TPIP/TPPI. 14. TPIP funding cannot be used to supplant funding for an existing program supported with another source of funds. 15. All program and financial reports must be submitted by the deadlines specified by the Department in the report fact sheet. 16. In addition to those mentioned here, the Grantee must adhere to its approved program work plan and all of the Teen Pregnancy Prevention Initiative's Minimum Program Requirements (MPRs). Department Requirementa 1. Provide administrative professional and technical consultation to the program. 2. Provide two two-day TPIP-sponsored Institutes per year. Reportina Reauirements 1. The Grantee shall submit progress reports on the following dates: Type of Report and Timefranne Quarterly Report (October 1 — December 31) Quarterly Report (January 1 — March 31) Quarterly Report (April 1 — June 30) Quarterly Report ( July 1 — September 30) Due Date January 30 April 30 July 30 October 30 2. Any such information as specified in the contract requirements and TRIP Report Fact Sheet shall be developed and submitted by the Grantee as required by the Contract Manager. 3. Reports and information shall be submitted to the Contract Manager at: Kara Anderson Teen Pregnancy Prevention Coordinator Michigan Department of Community Health 109W. Michigan Ave., 4th Floor Lansing, MI 48913 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and to make an evaluation of the projects as determined by the Contract Manager. Page 116 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 WIC SPECIAL REQUIREMENTS Grantee Reauirements 1. Provide for security of Project FRESH coupons and WIC EBT cards stored in the local Grantee prior to issuance. The Grantee must notify the WIC Division in writing of any lost, stolen, inappropriately issued or otherwise unaccounted for Project FRESH coupons or EBT cards, immediately upon recognition of such condition. 2. Comply with the requirements of the WIC program as prescribed in the Code of Federal Regulations (7 CFR, Part 246) including the following special provisions: If a local Grantee operates a WIC Program within a hospital or has a cooperative agreement with one or more hospitals, the hospital is required to advise the potentially eligible individuals that receive inpatient or outpatient prenatal, maternity, or postpartum services or accompany a child under age 5 years who receives well-child services, of the availability of WIC benefits [246.6(F)(1)]. 3. Maintain an inventory of all equipment purchased with WIC program funds and maintain such inventory at each WIC clinic location. 4. Assure each Grantee employee authorized for or requesting access to the automated WIC system complete and sign a security agreement. 5. The Grantee in accordance with the general purposes and objectives of this agreement, will comply with the federal regulations requiring that any individual that embezzles, willfully misapplies, steals or obtains by fraud, any funds, assets or property provided, whether received directly or indirectly from the USDA, that are of a value of $100 or more, shall be subject to a fine of not more than $25,000. 6. The Grantee is responsible for installation and maintenance of WIC hardware according to guidance provided by the Department WIC Program. Special Reporting Reauirements Grantees shall (when requested) annually report expenditures related to nutrition education and breastfeeding promotion and support, on a supplemental form, if needed and required, to be provided by the Department and attached to the final Financial Status Report (FSR) which is due on November 30 after the end of the fiscal year through the MI E-Grants system. The supplemental form will focus on expenditures related to Travel, Equipment, Subcontract and Other Expense categories and will not include expenditures related to salaries, wages and fringe benefits. Additionally, only expenditures supported by reaular WIC funds should be reflected on this supplemental form. Grantees shall report nutrition education and breastfeeding promotion and support expenditures by completing the WIC Nutrition Education and Breastfeeding Time Study as required by the Department. Page 117 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Breasffeeding Peer Counseling Program expenditures are not to be included. The 1/6th nutrition education requirement and breastfeeding target must still be met with regular WIC/NSA funds. Expenditures incurred that are related to general nutrition education and for the promotion and support of breastfeeding are to be summarized as: 1. Nutrition Education 2. Breastfeeding Allowable Nutrition Education (NE) Expenses are: 1. Costs for procuring equipment for NE (as approved by the State WIC Program). 2. Interpreter or translator services to facilitate NE. 3. Evaluation or monitoring of NE. 4. NE material costs. 5. Costs of training nutrition educators, including costs related conducting training sessions and purchasing & producing training materials. 6. Costs for clinic space devoted to NE activities. 7. Travel and related expenses incurred by WIC staff to conduct any NE activity. 8. Costs of reimbursable agreements with other organizations, public or private, to provide NE to WIC participates. Allowable Breasffeedinq (BF) Promotion & Support Expenses are: 1. Peer counseling if supported with funds allocated through the WIC funding formula. (Report as time study data.) 2. Cost of procuring BF educational materials. 3. Interpreter or translator services to facilitate BF promotion and support. 4. Costs of training BE promotion & support educators, including costs related to conducting training sessions and purchasing and producing training materials. 5. Costs of clinic space devoted to BF promotion & support educational and training activities, including space set aside for BF WIC infants. 6. BF aids which directly support the initiation and continuation of BF, as purchased with WIC funds allocated through the funding formula. 7. Costs of documenting, monitoring and/or evaluating BF promotion and support staff, activities, methods and materials. This includes the cost of collecting, analyzing and evaluating data concerning WIC participant's opinions on the effectiveness of the BF promotion and support they received. (Report as time study data.) 8. Travel and related expenses incurred by WIC staff to conduct any BF promotion and support activity. 9. Costs of reimbursable agreements with other organizations, public or private, to Page 118 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 undertake training and direct service delivery to WIC participants concerning BF promotion and support. The examples above are not all inclusive. In-kind support can also be included, if other non- WIC resources are used for those costs. Please note that costs for data processing, communications, postage, freight, rent and utilities necessary to conduct NE and BF activities must be prorated to the applicable functional category (NE/ BF promotion and support). The Grantee is required to complete the NE and BF staff time study survey as instructed by the Department WIC Program. Special Reauirements for the WIC Breastfeeding Peer Counseling Program Funds allocated for the Breastfeeding Peer Counseling Program are exempt from the WIC Nutrition Education and Breastfeeding Time Study. The Grantee may only charge certain allowed expenses to the Peer Counselor Grant. Expenses for Breastfeeding education and supplies must be charged to the normal WIC budget; not the Peer Counselor Grant. See "Allowable Expenses" below. Financial Reporting A Financial Status Report (FSR) must be submitted to the Department Accounting Office on a quarterly basis. To meet USDA grant reporting deadlines, the Grantee shall submit program expenditures to the State WIC Division using DCH-0386 Attachment B.2 Program Budget — Cost Detail Schedule Attachment B.2. Send to the attention of the State WIC Breastfeeding Coordinator. Reports are due by the 15th day of January, March, July and October. Allowable Expenses The primary purpose of these funds is to provide breastfeeding support services through peer counseling to WIC participants. Expenses may include: 111 Supervisor and/or mentor staff time El Materials that educate/advertise to WIC clients about the Peer Counseling Program El Educational resources for Peer 0 Voicemail, cell phones or phone-line expenses 1=I Equipment or office furniture 111 Indirect costs The Grantee, however, must not charge a disproportionate amount of funds for these above noted items when compared to funds spent on direct service delivery by the Peer Counselor. Page 119 of 121 MOCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Other Reporting The Grantee shall maintain monthly records for each individual Peer Counselor. Specific supplemental reporting forms will be provided by the State WIC Office. Reports are due to the State WIC Office by the 15 th day of January, March, July and October. Training and Education Designated Grantee staff are required: 111 To attend Supervisory training. O To attend a minimum of two program updates. O To train the peer counselors per standards set forth by USDA and the State WIC Division. Designated Peer Counselors are required to attend specific training that includes, but is not limited to: 1=1 Breastfeeding Basics Training O State WIC Peer Counselor Meetings D Annual WIC Conference Staff Training and Education Designated Grantee staff are required: O To attend Supervisory training. O To include designated State Lactation Consultants (LC) as part of the peer counselor recruitment and applicant interview team. O To attend a minimum of two program updates. O To train the peer counselors per standards set forth by USDA and the State WIC Division. Peer Counselors are required to attend specific training that includes, but is not limited to Breastfeeding Basics Training, State WIC Peer Counselor meetings and Annual WIC Conference. Other Grantee Obligations The following requirements apply to the Grantee receiving a special allocation for the Breastfeeding Peer Counseling Program. USDA and MDCH/W1C require the Grantee to comply with the following nine components: 1. Hire staff that meet the definition of Peer Counselor. 2. Designate a Breastfeeding Peer Counselor Manager at the local level. 3. Establish job parameters and a description for the peer counselor that is consistent with State WIC policy. 4. Establish compensation and reimbursement rates for peer counselors. 5. Train appropriate WIC local peer counseling management and clinic staff. 6. Establish standardized breastfeeding peer counseling program procedures at the local level as part of the Grantee's WIC Nutrition Services Plan. 7. Supervise and monitor the peer counselor(s). Establish community partnerships to enhance the effectiveness of the WIC peer counseling program. 8. To include designated State Lactation Consultants (LC) as part of the peer counselor Page 120 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 recruitment and applicant interview team. 9. Provide: El timely access to breastfeeding coordinators/lactation experts for assistance outside the peer counselor scope of practice; El regular, systematic contact with the supervisor; III participation in clinic staff meetings and breastfeeding in-services as part of the WIC team; El opportunities to meet regularly with other peer counselors. 10. Provide training and continuing education of the peer counselor(s). 11. Provide access to Peer Counselor outside of normal business hours via a cell phone or direct line with voicemail that can be accessed after hours. WELL-INTEGRATED SCREENING AND EVALUATION FOR WOMEN ACROSS THE NATION (WISEWOMAN) PROJECT SPECIAL REQUIREMENTS (DISTRICT HEALTH DEPARTMENT #10, DISTRICT HEALTH DEPARTMENT #2, GENESEE COUNTY HEALTH DEPARTMENT, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, HURON COUNTY HEALTH DEPARTMENT, LENAWEE COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH DEPARTMENT DELTA & MENOMINEE COUNTIES) Grantee Requirements W1SEWOMAN (Well-Integrated Screening and Evaluation for Women Across the Nation) is a program designed to screen women for chronic disease risk factors, counsel them about lifestyle changes to reduce risk factors, and refer them for medical treatment of hypertension, hyperlipidemia, and/or diabetes mellitus. This program will be based within Michigan's Breast and Cervical Cancer Control Program. For specific WISEWOMAN Program requirements, refer to the most current WISEWOMAN Program Policies and Procedures Manual. Page 121 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 (e) (f) (1) FOOTNOTES: FY 201412015 (a) Refer to Plan and Budget Framework for element definitions. (b) Refer to master comprehensive agreement and program and budget instructions package for further explanation of applicability of these reimbursement methods. (c) Negotiated starting from the average of the past two complete years' actual number where available. (d) Calculated by multiplying the "Total Performance Expectation" column by the ratio of the elements total State funding (DCH 0410, Line 24) to "Total Expenditures' DCH 0410, Line 17). Prior to calculation, adjustments will be made for unallowable cost, equipment funded by local funds and MDCH reimbursement not performance based (I.E., fixed unit rate, staffing). Calculated by multiplying the "State Funded Element Target Performance" column by the "Percent" column. Refer to master comprehensive agreement and budget instructions package for further explanation regarding these designations. CSHCS Care Coordination 1. Case Management A. Maximum of six (6) services per year B. Reimbursement - $201.58 per service provided face-to-face in the home setting. 2. CARE COORDINATION A. LEVEL I PLAN OF CARE 1. Annual Plan of Care in the home or home-like setting that requires the Care Coordinator to travel to a non-LHD site $150 2. Annual Plan of Care over the telephone $100 B. LEVEL II CARE COORDINATION 1. Level II Care Coordination is reimbursed at $30.00 per unit 2. A maximum of 10 units per beneficiary per eligibility year will be reimbursed. (2) Reimbursement Chart for Fixed Rates AIDS/HIV Prevention Non- $11.00 per blood draw for non-categorical health departments. Limited annually to $2,000. Categorical Biomonitoring of Toxic Substances in Michigan Urban Fisheaters Body Art $500 per clinic date $254 $258.25/appl. annual license prior to 7/1; $125 $129.13/appl. annual license after 7/1; $112.50 $116.21/appl. temporary license; $2513 $258.25/appl. renewal prior to 12/1; $3.7-5 $387.38/appl. renewal after 12/1; $25 $25.83/duplicate license FDA Tobacco Retailer $325.20 per inspection. (A&L) inspections - Oakland only Immunization Assessment $100 per personal visit or $50 for a phone call (with information mailed afterward) to the provider office, not to exceed the Feedback Incentive maximum set for each individual contractor. Exchange (AFIX) Follow-up Immunization Nurse Education Immunization VFC (only) Provider Site Visits $200 per session except Vaccines Across the Lifespan, which is to be reimbursed at $250 per session, upon completion and submission of Provider Contracts and Report Forms. Reimbursement can only be made for one in-service module session per physician clinic site per year. $150 per site visit, not to exceed the maximum set for each individual Contractor. Immunization VFC/AFIX $300 per site visit, not to exceed the maximum set for each individual Contractor. Original Notes FY 14/15 2/17/2014 Combined Provider Site Visits Informed Consent $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services. Laboratory Services & STD See contract language for gonorrhea and chlamydia testing reimbursement performance requirements, AIDS SIDS $125 for each family support visit A maximum of six (6) visits per infant death is reimbursable (3) Allocation to be reflected in individual programs during budgeting process. (4) Funding Source (not a single element). Hearing and Vision are single elements. (5) Subject to Statewide Maintenance of Effort requirement for Title X. (6) State funding is first source (after fees and other earmarked sources). (7) Fixed unit rate subject to actual costs. (8) The performance reimbursement target will be the base target caseload established by MDCH. (9) Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDCH agreement funding for Coordination. (10) Fixed rate limited to contract amount. (11) Up to six (6) visits per family. (12) Non-categorically funded Health Departments will be reimbursed at $11.00 per HIV test conducted up to a maximum of $2,000 annually. (13) Each delegate agency must serve a minimum percentage of Title X users to access their total allocated funds. Quarterly FPAR data will be used to determine total Title X users and Plan First! Enrollees. (14) Public Health Emergency Preparedness (PHEP) funding must be expended by June 30, 2015 and is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a nine month budget and a quarterly Financial Status Report (FSR) column for this program element. (15) Public Health Emergency Preparedness (PHEP) funding for July1 , 2015— September 30, 2015 is subject to a 10% match requirement as specified in the Public Health Emergency Preparedness (PHEP) Cooperative Agreement Guidance. LHDs must submit a three-month budget and a quarterly Financial Status Report (FSR) column for this program element. (16) Project meets the Research and Development criteria as defined by Title 2 CFR, Section 200.87. (17) American Recovery and Reinvestment Act (ARRA) provision applies. See attached appendix for provision. (18) Subject to match requirement as specified in Attachment In - Program Assurances and Specific Requirements. NOTE: Some footnotes may not apply to this agency. Original Notes FY 14/15 2/17/2014 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Proaram/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals General Administration - (Law) Annual State Appropriation Bills* - (Law) Public Health Code PA. 368 of 1978 (as amended)* - (Law) Single Audit Act - Amended"1996 - (Law) Federal MCH Block Grants-P.L. 97-35 of 1981 (as amended) - (Law) Subcontract Requirements, Civil Rights Laws/Special Assurances as specified in the agreements" - (Law) Local Uniform Budgeting Act P.A. 621 of 1978 (as amended)* - (Law) Local Uniform Accounting Act P.A. 71 of 1919 (as amended)* - (Law) Section 1352 of P.L. 101-121 (re: Lobbying) (3) - (Law) Management and Budget Act* - (Law) OBRA 89 P.L. 101-239 (amendment to Title V)* - (Law) 1968 PA. 317 and 1973 PA. 196 as amended regarding conflict of interest* - (Law) P.L. 103-227 Part C Environmental Tobacco Smoke* - (Law) PA 533 of 2004 - (Rules) 325.13053 - 2CFR Part 225 (OMB Circular A-87) (Revised) Cost Principles for State, Local and Indian Tribal Governments - Federal OMB Circular A-102 (Revised) Implemented through "Common Rules- Grants Management* - PHS Grants Management Handbook* - 45 CFR Part 96 Block Grant Regulations ci) - 45 CFR Part 74 Administration of Grants f') or; 45 CFR Part 92, Uniform Administrative Requirements for Grants and Cooperative Agreements to State and Local Governments, as applicable* - Federal OMB Circular A-133 Audits of States, Local Governments and Non-Profit Organizations* - Federal OMB Circular A-133 Compliance Supplement - 2 CFR Part 180 Guidelines to Agencies on Governmentwide Debarment and Suspension * - 45 CFR Part 93 Lobbying* - 45 CFR Part 6, Inventions and Patents* - 42 CFR Parts 432 and 433 (Title XIX Funded Programs) - 45 CFR, Part 46, Protection of Human Subjects - Catalog of Federal Domestic Assistance (CFDA)* FOR SUBGRANTEES: - 2 C.F.R. Part 220 (OMB Circular A-21) Cost Principles for Educational Institutions* - 2 CFR Part 215 (OMB Circuiar A-110) Uniform Administrative Requirements for Grants and Other Agreements with Institutions of Higher Education, Hospitals and Other Non-profit Organizations* - 2 C.F.R. Part 230 (OMB Circular A-122) Cost Principles for Non-profit Organizations* - Federal OMB Circular A-133 Audit Requirements for States, Local Governments and Non-Profit Organizations* - Federal OMB Circular A-133 Compliance Supplement - Americans With Disabilities Act of 1990* - Waiver Policy BCS- 2007* - MDCH Funding Allocation Policy* - Minimum Program Requirements - Department Policy 8000* - Capital Outlay Prior Approval Policy - BCS- 014* - Waiver Procedure BCS-2007.1* - Capital Outlay Prior Approval Procedure BCS-014.1* - (State) Local FMIS Manual* - (State) Treasury LHD Accounting Procedures Manual* - (State) MDCH Reporting Requirements Notebook (H-284)* - (State) Minimum Program Requirements - (Fed) PHS Grants Policy Statement* - (Fed) PHS Grants Administration Manual* - (Fed) HHS Grants Administration Manual* - (State) Annual Budget, FSR & Indirect instructions* MDCH/G&PD FY 14/15 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Policies Procedures Prodram/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals Breast & Cervical Cancer - (Law) P.L. 101-354 of 1990 Title XV of Preventive Health Services Act (42 U.S.C. 201) - (Law) Public Health Code PA. 368 of 1978, Part 95- (Law) P.L. 105- 340-VVomen=s Health Research and Prevention Amendments of 1998. - Dept. of HHS, CDC: Annual Announcements, Early Detection & Control of Breast & Cervical Cancer; Program Guidance, Instruction and information - Breast & Cervical Cancer Amendment of 1993 Campground Inspection - (Law) Public Health Code PA. 368 of 1978 as amended - (Rule) 325.1551 et, seq, Care for Individuals with serious communicable disease or infection - (Law) Public Health Code PA. 368 of 1978 - Part 53 - (Rule) 325.177 Child Health - (1) - (1) Childhood Lead Poisoning Prevention Program - (1) - (Law) Public Health Code PA. 368 of 1978 Part 24 and 51 - P.A. 55 of 2004 - (Law) Lead Abatement Act - (1) CDC Screening Young Children for Lead Poisoning, 1977 - CDC Managing Elevated Blood Lead Levels Among Young Children, 2002 - MDCH EBLL Protocol, 2005, or any subsequent revision - MDCH Case Management Protocol for Children, revised 2007- Provider Guidelines, MDCH CLPPP, September 2007, or any subsequent revision. - MDCH CLPPP Statewide Lead Testing/Lead Screening Plan, August 2007. - Lead Safe Home Program Regional Field Consultant Policy and Procedures Field Guide . 1997 - CDC: "Preventing Lead Poisoning in Young Children", 2005 - CDC: "Screening Young Children for Lead Poisoning", _ CDC: "Managing Elevated BLLs Among Young Children'', 2002 MDCH/G&PD FY 14/15 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals Children' s Special Health Care Services (CSHCS) - (Law) Public Health Code P.A. 368 of 1978 Part 58 - (Law) Title V of the Social Security Act of 1935 42 U.S.C. 701 to 706 Emergency Management- Community Health Annex - (Law) Emergency Management Act 310 of 1978 MCL 30.410 Family Planning - (1 ) - (Law) PA. 303 (1965); PA. 226 (1997); Public Health Code P.A. 368 of 1978; PA. 360 (2002) - (Law) The Family Planning Population Research Act (Title X of the Public Health Service Act - (Law) P.L. 91-572, 1970 - (1) - Catalog of Federal Domestic Assistance (93.217) - 42 CFR Part 59, Grants for Family Planning Services - (State) Title X Family Planning Standards & Review Manual (2006) - (Fed) Federal Program Guidelines for Project Grants for Family Planning Services (2001) - (Fed) Family Planning Annual Report (Eff.2007) - (Fed) Family Planning Annual Report, Effective2007, Standards and Guidelines Family Planning Services for Indigent Women - (Law) Public Health Code P.A. 368 of 1975- MCL 333.9131 - (Rules) 325-151 et, seq, Food Protection - (Law) Food Law of 2000 Act 92 of 2000 MCL 289,3105 - (Rules) 285.553.1 et. seq. Health Education - (Law) Public Health Code P.A. 368 of 1978 MCL 33.2433 Hearing - (Law) PA. 368 Sections R325.3271-3276. - School Aid Act - State of Michigan Hearing Screening Technician Manual MDCH/G&PD FY 14/15 Page 3 of 10 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals HIV/AIDS Care - (Law) Michigan Law MCL 333.5151 and MCL 333.1299 - (Law)—Ryan White HIV/AIDS Treatment Modernization Act of 2006 - DSS Policy Guidelines: - No. 1: Eligible Individuals and Services for Individuals Not Infected with HIV - No. 2: Aliowable Uses of Funds for Discretely - Principles and Standards of Services for HIV/AIDS Case Management in Michigan. - CARF-MDCH Procedures for completing the Client Authorization for Counselor Assisted Referral form (CARF), - (Federal) Ryan White CARE Act Title II Manual Defined Categories of Services, including January, 2006, or any subsequent revisions. Supplement - HAP IS Administrative Versus -- No 8: Staff Training Service/Program Cost Budget Guidance. - No. 4: DSS Policy on Contracting with For Profit Entities HAB Policy Notices: - No. 08-01: Use of Ryan White HIV/AIDS Program funds for Housing Referral Services and Short- term or Emergency Housing Needs. - No. 07-02: Use of Ryan White HIV/AIDS Program Funds for HIV Diagnostics and Laboratory Tests - No.07-01: Use of Ryan White HIV/AIDS Program Funds for American Indians and Alaska Natives and Indian Health Service Programs - No. 07-04 Transitional Social Support and Primary Care Services for Incarcerated Persons. - No. 07-06— Use of Ryan White HIV/AIDS Program Funds for Outreach Services - No. 07-07 Use of Ryan White HIV/AIDS Program Funds for Veterans. MDCH/G&PD FY 14/15 Page 4 of 10 Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies HIV Prevention Services (Law) P.A. 488 of 1988, as amended by Act 200 of 1994, and Act 420 of 1994 (MCL 333.5133) (Law) P.A. 489 of 1988 (MCL333.5144a) (Law) PA. 86 of 1992 (MCL 333.5131) (Law) Public Health Code P.A. 368 of 1978 (as amended) FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Procedures - Quality Assurance Standards for HIV Prevention Interventions, May 2003 or subsequent revisions. - MDCH, Important Health Information, DCH 0675 (previously HP-143). - Michigan HIV Event System CTR and PCRS modules. - Recommended Guidance for Conducting Partner Counseling and Referral Services (PCRS) Application for categorically Funded Local Public Health Departments, MDCH, October 2006 - Local Health Department PCRS Patient Field Investigation Form DCH-1275 or subsequent revisions. - Addendum to PCRS Guidance: Useful HIV and STD Investigation Techniques, January 2007 - Information Based Testing Guidance, MDCH 2004. - Policy for Provision of HIV Test results Via Telephone. MDCH, October 2002. - Michigan HIV Laws; What Physicians and Other Health Care Providers Need to know. MDCH, January 2006. Confidential Request for Assistance with Partner Counseling and Referral Services Form (DCH -1221), or subsequent revisions. - MDCH Strategies to Improve Client Return Rates for Receiving HIV Test Results., May 2007, or subsequent revisions. State/Federal Manuals - Michigan HIV Event System CTR and Data definitions and data collection templates. - HIV Prevention Referral Guidelines and Toolbox MDCH, July 2007 - MDCH/HAPIS HIV Prevention Counseling Quality Assurance Toolbox, February, 2007 - MDCH Rapid HIV Testing Quality Assurance Manual, 2008 or subsequent revisions. MDCH/G&PD FY 14/15 Page 5 of 10 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/ Federal Manuals - MDCH-Protocol for HIV Counseling and Testing using Oral Mucosa! Transudate Technology, MDCH 2002. - CARF-MDCH Procedures for Completing the Client Authorization for Counselor Assisted Referral Form (CARF), August 2003, or any subsequent revisions. - Michigan Local Public Health Accreditation Standards: Section XII 2008, or subsequent revisions. - Protocol for Low Morbidity Health - Department Response to Request for Assistance with Disease Management, MDCH June 2006, or any subsequent revisions. - Recalcitrant Behaviors Among HIV/AIDS Diagnosed Populations: Guidance for Local Pubic Health Department Response to Health Threat to Other Situations, 2005 or any subsequent revisions. - CDC Integrated STD/HIV Partner Services Guidelines, June 2008 - MDCH Targeted partner Counseling and Referral Services for HIV-Infected Women, June 2008 or subsequent revisions HOPWA - MCL 112 of 1968, Fair Housing; 42 USC Section BOO, Fair Housing -42 USC 12901 The AIDS Housing Opportunity Act - 24 CFR Part 574 - 5; income verification 24 CFR part rification and subsidy calculation -The Lead-Based Paint Poisoning Prevention Act (42 the Residential Lead-Based U Paint Hazard Reduction 4821-4846), the Act of 1992 (42 U.S.C. part 4851-4856), and implementing regulations at pa 35, subparts A, B, H, J, K, M, and R of this part apply to activities under this program. - 24 CFR 82.306(d) receiving benefits when housed with a family member - The policies, guidelines, and requirements of 24 CFR part 85 (codified pursuant to OMB Circular No. A- 102) and 2 CFR Part 225 (OMB Circular No. A-87) apply with respect to the acceptance and use of funds under the program by States and units of general local government, including public agencies, and 2 CFR 215 (OMB Circular A-110) and 2 CFR Part 230 (OMB Circular A-122) apply with respect to the acceptance and use of funds under the program - Adhere to HUD documentation & program requirements - Annual Fiscal Year HOPWA Formula Operating Instructions and attachments. Issued y early. - MDCH INSTRUCTIONS FOR PREPARATION OF BUDGET FORMS (DCH-0385, DCH-0386) in Attachment III - Completion of MDCH FSR Form and FSR-Supplemental (FSR-S) form. with FSR - MDCH Instructions for the use of HMIS and completion of CAPER data entry. HUD Community Development Program (CPD) Grantee Monitoring Handbook; Chapters: 1 Introduction, 2 Management of Monitoring Activities, and 10 Housing Opportunities for Persons With AIDS (HOPWA). Be familiar with Chapter 20 Consolidated Plan. HUD Office of HIV/AIDS Housing HOPWA Grantee Oversight Resource Guide HOPWA Online Financial Management Training. Minimum of one current staff that has passed the training. MDCH/G&PD P( 14/15 age 0 o FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals by private non-profit entities. - 24 CFR part 91 the Consolidated Plan must incorporate listed HIV/AIDS housing strategy or HOPWA elements & Submit a CAPER annually - Section 504 of the Rehabilitation Act of 1973 ("Section 504), and Title El of the Americans with Disabilities Act of 1990 ("ADA"). - Notice CPD-06-06 Issued: May 15, 2006 Subject: Staff that complete Tenant Based Rental Assistance Habitabkil Inspections or HUS Insctioh must complete the online ead-based paint Visual Assessment Training Standards for Fiscal Year 2006 HOPWA Permanent Supportive Housing Renewal Grant Applications - Notice CPD-06-07 Issued August 3, 2006 Subject: Standards for HOPWA Short-term Rent, Mortgage, and Utility (STRMU) Payments and Connections to Permanent Housing - Frequently asked questions on HOPWA STRMU - NOTICE: CPD 04-10 Issued: September 29, 2004 SUBJECT: Guidelines for Ensuring Equal Treatment of Faith-based Organizations participating in the HOME, CDBG, HOPE 3, HOPWA, Emergency Shelter Grants, Shelter Plus Care, Supportive Housing, and Youth-build Programs - CAPER-Measuring Performance Outcomes OMB Number 2506-0133 Exp Date 10/31/2014 form HUD- 0401 10-D - HUD Notice of Outcome Performance Measurement System for CPD Formula Grant Programs [Docket No. FR-4970-N-02] - Fed Reg/Vol. 71, No. 45/Wednesday, March 8, 2006/Notices HOPWA - Guidance to State Agencies Regarding the Use of Funds Received Under the American Recovery and Reinvestment Act (AREA) - Meet terms of the Federal Funding Accountability and Transparency Act of 2006 (FFATA) see www.whitehouse.ciov/omb/open Immunization - (1) - (1) - WIC policy - Vaccines for Children - (Law) P.L. 99-660, revised by P.L. 103-183, The Preventive Health memorandum #2001 Operations Manual - Immunization Program Operations Manual (1P0M) Law of 1993, section - Vaccine Preventable 1928, Part IV and section 13631 Disease Reporting Manual - (Law) P.L. 99-660, The - VFC Resource Book for National Childhood Providers Vaccine Injury Act of 1986 - (Law) P.A. 540 of 1996 - (Law) Public Health Code P.A. 368 of 1978, as amended - (Law) P.A. 273 of 1996 MDCH/G&PD FY 14/15 Page 7 of 10 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Program/Element Laws/Administrative Rules Federal Regulations/Circulars Policies Procedures State/Federal Manuals - (Law) Act 491 of 1988 - (Rules) 325.176 Immunization — Reaching More Children and Adults - Guidance to State Agencies Regarding the Use of Funds Received Under the American Recovery and Reinvestment Act (ARRA) Healthy Homes - Lead Safe Home Program - (Law) Lead Abatement Actl - Lead Hazard Control Rules - Lead Safe Home Program Regional Field Consultant Policy and Procedures Field Guide Local Public Health Operations (LPHO) - (Law) Public Health Code P.A. 368 of 1978 (as amended) - (Law) P.A. 92 of 2000 - (Rules) R327.41 - R327.65 Infectious! Communicable Disease Control - (Law) Public Health Code P.A. 368 of 1978, 333.2433; Parts 51 and 52 - (Rules) 325.171 et. seq. Maternal Infant Health Program - (1) - (Law) Comprehensive Omnibus Reconciliation Act of 1985 (COBRA) - (Law) Omnibus Reconciliation Acts of 1987 and 1989 - (Law) OBRA 89 P.L. 101-239 (Amendment to Title V) - CI ) -2008 MI Medicaid Provider Manual Nutrition Services - (Law) Public Health Code P.A. 368 of 1978, MCL 333.2433 Pregnancy Test Related to Informed Consent to Abortion - (Law) Public Health Code P.A. 368 of 1978, MCL 333.17015 (18) Prenatal Care Clinic Services - (1) & (2) - (Law) OBRA 89 P.L. 101-239 (Amendment to Title V) - (Law) OBRA 90 - Law PA. 368, 1978 - (1) MDCH/G&PD FY 14/15 age a a FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals AIDS Section Public/Private Sewer - (Law) Public Health Code PA. 368 of 1978, as amended* - (Rules) R299.4101 et. seq. Public/Private Water Supply - (Law) Public Health Code P.A. 368 of 1978, as amended - (Rules) 325.2291 et, seq, - (Rules) 323.19691 et, seq, - (Rules) 325.11391 et, seq, Public Swimming Pool Inspections - (Law) Public Health Code P.A. 368 of 1978 - (Rules) 325.2111 et. seq. Sexual Violence Prevention (Law) Violence Against Women Act of 2005, TITLE 42, CHAPTER 6A, SUBCHAPTER It , Part J § 280b-1 c SMILE! Michigan Dental Sealant - SEALS Data Collection Software, SEAL American, SMILE! Michigan Dental Sealant User's Guide STD Control - (Rules) MDCH, Communicable & Related Diseases, by Authority of Sec. 5111 of Public Health Code 368 P.A. of 1978 (as amended), - (Rules) 325,1777 - CDC Integrated STD/H1V partner Services Guidelines, June 2008 - (Fed) Centers for Disease Control and Prevention Program Operations and Treatment Guidelines (Advisory Only) SIDS - (Law) Act 350 PA. of 1974 (MCL 52.205a) - (State) Sudden Infant Death Professional Services Manual - (State) SIDS Task Force Manual TB Control- DOT - Public Health Code 5203 & 5205 - (State) Core Curriculum MDCH/G&PD FY 14/15 Page 9 of 10 FY 14/15 COMPREHENSIVE AGREEMENT APPLICABLE LAWS, RULES, REGULATIONS, POLICIES, PROCEDURES AND MANUALS Policies Procedures Program/Element Laws/Administrative Rules Federal Regulations/Circulars State/Federal Manuals Vaccine Quality Assurance - Cl) - (Law) Public Health Code PA. 368 of 1978, Part 92 - (Law) Section 317 of the Public Health Service Act (42 U.S.C. 247b) as amended - (1 ) - 42 CFR, Part 51b, Sub Parts A & B: Project Grants for Preventive Health Services; General Provisions; Grants for Communicable Disease Control - Federal Register, Vol. 58, No. 63, April 5, 1993 Vision - (Law) P.A. 368, Sections R 325.13091-13096 - School Aid Act - State of Michigan Vision Screening Technician Manual WIC - (Law) Federal Public Law 95-627 (Reauthorized through P.L. 101-147 Pursuant to the Child Nutrition Act) - (Law) Section 17 of the Child Nutrition Act of 1966, as amended - (Law) Following Public Laws: 95-627, 96-499, 97-35, 99-500, 99-591, 100-237, 101-147, 102- 518, 107-249 (Reauthorized through P.L. 109-85 and P.L. 108-265) - 7 CFR, Part 246 and Part 3015 and 3016 - USDA Policy Memos - (MDCH/WIC Laboratory Procedure Manual (DCH 0476) - (State) WIC/MDCH - (State) WIC Policy and Procedure Manual (DCH- 0296) - (State) Vendor Unit Policy and Procedures Manual - (Fed) Food and Nutrition Service (FNS) Instructions 800-1 through 821-1 and 113-2 - (Fed) WIC Administrative Cost Handbook/Advance Planning Handbook - (Fed) Financial Management Handbook (FNS-154) WISEWOMAN - (Law) P.L. 101-354 of 1990 Title XV of Preventive Health Services Act (42 U.S.C. 201) - (Law) Public Health Code P.A. 368 of 1978, Part 95 - (Law) P.L. 105-340- Women' s Health Research and Prevention Amendments of 1998, - Dept. of HHS, CDC: Annual Announcements, Early Detection & Control of Breast & Cervical Cancer; Program Guidance, Instruction and Information - Breast & Cervical Cancer Amendment of 1993 Footnotes: * Applies to multiple programs/elements, specific sections of the Law are noted for some programs/elements. m Initially noted under General Administration, but applies to other programs noted. 2) Initially noted under MIHAS, but applies to other programs noted. 3) Initially noted under General Administration, but applies to all federally funded programs/elements. "Laws/Administrative Rules" column: (Law) signifies a Law, (Rule) signifies Administrative Rule. "State/Federal Manuals" column: (State) signifies a State Manual, (Fed) signifies a Federal Manual. MDCH/G&PD FY 14/15 Page 10 of 10 Version: Comprehensive MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 14/15 AGREEMENT ADDENDUM A 1. This addendum adds the following section to Part 1 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 [imitations 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. 2. This addendum modifies the following sections of Part 11, General Provisions: Part II I. Responsibilities-Contractor J. Software Compliance. This section will be deleted in its entirety and replaced with the following language: Version: Comprehensive The Michigan Department of Community Health and the County of Oakland will work together to identify and overcome potential data incompatibility problems. III. 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 Portability and Accountability Act. The provisions in this section shall be deleted in their entirety and replaced with the following language: Contractor agrees that it will comply with the Health Insurance Portability and Accountability Act of 1996, and the lawfully enacted and applicable Regulations promulgated 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. 2 RICK SNYDER GOVERNOR STATE OF MICHIGAN DEPARTMENT OF COMMUNITY HEALTH LANSING NICK LYON DIRECTOR Dear September 23, 2014 Enclosed please find two copies of the Agreement between the Michigan Department of Community Health and your laboratory. Please have both agreements signed. Keep one copy for your records and return the other to me at the address below. If you have any question please contact me at (517) 335-9653. Thank you. Sincerely, \(.e Valerie Reed, RM (NRCM), M(ASCP) Bureau of Laboratories Michigan Department of Community Health P.O. Box 30035. Lansing, MI 48909 E-mail: reedv@michioan.00v Phone: 517-335-9653 Fax: 517-335-9631 CAPITOL VIEW BUILDING • 201 TOVVNSEND STREET • LANSING, MI 48913 www.rnichigan.gov • 517-373-3740 DC1-1-12T2 (09/14) Sandi t5 Shah Laboratory Dire-cTor, MDCH Bureau of Laboratories Agreement Between Michigan Department of Community Health Bureau of Laboratories (Hereafter referred to as the "Department") And Oakland County Health Division Laboratory 1200 N. Telegraph, Building 32 E Pontiac, MI 48341 For Laboratory Response Network (LRN) Reference Laboratory For the Period of September 1, 2014 through August 31, 2015 This letter serves to designate the above Agency as an approved LRN Reference Laboratory. Sites within your agency, which have been designated, include the following: Oakland County Health Division Laboratory. By signature below, the Agency agrees to follow the attached requirements to maintain designation as a Department-approved LRN Reference Laboratory. FOR THE AGENCY: Print Name and Title of Administrator Date Signature of Administrator Date FOR THE, DEPARTMENT: - 2_2 -071 Date Michigan Laboratory Response Network (LRN) Reference Laboratory Responsibilities and Roles: 1. The scope of LRN testing responsibilities for the agency is at the LRN Reference Lab designation. 2. Perform testing of samples according to LRN procedures based on the LRN Qualifications listed for your facility. 3. Assign trained personnel to the Department or other Michigan LRN laboratory, temporarily, in the event of an emergency requiring surge capacity testing as needed. 4. Provide surge capacity for testing additional samples from the MDCH lab or other LRN Reference lab(s) as needed. 5. Develop and implement a system that allows clinical laboratories or the Department to contact your facility 24 hours a day/7 days per week. 6. Maintain a sufficient number of trained testing personnel to respond to a request for LRN confirmatory testing based on the LRN Qualifications listed for your facility. 7. Maintain established chain of custody procedures for testing and storing samples with potential law enforcement implications. 8. Using available BT funds, maintain an inventory of supplies and reagents sufficient to perform 25 culture and confirming identification tests for each agent listed on your LRN Qualification. 9. Using available BT funds, purchase pipette tips, reagents and other ancillary equipment as needed. 10. Keep current maintenance contracts on designated LRN testing equipment. 11. Document testing personnel competency assessment records on all staff trained to perform LRN protocol testing based on the LRN Qualifications listed for your facility. 12. Use software designated by the Department to report results to the origin of sample, local health agency and the Department in the event that a specimen becomes suspect during routine testing. The MDCH Laboratory Director will be notified immediately of any suspect results and before any positive results are reported. 13. Notify the Department of equipment, supply and personnel needs during annual bioterrorism planning. Funds made available to the agency by the Department are intended to support LRN activities only. 14. Follow a quality assurance program acceptable to the Department that will include: participation in a proficiency testing program supplied or designated by the Department, documentation of testing personnel training and competency, quality control, equipment maintenance and repair, adoption of LRN procedures as standards of operation, etc. 15. Perform and document scheduled user maintenance and calibrations of equipment and pipettors provided by the Department. 16. Provide a quarterly report of activities supported by the funds provided by the Department to BOL BT coordinator. 17. Maintain APHIS/Select Agent Program registration based on the LRN Qualifications listed for your facility. 18. Participate in Department-sponsored training; training participants to train other internal laboratory personnel. 19. Biosafety cabinet must be certified annually. 20. Participate in a CMS approved external proficiency testing program for bacterial isolation and identification. 21. Participate in CDC and DCH proficiency testing program based on the LRN Qualifications listed for your facility. Maintain acceptable performance in CDC and Department proficiency testing programs, i.e., 80% or above average in two consecutive challenges. 22. Provide to the Department, copies of the scores of CDC BT proficiency testing challenges with corrective action plans for any discrepancies. 23. Maintain current LRN Qualification information with the LRN on facility capacity, capability and contact information. 2014-2015 Department Responsibilities 1) Provide initial and refresher training, as needed, to the LRN laboratory on LRN procedures. 2) Provide proficiency testing samples to the LRN laboratory on a periodic basis. 3) Provide surge capacity to other LRN laboratories for testing additional samples as needed. 4) The Department is the LRN point of contact with federal, state and local law enforcement agencies. 5) The Department will act as lead in development of statewide LRN planning and application for federal funds. 6) Provide funding, as available, to agency to purchase reagents, supplies, and ancillary needs to support LRN approved testing. Termination 1) This Agreement may be terminated by either party by giving thirty (30) days prior written notice to the other party stating the reasons for teunination and the effective termination date. Possible events that could result in termination include but are not limited to: facility closure, decrease in funding, or failure to meet performance expectations. 2014-2015 2.12 Fraud Prevention 14 2.13 - Grant and Cooperative Agreements 15 2.14 - Risk Considerations 18 2.15 - Buy American Requirement Applicable to State Agencies 18 2.16 - WhistleBlower Protection 20 2.17 - Internet Sites 20 SECTION 3 - ACCOUNTING AND FINANCIAL REPORTING GUIDANCE 21 3.1 - General R*Stars Coding Requirements 21 3.2. Profile Creation And Submission 21 3.3 - D39 Profile Structure 21 3.4 - 053 Profile Structure 22 3.5 - Budgetary Transaction Procedures 22 3.6 - Agency Receiving ARRA Revenue from another Agency 22 3.7 - Federal Reporting 22 SECTION 4- APPENDICES 23 4.1 - AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (TITLE XV & XVI)23 TITLE XV--ACCOUNTABILITY AND TRANSPARENCY 23 Sec. 1501. Definitions. 23 SUBTITLE A--TRANSPARENCY AND OVERSIGHT REQUIREMENTS 23 Sec. 1511. Certifications 23 Sec. 1512. Reports On Use Of Funds. 23 Sec. 1513. Reports Of The Council Of Economic Advisers. 24 Sec. 1514. Inspector General Reviews. 25 Sec. 1515. Access Of Offices Of Inspector General To Certain Records And Employees, 25 SUBTITLE B--RECOVERY ACCOUNTABILITY AND TRANSPARENCY BOARD 25 Sec. 1521. Establishment Of The Recovery Accountability And Transparency Board, 26 Sec. 1522. Composition Of Board 26 Sec. 1523. Functions Of The Board. 26 Sec. 1524. Powers Of The Board. 28 Sec. 1525. Employment, Personnel, And Related Authorities 28 Sec. 1526. Board Website 29 Guidance to State Agencies Regarding Funds Received April 16,2009 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1527. Independence Of Inspectors General. 31 Sec. 1528. Coordination With The Comptroller General And State Auditors. 31 Sec. 1529. Authorization Of Appropriations. 31 Sec. 1530. Termination Of The Board. 31 SUBTITLE C—RECOVERY INDEPENDENT ADVISORY PANEL 31 Sec. 1541. Establishment Of Recovery Independent Advisory Panel. 31 Sec. 1542. Duties Of The Panel 32 Sec. 1543. Powers Of The Panel 32 Sec. 1544. Panel Personnel Matters 32 Sec. 1645. Termination Of The PaneL 33 Sec. 1546. Authorization Of Appropriations. 33 SUBTITLE D--ADDITIONAL ACCOUNTABILITY AND TRANSPARENCY REQUIREMENTS 33 Sec. 1551. Authority To Establish Separate Funding Accounts. 33 Sec. 1552. Set-Aside For State And Local Government Reporting And Recordkeeping 33 Sec. 1553. Protecting State And Local Government And Contractor Whistleblowers, 34 See. 1554. Special Contracting Provisions. 39 TITLE XVI--GENERAL PROVISIONS—THIS ACT 39 Guidance to State Agencies Regarding Funds Received Apr1116, 2009 Under the American Recovery and Reinvestment Act (ARRA) BACKGROUND On Tuesday, February 17, 2009, President Obama signed into law the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5 (ARRA). This Act provided $787 billion of federally financed economic stimulus funding through a combination of spending programs and reductions in business and individual taxes, The ARRA funds are provided for purposes which include preserving and creating jobs and promoting economic recovery; assisting those most impacted by the recession; investing in transportation, environmental protection, and other infrastructure to provide long-term economic benefits; and stabilizing state and local government budgets. The State of Michigan will receive hundreds of millions of dollars of ARRA funds. Governor Granholm has identified five key priorities for spending Michigan's share of the economic recovery dollars. We will: • Create new jobs and jump start Michigan's economy; • Train Michigan workers and educate Michigan students for the good jobs here today, and the new jobs we create tomorrow; • Rebuild Michigan infrastructure—roads, bridges, water and sewer systems, mass transit, broadband, health information technology, and schools; • Provide assistance for struggling Michigan families, helping them make ends meet; and • Invest in energy efficiency and renewable energy technologies to create jobs, save money, and reduce our reliance on fossil fuels. Michigan has been selected as one of sixteen states to be part of a core group of states that will be monitored over the next three years to provide an analysis of the use of funds under the ARRA. PURPOSE The purpose of this correspondence is to give some preliminary guidance to State Agencies regarding the use of ARRA funds, including contractual and grant requirements and accounting and financial reporting requirements. State agencies will continue to adhere to the existing state procurement guidelines including the Public Acts, Executive Directives, Administrative Guides, and the Financial Management Guide. These requirements and considerations also apply to those contract types which are currently handled by the agency through statutory authority or Administrative Guide delegation (i.e. grants, direct human services, medical services, construction, MOOT, DNR leases, etc.), In addition, the ARRA has some specific contractual, grant, and reporting requirements that are outlined in 'Title XV Accountability and Transparency & Title XVI General Provisions' of the Act. This document will be updated as necessary. Guidance provided herein is not intended to be exhaustive and the agency will have responsibility to research these two titles for complete detail. Guidance to State Agencies Regarding Funds Received April 16, 2009 4 Under the American Recovery and Reinvestment Act (ARRA) INTRODUCTION All contracts and grants Involving the use of funds made available under the American Recovery and Reinvestment Act (ARRA) must include provisions described in the ARRA, in addition to the standard terms and conditions typically used by state agencies for contracts, grants, and other types of agreements involving the use of federal funds. Our task will be to administer contracts that include the reporting tools, monitoring procedures, and accountability requirements that will help prevent fraud, waste, and abuse of these funds. Agencies should put in place the internal controls that will support the requirements of ensuring that the ARRA funds are spent properly, efficiently, and effectively, and are meeting the intended goal This will require that these contracts are overseen by an adequate number of trained purchasing and grant personnel. In light of the Administration's commitment to high levels of accountability and transparency, special attention should be given to maintaining strong internal controls over ARRA program funds. The high risk associated with the award and expenditure of ARRA program funds merits increased oversight by the agency. Much of the guidance provided herein comes from the Federal Office of Management and Budget guidance and requirements to Federal Agencies (M-09-15, April 3, 2009) and the Federal Registry Vol. 74 Rules and Regulations (March 31, 2009, pages 14622-14651). We expect that Federal guidance and requirements to federal agencies will trickle down to first tier recipients of the ARRA funds. We encourage State Agencies to become familiar with the details of these requirements. Guidance to State Agencies Regarding Funds Received April 16, 2009 Under the American Recovery and Reinvestment Act (ARRA) SECTION 1 — CONTRACT AND GRANT TERMS AND REQUIREMENTS All contracts, both new and existing, involving the use of ARRA funds must include provisions like those set forth in this Section. As used in this Section, "Recipient" refers to the recipient of ARRA funds from the State of Michigan (i.e. the contractor or grantee). 1.1 - Buy Michigan Preference A preference is given to products manufactured or services offered by Michigan- based firms if all other things are equal and if not inconsistent with federal statute (see MCL 18.1251). 1.2 - Buy American Requirement The Buy American provision in Section 1605 of Division A, Title XVI of the ARRA requires that all "iron, steel and manufactured goods used in the construction, alteration, maintenance or repair of a "public building or public work funded in whole or in part by funds made available under the ARRA be "produced in the United States," unless this requirement is waived by the appropriate federal agency. iron and steel are "produced in the United States" if all of the manufacturing processes, except metallurgic processes involving refinement of steel additives, take place in the United States. Iron or steel used as components or subcomponents of manufactured goods used in an ARRA-funded project, however, do not have to be "produced in the United States." Manufactured goods are "produced in the United States" if the manufacturing occurs in the United States (there is no requirement about the origin of the components or subcomponents of the manufactured goods). The Buy American requirement may be waived by federal agencies in the following circumstances only: (1) application of the Buy American requirement would be Inconsistent with the public interest; (2) iron, steel and the relevant manufactured goods are not produced in the United States in sufficient and reasonably available quantities and of a satisfactory quality; (3) or inclusion of iron, steel or manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent. As used in this Section, "steel" means any alloy that includes at least 50 percent iron, between .02 and 2 percent carbon, and may include other elements. "Manufactured good" means a good brought to the construction site for incorporation into the building or work that has been -- (1) processed into a specific form and shape; or (2) combined with other raw material that has different properties than the properties of individual raw materials. "Public building or public work" means a public building of, and a public work of, the United States; the District of Columbia; commonwealths, territories, and minor outlying islands of the United States; State and local governments; and multi-State regional or interstate entities which have governmental functions). Guidance to State Agencies Regarding Funds Received April 16. 2009 Under the American Recovery and Reinvestment Act (ARRA) 1.3 - Whistieblower Protections Section 1663 of Title XV of Division A of the ARRA prohibits all non-federal recipients of ARRA funds, including the State of Michigan, and all contractors and grantees of the State of Michigan, from discharging, demoting or otherwise discriminating against an employee for disclosures by the employee that the employee reasonably believes are evidenceof (1) gross mismanagement of a contract or grant relating to ARRA funds; (2) a gross waste of ARRA funds; (3) a substantial and specific danger to public health or safety related to the implementation or use of ARRA funds; (4) an abuse of authority related to implementation or use of ARRA funds; or (5) a violation of law, rule, or regulation related to an agency contract (including the competition for or negotiation of a contract) or grant, awarded or issued relating to ARRA funds. The Recipient must post notice of the rights and remedies available to employees under Section 1553 of Title XV of Division A of the ARRA. This term must be included in all subcontracts or sub-grants involving the use of funds made available under the ARRA. 1.4 - Wage Requirements All laborers and mechanics employed by contractors and subcontractors on projects funded in whole or in part with funds available under the ARRA shall be paid wages at rates not less than those prevailing on projects of a character similar in the locality, as determined by the United States Secretary of Labor in accordance with subchapter IV of chapter 31 of title 40 of the United States Code. (See ARRA Sec, 1606 & RFP Section 2.204 Prevailing Wage), The Secretary of Labors determination regarding the prevailing wages applicable in Michigan is available at ,http://www.opo.govidavisbacon/mi.html. 1.5 - Publicizing Contract Actions All contract solicitations funded in whole or in part with ARRA funds will be posted on the www.bid4michigan.com website. All contracts resulting from the ARRA will be published on the State of Michigan's Recovery Web site, www_mislikiaanagyjmegvery. 1.6 - Reporting Requirements Not later than ten calendar days after the end of each calendar quarter, the State must submit a report that, at a minimum, contains the information specified in Section 1612 of Division A, Title XV of the ARRA. It is imperative all contracts involving the use of ARRA funds include requirements that the Vendor supply the State with the necessary information to submit these reports to the federal government (see RFP Section 1.042 Reports) in a timely manner. More detail will follow regarding the timing and submission of reports. The Recipient's failure to provide complete, accurate, and timely reports shall constitute an "Event of Default". Upon the occurrence of an Event of Default, the Guidance to State Agencies Regarding Funds Received Aptil 16,2009 7 Under the American Recovery and Reinvestment Act (ARRA) state department or agency may terminate this contract upon 30 days prior written notice if the default remains uncured within five calendar days following the last day of the calendar quarter, in addition to any other remedy available to the state department or agency in law or equity. 1.7 - Inspection of Records The Recipient shall permit the United States Comptroller General or his representative or the appropriate inspector general appointed under section 3 or 8G of the Inspector General Act of 1998 or his representative (1) to examine any records that directly pertain to, and involve transactions relating to, this contract; and (2) to interview any officer or employee of the Recipient or any of its subcontractors/subgrantees regarding the activities funded with funds appropriated or otherwise made available by the ARRA. 1.8 - Availability of Funding The Recipient acknowledges that the programs supported with temporary federal funds made available by the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, will not be continued with state financed appropriations once the temporary federal funds are expended. 1.9 - Non-Discrimination The Recipient shall comply with Title VI of the Civil Rights Act of 1964, Section 504 of the Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, the Age Discrimination Act of 1975, and other civil rights laws applicable to recipients of Federal financial assistance (see RFP Section 2.201 Non-Discrimination). 1.10 - Prohibition on Use of Funds None of the funds made available under this contract may be used for any casino or other gambling establishment, aquarium, zoo, golf course, swimming pools, or similar projects. 1.11 - Publications Recipient shall include the Michigan Recovery logo on all signage or other publications in connection with the activities funded by the state of Michigan through funds made available by the American Recovery and Reinvestment Act of 2009, Pub. L. 1.12 - False Claims Act The Recipient shall promptly refer to an appropriate federal inspector general any credible evidence that a principal, employee, agent, contractor, sub-grantee, subcontractor or other person has committed a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds. Guidance to State Agencies Regarding Funds Received April 16,2009 Under the American Recovery and Reirsvestrnent Act (ARRA) 1.13 - Conflicting Requirement If the ARRA requirements conflict with State of Michigan requirements, then ARRA requirements control. 1,14 Sub-Recipient Requirements Recipient shall include these terms, including this requirement, in any of its subcontracts or subgrants in connection with projects funded in whole or in part with funds available under the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5. 1.15 - Competitive Fixed Price Contracts Recipient, to the maximum extent possible, shall award any subcontracts funded, in whole or in part, with Recovery Act funds as fixed-price contracts through the use of competitive procedures. 1.16 - Segregation of Funds Recipient shall segregate obligations and expenditures of Recovery Act funds from other funding. No part of funds made available under the American Recovery and Reinvestment Act of 2009, Pub. L. 111-5, may be comingled with any other funds or used for a purpose other than that of making payments for costs allowable under the ARRA. 1.17 . Job Opportunity Posting Requirements Recipient shall post notice of job opportunities created in connection with activities funded in whole or in part with ARRA funds in the Michigan Talent Bank, vvww. michworks. orgimtb. Guidance to State Agencies Regarding Funds Received April 16, 2099 9 Under the American Recovery and Reinvestment Aot (ARRA) SECTION 2- COMPLIANCE AND CONTRACT MANAGEMENT: This Section provides guidance to state agencies on Compliance and Contract Management in connection with funds made available under the ARRA. As used in this Section, "Recipient" refers to the recipient of ARRA funds from the State of Michigan (Le. the contractor or grantee). 2.1 General Planning and Process In addition to any applicable state or federal procurement requirements, state agencies and Recipients, to the maximum extent possible, shall award any contracts funded, in whole or in part, with ARRA funds with the following provisions; 1. Fixed-price contracts whenever possible. Fixed price contracts can accommodate market fluctuations when appropriate, when tied to economic index price adjustments. 2. Competitive bidding with fair and open competition. Agencies are expected to follow the same laws, principles, policy, and procedures in awarding ARRA contracts as they do in awarding with other funds. (See PA 431 - 18.1261 (3), Administrative Guide 0510,02 & 0510.32, and Executive Directive 2005-3.) 3. A summary of any contract or order (or modification to an existing contract or order), including a description of the required products and services, using such funds may be posted in a special section of the Web site Recovery,gov or Michigan.govirecovery unless the contract or order is both fixed-price and competitively awarded (see item 1 & 2 above). 4. State agencies and sub-recipients of ARRA funds shall use ARRA funds in a manner that maximizes job creation and economic growth. 5. Statement of Work development should ensure that performance measures are meaningful, measurable, time bound, results-oriented, and consistent with agency plans and the goals of the ARRA, 6. Contract terms should address the failure to complete the project, meet milestones or deliver the deliverables. 7. Planning should involve mitigating schedule, cost, and performance risk (see Risk Assessment Report & Worksheet in the DIVIB Purchasing Operations Intranet ARRA toolklt). 8. If applicable, terms should include special Buy American requirements (see Division A, Title XVI, Section 1605 of the ARRA). 9. Requirements should assure that all sub-recipients of ARRA funds can report essential information as may be required under the ARRA, 2.2 - Determination of Responsibility The award of a contract based solely on lowest evaluated price can produce a false economy, thus increasing performance, cost, and schedule risk. The general standards for responsibility include that the prospective contractor have: 1. Adequate financial resources to perform the contract or the ability to obtain them; Guidance to State Agencies Regarding Funds Received Aixil 16,2009 10 Under Me American Recovery and Reinvestment Act (ARRA) 2. The ability to comply with the required or proposed delivery or performance schedule, taking into consideration all existing commercial and governmental business commitments; 3. A satisfactory record of past performance, integrity, and business ethics; 4, The necessary organization, experience, accounting and operational controls, and technical skills, or the ability to obtain them; and 5. The necessary production, construction, and technical equipment and facilities, or the ability to obtain them. 2.3 - Delegated Authority There will be no 'Delegated Authority" (to SOM agencies) for ARRA-related contracts. Regardless of value, all purchase requests must be submitted to the DMB Purchasing Operations. There will be restrictions on the use of direct vouchers, and other controls will be in place to ensure that all ARRA-related payments can be "identified" to ARRA contracts. Requests for direct vouchers must be preapproved by DMB Purchasing Operations. There will be monitoring of SOM agencies ADPICS transactions for potential ARRA-related payments on contracts not previously approved by DMB Purchasing Operations/State Administrative Board. More details on the process and procedures will be forthcoming. This restriction does not apply to those contract types which are currently handled by the agency through statutory authority or Administrative Guide delegation (i.e. grants, direct human services, medical services, construction, MOOT, DNR leases, etc.), 24 - Contract Surveillance/Administration Contract surveillance and administration will be a critical component to the successful tracking of ARRA expenditures and monitoring of deliverables. The DMB buyer will continue to fill the role of Contract Administrator for DMB contracts. The Agency appointed Contract Compliance Inspectors (CCI) should be carefully chosen for their knowledge of the program, proximity to the deliverables and experience with the project. The CCI will play an important role in the day-to-day surveillance and supervision of the contract including: 1. Approving payments, 2. Documenting timely vendor performance issues, 3. Monitoring contract compliance, cost, schedules and deliverables, 4. Completing a vendor rating and contract closeout, 5. Documenting timely inspections and acceptance of deliverables, 6. Identify and help remedy deficiencies identified related to contract performance. The agency should ensure that these persons have clear guidance as to their roles and responsibilities and that there is adequate training before assigning these roles. You will find the following tools on the DMB intranet, in the ARRA toolkit, to assist with contract administration and contract monitoring: Guidance to State Agencies Regarding Funds Received April 16, 2069 11 Under the American Recovery and Reinvestment Act (ARRA) I , Risk Assessment Report & Worksheet 2. Kick-Off Meeting Record 3. Contract Compliance Report 4, Vendor Scorecard 5. Contract Closeout Report 2.5 - Emergency Purchases Agencies are cautioned that the ARRA does not independently trigger use of emergency procurement authorities in Administrative Guide 0510.38. These authorities are triggered in limited, statutorily identified, circumstances. Unless one of these circumstances exists, the special emergency authorities shall not be used. 2.6 - Reporting Procurement officers will need to be able to report data and statistics on the following: 1. All competitively bid contracts 2. Non-competitive contract awards 3. Contract types & type of projects 4. The recipients of contracts 5. Amount of awards Section 1512 of the ARRA requires reporting on the following: 1. The total amount of ARRA funds received by the Recipient/Contractor/Grantee during the Reporting Period; 2. The amount of ARRA funds that were expended or obligated during the Reporting Period; 3. A detailed list of all projects or activities for which ARRA funds were expending or obligated, including: a) the name of the project or activity; b) a description of the project or activity; c) an evaluation of the completion status of the project or activity; and d) an estimate of the number of jobs created and the number of jobs retained by the project or activity; 4. For any subcontracts or subgrants equal to or greater than $25,000: a) The name of the entity receiving the subaward; b) The amount of the subaward; c) The transaction type; d) The North American Industry Classification System (NAICS) code or Catalog of Federal Domestic Assistance (CFDA) number; e) Program source; f) An award title descriptive of the purpose of each funding action; g) The location of the entity receiving the subaward; h) The primary location of the subawand, including the city, state, congressional district and country; and i) A unique identifier of the entity receiving the subaward and the parent entity of the recipient, should the entity be owned by another. GuidanCe to State Agencies Regarding Funds Received April 16, 2009 12 Under the American Recovery and Reinvestment Act (ARRA) 5. For any subcontracts or subgrants of less than $25,000 or to individuals, the information required in (4) (a)-(i) may be reported in the aggregate. a) The certification of an authorized officer of the Recipient/Contractor/Grantee that the information contained in the report is accurate; and 6. Any other information reasonably requested by the Contract Manager/Grant Manager or required by state or federal law or regulation. Besides these reports, the Government Accountability Office (GOA) is required to conduct bimonthly reviews and prepare reports on such reviews on the use by selected states and localities of funds made available in the ARRA. The ARRA does not specify the criteria by which the states and localities will be selected. The reports are to be available online. For additional details about the 'Reporting' requirements, see the Section 1512 of the ARRA and Federal Register, Volume 74, Number 61 available at: hftp://vvww.fta.dotgov/clocuments/040409 OMB Cmt Request 1512 data specs(1 Further guidance regarding the specific data element as well as the method for submission of the information will be provided as soon as it becomes available. 2.7 - Segregation of Costs Obligations and expenditures of ARRA funds must be segregated from other funding. No part of ARRA funds may be comingled with any other funds or used for a purpose other than that of making payments for costs allowable under the ARRA. Refer to section 3 for specific guidance on accounting and financial reporting requirements. The Purchase Request Form (PRF) and the Administrative Bid Tab will have a check box added to designate which contracts are using ARRA funds, in whole or in park These ARRA-funded projects that must receive State Administrative Board approval will be considered on a separate State Administrative Board agenda. 2.8 Government Accountability Office/Inspector General Access The Civilian Agency Acquisition Council and the Defense Acquisition Regulations Council (Councils) are issuing an interim rule amending the Federal Acquisition Regulation (FAR) to implement Sections 902, 1514, and 1515 of the American Recovery and Reinvestment Act of 2009. Collectively, these Sections provide for the audit and review of both contracts and subcontracts, and the ability to interview such contractor and subcontractor personnel under contracts containing Recovery Act funds. For the Comptroller General these alternate clauses provide specific authority to audit contracts and subcontracts and to interview contractor and subcontractor employees under contracts using Recovery Act funds. Agency inspector generals receive the same authorities, with the exception of interviewing subcontractor employees. Guidance to State Agencies Regarding Funds Received April 16, 2003 13 Under the American Recovery and Reinvestment Act (ARFtA) For full details of the 'Government Accountability Office & Inspector General Access' requirements, see the Federal Registry Vol. 74 Rules and Regulations (March 31, 2009, pages 14646-14649), 2.9 - Ethics It is critical that transparency and integrity are a cornerstone of this process. The risk of fraud and abuse grows when the distribution of millions of dollars is mixed with new programs, new requirements, and new staffing. DMB Purchasing Operations has reformatted the Confidentiality Statement and the Conflict of Interest and Disclosure Forms to add more accountability. 2.10 Michigan Economic Recovery Office Notification Agencies should forward all Requests for Proposals (RFP), Invitations to Bid (ITB), or similar solicitations to the Michigan Economic Recovery Office for review at least three days prior to releasing them to the pubic. Agencies may-go ahead and release/post the document if they have not heard back from the Michigan Economic Recovery Office on the third day after notification. 2.11 - Notice Requirements under PA 7 of 2009 Section 203 of the bill provides for an automatic appropriation of any additional Recovery Act funds available to the state through the redistribution provisions of the Recovery Act, If your department receives additional funds under the Recovery Act as a result of these redistribution provisions, the department must report to the senate and house standing committees on appropriations subcommittee, senate and house fiscal agencies, state budget director and the Governor on the amount of the funds received and the purposes for which they will be spent within 30 days of receiving the funds. If your department is distributing funds received under the Recovery Act through a competitive grant process, you must notify the senate and house of representatives standing committees on appropriations, senate and house fiscal agencies, and state budget office at least one day prior to the issuance of the request for proposals. Please include the Michigan Economic Recovery Office on this notice. 2.12 Fraud Prevention By establishing an effective fraud prevention program, agencies can provide reasonable assurance that ARRA funds benefit intended recipients. A well-designed fraud prevention program will minimize waste and abuse and should consist of preventive controls, detection, monitoring, investigations, and prosecutions. These controls prevent ineligible individuals and questionable firms from gaining access to government funds in the first place. Most recently, in February 2009, the National Procurement Fraud Task Force (NPFTF) published a white paper (A Guide to Grant Oversight and Best Practices for Combating Grant Fraud, Washington, D.C.: February, 2009) that identified best practices and made recommendations for agencies to consider in preventing fraud, Guidance to State Agencies Regarding Funds Received April 16,2009 14 Under the American Recovery and Reinvestment Aot (ARRA) waste, and abuse In grants they administer. These recommendations included enhanced certifications, increased training, improved communications with grant recipients, increased information sharing concerning potential fraud, and rigorous oversight of how grant dollars are spent after they are awarded. We recommend you access and read that report. 2,13 - Grant and Cooperative Agreements The passage of the American Recovery and Reinvestment Act of 2009 (ARRA) changed the way the State of Michigan will report information to the Federal Government related to grants. As a result, grant agreements must require recipients and sub-recipients to: 1. Maintain current registrations in the Central Contractor Registration (CCR) database, http://www.ccr ,gov/ 2. Report quarterly on project activity status (further defined in Section 4.7), in addition to any reporting requirements that currently apply to recipients of federal funds; 3. Follow Buy American guidelines (section 1605 of ARRA and section 1.10 of this document) 4. Implement wage rate requirements (section 1606 of ARRA and section 1.5 of this document) 5. Ensure proper accounting and reporting of ARRA expenditures in Single Audits Grant agreements must also include any terms needed to implement agency/program specific provisions and general provisions of ARRA. For complete details of the "Grants and Cooperative Agreements" requirements, see the Federal Office of Management & Budget guidance letter of April 3, 2009 (M- 09-15), Section 5 and Appendix 9. http://www.recoverv.qov/sites/defaultifiles/m09- 15.ødf We have included some excerpts pertinent to grant requirements: "5.1 Are there actions, beyond standard practice, that agencies must take while planning for competitive and formula grant awards under Recovery Act? Yes. (1) Determining Grant Objectives and Evaluation Criteria for Award Agencies should structure grants to result in meaningful and measurable outcomes that are consistent with agency plans and that promote the goals of the Recovery Act, The evaluation criteria for award should include those that bear on the measurement and likelihood of achieving these outcomes, such as jobs creation and preservation. (2) Competition Although the Recovery Act calls on agencies to commence expenditures and activities as quickly as possible consistent with prudent management, this Guidance to State Agencies Regarding Funds Received April 16, 2059 15 Under the American Recovery and Reinvestment Act (ARM) statement, by itself, does not constitute a sufficient justification to support award of a federal grant on a non-competitive basis. Agencies are expected to follow the same laws, principles, procedures, and practices in awarding discretionary grants with Recovery Act funds as they do with other funds. Agencies should review their internal policies with a goal towards promoting competition to the maximum extent practicable. In conducting this review, agencies may want to consider the appropriateness of limited competitions among existing high- performing projects versus full and open competitions. (3) Existing Grants Ultimately, agencies must determine what award method(s) will allow recipients to commence expenditures and activities as quickly as possible consistent with prudent management and statutory requirements. Agencies may consider obligating funds provided under the Recovery Act on an existing grant, including, but not limited to, a continuation or renewal grant. Because Recovery Act funds must be tracked and accounted for separately, supplements to existing agreements are not recommended as there is a greater risk that the grant recipient will be unable to track and report Recovery Act funds separately. Also, agreements must spell out the assignment of agency roles and responsibilities to fulfill the unique requirements of the Recovery Act. These include, but are not limited to, report development and submission, accurate and timely data reporting, and special posting requirements to agency Web sites and Recovery.gov. (4) Timeliness of Awards Agencies need to assess existing processes for awarding formula allocations and announcing, evaluating and awarding discretionary grant opportunities to comport with the objective to make awards timely. 5.4 Are Federal agencies expected to initiate additional oversight requirements for grants, such as mandatory field visits or additional case examinations for error measurements, to comply with grant rules and regulations? Yes, Agencies must take steps, beyond standard practice, to initiate additional oversight mechanisms in order to mitigate the unique implementation risks of the Recovery Act At a minimum, agencies should be prepared to evaluate and demonstrate the effectiveness of standard monitoring and oversight practices. (1) Performance Management and Accountability Agencies must adapt current performance evaluation and review processes to include the ability to report periodically on completion status of the program or activity, and program and economic outcomes, consistent with Recovery Act requirements. Guidance to State Agencies Regarding Funds Received Aptil 16, 2009 16 Under the American Recovery and Reinvestment Act (ARRA) Agencies, in consultation with the Inspectors General, shall establish procedures to validate the accuracy of information submitted on a statistical basis and/or risk based approach as approved by OMB, (2) Internal Controls Assessment Consistent with normal practices, agencies must use appropriate internal control assessments to assess the risk of program waste, fraud, and/or abuse. Using the aforementioned risk assessments, agencies must have defined strategies, developed with input from the Inspector General for the agency, to prevent or timely detect waste, fraud, or abuse. Also, consistent with Section 3 of this Guidance, agencies should initiate additional measures, as appropriate, to address higher risk areas, 6,9 Are there terms and conditions, beyond standard practice, that must be included in competitive and formula grant agreements under the Recovery Act? Agencies must: • Use the agency's standard award terms and conditions on award notices, where applicable, unless they conflict with the requirements of the Recovery Act, in the case where the Recovery Act requirement conflicts with an agency's standard award term or condition, the agency's award term or condition should be modified, as necessary, to ensure compliance with the Recovery Act requirement. Ensure other award terms needed to implement the agency/program-specific provisions and general provisions of the Recovery Act are included on awards. Note that OMB has issued standard award terms for agencies to use in implementing Sections 1512, 1605 and 1606 for grants, cooperative agreements, and loans. Agencies must ensure that they use any terms and conditions that implement other Recovery Act provisions, where applicable and as appropriate, such provisions in Sections 1511, 1515, 1653, 1604, and 1609, • Ensure that there is an award term or condition requiring first tier sub- awardees to begin planning activities, including obtaining a DUNS number (or updating the existing DUNS record), and registering with the Central Contractor Registration (CCR). Prime recipients and Federal agencies must establish mechanisms to meet Recovery Act data collection requirements. Agencies should work with prime recipients to ensure that DUNS and CCR requirements for first tier sub-awardees are met no later than the first time Recovery Act data requirements are due. • Make clear that that any funding provided through the Recovery Act is one- time funding. Guidance to State Agencies Regarding Funds Received April 16, 2009 17 Under the American Recovery and Reinvestment At (ARRAY Include the requirement that each grantee or sub-grantee awarded funds made available under the Recovery Act shall promptly refer to an appropriate inspector general any credible evidence that a principal, employee, agent, contractor, sub-grantee, subcontractor, or other person has submitted a false claim under the False Claims Act or has committed a criminal or civil violation of laws pertaining to fraud, conflict of interest, bribery, gratuity, or similar misconduct involving those funds." 2.14 Risk Considerations Risk identification and mitigation is a critical component to the contract process. For complete details of the "Governance, Risk Management and Program Integrity' requirements, see the Federal Office of Management & Budget guidance letter of April 3, 2009 (M-09-15), Section 3 and Appendix 4. We encourage you to read the entire context of those sections to learn how to better identify and mitigate risks associated with grant funds. The following acquisition process questions should prove helpful. 1. Do new Requests for Proposals issued under Recovery Act initiatives contain the necessary language to satisfy the requirements of the Recovery Act? 2. Are contracts awarded in a prompt, fair, and reasonable manner? 3. Do new contracts using Recovery Act funds have the specific terms required? 4. Are contracts awarded using Recovery Act funds transparent to the public? Are the public benefits of the funds used under these contracts reported clearly, accurately and in a timely manner? 5. Are funds used for authorized purposes and the potential for fraud, waste, error, and abuse minimized and/or mitigated? 6. Do projects funded under the Recovery Act avoid unnecessary delays and cost overruns? 7. Are there any performance issues identified with regard to (potential) contractor? Are there follow up actions to address the performance issues? 2.15 Buy American Requirement Applicable to State Agencies The Buy American provision in Section 1606 of Division A, Title XVI of the ARRA requires that all "iron, steel and manufactured goods used in the construction, alteration, maintenance or repair of a "public building or public work funded in whole or in part by funds made available under the ARRA be "produced in the United States," unless this requirement is waived by the appropriate federal agency. Iron and steel are "produced in the United States" if all of the manufacturing processes, except metallurgic processes involving refinement of steel additives, take place in the United States. Iron or steel used as components or subcomponents of manufactured goods used in an ARRA-funded project, however, do not have to be "produced in the United States." Manufactured goods are "produced in the United States" if the manufacturing occurs in the United States (there is no requirement about the origin of the components or subcomponents of the manufactured goods). Guidance to State Agencies Regarding Funds Received April 16, 20139 18 Under the American Recovery and Reinvestment Act (ARM) The ARRA also provides that the Buy American requirement in Section 1605 "shall be applied in a manner consistent with United States obligations under international agreements." As a practical matter, this means that, for procurement under state construction contracts valued at $7,443,000 or more, iron, steel, and manufactured goods may be purchased if they are produced in the United States or produced in any of the following countries: Aruba, Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hong Kong, Hungary, Iceland, Ireland, Israel, Italy, Japan, Korea (Republic of), Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Singapore, Slovak Republic, Slovenia, Spain, Sweden, Switzerland, United Kingdom, Australia, or Chile. The "exception" to the Buy American requirement for obligations under international agreements does not apply to dredging, the restrictions attached to federal funds to states for mass transit and highway projects, or the purchase of construction grade steel, motor vehicles or coal. Consequently, if using ARM funds in connection with these activities or for construction grade steel, motor vehicles or coal, only items produced in the United States may be procured. The Buy American requirement may be waived by Federal agencies in the following circumstances only: (1) application of the Buy American requirement would be inconsistent with the public interest; (2) iron, steel and the relevant manufactured goods are not produced in the United States in sufficient and reasonably available quantities and of a satisfactory quality; (3) or inclusion of iron, steel or manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent. Requests for waivers must be submitted before funds are awarded by a federal agency or obligated by the state. The process for requesting a waiver of the Buy American requirements, including information that must be provided to federal agencies in support of a request for a waiver, is described on pages 139-141 of the federal Office of Management and Budget's April 3, 2009 guidance. As used in this Section, "steel" means any alloy that includes at least 50 percent iron, between .02 and 2 percent carbon, and may include other elements. "Manufactured good" means a good brought to the construction site for incorporation into the building or work that has been -- (1) processed into a specific form and shape; or (2) combined with other raw material that has different properties than the properties of individual raw materials. "Public building or public work" means a public building of, and a public work of, the United States; the District of Columbia; commonwealths, territories, and minor outlying islands of the United States; State and local governments; and multi-State regional or interstate entities which have governmental functions). Guidance to State Agencies Regarding Funds Received April 16, 2009 19 Under the American Recovery and Reinvestment Act (ARRA) 2.16 - WhistleBlower Protection All state agencies must post notice of the rights and remedies available to employees under Section 1553 of the ARIA. (For the Michigan Civil Service Whistle Blowers Rule 2-10 link to: http://www.michigan.gov/mdcs/041607,7-147-6877 8155-72500—,00.html) 2.17 - Internet Sites The following links may be helpful to your staff: The fastest and easiest way to obtain copies of GAO documents at no cost is through GAO's Web site (www.gao,gov), Each weekday afternoon, GAO posts on its Web site newly released reports, testimony, and correspondence. To have GAO e-mail you a list of newly posted products, go to www.gaagov and select "E-mail Updates." Michigan Recovery site - http://www.michigan.govirecovery Federal Recovery site - http://www.recoverv.gov/ NASPO Recovery site - http://www.naspo.org/content.cfm/id/stimulus Council of State Governments ARRA Web site - hffp://www.staterecoverv.org/ The American Recovery and Reinvestment Act - ht.ipi/JvAw_rwacpiemoyent/act OMB Guidance Memo (2/1712009): http://www.naspcxorg/documents/initial omb guidance 090218.pdf OMB Guidance Memo (04/03/2009): hffp://www.whitehousegov/omb/assets/memoranda fv2009/m09-15.pdf Access to the Federal Register htt : /ww_s_j_m oacgavl DMB Intranet site - hffp://connect. michigan.gov/portal/site/dmb/ Guidance to State Agencies Regarding Funds Received AA 16, 2009 20 Under the American Recovery and Reinvestment Act (ARRA) SECTION 3- ACCOUNTING AND FINANCIAL REPORTING GUIDANCE No part of ARRA funds may be comingled with any other funds or used for a purpose other than that of making payments for costs allowable under the ARRA. To assist in tracking and keeping ARRA funds separate from non-ARRA funds, the following steps will be taken. 3.1 General R*Stars Coding Requirements In order to meet specific ARRA reporting guidelines, it is necessary to track all federal ARRA revenues separately from existing federal program revenue, Each ARRA-related line item appropriation will require unique appropriation (20 profile) and fund (D23 profile) numbers. 3.2 - Profile Creation And Submission Departments will submit new profile requests for 20s and D23s to the State Budget Office (880) for approval. SBO approved profiles will be sent to the Office of Financial Management (OEM) for final approval and entry into the R*Stars system. All profiles must have the acronym ARRA in the title. The ARRA funds will be tied to like fund sources through the use of the State Fund Group (D39 profile) and Finance Source (053 profile) fields located on the 023 profile. These two coding elements will be created by 5130, Office of Budget Development (OBD) and OFM and entered on the agency submitted D23 profiles, 3.3 - D39 Profile Structure The 039 values established to track ARRA revenue will use each of the four place holders of the profile to identify funds at multiple levels. The placehokiers will be defined by SBO and OEM. 1. The first indicator identifies ARRA-related revenues and expenditures 2. The second indicator identifies a group of programs 3. The third indicator identifies major programs within a group 4. The fourth indicator identifies sub-programs (if needed) The groups have been defined as follows: 1. 90XX — Fiscal Stabilization 2. 91)0( — Health & Human Services 3. 92XX — Education 4. 93XX — Transportation 5. 94XX — Energy 6. 95XX — Economic Development 7. 96XX — Natural Resources & Environmental 8. 97XX — Justice 9. 96XX — Labor 10. 99XX — Miscellaneous Guidance to State Agencies Regarding Funds Received April 16, 2009 21 Under the American Recovery and Reinvestment Act (ARRA) 3.4 - D53 Profile Structure The D53 values established to track ARRA revenues will use two values to distinguish between competitive and formula driven grants, 1. 70 — ARRA Funding/Expenditures — Competitive 2. 80 — ARRA Funding/Expenditures — Formula Driven 3, 3.5 - Budgetary Transaction Procedures Departments will follow the same budgetary transaction procedures for supplemental appropriations as established by the 8130-013D, The instructions are available electronically on the S130 Intranet at http://connect.michigan.qov/budget. 3.6 Agency Receiving ARRA Revenue from another Agency If an Agency plans to receive ARRA funds from another Agency, the recipient agency should contact their OFM Accounting Liaison for guidance related to profile establishment and transaction processing. 3.7 - Federal Reporting On April 1, 2009, the Office of Management and Budget (OMB) issued federal reporting guidance related to ARRA revenue. The guidance contains standard data elements that agencies will be responsible for in order to comply with the reporting requirements under section 1512 of the American Recovery and Reinvestment Act of 2009 (Public Law 111 — 5). The data elements are listed in detail within the Federal Register, Volume 74, Number 61, A copy of those reporting data elements can be found at: hftp://www.fta.dot.qovidocuments/040409 OMB Cmt Request 1512 data specs(1 ).pdf Further guidance regarding the specific data element as well as the method for submission of the information will be provided as soon as it becomes available. Guidance to State Agencies Regarding Funds Received April IS, 2009 22 Under the American Recovery and Reinvestment Act (ARRA) SECTION 4-APPENDICES 4.1 AMERICAN RECOVERY AND REINVESTMENT ACT OF 2009 (TITLE XV & XVI) TITLE XV--ACCOUNTABILITY AND TRANSPARENCY Sec. 1501. Definitions. In this title: (1) AGENCY - The term 'agency' has the meaning given under section 551 of title 5, United States Code. (2) BOARD - The term 'Board' means the Recovery Accountability and Transparency Board established in section 1521. (3) CHAIRPERSON - The term 'Chairperson' means the Chairperson of the Board. (4) COVERED FUNDS - The term 'covered funds' means any funds that are expended or obligated from appropriations made under this Act. (5) PANEL - The term 'Panel' means the Recovery Independent Advisory Panel established in section 1541. SUBTITLE A--TRANSPARENCY AND OVERSIGHT REQUIREMENTS Sec. 1511. Certifications. With respect to covered funds made available to State or local governments for infrastructure investments, the Governor, mayor, or other chief executive, as appropriate, shall certify that the infrastructure investment has received the full review and vetting required by law and that the chief executive accepts responsibility that the infrastructure investment is an appropriate use of taxpayer dollars. Such certification shall include a description of the investment, the estimated total cost, and the amount of covered funds to be used, and shall be posted on a website and linked to the website established by section 1526, A State or local agency may not receive infrastructure investment funding from funds made available in this Act unless this certification is made and posted. Sec. 1512. Reports On Use Of Funds. (a) Short Title - This section may be cited as the 'Jobs Accountability Act. (b) Definitions - In this section: (1) RECIPIENT - The term 'recipient'-- (A) means any entity that receives recovery funds directly from the Federal Government (including recovery funds received through grant, loan, or contract) other than an individual; and (B) includes a State that receives recovery funds. (2) RECOVERY FUNDS - The term 'recovery funds' means any funds that are made available from appropriations made under this Act. Guidance to State Agencies Regarding Funds Received April 16,2009 23 Under the American Recovery and Reinvestment Act (ARRA) (c) Recipient Reports - Not later than 10 days after the end of each calendar quarter, each recipient that received recovery funds from a Federal agency shall submit a report to that agency that contains-- (1) the total amount of recovery funds received from that agency; (2) the amount of recovery funds received that were expended or obligated to projects or activities; and (3) a detailed list of Mt projects or activities for which recovery funds were expended or obligated, including-- (A) the name of the project or activity; (B) a description of the project or activity; (C) an evaluation of the completion status of the project or activity; (D) an estimate of the number of jobs created and the number of jobs retained by the project or activity; and (E) for infrastructure investments made by State and local governments, the purpose, total cost, and rationale of the agency for funding the infrastructure investment with funds made available under this Act, and name of the person to contact at the agency if there are concerns with the infrastructure investment. (4) Detailed information on any subcontracts or subgrants awarded by the recipient to include the data elements required to comply with the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109- 282), allowing aggregate reporting on awards below $25,000 or to individuals, as prescribed by the Director of the Office of Management and Budget. (d) Agency Reports - Not later than 30 days after the end of each calendar quarter, each agency that made recovery funds available to any recipient shall make the'information in reports submitted under subsection (c) publicly available by posting the information on a website, (e) Other Reports - The Congressional Budget Office and the Government Accountability Office shall comment on the information described in subsection (c) (3) (0) for any reports submitted under subsection (c). Such comments shall be due within 45 days after such reports are submitted. (f) COMPLIANCE - Within 180 days of enactment, as a condition of receipt of funds under this Act, Federal agencies shall require any recipient of such funds to provide the information required under subsection (c). (g) GUIDANCE - Federal agencies, in coordination with the Director of the Office of Management and Budget, shall provide for user-friendly means for recipients of covered funds to meet the requirements of this section. (h) REGISTRATION - Funding recipients required to report information per subsection (c) (4) must register with the Central Contractor Registration database or complete other registration requirements as determined by the Director of the Office of Management and Budget. Sec. 1513. Reports Of The Council Of Economic Advisers. (a) In General - In consultation with the Director of the Office of Management and Budget and the Secretary of the Treasury, the Chairperson of the Council of -Guidance to State Agencies Regarding Funds Received Apiil 18,2009 2-4 Under the American Recovery and Reinvestment Act (ARRA) Economic Advisers shall submit quarterly reports to the Committees on Appropriations of the Senate and House of Representatives that detail the impact of programs funded through covered funds on employment, estimated economic growth, and other key economic indicators. (b) Submission of Reports- (1) FIRST REPORT - The first report submitted under subsection (a) shall be submitted not later than 45 days after the end of the first full quarter following the date of enactment of this Act. (2) LAST REPORT - The last report required to be submitted under subsection (a) shall apply to the quarter in which the Board terminates under section 1530. Sec. 1514. Inspector General Reviews. (a) Reviews - Any inspector general of a Federal department or executive agency shall review, as appropriate, any concerns raised by the public about specific investments using funds made available in this Act. Any findings of such reviews not related to an ongoing criminal proceeding shall be relayed immediately to the head of the department or agency concerned. In addition, the findings of such reviews, along with any audits conducted by any inspector general of funds made available in this Act, shall be posted on the inspector general's website and linked to the website established by section 1526, except that portions of reports may be redacted to the extent the portions would disclose information that is protected from public disclosure under sections 552 and 552a of title 5, United States Code. Sec. 1515. Access Of Offices Of Inspector General To Certain Records And Employees. (a) Access - With respect to each contract or grant awarded using covered funds, any representative of an appropriate inspector general appointed under section 3 or 80 of the Inspector General Act of 1978 (5 U.S.C. App.), is authorized- (1) to examine any records of the contractor or grantee, any of its subcontractors or subgrantees, or any State or local agency administering such contract, that pertain to, and involve transactions relating to, the contract, subcontract, grant, or subgrant; and (2) to interview any officer or employee of the contractor, grantee, subgrantee, or agency regarding such transactions. (b) Relationship to Existing Authority - Nothing in this section shall be interpreted to limit or restrict in any way any existing authority of an inspector general. SUBTITLE B-RECO VERY ACCOUNTABILITY AND TRANSPARENCY BOARD Guidance to State Agencies Regarding Funds Received April 16, 2009 25 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1521. Establishment Of The Recovery Accountability And Transparency Board. There is established the Recovery Accountability and Transparency Board to coordinate and conduct oversight of covered funds to prevent fraud, waste, and abuse. Sec. 1522. Composition Of Board, (a) Chairperson- (1) DESIGNATION OR APPOINTMENT The President shall-- (A) designate the Deputy Director for Management of the Office of Management and Budget to serve as Chairperson of the Board; (B) designate another Federal officer who was appointed by the President to a position that required the advice and consent of the Senate, to serve as Chairperson of the Board; or (C) appoint an individual as the Chairperson of the Board, by and with the advice and consent of the Senate. (2) COMPENSATION- (A) DESIGNATION OF FEDERAL OFFICER - If the President designates a Federal officer under paragraph (1) (A) or (B) to serve as Chairperson, that Federal officer may not receive additional compensation for services performed as Chairperson. (B) APPOINTMENT OF NON-FEDERAL OFFICER - If the President appoints an individual as Chairperson under paragraph (1)(C), that individual shall be compensated at the rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code. (b) Members - The members of the Board shall include-- (1) the Inspectors General of the Departments of Agriculture, Commerce, Education, Energy, Health and Human Services, Homeland Security, Justice, Transportation, Treasury, and the Treasury Inspector General for Tax Administration; and (2) any other Inspector General as designated by the President from any agency that expends or obligates covered funds. Sec. 1523. Functions Of The Board, (a) Functions- (1) IN GENERAL - The Board shall coordinate and conduct oversight of covered funds in order to prevent fraud, waste, and abuse. (2) SPECIFIC FUNCTIONS - The functions of the Board shall include-- (A) reviewing whether the reporting of contracts and grants using covered funds meets applicable standards and specifies the purpose of the contract or grant and measures of performance; (B) reviewing whether competition requirements applicable to contracts and grants using covered funds have been satisfied; (C) auditing or reviewing covered funds to determine whether wasteful spending, poor contract or grant management, or other Guidance to State Agencies Regarding Funds Received April 16,2009 25 Under the American Recovery and Reinvestment Act (ARRA) abuses are occurring and referring matters it considers appropriate for investigation to the inspector general for the agency that disbursed the covered funds; (0) reviewing whether there are sufficient qualified acquisition and grant personnel overseeing covered funds; (E) reviewing whether personnel whose duties involve acquisitions or grants made with covered funds receive adequate training; and (F) reviewing whether there are appropriate mechanisms for interagency collaboration relating to covered funds, including coordinating and collaborating to the extent practicable with the Inspectors General Council on Integrity and Efficiency established by the Inspector General Reform Act of 2008 (Public Law 110-409). (b) Reports- (1) FLASH AND OTHER REPORTS The Board shall submit to the President and Congress, including the Committees on Appropriations of the Senate and House of Representatives, reports, to be known as 'flash reports', on potential management and funding problems that require immediate attention. The Board also shall submit to Congress such other reports as the Board considers appropriate on the use and benefits of funds made available in this Act. (2) QUARTERLY REPORTS - The Board shall submit quarterly reports to the President and Congress, including the Committees on Appropriations of the Senate and House of Representatives, summarizing the findings of the Board and the findings of inspectors general of agencies. The Board may submit additional reports as appropriate. (3) ANNUAL REPORTS - The Board shall submit annual reports to the President and Congress, including the Committees on Appropriations of the Senate and House of Representatives, consolidating applicable quarterly reports on the use of covered funds_ (4) PUBLIC AVAILABILITY- (A) IN GENERAL - All reports submitted under this subsection shall be made publicly available and posted on the website established by section 1526. (B) REDACTIONS Any portion of a report submitted under this subsection may be redacted when made publicly available, if that portion would disclose information that is not subject to disclosure under sections 552 and 552a of title 5, United States Code. (c) Recommendations- (1) IN GENERAL - The Board shall make recommendations to agencies on measures to prevent fraud, waste, and abuse relating to covered funds. (2) RESPONSIVE REPORTS - Not later than 30 days after receipt of a recommendation under paragraph (1), an agency shall submit a report to the President, the congressional committees of jurisdiction, including the Committees on Appropriations of the Senate and House of Representatives, and the Board on-- Guidance to State Agencies Regarding Funds Received April 10, 200S 27 Under the American Recovery and Reinvestment Act (ARRA) (A) whether the agency agrees or disagrees with the recommendations; and (B) any actions the agency will take to implement the recommendations. Sec. 1524. Powers Of The Board. (a) In General - The Board shall conduct audits and reviews of spending of covered funds and coordinate on such activities with the inspectors general of the relevant agency to avoid duplication and overlap of work. (b) Audits and Reviews - The Board may— (1) conduct its own independent audits and reviews relating to covered funds; and (2) collaborate on audits and reviews relating to covered funds with any inspector general of an agency. (c) Authorities- (1) AUDITS AND REVIEWS - In conducting audits and reviews, the Board shall have the authorities provided under section 6 of the Inspector General Act of 1978 (5 U.S.C. App.). Additionally, the Board may issue subpoenas to compel the testimony of persons who are not Federal officers or employees and may enforce such subpoenas in the same manner as provided for inspector general subpoenas under section 6 of the Inspector General Act of 1978 (5 U.S.C. App.). (2) STANDARDS AND GUIDELINES - The Board shall carry out the powers under subsections (a) and (b) in accordance with section 4(b)(1) of the Inspector General Act of 1978 (5 U.S.C. App.). (d) Public Hearings - The Board may hold public hearings and Board personnel may conduct necessary inquiries. The head of each agency shall make all officers and employees of that agency available to provide testimony to the Board and Board personnel. The Board may issue subpoenas to compel the testimony of persons who are not Federal officers or employees at such public hearings. Any such subpoenas may be enforced in the same manner as provided for inspector general subpoenas under section 6 of the Inspector General Act of 1978 (5 U.S.G. App.). (e) Contracts - The Board may enter into contracts to enable the Board to discharge its duties under this subtitle, including contracts and other arrangements for audits, studies, analyses, and other services with public agencies and with private persons, and make such payments as may be necessary to carry out the duties of the Board. (f) Transfer of Funds - The Board may transfer funds appropriated to the Board for expenses to support administrative support services and audits, reviews, or other activities related to oversight by the Board of covered funds to any office of inspector general, the Office of Management and Budget, the General Services Administration, and the Panel. Sec. 1525. Employment, Personnel, And Related Authorities. (a) Employment and Personnel Authorities- Guidance to Slate Agencies Regarding Funds Received April 16, 2009 28 Under the American Recovery and Reinvestment Act (ARRA) (1) IN GENERAL- (A) AUTHORITIES - Subject to paragraph (2), the Board may exercise the authorities of subsections (b) through (1) of section 3161 of title 5, United States Code (without regard to subsection (a) of that section). (B) APPLICATION - For purposes of exercising the authorities described under subparagraph (A), the term 'Chairperson of the Board' shall be substituted for the term 'head of a temporary organization'. (C) CONSULTATION - In exercising the authorities described under subparagraph (A), the Chairperson shall consult with members of the Board. (2) EMPLOYMENT AUTHORITIES - In exercising the employment authorities under subsection (b) of section 3161 of title 5, United States Code, as provided under paragraph (1) of this subsection-- (A) paragraph (2) of subsection (b) of section 3161 of that title (relating to periods of appointments) shall not apply; and (B) no period of appointment may exceed the date on which the Board terminates under section 1530. (b) Information and Assistance- (1) IN GENERAL - Upon request of the Board for information or assistance from any agency or other entity of the Federal Government, the head of such entity shall, insofar as is practicable and not in contravention of any existing law, furnish such information or assistance to the Board, or an authorized designee, (2) REPORT OF REFUSALS - Whenever information or assistance requested by the Board is, in the judgment of the Board, unreasonably refused or not provided, the Board shall report the circumstances to the congressional committees of jurisdiction, including the Committees on Appropriations of the Senate and House of Representatives, without delay. (c) Administrative Support - The General Services Administration shall provide the Board with administrative support services, including the provision of office space and facilities. Sec. 1526. Board Website. (a) Establishment - The Board shall establish and maintain, no later than 30 days after enactment of this Act, a user-friendly, public-facing website to foster greater accountability and transparency in the use of covered funds, (b) Purpose - The website established and maintained under subsection (a) shall be a portal or gateway to key information relating to this Act and provide connections to other Government websites with related information. (c) Content and Function - In establishing the website established and maintained under subsection (a), the Board shall ensure the following: (1) The website shall provide materials explaining what this Act means for citizens. The materials shall be easy to understand and regularly updated. Guidance to State Agencies Regarding Funds Received April 16, 2009 29 Under the American Recovery and Reinvestment Act (ARRA) (2) The website shall provide accountability information, including findings from audits, inspectors general, and the Government Accountability Office. (3) The website shall provide data on relevant economic, financial, grant, and contract information in user-friendly visual presentations to enhance public awareness of the use of covered funds. (4) The website shall provide detailed data on contracts awarded by the Federal Government that expend covered funds, including information about the competitiveness of the contracting process, information about the process that was used for the award of contracts, and for contracts over $500,000 a summary of the contract. (5) The website shall include printable reports on covered funds obligated by month to each State and congressional district. (6) The website shall provide a means for the public to give feedback on the performance of contracts that expend covered funds. (7) The website shall include detailed information on Federal Government contracts and grants that expend covered funds, to include the data elements required to comply with the Federal Funding Accountability and Transparency Act of 2006 (Public Law 109-282), allowing aggregate reporting on awards below $25,000 or to individuals, as prescribed by the Director of the Office of Management and Budget. (8) The website shall provide a link to estimates of the jobs sustained or created by the Act. (9) The website shall provide a link to information about announcements •of grant competitions and solicitations for contracts to be awarded. (10) The website shall include appropriate links to other government websites with information concerning covered funds, including Federal agency and State websites. (11) The website shall include a plan from each Federal agency for using funds made available in this Act to the agency. (12) The website shall provide information on Federal allocations of formula grants and awards of competitive grants using covered funds. (13) The website shall provide information on Federal allocations of mandatory and other entitlement programs by State, county, or other appropriate geographical unit. (14) To the extent practical, the website shall provide, organized by the location of the job opportunities involved, links to and information about how to access job opportunities, including, if possible, links to or information about local employment agencies, job banks operated by State workforce agencies, the Department of Labor's CareerOneStop website, State, local and other public agencies receiving Federal funding, and private firms contracted to perform work with Federal funding, in order to direct job seekers to job opportunities created by this Act. (15) The website shall be enhanced and updated as necessary to carry out the purposes of this subtitle. (d) Waiver - The Board may exclude posting contractual or other information on the website on a case-by-case basis when necessary to protect national security Guidance to State Agencies Regarding Funds Received April 16, 2000 30 Under the American Recovery and Reinvestment Act (ARRA) or to protect information that is not subject to disclosure under sections 552 and 552a of title 5, United States Code. Sec. 1527. Independence Of Inspectors General. (a) Independent Authority - Nothing in this subtitle shall affect the independent authority of an inspector general to determine whether to conduct an audit or investigation of covered funds. (b) Requests by Board - If the Board requests that an inspector general conduct or refrain from conducting an audit or investigation and the inspector general rejects the request in whole or in part, the inspector general shall, not later than 30 days after rejecting the request, submit a report to the Board, the head of the applicable agency, and the congressional committees of jurisdiction, including the Committees on Appropriations of the Senate and House of Representatives. The report shall state the reasons that the inspector general has rejected the request in whole or in part. The inspector general's decision shall be final. Sec. 1528. Coordination With The Comptroller General And State Auditors. The Board shall coordinate its oversight activities with the Comptroller General of the United States and State auditors. Sec. 1529. Authorization Of Appropriations. There are authorized to be appropriated such sums as necessary to carry out this subtitle. Sec. 1530. Termination Of The Board. The Board shall terminate on September 30, 2013. SUBTITLE C—RECOVERY INDEPENDENT ADVISORY PANEL Sec. 1541. Establishment Of Recovery Independent Advisory Panel (a) Establishment - There is established the Recovery Independent Advisory Panel. (b) Membership - The Panel shall be composed of 5 members who shall be appointed by the President. (c) Qualifications - Members shall be appointed on the basis of expertise in economics, public finance, contracting, accounting, or any other relevant field. (d) Initial Meeting - Not later than 30 days after the date on which all members of the Panel have been appointed, the Panel shall hold its first meeting. (e) Meetings - The Panel shall meet at the call of the Chairperson of the Panel. (f) Quorum - A majority of the members of the Panel shall constitute a quorum, but a lesser number of members may hold hearings. (g) Chairperson and Vice Chairperson - The Panel shall select a Chairperson and Vice Chairperson from among its members. Guidance to State Agencies Regarding Funds Received April 16, 2009 31 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1542. Duties Of The Panel The Panel shall make recommendations to the Board on actions the Board could take to prevent fraud, waste, and abuse relating to covered funds. Sec. 1543. Powers Of The Panel. (a) Hearings - The Panel may hold such hearings, sit and act at such times and places, take such testimony, and receive such evidence as the Panel considers advisable to carry out this subtitle. (b) Information From Federal Agencies - The Panel may secure directly from any agency such information as the Panel considers necessary to carry out this subtitle. Upon request of the Chairperson of the Panel, the head of such agency shall furnish such information to the Panel. (c) Postal Services - The Panel may use the United States mails in the same manner and under the same conditions as agencies of the Federal Government. (d) Gifts - The Panel may accept, use, and dispose of gifts or donations of services or property. Sec. 1544. Panel Personnel Matters. (a) Compensation of Members - Each member of the Panel who is not an officer or employee of the Federal Government shall be compensated at a rate equal to the daily equivalent of the annual rate of basic pay prescribed for level IV of the Executive Schedule under section 5315 of title 5, United States Code, for each day (including travel time) during which such member is engaged in the performance of the duties of the Panel. All members of the Panel who are officers or employees of the United States shall serve without compensation in addition to that received for their services as officers or employees of the United States. (b) Travel Expenses - The members of the Panel shall be allowed travel expenses, including per diem in lieu of subsistence, at rates authorized for employees of agencies under subchapter I of chapter 57 of title 5, United States Code, while away from their homes or regular places of business in the performance of services for the Panel. (c) Staff- (1) IN GENERAL - The Chairperson of the Panel may, without regard to the civil service laws and regulations, appoint and terminate an executive director and such other additional personnel as may be necessary to enable the Panel to perform its duties_ The employment of an executive director shall be subject to confirmation by the Panel. (2) COMPENSATION - The Chairperson of the Panel may fix the compensation of the executive director and other personnel without regard to chapter 51 and subchapter III of chapter 53 of title 5, United States Code, relating to classification of positions and General Schedule pay rates, except that the rate of pay for the executive director and other personnel may not exceed the rate payable for level V of the Executive Schedule under section 5316 of such title. (3) PERSONNEL AS FEDERAL EMPLOYEES- Guidance to State Agencies Regarding Funds Received April 15,2009 32 Under the American Recovery and Reinvestment Act (ARRA) (A) IN GENERAL - The executive director and any personnel of the Panel who are employees shall be employees under section 2105 of title 5, United States Code, for purposes of chapters 63, 81, 83, 84, 85, 87, 89, 89A, 89B, and 90 of that title. (B) MEMBERS OF PANEL - Subparagraph (A) shall not be construed to apply to members of the Panel. (d) Detail of Government Employees - Any Federal Government employee may be detailed to the Panel without reimbursement, and such detail shall be without interruption or loss of civil service status of privilege. (e) Procurement of Temporary and Intermittent Services - The Chairperson of the Panel may procure temporary and intermittent services under section 3109(b) of title 5, United States Code, at rates for individuals which do not exceed the daily equivalent of the annual rate of basic pay prescribed for level V of the Executive Schedule under section 5316 of such title, (f) Administrative Support - The General Services Administration shall provide the Panel with administrative support services, including the provision of office space and facilities. Sec. 1545. Termination Of The Panel. The Panel shall terminate on September 30, 2013, Sec. 1546. Authorization Of Appropriations. There are authorized to be appropriated such sums as necessary to carry out this subtitle, SUBTITLE D--ADDITIONAL ACCOUNTABILITY AND TRANSPARENCY REQUIREMENTS Sec. 1551. Authority To Establish Separate Funding Accounts. Although this Act provides supplemental appropriations for programs, projects, and activities in existing Treasury accounts, to facilitate tracking these funds through Treasury and agency accounting systems, the Secretary of the Treasury shall ensure that all funds appropriated in this Act shall be established in separate Treasury accounts, unless a waiver from this provision is approved by the Director of the Office of Management and Budget. Sec. 1552. Set-Aside For State And Local Government Reporting And Record keeping. Federal agencies receiving funds under this Act, may, after following the notice and comment rulemaking requirements under the Administrative Procedures Act (5 U.S.C. 500), reasonably adjust applicable limits on administrative expenditures for Federal awards to help award recipients defray the costs of data collection requirements initiated pursuant to this Act. Guidance to State Agencies Regarding Funds Received April 16, 2009 33 Under the American Recovery and Reinvestment Act (ARRA) Sec. 1553. Protecting State And Local Government And Contractor Whistieblowers. (a) Prohibition of Reprisals - An employee of any non-Federal employer receiving covered funds may not be discharged, demoted, or otherwise discriminated against as a reprisal for disclosing, including a disclosure made in the ordinary course of an employee's duties, to the Board, an inspector general, the Comptroller General, a member of Congress, a State or Federal regulatory or law enforcement agency, a person with supervisory authority over the employee (or such other person working for the employer who has the authority to investigate, discover, or terminate misconduct), a court or grand jury, the head of a Federal agency, or their representatives, information that the employee reasonably believes is evidence of-- (1) gross mismanagement of an agency contract or grant relating to covered funds; (2) a gross waste of covered funds; (3) a substantial and specific danger to public health or safety related to the implementation or use of covered funds; (4) an abuse of authority related to the implementation or use of covered funds; or (5) a violation of law, rule, or regulation related to an agency contract (including the competition for or negotiation of a contract) or grant, awarded or issued relating to covered funds, (b) Investigation of Complaints- (1) IN GENERAL - A person who believes that the person has been subjected to a reprisal prohibited by subsection (a) may submit a complaint regarding the reprisal to the appropriate inspector general. Except as provided under paragraph (3), unless the inspector general determines that the complaint is frivolous, does not relate to covered funds, or another Federal or State judicial or administrative proceeding has previously been invoked to resolve such complaint, the inspector general shall investigate the complaint and, upon completion of such investigation, submit a report of the findings of the investigation to the person, the person's employer, the head of the appropriate agency, and the Board. (2) TIME LIMITATIONS FOR ACTIONS- (A) IN GENERAL - Except as provided under subparagraph (B), the inspector general shall, not later than 180 days after receiving a complaint under paragraph (1)-- (I) make a determination that the complaint is frivolous, does not relate to covered funds, or another Federal or State judicial or administrative proceeding has previously been invoked to resolve such complaint; or (ii) submit a report under paragraph (1). (B) EXTENSIONS- (I) VOLUNTARY EXTENSION AGREED TO BETWEEN INSPECTOR GENERAL AND COMPLAINANT - If the Guidance lo State Agencies Regarding Funds Received April '16,2009 Under the American Recovery and Reinvestment Act (ARRA) inspector general is unable to complete an investigation under this section in time to submit a report within the 180- day period specified under subparagraph (A) and the person submitting the complaint agrees to an extension of time, the inspector general shall submit a report under paragraph (1) within such additional period of time as shall be agreed upon between the inspector general and the person submitting the complaint. (it) EXTENSION GRANTED BY INSPECTOR GENERAL - If the inspector general is unable to complete an investigation under this section in time to submit a report within the 180- day period specified under subparagraph (A), the inspector general may extend the period for not more than 180 days without agreeing with the person submitting the complaint to such extension, provided that the inspector general provides a written explanation (subject to the authority to exclude information under paragraph (4)(C)) for the decision, which shall be provided to both the person submitting the complaint and the non-Federal employer. (iii) SEMI-ANNUAL REPORT ON EXTENSIONS - The inspector general shall include in semi-annual reports to Congress a list of those investigations for which the inspector general received an extension. (3) DISCRETION NOT TO INVESTIGATE COMPLAINTS- (A) IN GENERAL - The inspector general may decide not to conduct or continue an investigation under this section upon providing to the person submitting the complaint and the non- Federal employer a written explanation (subject to the authority to exclude information under paragraph (4)(C)) for such decision. (B) ASSUMPTION OF RIGHTS TO CIVIL REMEDY - Upon receipt of an explanation of a decision not to conduct or continue an investigation under subparagraph (A), the person submitting a complaint shall immediately assume the right to a civil remedy under subsection (c)(3) as if the 210-day period specified under such subsection has already passed. (C) SEMI-ANNUAL REPORT - The inspector general shall include in semi-annual reports to Congress a list of those investigations the inspector general decided not to conduct or continue under this paragraph. (4) ACCESS TO INVESTIGATIVE FILE OF INSPECTOR GENERAL- (A) IN GENERAL - The person alleging a reprisal under this section shall have access to the investigation file of the appropriate inspector general in accordance with section 552a of title 5, United States Code (commonly referred to as the *Privacy Act). The investigation of the inspector general shall be deemed closed for Guidance to State Agencies Regarding Funds Received April 16, 2000 35 Under the American Recovery and Reinvestment Act (ARRA) purposes of disclosure under such section when an employee files an appeal to an agency head or a court of competent jurisdiction. (B) CIVIL ACTION - In the event the person alleging the reprisal brings suit under subsection (c)(3), the person alleging the reprisal and the non-Federal employer shall have access to the investigative file of the inspector general in accordance with the Privacy Act. (C) EXCEPTION - The inspector general may exclude from disclosure-- (I) information protected from disclosure by a provision of law; and (ii) any additional information the inspector general determines disclosure of which would impede a continuing investigation, provided that such information is disclosed once such disclosure would no longer impede such investigation, unless the inspector general determines that disclosure of law enforcement techniques, procedures, or information could reasonably be expected to risk circumvention of the law or disclose the identity of a confidential source. (5) PRIVACY OF INFORMATION - An inspector general investigating an alleged reprisal under this section may not respond to any inquiry or disclose any information from or about any person alleging such reprisal, except in accordance with the provisions of section 552a of title 5, United States Code, or as required by any other applicable Federal law. (c) Remedy and Enforcement.Authority- (1) BURDEN OF PROOF- (A) DISCLOSURE AS CONTRIBUTING FACTOR IN REPRISAL- (1) IN GENERAL - A person alleging a reprisal under this section shall be deemed to have affirmatively established the occurrence of the reprisal if the person demonstrates that a disclosure described in subsection (a) was a contributing factor in the reprisal. (ii) USE OF CIRCUMSTANTIAL EVIDENCE - A disclosure may be demonstrated as a contributing factor in a reprisal for purposes of this paragraph by circumstantial evidence, including-- (I) evidence that the official undertaking the reprisal knew of the disclosure; or (II) evidence that the reprisal occurred within a period of time after the disclosure such that a reasonable person could conclude that the disclosure was a contributing factor in the reprisal. (B) OPPORTUNITY FOR REBUTTAL - The head of an agency may not find the occurrence of a reprisal with respect to a reprisal that is affirmatively established under subparagraph (A) if the non- Guidance to State Agencies Regarding Funds Received April 16, 2009 36 Under the American Recovery and Reinvestment Act (ARRA) Federal employer demonstrates by clear and convincing evidence that the non-Federal employer would have taken the action constituting the reprisal in the absence of the disclosure. (2) AGENCY ACTION - Not later than 30 days after receiving an inspector general report under subsection (b), the head of the agency concerned shall determine whether there is sufficient basis to conclude that the non- Federal employer has subjected the complainant to a reprisal prohibited by subsection (a) and shall either issue an order denying relief in whole or in part or shall take 1 or more of the following actions: (A) Order the employer to take affirmative action to abate the reprisal. (B) Order the employer to reinstate the person to the position that the person held before the reprisal, together with the compensation (including back pay), compensatory damages, employment benefits, and other terms and conditions of employment that would apply to the person in that position if the reprisal had not been taken. (C) Order the employer to pay the complainant an amount equal to the aggregate amount of all costs and expenses (including aftomeys fees and expert witnesses' fees) that were reasonably incurred by the complainant for, or in connection with, bringing the complaint regarding the reprisal, as determined by the head of the agency or a court of competent jurisdiction. (3) CIVIL ACTION - If the head of an agency issues an order denying relief in whole or in part under paragraph (1), has not issued an order within 210 days after the submission of a complaint under subsection (b), or in the case of an extension of time under subsection (b)(2)(B)(i), within 30 days after the expiration of the extension of time, or decides under subsection (b)(3) not to investigate or to discontinue an investigation, and there is no showing that such delay or decision is due to the bad faith of the complainant, the complainant shall be deemed to have exhausted all administrative remedies with respect to the complaint, and the complainant may bring a de novo action at law or equity against the employer to seek compensatory damages and other relief available under this section in the appropriate district court of the United States, which shall have jurisdiction over such an action without regard to the amount in controversy. Such an action shall, at the request of either party to the action, be tried by the court with a jury. (4) JUDICIAL ENFORCEMENT OF ORDER - Whenever a person fails to comply with an order issued under paragraph (2), the head of the agency shall file an action for enforcement of such order in the United States district court for a district in which the reprisal was found to have occurred. In any action brought under this paragraph, the court may grant appropriate relief, including injunctive relief, compensatory and exemplary damages, and attorney's fees and costs. Guidance to Stale Agendas Regarding Funds Received April 16, 2009 37 Under the American Recovery and Reinvestment Act (ARRA) (5) JUDICIAL REVIEW - Any person adversely affected or aggrieved by an order issued under paragraph (2) may obtain review of the orders conformance with this subsection, and any regulations issued to carry out this section, in the United States court of appeals for a circuit in which the reprisal is alleged in the order to have occurred. No petition seeking such review may be filed more than 60 days after issuance of the order by the head of the agency. Review shall conform to chapter 7 of title 5, United States Code. (d) Nonenforceability of Certain Provisions Waiving Rights and Remedies or Requiring Arbitration of Disputes- (1) WAIVER OF RIGHTS AND REMEDIES - Except as provided under paragraph (3), the rights and remedies provided for in this section may not be waived by any agreement, policy, form, or condition of employment, including by any predispute arbitration agreement. (2) PREDISPUTE ARBITRATION AGREEMENTS - Except as provided under paragraph (3), no predispute arbitration agreement shall be valid or enforceable if it requires arbitration of a dispute arising under this section_ (3) EXCEPTION FOR COLLECTIVE BARGAINING AGREEMENTS - Notwithstanding paragraphs (1) and (2), an arbitration provision in a collective bargaining agreement shall be enforceable as to disputes arising under the collective bargaining agreement, (e) Requirement to Post Notice of Rights and Remedies - Any employer receiving covered funds shall post notice of the rights and remedies provided under this section. (f) Rules of Construction- (1) NO IMPLIED AUTHORITY TO RETALIATE FOR NON-PROTECTED DISCLOSURES - Nothing in this section may be construed to authorize the discharge of, demotion of, or discrimination against an employee for a disclosure other than a disclosure protected by subsection (a) or to modify or derogate from a right or remedy otherwise available to the employee. (2) RELATIONSHIP TO STATE LAWS - Nothing in this section may be construed to preempt, preclude, or limit the protections provided for public or private employees under State whistleblower laws, (g) Definitions - In this section: (1) ABUSE OF AUTHORITY - The term 'abuse of authority' means an arbitrary and capricious exercise of authority by a contracting official or employee that adversely affects the rights of any person, or that results in personal gain or advantage to the official or employee or to preferred other persons. (2) COVERED FUNDS - The term 'covered funds' means any contract, grant, or other payment received by any non-Federal employer if-- (A) the Federal Government provides any portion of the money or property that is provided, requested, or demanded; and (B) at least some of the funds are appropriated or otherwise made available by this Act. (3) EMPLOYEE - The term 'employee'-- Guidance to State Agencies Regarding Funds Received April 10, 2009 38 Under the Arnerican Recovery and Reinvestment Act (ARRA) (A) except as provided under subparagraph (B), means an individual performing services on behalf of an employer; and (B) does not include any Federal employee or member of the uniformed services (as that term is defined in section 101(a)(5) of title 10, United States Code). (4) NON-FEDERAL EMPLOYER - The term 'non-Federal employee— (A) means any employer- @ with respect to covered funds— (I) the contractor, subcontractor, grantee, or recipient, as the case may be, if the contractor, subcontractor, grantee, or recipient is an employer; and (II) any professional membership organization, certification or other professional body, any agent or licensee of the Federal government, or any person acting directly or indirectly in the interest of an employer receiving covered funds; or (ii) with respect to covered funds received by a State or local government, the State or local government receiving the funds and any contractor or subcontractor of the State or local government; and (B) does not mean any department, agency, or other entity of the Federal Government. (5) STATE OR LOCAL GOVERNMENT - The term 'State or local government' means— (A) the government of each of the several States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, American Samoa, the Virgin Islands, the Commonwealth of the Northern Mariana Islands, or any other territory or possession of the United States; or (B) the government of any political subdivision of a government listed in subparagraph (A). Sec. 1554, Special Contracting Provisions. To the maximum extent possible, contracts funded under this Act shall be awarded as fixed-price contracts through the use of competitive procedures. A summary of any contract awarded with such funds that is not fixed-price and not awarded using competitive procedures shall be posted in a special section of the website established in section 1526. TITLE XVI—GENERAL PROVISIONS—THIS ACT RELATIONSHIP TO OTHER APPROPRIATIONS Sec. 1601, Each amount appropriated or made available in this Act is in addition to amounts otherwise appropriated for the fiscal year involved. Enactment of this Guidance to State Agencies Rearding Funds Received Anti! 16, 2909 39 Linder the American Recovery and Reinvestment Act (ARRA} Act shall have no effect on the availability of amounts under the Continuing Appropriations Resoiution, 2009 (division A of Public Law 110-329). PREFERENCE FOR QUICK-START ACTIVITIES SEC. 1602. In using funds made available in this Act for infrastructure investment, recipients shall give preference to activities that can be started and completed expeditiously, including a goal of using at least 50 percent of the funds for activities that can be initiated not later than 120 days after the date of the enactment of this Act. Recipients shall also use grant funds in a manner that maximizes job creation and economic benefit, PERIOD OF AVAILABILITY SEC. 1603. All funds appropriated in this Act shall remain available for obligation until September 30, 2010, unless expressly provided otherwise in this Act. LIMIT ON FUNDS SEC, 1604. None of the funds appropriated or otherwise made available in this Act may be used by any State or local government, or any private entity, for any casino or other gambling establishment, aquarium, zoo, golf course, or swimming pool. BUY AMERICAN Sec. 1605. Use of American Iron, Steel, and Manufactured Goods. (a) None of the funds appropriated or otherwise made available by this Act may be used for a project for the construction, alteration, maintenance, or repair of a public building or public work unless all of the iron, steel, and manufactured goods used in the project are produced in the United States, (b) Subsection (a) shall not apply in any case or category of cases in which the head of the Federal department or agency involved finds that-- (1) applying subsection (a) would be inconsistent with the public interest; (2) iron, steel, and the relevant manufactured goods are not produced in the United States in sufficient and reasonably available quantities and of a satisfactory quality; or (3) Inclusion of iron, steel, and manufactured goods produced in the United States will increase the cost of the overall project by more than 25 percent, (c) If the head of a Federal department or agency determines that it is necessary to waive the application of subsection (a) based on a finding under subsection (b), the head of the department or agency shall publish in the Federal Register a detailed written justification as to why the provision is being waived. (d) This section shall be applied in a manner consistent with United States obligations under international agreements. WAGE RATE REQUIREMENTS SEC. 1606. Notwithstanding any other provision of law and in a manner consistent with other provisions in this Act, all laborers and mechanics employed Guidance to State Agencies Regarding Funds Received April 16,2009 40 Under the American Recovery and Reinvestment Act (ARRA) by contractors and subcontractors on projects funded directly by or assisted in whole or in part by and through the Federal Government pursuant to this Act shall be paid wages at rates not less than those prevailing on projects of a character similar in the locality as determined by the Secretary of Labor in accordance with subchapter IV of chapter 31 of title 40, United States Code. With respect to the labor standards specified in this section, the Secretary of Labor shall have the authority and functions set forth in Reorganization Plan Numbered 14 of 1950(64 Stat. 1267; 5 U.S.C. App.) and section 3145 of title 40, United States Code. ADDITIONAL FUNDING DISTRIBUTION AND ASSURANCE OF APPROPRIATE USE OF FUNDS SEC. 1607. (a) Certification by Governor - Not later than 45 days after the date of enactment of this Act, for funds provided to any State or agency thereof, the Governor of the State shall certify that: (1) the State will request and use funds provided by this Act; and (2) the funds will be used to create jobs and promote economic growth, (b) Acceptance by State Legislature - If funds provided to any State in any division of this Act are not accepted for use by the Governor, then acceptance by the State legislature, by means of the adoption of a concurrent resolution, shall be sufficient to provide funding to such State. (c) Distribution - After the adoption of a State legislature's concurrent resolution, funding to the State will be for distribution to local governments, councils of government, public entities, and public-private entities within the State either by formula or at the State's discretion. ECONOMIC STABILIZATION CONTRACTING SEC. 1608. REFORM OF CONTRACTING PROCEDURES UNDER EESA. Section 107(b) of the Emergency Economic Stabilization Act of 2008 (12 U.S.C. 5217(b)) is amended by inserting 'and individuals with disabilities and businesses owned by individuals with disabilities (for purposes of this subsection the term 'individual with disability' has the same meaning as the term 'handicapped individual' as that term is defined in section 3(f) of the Small Business Act (15 U.S.C. 632(f)),' after '(12 U.S.C. 1441a(r)(4)),'. SEC. 1609, (a) FINDINGS- (1) The National Environmental Policy Act protects public health, safety and environmental quality: by ensuring transparency, accountability and public involvement in federal actions and in the use of public funds; (2) When President Nixon signed the National Environmental Policy Act into law on January 1, 1970, he said that the Act provided the 'direction' for the country to 'regain a productive harmony between man and nature': (3) The National Environmental Policy Act helps to provide an orderly process for considering federal actions and funding decisions and prevents ligation and delay that would otherwise be inevitable and existed prior to the establishment of the National Environmental Policy Act. Guidance to State Agencies Regarding Funds Received April 16, 2009 41 Under the American Recovery and Reinvesiment Act (ARRA) (b) Adequate resources within this bill must be devoted to ensuring that applicable environmental reviews under the National Environmental Policy Act are completed on an expeditious basis and that the shortest existing applicable process under the National Environmental Policy Act shall be utilized_ (c) The President shall report to the Senate Environment and Public Works Committee and the House Natural Resources Committee every 90 days following the date of enactment until September 30, 2011 on the status and progress of projects and activities funded by this Act with respect to compliance with National Environmental Policy Act requirements and documentation. SEC. 1610. (a) None of the funds appropriated or otherwise made available by this Act, for projects initiated after the effective date of this Act, may be used by an executive agency to enter Into any Federal contract unless such contract is entered into in accordance with the Federal Property and Administrative Services Act (41 U.S.C. 253) or chapter 137 of title 10, United States Code, and the Federal Acquisition Regulation, unless such contract is otherwise authorized by statute to be entered into without regard to the above referenced statutes. (b) All projects to be conducted under the authority of the Indian Self- Determination and Education Assistance Act, the Tribally-Controlled Schools Act, the Sanitation and Facilities Act, the Native American Housing and Self- Determination Assistance Act and the Buy-Indian Act shall be identified by the appropriate Secretary and the appropriate Secretary shall Incorporate provisions to ensure that the agreement conforms with the provisions of this Act regarding the timing for use of funds and transparency, oversight, reporting, and accountability, including review by the Inspectors General, the Accountability and Transparency Board, and Government Accountability Office, consistent with the objectives of this Act. Sec. 1611 Hiring American Workers in Companies Receiving TARP Funding. (a) SHORT TITLE - This section may be cited as the 'Employ American Workers Act`, (b) PROHIBITION- (1) IN GENERAL - Notwithstanding any other provision of law, it shall be unlawful for any recipient of funding under title I of the Emergency Economic Stabilization Act of 2008 (Public Law 110-343) or section 13 of the Federal Reserve Act (12 U.S.C, 342 et seq.) to hire any nonimmigrant described in section 101(a)(15)(h)(i)(b) of the Immigration and Nationality Act (8 U.S.C. 1101(a)(15)(h)(i)(b)) unless the recipient is in compliance with the requirements for an H-1B dependent employer (as defined in section 212(n)(3) of such Act (8 U.S.C. 1182(n)(3))), except that the second sentence of section 212(n)(1)(E)(11) of such Act shall not apply, (2) DEFINED TERM - In this subsection, the term 'hire' means to permit a new employee to commence a period of employment. (c) Sunset Provision - This section shall be effective during the 2-year period beginning on the date of the enactment of this Act. SEC. 1612. During the current fiscal year not to exceed 1 percent of any appropriation made available by this Act may be transferred by an agency head between such appropriations funded in this Act of that department or agency: Guidance to State Agencies Regarding Funds Received April 16, 2009 42 Under the American Recovery and Reinvestment Act (ARRA) Provided, That such appropriations shall be merged with and available for the same purposes, and for the same time period, as the appropriation to which transferred: Provided further, That the agency head shall notify the Committees on Appropriations of the Senate and House of Representatives of the transfer 15 days in advance: Provided further, That notice of any transfer made pursuant to this authority be posted on the website established by the Recovery Act Accountability and Transparency Board 15 days following such transfer: Provided further, That the authority contained in this section is in addition to transfer authorities otherwise available under current law: Provided further, That the authority provided in this section shall not apply to any appropriation that is subject to transfer provisions included elsewhere in this Act. Guidance to State Agencies Regarding Funds Received April 16, 2009 43 Under the American Recovery and Reinvestment Act (ARRA) ATTACHMENT III MICHIGAN DEPARTMENT OF COMMUNITY HEALTH FY 14/15 COMPREHENSIVE AGREEMENT PROGRAM SPECIFIC ASSURANCES AND REQUIREMENTS Local health service program elements funded under this agreement will be administered by the Grantee and the Department in accordance with the Public Health Code (P.A. 368 of 1978, as amended), rules promulgated under the Code, minimum program requirements and all other applicable Federal, State and Local laws, rules and regulations. These requirements are fulfilled through the following approach: A. Development and issuance of minimum program requirements, further describing the objective criteria for meeting requirements of law, rule, regulation, or professionally accepted methods or practices for the purpose of ensuring the quality, availability and effectiveness of services and activities, B. Utilization of a Minimum Reporting Requirements Notebook listing specific reporting formats, source documentation, timeframes and utilization needs for required local data compilation and transmission on program elements funded under this agreement. C. Utilization of annual program and budget instructions describing special program performance and funding policies and requirements unique to each State fiscal year. D. Execution of an agreement setting forth the basic terms and conditions for administration and local service delivery of the program elements, E. Emphasis and reliance upon service definitions, minimum program requirements, local budgets and projected output measures reports, State/local agreements, and periodic department on-site program management evaluation and audits, while minimizing local program plan detail beyond that needed for input on the State budget process. Many program specific assurances and other requirements are defined within the referenced documents including Minimum Program Requirements established for the following program elements as of October 1, 2006: A. B. C. D. E. F. G. H. Breast and Cervical Cancer Control Clinical Laboratory Family Planning Food Service Sanitation General Communicable Disease Healthy Homes and Lead Poisoning Hearing HIV/STD Prevention & Treatment Immunization —(Essential Local Public Services & Categorical) J. LHD/CSHCS K. Michigan Care Improvement Registry L. On-Site Sewage M. Private/Type II Water Supplies N. Vision 0. WIC Page 1 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 5/22/14 For FY 14/15, special requirements are applicable for the remaining program elements listed in the attached pages. Adolescent STD Screening Body Art Facility Licensing Biomonitoring of Persistent Toxic Substances in Michigan Urban Fisheries Breast and Cervical Cancer Control Program (BCCCP) Centralized Access Home Visiting Hub Childhood Lead Poisoning Education & Outreach Childhood Lead Poisoning Intervention Childhood Lead Poisoning Prevention Children's Special Health Care Services (CSHCS) Comprehensive Cancer Control (CCC) Community Implementation Project Eat Safe Fish Essential Local Public Health Services (ELPHS) Family Planning/BCCCP Joint Project Family Planning Medical/Pharmaceutical Supplies Project Family Planning-Pregnancy Prevention FDA Tobacco Retailer (A & L) Inspections Fetal Alcohol Spectrum Disorder Projects Fetal Infant Mortality Review (FIMR) Case Abstractions Health Disparities Building Organizational Capacity to Adopt CLAS HIV Ryan White Part B HIV Expanded Testing Dental HIV Prevention Services HIV Rapid Testing HIV/STD Partner Services HIV Surveillance Support HOPWA (Housing Opportunities for Persons Living with HIV/AIDS) Immunization Action Plan Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up Site Visit Immunization - Field Service Representatives Immunizations MCIR Regions Immunization - Nurse Education Reimbursement Immunization - Vaccine Quality Assurance Program Immunization - VFC/AFIX Site Visit Infant Safe Sleep Informed Consent lnterconception Care Evaluation Project Laboratory Services Bioterrorism Laboratory Services Epidemiology Laboratory Capacity (ELC) Laboratory Services STD Local Maternal and Child Health (MCH) Page 2 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 5/22/14 Local Health Department Project SNAP-Ed Local Tobacco Reduction Maternal infant Early Childhood Home Visiting Initiative (MIECHV) Competitive Exp. Grant Seed Funding Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Local Home Visiting Leadership Group Maternal Infant Early Childhood Home Visiting Pgm. (MIECHVP) Healthy Fam. America Expansion Michigan Abstinence Program Michigan Adolescent Pregnancy & Parenting Program Michigan Care Improvement Registry Michigan Colorectal Cancer Early Detection Program Nurse Family Partnership Services Nurse Family Partnership Services M1ECHV Practices to Reduce' Infant Mortality through Equity (PRIME) Local Learning Collaborative Public Health Emergency Preparedness (PHEP) PHEP (Public Health Emergency Preparedness) (Now includes EPI support) PHEP (Public Health Emergency Preparedness) CRI Sexually Transmitted Disease (STD) Control Sudden Unexplained Infant Death SUIDS SEAL! Michigan Dental Sealant Program TB Control and Elimination Taking Pride in Prevention (TP1P) WIC Breastfeeding WIC Services WISEWOMAN Coordination Page 3 of 121 MDCH/G&PD FY 14/15 ATTACHMENT 111 5/22/14 FORMAT (PROGRAM/ELEMENT1 SPECIAI, REQUIREMENTS I. Budget and Agreement Requirements - Lists those special funding and agreement requirements applicable to the program/element as a whole. IL Grantee Requirements - Lists those special requirements applicable to all agencies administering the program element. III. Department Requirements - Lists those special requirements applicable to the Department. IV. Grantee Specific Requirements - Lists those unique requirements applicable only to the single Grantee covered by this agreement. Page 4 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 ADOLESCENT SEXUALLY TRANSMITTED DISEASE (STD) SCREENING SPECIAL REQUIREMENTS (OAKLAND COUNTY HEALTH DIVISION) Grantee Specific Reauirements Project Summary: Individuals 15-24 years of age will be screened for chlamydia and gonorrhea at the following Oakland County sites: 1. Oakland County Children's Village Detention 2. Oakland County Children's Village Shelter Care 3. Oakland County Main Jail 4. Oakland County Utilizing the identified project sites: 1. Test at least 100 adolescents and young adults per month, using NAAT tests for gonorrhea and chlamydia. 2. Collect race, gender, age, test result, and treatment date for all tests. 3. Refer clients for further health evaluation if indicated. 4. Provide client centered risk reduction plan, promoting abstinence. 5. Treat all positives on site if possible. 6. Contact positive clients that are released prior to treatment with treatment options in community. 7. Promote self-notification of partners 8. Analyze and forward data to the Department every quarter. 9. Develop one annual slide set highlighting year end data by demographic variable including trend data. 10. Continue to promote awareness of prevalence of STDS within adolescent and young adult populations. 11. Participate in quarterly Michigan Infertility Prevention Project meetings; providing quarterly screening project data. BODY ART FACILITY LICENSING SPECIAL REQUIREMENTS Budget and Aareement ReauirementA This agreement is intended to establish a payment schedule to the Grantee, following notification of a completed inspection and recommendation for issuance of license. The intent is to help offset costs related to the licensing of a body art facility, when fees are collected from the respective Grantee's jurisdiction in accordance with Section 13101- 13111of the Public Health Code, Public Act 149 of 2007, which was updated on December 22,2010 and is now Public Act 375. Page 5 of 121 MDCH/G&PD FY 14/15 ATTACHMENT 111 07/03/14 The Department will reimburse the Grantee on a quarterly basis according to the following criteria: Initial annual license for a Body Art Facility prior to July 1 $258.25 51.65% of state fee Initial annual license for a Body Art Facility on or after July 1 $129.13 51.65% of state fee Issue a temporary license for a Body Art Facility $116.21 77.47% of state fee License renewal prior to December 1 $258.25 51.65% of state fee License renewal after December 1 $387.38 51.65% of state fee + 51.65% of penalty Duplicate License $25.83 Payment will be made for those body art facilities that have applied and paid in full to the Department after the signing of PA 375 (December 22, 2010), following notification of a completed inspection and recommendation for issuance of license. grantee Requirements The Grantee is authorized to enforce PA 375 and conduct an inspection of all body art facilities under its jurisdiction, investigate complaints, and enforce licensing regulations and requirements. The Grantee must complete a Body Art Facility Inspection Report [DOH-1468 (07-09)1 as provided by the Department, or other report form approved by the Department that meets, at minimum, all standards of the state inspection report. Only body art facilities that have applied for licensure should be inspected. All body art facilities must be inspected annually. Licenses will only be released from the Department following notification of a completed inspection and upon recommendation by the Grantee. Completed inspection reports should be signed by the facility owner and recommendation for licensure should be forwarded to the Department within two to four weeks following the inspection. Reports should be entered via the online interface or can be sent to: HIV/STDNH/TB Epidemiology Section, Division of Communicable Diseases, 201 Townsend Rd, 5 th Floor, Lansing, Michigan 48913. The contact person is Mr. Michael Kucab, who can be reached at 517-335- 8168 or by e-mail at kucabmmichiqan.qov. Department Requirements The Department will notify the Grantee by email when an applicant has paid for licensure or renewal. This will serve as the request to the Grantee to perform an inspection. The Department will issue a license to an applicant upon the recommendation of the Grantee performing the inspection. The Department will reimburse the Grantee according to this payment schedule to help offset the costs related to the licensing of the body art facility. Payments will be released quarterly based on the FSR submitted. The Department will provide a reporting template to be attached to the FSR. Page 6 of 121 MDCH/G&PD FY 14/15 ATTACHMENT ill 07/03/14 BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) SPECIAL REQUIREMENTS Grantee Requirements The BCCCP (Breast and Cervical Cancer Control Program) is a program designed to provide comprehensive breast and cervical cancer screening and diagnostic services to low-income women between the ages of 40-64. Although the BCCCP serves all income eligible women between the ages of 40-64, recruitment efforts are focused on hard to reach populations, such as minorities, particularly African American and Native American women, and women aged 50-64, as well as women who have never before been screened for either breast of cervical cancer. For specific BCCCP requirements, refer to the most current BCCCP Policies and Procedures Manual. CENTRALIZED ACCESS HOME VISITING HUB SPECIAL REQUIREMENTS (GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT AND ST. CLAIR COUNTY HEALTH DEPARTMENT) Purpose: To carry out the activities outlined in the Grantee's Home Visiting Hub Work Plan, as developed and submitted to the Department. Funding Reauirements: 1. Only one Home Visiting Hub project may be convened per community. a. The project must be conducted collaboratively. b. Partners in the project must include: Public Health, Department of Human Services and/or CAN Council, Substance Abuse Coordinating Agency, Head Start/Early Head Start. c. You are strongly encouraged to also partner with Community Mental Health, Intermediate School Districts/Early On, Great Start Collaborative Bodies, all existing home visiting programs/models and Parents. 2. The project must be tied to efforts to build the community linkages component of medical homes. 3. Each subcontracting Grantee must use the funding to carry out the specific activities outlined in their respective Home Visiting Hub Work Plan, for the purposes of working toward the establishment of a Home Visiting Hub within each community. 4. Each subcontracting Grantee must work with the Department's Technical Assistance (TA) Specialist, and must participate in all TA opportunities provided. 5. Each subcontracting Grantee must receive prior approval from the Department, in order to make changes to their work plans and associated budgets. Page 7 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 6. If a subcontracting Grantee wishes to print promotional or educational materials related to the MIECHV initiative, they must: a. Send draft materials electronically to the contract manager, Penny Eisfelder, at eisfelderpAmichidan.gov b. Materials must be approved by the Department staff and a written approval received by the subcontracting Grantee. c, All materials must include the Michigan Home Visiting Initiative logo, which can be obtained from the contract manager, upon request. d. All materials must include the HRSA federal grant disclaimer and grant number, which can be obtained from the contract manager upon request. e. Separate approval must be obtained for each publication a Grantee wishes to print. 7. Each subcontracting Grantee must fully expend these funds by September 30, 2015 as there will be no opportunity for carryover of the funds beyond that date. Work Plan Requirements: 1. Upon initiation of the FY15 contract, the subcontracting Grantee must submit an updated work plan via e-mail or fax to the Contract Manager, Penny Eisfelder (see contact information in reporting requirements). The work plan must include: a. Activities related to the sustainability plan, outlining how the community's home visiting hub will be sustained as M1ECHV funding decreases; b. Activities related to the submitted outreach plan, outlining how joint outreach will be conducted by the community, in collaboration with the home visiting hub; c. Activities related to the plan submitted showing how the Convener is building community consensus and understanding around the home visiting hub arrangement; d. Assurance that representatives from the community's home visiting hub will participate in quarterly grantee meetings conducted by the Department. Reporting Requirements: 1. All activities, as specified in the Work Plan, shall be implemented and quarterly narrative reports submitted by the Grantee in each quarter of the fiscal year. These reports are to be submitted via e-mail or fax to the Contract Manager, Penny Eisfelder (contact information below). The reports are due 15 days after each quarter ends. Quarter St 2nd 3rd 4th Final Report Reporting Time Period October 1 — December 31 January 1— March 31 April 1 — June 30 July 1 — September 30 Due Date January 15 April 15 July 15 October 15 Page 8 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 2. The narrative report should provide updates on implementation of all activities under the contract. Comparative data should be included to illustrate progress. Each quarterly work plan report must include: a. Number of home visiting slots in the community as of that reporting period b. What percentage of those slots are filled as of that reporting period, c. Number of families on waiting lists as of that reporting period, d. Number of referrals to each program (including program name), e. Number of families that were enrolled in the program they were referred to, f. Number of families that were not enrolled in the program they were referred to and were re-assigned to another program, who is participating at the Convener table, 9. Which joint outreach activities were undertaken in the reporting period, h. Problems identified and policy/procedure changes implemented in response, i. Number of policies/procedures that have changed. 3. FSRs are to be submitted quarterly through the Ml-E-Grants system. 4. Any such other information as specified in the Work Plan shall be developed and submitted by each subcontracting Grantee, as required by the Contract Manager. 5. All other reports or information are to be submitted electronically to: Penny Eisfelder, Program Analyst Division of Family & Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, MI 48909 Phone: 517-241-6841 Fax: 517-335-8697 eisfelderbmichician.qov 6. The Contract Manager shall evaluate the reports submitted as described for their completeness and adequacy. 7. Each subcontracting Grantee shall permit the Department or its designee to visit and to make an evaluation of the project as determined by the Contract Manager. Page 9 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 CHILDHOOD LEAD POISONING EDUCATION & OUTREACH SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, INGHAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH, DELTA-MENOM1NEE COUNTIES, SAGINAW COUNTY DEPARTMENT OF PUBLIC HEALTH, WAYNE COUNTY HEALTH DEPARTMENT,) Purpose Grantee activities funded by the Department are expected to be focused on educational activities throughout the prosperity region, with special attention to high risk areas. Continued funding is contingent on completion of the required activities. Grantee Requirements 1. Education and training to professionals that serve as distribution channels to families, especially those living in geographical areas with a higher risk of lead exposure. Training will include a component on how to engage parents of children at risk for lead poisoning. Professionals to train must include: a. WIC staff/consultants b. Great Start Collaborative partners c. Great Start Parent Coalition participants d. Child care providers 2. Distribute, through trainings and other means, an education toolkit developed by the Department /partners, available through the Department. 3. Participation of at least one representative from each regional project in a learning community to assess and improve the use of the education toolkit over the course of the year. Attendance in person is preferred, but participation by conference call/webinar will be available. 4. A narrative report describing progress made and barriers encountered for each of the SMART goals and activities outlined in the work plan submitted with the project proposal. To the extent possible, this narrative should include measurements for each of the SMART goals and activities. Reports should be submitted to Karen Lishinski: lishinskikmichician.qov. 5. Required Reporting due 30 days after the end of each of three quarters Reporting Time Period Due Date October 1 — January 31 March 2 February 1— May 31 June 30 June 1 — September 30 October 30 6. Prohibited expenditures a. These funds may not be used to provide direct health care services such as lead testing, care coordination, case management, or to provide services such as environmental investigations or remediation/repair of a dwelling. b. These funds may not be used to fund other local public health operations. Page 10 of 123. MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 CHILDHOOD LEAD POISONING INTERVENTION SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, KENT COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) Purpose: Grantee activities funded by the Department are expected to be focused on case management and intervention activities for children with elevated blood lead levels (above > 2Oug/dL). Continued funding is contingent on completion of the required activities. Funding requirements: 1. Funds may be used to provide intervention services in the following locations: a. Detroit — Detroit b. Kent County Grand Rapids c. Wayne County — Hamtramck and Highland Park 2. Funds may only be used for the following purposes: a. Administrative support for case management services b. For children insured by Medicaid, any nursing visits and other case management services beyond those billable to Medicaid. c. For children not insured by Medicaid, all nursing visits and other case management services provided. Grantee Requirements: 1. Each child in the jurisdiction with a confirmed blood lead level equal to or greater than 20 1.1g/dL will receive a full complement of case management services. Refer to the most current "Michigan's Case Management Protocol for Children with a Blood Lead Levels (venous) Equal to or Greater than 201.1g/dL" for an explanation of required services. 2. Children in the jurisdiction with blood lead levels from 5 to 19 ug/dL will receive case management services to the extent that resources allow. 3. Grantee must bill Medicaid for services rendered to Medicaid-insured children, for the maximum amount possible. For specific information on Medicaid covered services, please refer to the Medicaid Provider Manual. 4. The Department CLPPP protocol must be followed and standardized case management forms must be used, for all case management activities. 5. Grantee must participate in quarterly grantee activities as scheduled by the Department CLPPP. 6. Required Reporting: Timely documentation of all case management activities, communications and Medicaid billing in the Healthy Homes and Lead Poisoning Surveillance System (HHLPSS), in a manner prescribed by the Department CLPPP. Page 11 of 121 mDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 7. Prohibited expenditures: a. Screening or Testing for Blood Lead b. Billable services for children insured by Medicaid c. Childhood Lead Poisoning Prevention funds may not be used to fund other local public health operations. CHILDHOOD LEAD POISONING PREVENTION (CLPPP) SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT„ KENT COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH-MUSKEGON COUNTY, SAGINAW COUNTY DEPARTMENT OF PUBLIC Purpose: HEALTH, WAYNE COUNTY HEALTH DEPARTMENT) Grantee activities funded by the Department are expected to be focused on the prevention of lead poisoning in children with lead levels > 5ug/dL. The terms of this contract require funding to be used in high risk communities only (as designated by the Department CLPPP), and must be used for lead program services only. Continued funding is contingent on completion of the required activities. Funding requirements: 1 Funds may be used to provide prevention services in the following locations: a. Detroit — Detroit b. Genesee County — Flint c. Ingham County — Lansing d. Jackson County Jackson e. Kent County Grand Rapids f. Muskegon County Muskegon and Muskegon Heights g. Saginaw County - Saginaw h. Wayne County Hamtramck and Highland Park Grantee Requirements: 1. Community Prescription — Develop a "Community Prescription" that can be used by home visitors, health care providers, and other partners to promote action by parents and point them to community resources. the Department CLPPP will supply a format for this activity. 2. Rental Property Owner Presentations — Provide presentations at meetings of rental property owner associations, educating them on the dangers of lead poisoning, legal requirements for RPOs, and methods for keeping properties lead safe. In collaboration with other agencies, the Department CLPPP will provide a Power Point-style outline, and other materials, that can be adjusted as appropriate. 3. Dashboard on the community's status related to code enforcement/lead inspections — Create a dashboard or report card to publicly report the extent to which code Page 12 of 121. MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 enforcement agencies follow best practices with regard to lead inspection activities. The format will be developed collaboratively with the Department CLPPP. 4. Other Prevention Activities — Conduct other lead poisoning prevention activities for families with children with elevated blood lead levels (above > 5ug/dL), which may include: a. Providing information on lead safe cleaning methods b. Providing lead safe cleaning supplies/equipment c. Providing direct training and coaching on lead safe cleaning methods d. Conducting lead safe cleaning in the home e. Providing supplies to make temporary fixes to prevent lead poisoning f. Arranging for minor repairs that will prevent lead poisoning, using lead safe practices. 5. Conference calls/webinars — Participate in quarterly grantee activities as scheduled by the Department CLPPP. 6. Required Reporting due 30 days after the end of each quarter: a. Documentation of the "Community Prescription" or its most complete draft to date. b. A log of RPO presentations, including date, venue, organization, and a synopsis of audience feedback and issues raised. c. A copy of the current Dashboard. d. A description of other prevention activities conducted, including type of activity, the number of families and children directly impacted, cost per activity. TST--- Quarter Reporting Time Period October 1 — December 31 2nd January 1— March 31 3rd April 1 — June 30 4th Final Report July 1 — September 30 7. Prohibited expenditures: a. Prevention funds may not be used to support Intervention services. b. Screening or Testing for Blood Lead c. Billable services for children insured by Medicaid d. Childhood Lead Poisoning Prevention funds may not be used to fund other local public health operations. Due Date January 30 April 30 July 30 October 30 CHILDREN'S SPECIAL HEALTH CARE SERVICES (CSHCS) SPECIAL REQUIREMENTS Program Management: Reporting Requirements The Grantee shall submit: 1. Annual Narrative Progress Report A brief annual narrative report is due by November 15 following the end of the fiscal year. The reporting period is October 1 — September 30. The annual report will be submitted to the Department and shall include: Page 13 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Reporting Time Period October 1 — December 31 January 1— March 31 April 1 — June 30 July 1 — September 30 Quarterly Logs Due Date January 30 April 30 July 30 October 30 a. Summary of CSHCS successes and challenges b. Technical assistance needs the Grantee is requesting the Department to address c. Brief description of how any local MCH funds allocated to CSHCS were used (e.g., CSHCS salaries, outreach materials, mailing costs,etc.) (if applicable) d. The duplicated number of clients referred for diagnostic evaluations e. The unduplicated number of CSHCS eligible clients assisted withCSHCS enrollment f. The unduplicated number of CSHCS clients in the CSHCS renewal process. Duplicated Number of Clients Referred for Diagnostic Evaluation is defined as: Number of individuals the Grantee referred for and/or assisted in obtaining a diagnostic evaluations during the fiscal year. Those eligible for this service must have symptoms and medical history indicating the information. Individuals currently enrolled in a commercial Health Maintenance Organization (HMO), Medicaid Health Plan (MHP) or with other commercial insurance coverage must seek an evaluation by an appropriate physician sub-specialist through their respective health insurer. A diagnostic may be issued for insured persons to cover the cost of the evaluation that is by policy not covered by the health insurance (e.g. co-pay, deductible). Unduplicated Number of CSHCS Eligible Clients Assisted with CSHCS Enrollment is defined as: Number of CSHCS eligible clients the Grantee assisted in the CSHCS enrollment process during the fiscal year. This assistance includes but is not limited to helping the family obtain necessary medical reports to determine clinical eligibility, completing the CSHCS Application for Services, completing the CSHCS financial assessment forms, etc. "Assisted" refers to help provided either over the telephone or in person with the client. Unduplicated Number of CSHCS Clients Assisted in the CSHCS Renewal Process is defined as: Number of CSHCS enrollees the Grantee assisted in the completion and/or submission of the documents required for the Department to make a determination whether to continue/renew CSHCS coverage during the fiscal year. "Assisted" refers to help provided either over the telephone or in person with the client. 2. Quarterly Care Coordination and Case Management Logs Submit the Care Coordination and Case Management Logs electronically in an encrypted manner to the Contract Manager. The quarterly logs will be submitted in coordination with the FSRs no later than thirty (30) days after the close of the quarter. Quarter 1 st 2nd 3rd 4th MDCH/G&PD FY 14/15 ATTACHMENT Page 14 of 121 07/03/14 Unless otherwise stated, all reports and information shall be submitted electronically or via US mail to: Courtney Lawler Quality and Program Services Section Children's Special Health Care Services Michigan Department qtCommunity Health Lewis Cass Building, 6`" Floor 320 S. Walnut Lansing, Michigan 48933 Phone: (517) 241-7182 Fax: (517) 241-8970 The Contract Manager shall evaluate the reports submitted as described in A above, for their completeness and adequacy. The Contract Manager will conduct case management and care coordination log audits on a quarterly basis. Relationship between_Grantees and Medicaid Health Plans: The Grantee must enter into agreements with all Medicaid Health Plans for CSHCS enrollees in the Grantees service area. Grantees and the Medicaid Health Plans may share enrollee information to facilitate coordination of care without specific, signed authorization from the enrollee. The enrollee has given consent to share information for purposes of payment, treatment and operations as part of the Medicaid Beneficiary Application. The agreement must address all of the following topics: 0 Data sharing El Communication on development of Care Coordination Plan El Reporting requirements El Quality assurance coordination O Grievance and appeal resolution LI Dispute resolution D Transition planning for youth COMPREHENSIVE CANCER CONTROL (CCC) COMMUNITY IMPLEMENTATION PROJECT SPECIAL REQUIREMENTS (BARRY-EATON DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10, INGHAM COUNTY HEALTH DEPARTMENT) Program Purpose: The purpose of this project is to achieve the Michigan Cancer Plan goals and objectives through increased local implementation of activities. Specifically, the purpose is to fund activities that focus on cancer policy and reduction of health disparities. Projects much include at least one policy strategy and one health disparities strategy. Strategies should be based upon a recent evaluation of the community's cancer burden and the community's clearly-identified and specific gaps and needs. Community Implementation/Collaboration — Community implementation is defined as using an evidenced-based intervention within a community. Collaboration is defined as a process where two or more organizations work together to realize shared goals. Page 15 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Grantee Requirements: 1. Any print or media materials produced by the grant must be reviewed by the Department prior to products being finalized and distributed. 2. Any print or media materials produced by the grant must include CDC credit language: "This publication (journal article, etc.) was supported by the Cooperative Agreement 5U58DP003921 from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Centers for Disease Control and Prevention." 3. Institutional Review Board approval must be considered for focus groups, surveys and other similar activities. This should be factored into the project timeline and the Department should be involved and kept apprised. 4. Quarterly Progress Reports and one Final Report of Results and Program Issues, including the following information: Quarter jst 2nd 3rd 4th Final Report Reporting Time Period October 1 — December 31 January 1— March 31 April 1 — June 30 July 1 — September 30 Due Date no later than no later than no later than no later than January 31 April 30 July 31 October 31 Reports shall be submitted to the Contract Manager at: Polly A. Hager, MSN RN, Manager Comprehensive Cancer Control Unit Cancer Prevention & Control Section P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-9729 E-mail: hagerpmichician.00v EAT SAFE FISH SPECIAL REQUIREMENTS (BAY COUNTY HEALTH DEPARTMENT) The Grantee will collaborate with the Department and the EPA Region V Saginaw Community Information Office to deliver a uniform message for the Saginaw River and connected waters regarding the fish and wild game consumption advisories within their jurisdictions. Bay County Health Department (BCHD) will develop a plan to distribute that message using existing health department programs, the medical community, special events, and community service providers to communicate with the at-risk population. BCHD Page 16 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 will get approval from the Department program manager and for any changes to the Saginaw and Bay County Cooperative Agreement Scope of Work including budget and budget narratives, Grantee Reauirements: The Grantee will provide appropriate staff to fulfill the following objectives and outputs as detailed below. 1 Comply with the Saginaw and Bay County Cooperative Agreement budget and budget narratives as describe in the scopes of work provided to the BCHD program manager as applicable from October 1 to September 30. 2. Provide 30 hours of health education and community outreach per week. a. Conduct health education and community outreach in Saginaw, Midland, and Bay Counties. Activities will include, but not be limited to, internal BCHD distribution, health care provider outreach, and key event participation. b. Track hours to comply with cost recovery requirements. 3. Development, Printing, and Distribution of Outreach Materials and implementation of Display Booth a. Identify, track, and record of materials distributed at additional locations within Midland, Bay, and Saginaw Counties. b. Make payment for the replacement of signage on the Tittabawasse and Saginaw Rivers. 4. Conduct Capacity Building in Saginaw, Midland and Bay Counties a. Actively seek out new community partners in Saginaw, Midland and Bay Counties. 5. Participate in monthly SBCA teleconference. 6. Track and report output measures. 7. Write and Submit quarterly reports and an annual report to the Department. a. Submit draft quarterly reports within 15 days after the end of each quarter. b. Annual reports upon request. 8. Provide Presentation of display booth at select community events in coordination with EPA Region V Saginaw Community Information Office. 9. Conduct Outreach though existing BCHD Programs such as WIC, Immunizations, programs for young mothers, or other programs reaching the target population. 10. Assist the EPA Region V Saginaw Community information Office with community outreach. 11. Outreach to Health Care Providers. Page 17 of 121 MDCH/G&PD FY 14/15 ATTACHMENT !II 07/03/14 ESSENTIAL LOCAL PUBLIC HEALTH SERVICES (ELPHS1 SPECIAL REQUIREMENTS B cLujggili r Reau irem entsl 1. State funding for ELPHS shall support and the Grantee shall provide for all of the following required services in accordance with P.A. 368, of 1978 and P.A. 92 of 2000, as amended, Part 24 and Act No. 336, of 1998 Section 909. Infectious/Communicable Disease Control Sexually Transmitted Disease Immunization On-Site Sewage Treatment Management Drinking Water Supply Food Service Sanitation Hearing Vision State funding for ELPHS can support administrative cost for the eight required services including allowable indirect cost, or a Grantee's cost allocation plan. 2. ELPHS funding can also be used to fund other core health functions including; Community Health Assessment & Improvement, Public Policy Development, Health Services Administration, Quality Assurance, Creating & Maintaining a Competent Work Force and Local Public Health Accreditation. These services may be budgeted separately as part of the Administrative Budget element. 3. Net allowable expenditures are the authorized actual/allowable expenditures (total costs less specified exclusions). Available funding is also limited by state appropriations. 4. First and second party fees earned in each required service program may be used only in that required service program. 5. State ELPHS funding is subject to local maintenance of effort compliance distribution of state ELPHS funds shall only be made to agencies with total local general fund public health services spending in FY 14/15 of at least the amount expended in FY 92/93. To be eligible for any of the State funding increases from FY 94/95 through FY 14/15, the FY 92/93 Local Maintenance of Effort Level must be met. 6. A final statewide cost settlement will be performed to assure that all available ELPHS funds are fully distributed and applied for required services. Grantee Requirements 1. Assure the availability and accessibility of services for the following basic health services; Prenatal Care; Immunizations; Communicable Disease Control; STD Disease Control; Tuberculosis Control; Health/Medical Annex of Emergency Preparedness Plan. 2. Fully comply with the Minimum Program Requirements for each of the required services. 3. Grantee will be held to accreditation standards and follow the accreditation process and schedule established by the Department for the required services to achieve full accreditation status. Agencies designated as "not accredited" may have their - Page 18 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Department allocations reduced for Departmental costs incurred in the assurance of service delivery. The accreditation process is based upon the Minimum Program Standards and scheduled on a three-year cycle. The Minimum Program Standards include the majority of the required Department reviews. Some additional reviews, as mandated by the funding agency, may not be included in the Program Standards and may need to be scheduled at other times. Department Requirements 1. Whenever the Department delivers direct services within the Grantee's area, it shall give prior notification and provide summary reports of those activities upon the request of the Grantee health officer. Grantee Specific Reauirements — Food Service Sanitation Budget and Aareement Requirements Michigan Department of Agriculture and Rural Development (MDARD) Agrees to: Food Service Establishment Licensing 1. Furnish pre-printed food service establishment license applications and pre-printed licenses to the Grantee for each licensing year (May 1 through April 30) using previous year active license data. 2. Provide a count of all licenses sent to the Grantee titled "Record of Licenses Received." 3. Reprint any licenses requiring correction and send corrected copies to the Grantee. 4. Bill the local health department for state fees upon notification by Grantee that the license has been approved and issued. Temporary Food Service Establishment Licensing 1. Furnish blank temporary food service license application forms (forms Fl-231, Fl-231A) and blank Combined License/Inspection forms (FI-229) upon request from the local health department. a. Furnish a "Record of Licenses Received" with each order of Combined Licenses/Inspection forms. b. Periodically reconcile temporary food service establishment licenses sent to the Grantee with the licenses that have been issued (copy returned to MDARD). c. Bill the local health department for state fees upon notification by the Grantee that the license has been approved and issued. Page 19 of 121 MDCH/G&PD FY 14/15 ATTACHMENT HI 07/03/14 Grantee Reauirements The Grantee agrees to: Food Service Establishment Licensing 1. Accept responsibility for all licenses specified in the "Record of Licenses Received." 2. Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Provide updates to MDARD on the 1 st and 15th of each month, as necessary to: a. Provide a list of food service establishments approved for licensure/license issued. b. Provide a list of food service establishment licenses that have not been approved for licensure and are considered voided or deleted. c. Return the actual licenses to MDARD that are to be voided or deleted. d. Return renewal license applications and licenses that require correction. Mark the corrections on the renewal application. Temporary Food Establishment Licensing 1. Upon receipt, sign and return the "Record of Licenses Received" to MDARD. 2, Issue licenses in accordance with the Michigan Food Law 2000, as amended. 3. Make every effort to issue temporary food establishment licenses in numerical order. 4. Provide updates to MDA on the 1 st and 15th of each month, as necessary, to provide: a. A copy of each temporary food establishment license issued. b. A list of lost or voided licenses by license number. Grantee Specific Reauirements — Private and Tvoe III Drinking Water Supply Requirements The Grantee shall perform the following services including but not limited to: 1. Perform water well permitting activities, pre-drilling site reviews and water supply system inspections for code compliance purposes with qualified individuals classified as sanitarians or equivalent. 2. Assign one individual to be responsible for quarterly reporting of the data and to coordinate communication with the assigned State staff. Reports shall be submitted no later than fifteen (15) days following the end of the quarter on forms provided by the State. The report form EQP 2057(3) is available on the MDEQ website. All quarterly reports are submitted directly to the MDEQ address noted on the form. 3. Perform the activities described in items 5 through 8 of the attached Minimum Program Requirements (MPRs), Drinking Water Supply, dated October 1, 1996, the associated performance indicators, and use the "Guidance Manual for the Private and Type Ill Drinking Water Supply Program," October 2002, 112007, as furnished by the State to implement the MPR provisions. The guidance manual is available online at www.michigan.gov/documents/deg/deq-wb-dwehs-wcu- guidancemanual 221342 7.pdf Page 20 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Grantee Specific Reauirements — Private On-Site Sewaae Treatment Manaaement Proaram Requirements The Grantee shall perform the following services for private single- and two-family homes and other establishments that generate less than 10,000 gallons per day of sanitary sewage: 1. Maintain an up-to-date regulation for on-site sewage treatment and disposal systems (Systems). The regulation shall be supplemented by established internal policies and procedures. Technical guidance for staff that defines site suitability requirements, the basis for permit approval and/or denial, and issues not specifically addressed by the regulation shall be provided. 2. Evaluate all parcels to determine the suitability of the site for the installation of initial and replacement Systems in accordance with applicable regulation(s). These evaluations shall be conducted by a trained sanitarian or equivalent and shall consist of a review of the permit application for the installation of a System and a physical evaluation of the site to determine suitability. 3. Accurately record on the permit to install the initial or replacement System or on an attachment to the permit the site conditions for each parcel evaluated including soil profile data, seasonal high water table, topography, isolation distances, and the available area and location for initial and replacement Systems. The requirement for identifying a replacement System applies to issuance of new construction permits only. 4. Issue a permit, prior to construction, in accord with applicable regulation(s) for those sites that meet the criteria for the installation of a System. The permit shall include a detailed plan and/or specifications that accurately define the location of the initial or replacement System, System size, other pertinent construction details, and any documented variances. 5. Provide and keep on file formal written denials, stating the reason for denial, for those applications where site conditions are found to be unsuitable. 6. Conduct a construction inspection prior to covering each System to confirm that the completed System complies with the requirements of the permit that has been issued. Maintain, on file, an accurate individual record of each inspection conducted during construction of each system. in limited circumstances where constraints prohibit staff from completing the required construction inspection in a timely manner, an effective alternate method to confirm the adequacy of the completed System shall be established. The effective alternative method shall be utilized for no more than 10 percent of the total number of final inspections unless specific authorization has been granted by the State for other percentage. The results of all such inspections or an alternate method shall be clearly documented. 7. Maintain art organized filing system with retrievable information that includes documentation regarding all site evaluations, permits issued or denied, final inspection documentation, and the results of any appeals. 8. Conduct review and approval or rejection of proposed subdivisions, site condominiums and also land divisions under one acre in size for site suitability Page 21 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 according to the statutes and Administrative Rules of the Michigan Department of Environmental Quality (MDEQ). 9. Utilize the State's "Michigan Criteria for Subsurface Sewage Disposal" (Criteria) for Systems other than private single- and two-family homes that generate less than 10,000 gallons per day. Systems treating less than 1,000 gallons per day may be approved in accordance with the Grantee's regulation. Advise the State prior to issuance of a variance from the Criteria. Variances are only to be issued by the Director of Environmental Health of the Grantee after consultation with the State. Appeals of any decision of the Grantee pursuant to the Criteria including systems treating less than 1,000 gallons evaluated in accordance with the Grantee's regulation shall only be made to the State. 10. Maintain quarterly reports that summarize the total number of parcels evaluated, permits issued, alternative or engineered plans reviewed, and number of appeals, number of inspections during construction, number of failed systems evaluated, and number of sewage complaints received and investigated. The report form EQP 2057a is available on the MDEQ website. All quarterly reports are to be submitted directly to MDEQ to the address noted on the form within 15 days following the end of each quarter to the address noted on the form. 11. Review all engineered or alternative System plans. Conduct adequate inspections during the various phases of construction to ensure proper installation. 12. Collect data at the time of permit issuance when a System has failed to document the System age, design, site conditions, and other pertinent factors that may have contributed to the failure of the original System. Evaluations shall record information indicated on the MDEQ Residential and Non- Residential Failed System Data Collection forms. The results for all failed Systems evaluated shall be maintained in a retrievable file or database and summarized in an annual calendar year data report. Annual summaries of failed system data shall be provided to the MDEQ for input into the state-wide failed system database. MDEQ Failed System Data Submission Forms (Non Residential and Residential) shall be provided to the State no later than February 1st of the year following the calendar year for which the data has been collected. 13. Provide training for staff involved in the Program as necessary to maintain knowledge of current regulations and internal policies and procedures and to keep staff informed of technological improvements and advancements in Systems. 14. Establish and maintain an enforcement process that is utilized to resolve violations of the Local Entity and/or State's rules and regulations. 15. Maintain complaint forms and a filing system containing results of complaint investigations and documentation of final resolution. investigate and respond to all complaints related to Systems in a timely manner. Page 22 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 FAMILY PLANNING/BREAST AND CERVICAL CANCER CONTROL PROGRAM (BCCCP) JOINT PROJECT SPECIAL REQUIREMENTS Grantee Requirements The FP/BCCCP Demonstration Project is a joint program between Family Planning and BCCCP designed to provide diagnostic services to Title X (Family Planning) clients who have Pap tests indicating possible cervical cancer. Extensive data is required by the Center for Disease Control and Prevention (CDC) for each woman served by federal funds. Dates of service and results of testing are required prior to authorizing reimbursement to providers. Therefore, data about the abnormal Pap smear will have to be transmitted from the Family Planning program to the designated BCCCP Grantee prior to arranging diagnostic services. 1. Women eligible for this program will be Title X clients, be uninsured or underinsured, and with income under 250% of poverty. A Family Planning client meeting these eligibility criteria will sign a release form to allow her data to be provided to the BCCCP. Forms will be provided to the Family Planning agencies for recording data required for referral to a BCCCP Grantee. All data required for enrollment in the BCCCP will be collected by the BCCCP Grantee. 2. Each delegate agencies must serve a minimum of 95% of proposed Title X users to access its total amount of allocated funds. Quarterly FPAR data will be used to determine total Title X users. 3. Dates and results of all diagnostic procedures must be recorded in the Michigan Breast and Cervical Cancer Information System (MBCIS) by the BCCCP Grantee before reimbursement can be approved. 4. The data must indicate the outcome of testing with a final diagnosis of cancer/not cancer and, if cancer, the stage and date of treatment initiation, as well as the type of treatment. It is expected that there will be extensive communication between the referring Title X agency and the BCCCP Grantee managing the diagnostic process, so that the woman will proceed seamlessly through the medical system(s). 5. The BCCCP Grantee must provide results of diagnostic evaluation to the referring Family Planning agency upon request, and upon completion of the diagnostic process. 6. if cancer is diagnosed the woman will have access to the BCCCP treatment network, and the BCCCP Grantee must make every effort to ensure the woman receives proper treatment. Women diagnosed with cervical cancer or pre-cancer (CIN 2) in the FP/BCCCP Joint Project are eligible to apply for Medicaid to pay for treatment. Page 23 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 FAMILY PLANNING - PREGNANCY PREVENTION SPECIAL REQUIREMENTS Grantee Requirements 1. The funds appropriated in the current State Public Health Appropriations Act for pregnancy prevention programs shall not be used to provide abortion counseling, referrals or services, unless contradicts Title X Federal Law (Title X of the Public Health Service Act). 2. Each delegate grantee must serve a minimum of 95% of proposed Title X users, to access its total amount of allocated funds. Biannual FPAR data will be used to determine total Title X users. 3. Title X Family Planning grantees must collect Medicaid. The information must be reported on the Michigan Table 15, as provided by program, and must be submitted biannually along with Family Planning Annual Report (FPAR) in an electronic reporting format as prescribed by the Department. Reporting Requirements The Grantee shall submit Family Planning Annual Reports (FPAR): Period covered Due to the Department Mid-Year Report (Jan-June) July 15 Annual Report (Jan-Dec) January 10 FDA TOBACCO RETAILER jA&L) INSPECTIONS SPECIAL REQUIREMENTS (CITY OF DETROIT HEALTH AND WELLNESS, DISTRICT HEALTH DEPARTMENT #4, GENESEE COUNTY HEALTH DEPARTMENT, ING HAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, MIDLAND COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY PUBLIC HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) 1. One Grantee staff person to be commissioned by FDA to carry out FDA Advertising and Labeling Inspections and related activities. 2. Participate in all FDA Program Training, annual refresher training/courses and other related the Department /FDA meetings and site visits. 3. Conduct and document the agreed upon number of routine, compliance and complaint follow-up Advertising and Labeling Inspections, including all follow-up activities, utilizing FDA report forms and protocol. 4. Provide written affidavits and/or in-person testimony for FDA-specified A&L Tobacco Control Act violations upon request. Page 24 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 5. On a daily basis (i.e., when conducting FDA-related activities), provide documentation of all FDA activities by utilizing either the Department Activity Log or other similar form. 6. Submit quarterly and year-end reports to the Department utilizing the template provided. Quarterly report due dates: November 30, February 28, Mary 28, and August 15. The August 15 report will serve as a quarterly/year-end report. FDA TOBACCO RETAILER (A&L) INSPECTIONS SPECIAL REQUIREMENTS (OAKLAND COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES/HEALTH DIVISION) 1. One local health department staff person to be commissioned by FDA to carry out FDA Advertising and Labeling Inspections and related activities. 2. Participate in all FDA Program Training, annual refresher training/courses and other related Department/FDA meetings and site visits. 3. Conduct and document up to 123 new Routine Compliance Inspections as assigned through the FDA TIMS system, as well as complete all follow-up activities utilizing FDA report forms and protocol. 4. Conduct and document assigned Compliance Follow-up, Complaint Follow-up and Recheck Inspections as assigned through the FDA TIMS system, as well as complete all follow-up activities utilizing FDA report forms and protocol. 5. Provide written affidavits and/or in-person testimony for FDA-specified A&L Tobacco Control Act violations upon request. 6. Submit quarterly and year-end reports to the Department utilizing the template provided. Quarterly report due dates: November 30, February 28, Mary 28, and August 15. The August 15 report will serve as a quarterly/year-end report. Quarter 1st 2nd 3rd 4th Due Date November 30 February 28 Mary 28 August 15 FDA TOBACCO RETAILER (A&L) INSPECTIONS SPECIAL REQUIREMENTS (CITY OF DETROIT HEALTH AND WELLNESS) 1. One staff person to be commissioned by FDA to carry out FDA Advertising and Labeling Inspections and related activities. 2. Grantees will subcontract with up to three additional commissioned FDA Inspectors to conduct inspections on an as-needed basis statewide. 3. Participate in all FDA Program Training, annual refresher training/courses and other related the Department /FDA meetings and site visits. Page 25 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 4. Conduct and document up to 120 new Routine Compliance Inspections, as assigned through the FDA TIMS system, as well as complete all Recheck and Compliance Follow-up Inspections utilizing FDA report forms and protocol. 5. Provide written affidavits and/or in-person testimony for FDA-specified A&L Tobacco Control Act violations upon request. 6. Submit quarterly and year-end reports to the Department utilizing the template provided. Quarter s 2nd 3rd 4th Due Date November 30 February 28 Mary 28 August 15 FETAL ALCOHOL SPECTRUM DISORDER (FASD) PROJECTS SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT AND PUBLIC HEALTH, DELTA- MENOMINEE COUNTIES) Objective: For the project period of October 1 to September 30, the Grantees will collaborate with the Department to assist local communities with evidence-based activities identified in the FASD Interagency Strategic Plan, to prevent prenatal alcohol exposure among women of reproductive age and to refer affected children, birth to 18 years of age, and their families to an FASD Diagnostic Center for evaluation and intervention for the purpose of improving care and services for women, infants and families. Grantee Requirements 1. FASD project coordinator (or designee) must participate/attend semi-annual FASO Grantees Conference Calls provided by the department during FY 2015. 2. Implement the FASD Interagency Strategic Plan, activities as approved by the department. 3. Produce quarterly and year-end reports using the Uniform Data collection Tool (UDCT) form provided by the department that provides documentation of the types, numbers and demographic data including racial data of contacts for screening, motivational interviews and/or referrals from the grantee's FASD community based program. The UDCT from is available at www.michigan.gov/fas . The FASD UDCT quarterly reports are to be submitted via the MI E-Grants system attached to the FSR. The 4th quarter report, due October 15, will serve as the year- end report. Department Reauirements 1. Convene FASD Grantees semi-annual conference calls during FY 2015 to discuss progress toward community project goals outlined in the cooperative agreement and Page 26 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 provide technical assistance questions/answers as outlined in the cooperative agreement. 2. Describe and provide resources and updates for the evidence-based interventions required by this contract. 3. Provide technical assistance for each requirement of this contract. 4. Provide reporting formats for data collection and deliverables. Reporting Reauirements 1. Deliverables are due QUARTERLY and a YEAR-END REPORT will summarize the results of the contract year. The Grantee shall submit the following reports within 15 days after the end of each quarter on the following dates: Quarter End Date Report Due Date Quarter Reporting Time Period Due Date 1st October 1 — December 31 January 15 2nd January 1— March 31 April 15 3rd April 1 June 30 July 15 4th July 1 — September 30 October 15 2. The Grantee will collect data using the Uniform Data Collection Tool (UDCT) project evaluation/data tracking forms to monitor the FASD community program effectiveness. The Uniform Data Collection Tool (UDCT) is available at www.michioansiov/fas 3. The Grantee shall submit the following information electronically to the Department FASD Program via the MI E-Grants system attached to FSR a. The Grantee must provide documentation that FASD services are tracked for all individuals referred through the FASD community project program and shall submit a UDCT Data Tracking Form to be sent at the end of each quarter. Submit quarterly & year-end reports via the MI E-Grants system attached to FSR Program Contact Information: Debra Kimball, FASO State Program Coordinator Michigan Department of Community Health, Division of Family and Community Health P.O. Box 30195, Lansing, Ml 48909 Phone (517)335-8379 Fax (517)335-8822 Kimballd1©michigan.gov Page 27 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 FETAL AND INFANT MORTALITY REVIEW (FIMR) CASE ABSTRACTIONS SPECIAL REQUIREMENTS (ALLEGAN COUNTY HEALTH DEPARTMENT, BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT, CITY OF DETROIT HEALTH AND WELLNESS, GENESEE COUNTY HEALTH DEPARTMENT, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN JACKSON COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH DEPARTMENT) Grantee Reauirements Objective: To assist local communities to learn from individual cases of fetal and infant death regarding what factors contribute to poor pregnancy outcome in their community, for the purpose of improving care and services for women, infants and families. Key Activities: Qualified individuals will perform medical record case abstraction for Fetal Infant Mortality Review to include the following: 1. Review of medical records involved in fetal and infant death to include but not limited to hospital records, pre-natal records, pediatric records, emergency and medical examiner's records. 2. Interact with other agencies and service providers involved in infant's death (M1 Department of Human Services, Child Protective Services, local health department, law enforcement). 3. Develop case summaries from the above abstracted information as well as the Maternal Interview, using Michigan FIMR Network tools and guidelines 4. Attend the review team meetings to facilitate the presentation of the cases. 5. Enter cases into access data base and submit cases to MPH I for MF1MR data base Department Requirements 1. Each completed case abstraction will be compensated at $270.00 per case. 2. Department will provide ongoing technical assistance to local F1MR teams for medical record case abstraction, developing case summaries, maintaining a functioning Case Review Team, and facilitating moving recommendations to community action. 3. Department provides the statewide FIMR database, administered through MPH I. Repartina Requirements Quarterly progress reports following the template supplied by the FIMR State support program. Quarterly reports are due the 15th of the month following the end of the quarter and are submitted to the State coordinator. End of FY final report on cases completed and Page 28 of 121 MDCH/G&PD FY 14/15 ATTACHMENT RI 07/03/14 team findings are submitted to the State coordinator. Quarter Re_porting Time Period s October 1 — December 31 2nd January 1— March 31 3rd April 1 — June 30 4th July 1 — September 30 Due Date January 15 April 15 July 15 October 15 HIV SCREENING IN DENTAL CLINIC SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION) Purpose: The purpose of this project is to support HIV screening for clients receiving dental care services. Program development, implementation and evaluation will be delivered according to the methods, time line, work plan, budget and staffing plan approved by the Department. Grantee Requirements: 1. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 2. Adhere to all federal and state issued guidance and policy for services provided. 3. Participate in monitoring site visits including review of fiscal and programmatic compliance with HAPIS policies and contract requirements. 4. Ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 5. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. All subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. c. Provide one copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement the Department by October 15, or within 30 days of execution. 6. Establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: Page 29 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 a. Regular back-up of client records with back-up files stored in a secure location; b. use of passwords to prevent unauthorized access to the computer or Client Level Data program c. Use of virus protection software to guard against computer viruses; and d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to the Department policies concerning Sharing and Secured Electronic Data. 7. Client and service level data is the property of the Department. In the event that services are no longer delivered under this agreement, electronic data files held outside of the HES database must be returned to the Department within 30 days of the loss of services. 8. Provide immediate notification to the Departemnt, in writing, in the event of any of the following: a. Formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring, or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Staff vacancies that impact the delivery of services to clients. 9. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. Standards and Practices must address sexual minorities. 10. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used in conjunction with program activities to the STD/HIV Prevention Program Review Panel for review and approval prior to their use, if funding is used to purchase these materials. 11. Submit preliminary agendas to the Department for review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. 12. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters and community health centers. 13. Assist the Departemnt in appropriate needs assessment activities. 14. Maintain, for a minimum of three (3) years, program and fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. 15. Financial Status Reports (FSR) must be submitted quarterly in the MI E-Grants system, no later than 30 days after the end of the period. Page 30 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Grantee Specific Reauirements: 1. Routinely recommend to all clients receiving dental care services HIV testing. 2. Develop, implement and maintain protocol and procedures necessary to implement services responsive to the intent of the funding made available through this agreement. Protocol and procedures must be reviewed periodically and approved by the Department. 3. Comply with guidelines and standards issued by the Department and: a. Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised, are to be submitted to the Department. Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing, MDCH (October 2008, or subsequent revisions). b. Enroll and participate in the Model Performance Evaluation Program (MPEP), CDC's external proficiency testing program. c. Submit a photocopy of the local health department's current CLIA certificate to the Department. d. Report anomalous test results to the Depatment pursuant to established protocol. e. Submit quality control, daily patient logs and test inventory on a monthly basis. f. Ensure that staff performing counseling and/or testing with rapid test technologies has completed, successfully, rapid test counselor certification course (if applicable), test device training, and proficiency testing. g. Ensure that site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training. h. Develop, implement and monitor protocol and procedures to ensure that patients receive confirmatory test results. 4. The Grantee and its subcontractors are required to use the HES to enter client and service data into the centrally managed database on a secure server. The collection of all required data variables and the clean-up of any missing data or service activities should be completed in HES no later than the 15th day after the end of each calendar quarter. Department Reauirements 1. The Department will provide rapid HIV test devices and external controls in sufficient quantity to ensure that HIV testing is provided as a standard of care to clients seeking STD prevention and treatment services (formerly known as the "Expanded HIV Testing in High Prevalence Health Care Settings to Address Racial/Ethnic Disparities in Access to Testing Services") and to facilitate staff training and proficiency testing. 2. Provide training and technical assistance in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. Page 31 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 3. Provide training on HES, CLAS, the MI E-Grants system and other issues related to Prevention services. 4. Conduct a site visit, including both fiscal and programmatic review, at least annually. Provide 30 days written notice of the site visit, including an agenda and the assessment tool. 5. Review Semi-annual and Annual reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission date. HIV/STD PARTNER SERVICES PROGRAM SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT) Grantee Reauirements I . Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 2. Adhere to all federal and state issued guidance and policy for services provided. 3. Participate in monitoring site visits including review of fiscal and programmatic compliance with Department's policies and contract requirements. 4. Ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 5. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. All subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. c. Provide one copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement to the Department by October 15 or within 30 days of execution. 6. Establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location; b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program; Page 32 of 121 MDCH/G&PD FY 14/15 ATTACHMENT 11 07/03/14 c. Use of virus protection software to guard against computer viruses; and d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to the Department policies concerning Sharing and Secured Electronic Data. 7. Client and service level data is the property of the Department.. In the event that services are no longer delivered under this agreement, electronic data files held outside of the central CARE Ware and/or HES database must be returned to the Department within 30 days of the loss of services. 8. Provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring, or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Staff vacancies that negatively impact the delivery of services to clients. 9. Assess client or participant satisfaction annually and use methods, instruments and analysis that minimize bias and ensure confidentiality of responses. Establish and maintain a mechanism to obtain input about needed services from infected and affected persons. Use results from these assessments and other evaluation activities to make appropriate program level changes and monitor the effects of these changes. 10. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. Standards and Practices must address sexual minorities. 11. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used in conjunction with program activities to the STD/HIV Prevention Program Review Panel for review and approval prior to their use, if funding is used to purchase these materials. 12. Submit preliminary agendas to the Department for review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. 13. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters and community health centers. 14. Assist the Department in appropriate needs assessment activities. 15. Maintain, for a minimum of three (3) years, program and fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. Page 33 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 16. Financial Status Reports (FSR) must be submitted quarterly in the MI E-Grants system, no later than 30 days after the end of the period. Grantee Specific Requirements 1. Pursuant to a protocol established by the Department, provide positive test notification, HIV and syphilis partner counseling and referral services, victim notification and recalcitrant investigation for the following local health departments: Bay County Health Department, Benzie-Leelanau District Health Department, Central Michigan District Health Department, Chippewa County Health Department, Dickinson-Iron District Health Department, District Health Department # 2, District Health Department # 4, District Health Department #10, Grand Traverse County Health Department, Luce-Mackinac-Alger-Schoolcraft District Health Department, Marquette County Health Department, Mid-Michigan District Health Department, Midland County Health Department, Northwest Michigan Community Health Agency, Public Health, Delta and Menominee Counties, and Western Upper Peninsula District Health Department. 2. Provide these services fifty-two weeks a year. 3. Conduct program activities pursuant to applicable federal and state laws, rules and policies and in accordance with the Recommendations for Conducting Partner Services in the Prevention of HIV/STDs, MDCH (2011). 4. Establish, maintain and document (e.g., via MOU or MOA) linkages with community resources that are necessary and appropriate to addressing the needs of clients and that are essential to the success and effectiveness of services supported under this agreement. 5. The Grantee and its subcontractors are required to use the HIV Event System (HES) to enter HIV client and service data into the centrally managed database on a secure server. Data must include all clients who receive any Part B eligible service (regardless of the source of funding for the services) and all Part B eligible services delivered to HIV-infected or affected clients. The collection of all required data variables and the clean-up of any missing data or service activities should be completed in HES no later than the 15 th day after the end of each calendar quarter. Department Requirements 1. Provide technical assistance, as requested, on the development and implementation of the Quality Management Plan. 2. Provide training on HES, CLAS, M I E-Grants system and other issues related to Prevention services. 3. Conduct a site visit, including both fiscal and programmatic review, at least annually. HAPIS will provide 30 days written notice of the site visit, including an agenda and the assessment tool. 4. Review Semi-annual and Annual reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission date. Page 34 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 HIV PREVENTION PROGRAM SPECIAL REQUIREMENTS Purpose: Local health departments will provide HIV counseling, testing and referral and partner services within their jurisdiction, pursuant to applicable federal and state laws; and policies and program standards issued by the Department. Grantee Requirements — Categorical 1. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 2. Adhere to all federal and slate issued guidance and policy for services provided. 3. Participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 4. Ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 5. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. All subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and rennediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. c. Provide one copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement to the Department by October 15, or within 30 days of execution. 6. Establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location. b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program; c. Use of virus protection software to guard against computer viruses; and d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to the Department policies concerning Sharing and Secured Electronic Data. 7. Client and service level data is the property of the Department. In the event that services are no longer delivered underthis agreement, electronic data files held Page 35 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 outside of the HES must be returned to the Department within 30 days of the loss of services. 8. Provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring, or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Staff vacancies that negatively impact the delivery of services to clients. 9. Assess client or participant satisfaction annually and use methods, instruments and analysis that minimize bias and ensure confidentiality of responses. Establish and maintain a mechanism to obtain input about needed services from infected and affected persons. Use results from these assessments and other evaluation activities to make appropriate program level changes and monitor the effects of these changes. 10. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. Standards and Practices must address sexual minorities. 11. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used in conjunction with program activities to the STD/HIV Prevention Program Review Panel for review and approval prior to their use, regardless of the source of funding used to purchase these materials. 12. Submit preliminary agendas to the Departmentfor review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. 13. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters and community health centers. 14. Assist the Department in appropriate needs assessment activities. 15. Maintain, for a minimum of three (3) years, program and fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. 16. Financial Status Reports (FSR) must be submitted quarterly in the MI E-Grants system, no later than 30 days after the end of the period. Contract oecific Requirements - Cateaorical 1. If conducting HIV testing using rapid HIV testing, comply with guidelines and standards issued by the Department and: Page 36 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II4 07/03/14 a. Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised, are to be submitted to the Department , Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing, MDCH (October 2008, or subsequent revisions). b. Enroll and participate in the Model Performance Evaluation Program (MPEP), CDC's external proficiency testing program. c. Submit a photocopy of the local health department's current CLIA certificate to Division of Health, Wellness and Disease Control. d. Report anomalous test results to the Division of Health, Wellness and Disease Control, pursuant to established protocol. e. Submit quality control, daily patient logs and test inventory on a monthly basis. f. Ensure that staff performing counseling and/or testing with rapid test technologies has completed, successfully, rapid test counselor certification course (if applicable), test device training, and proficiency testing. g. Ensure that site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training. h. Develop, implement and monitor protocol and procedures to ensure that patients receive confirmatory test results. 2. The Grantee and its subcontractors are required to use the HIV Event System (HES)to enter client and service data into the centrally managed database on a secure server. Data must include all clients who receive any Part B eligible service (regardless of the source of funding for the services) and all Part B eligible services delivered to HIV-infected or affected clients. The collection of all required data variables and the clean-up of any missing data or service activities should be th completed in HES no later than the 15 day after the end of each calendar quarter. Department Reauirements - Cateaoricat 1. The Deparlmentwill provide rapid HIV test devices and external controls in sufficient quantity to ensure that HIV testing is provided as a standard of care to clients seeking STD prevention and treatment services (formerly known as the "Expanded HIV Testing in High Prevalence Health Care Settings to Address Racial/Ethnic Disparities in Access to Testing Services") and to facilitate staff training and proficiency testing. For FY 15, the quantity of rapid HIV test devices provided by the Department shall not exceed: Page 37 of 121 MDCH/G&PD FY 14/15 ATTACHMENT HI 07/03/14 Grantees Maximum Number of Rapid Berrien County Health Department 1,140 Calhoun County Health Department 2,235 Detroit Department of Health and Wellness 9,020 Genesee County Health Department 3,300 Ingham County Health Department 2,440 Jackson County Health Department 300 Kalamazoo County Health and Community Services 3,340 Kent County Health Department 3,420 Muskegon County Health Department 2,200 Oakland County Health Division 14,420 Saginaw County Health Department 1,620 Washtenaw County Health Department 1,700 Wayne County Health Department 2,200 Van Buren —Cass District Health Department 920 Additional quantities of rapid HIV test devices and controls may be made available to Grantee provided that the Grantee can demonstrate that test devices will be used in a manner consistent with the general purposes of this agreement and in accordance with approved program methodologies and predicated upon availability of resources. 2. Provide training and technical assistance in support of implementation of HIV testing as a standard of care and use of rapid HIV tests. 3. Provide technical assistance, as requested, on the development and implementation of the Quality Management Plan. 4. Provide training on HES, CLAS, MI E-Grants system and other issues related to Prevention Services. 5. Conduct a site visit, including both fiscal and programmatic review, at least annually. HAPIS will provide 30 days written notice of the site visit, including an agenda and the assessment tool. 6. Review Semi-annual and Annual reports. Questions or clarifications, if any, will be requested within 30 calendar days of submission date. Grantee Reauirements — Nan-Cateaorical Grantees that do not receive categorical HIV prevention funds and that elect to conduct HIV testing may request reimbursement for performing HIV tests. For Grantees that do not receive categorical AIDS/HIV prevention funds and who elect to conduct HIV testing: 1. Provide HIV Counseling, testing and referral services, pursuant to statute and the Department -issued accreditation standards. Page 38 of 121 MDCH/Gg/PD FY 14/15 ATTACHMENT II 07/03/14 2. Submit client-level service data to the Department via the HES. The time line and procedures for submitting these data are to conform to guidelines issued by the Department. 3. Reimbursement requests must be submitted quarterly on the FSR. Requests for reimbursement will be verified based on data submitted to the Department via HES. Grantees will not receive reimbursement for tests not entered into the HES. Department Reauirements — Non-Categorical Reimburse Grantees at a rate of $11.00 per test, not to exceed $2,000 for Fiscal Year 2014/2015. HIV PREVENTION HIV RAPID TESTING SPECIAL REQUIREMENTS (DETROIT DEPARTMENT OF HEALTH AND WELLNESS PROMOTION— STD CLINIC) Purpose: The purpose of this agreement is to facilitate HIV testing as standard of care in the STD clinic by providing support for dedicated staff to conduct point-of-care rapid HIV testing in the STD Clinic stet lab. Grantee Reauirements 1. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 2. Adhere to all federal and state issued guidance and policy for services provided. 3. Participate in monitoring site visits including review of fiscal and programmatic compliance with Department policies and contract requirements. 4. Ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 5. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. All subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; report the results of all contract monitoring activities to the Department. Page 39 of 121 MDCH/G&FD FY 14/15 ATTACHMENT 10 07/03/14 c. Provide one copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement to the Department by October 15or within 30 days of execution. 6. Establish written procedures for protecting client information kept electronically or in charts or other paper records. Protection of electronic client-level data will minimally include: a. Regular back-up of client records with back-up files stored in a secure location; b. Use of passwords to prevent unauthorized access to the computer or Client Level Data program; c. Use of virus protection software to guard against computer viruses; and d. Provide annual training to staff on security and confidentiality of client level data and sharing of electronic data files according to the Department policies concerning Sharing and Secured Electronic Data. 7. Client and service level data is the property of the Department. In the event that services are no longer delivered under this agreement, electronic data files held outside of the central CAREWare and/or HES database must be returned to the Department within 30 days of the loss of services. 8. Provide immediate notification to the Department, in writing, in the event of any of the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring, or notice received by the Grantee or subcontractor, that reasonably suggests that the Grantee or subcontractor may be the subject of, or a defendant in, legal action. This includes, but is not limited to, events or notices related to grievances by service recipients or Grantee or subcontractor employees. c. Staff vacancies that negatively impact the delivery of services to clients. 9. Assess client or participant satisfaction annually and use methods, instruments and analysis that minimize bias and ensure confidentiality of responses. Establish and maintain a mechanism to obtain input about needed services from infected and affected persons. Use results from these assessments and other evaluation activities to make appropriate program level changes and monitor the effects of these changes. 10. Adhere to Culturally and Linguistically Appropriate Service (CLAS) Standards. Standards and Practices must address sexual minorities. 11. Submit all educational materials (e.g., brochures, posters, pamphlets and videos) used in conjunction with program activities to the the Department Program Review Panel for review and approval prior to their use, regardless of the source of funding used to purchase these materials. 12. Submit preliminary agendas to the Department for review and approval, for conferences, trainings, workshops and similar activities supported wholly or in part under this agreement. Page 40 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 13. Maintain appropriate relationships with entities in the area served that constitute key points of access to the health care system for individuals with HIV disease. Key points of access include, but are not limited to, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters and community health centers. 14. Assist the Department in appropriate needs assessment activities. 15. Maintain, for a minimum of three (3) years, program and fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement, for clients residing in the State of Michigan. 16. Financial Status Reports (FSR) must be submitted quarterly in the MI E-Grants system, no later than 30 days after the end of the period. Grantee Specific Requirements 1. Provide dedicated staff for the STD clinic stet lab to ensure and support routine HIV testing for clients receiving services for the prevention and/or treatment of sexually transmitted diseases. 2. Comply with guidelines and standards issued by the Department and: a. Conduct quality assurance activities, guided by written protocol and procedures. Protocols and procedures, as updated and revised, are to be submitted to the Department. Quality assurance activities are to be responsive to: Quality Assurance for Rapid HIV Testing, MDCH (October 2008, or subsequent revisions). b. Enroll and participate in the Model Performance Evaluation Program (MPEP), CDC's external proficiency testing program. c. Submit a photocopy of the local health department's current CLIA certificate to the Department. d. Submit quality control, daily patient logs and test inventory on a monthly basis. e. Ensure that staff performing counseling and/or testing with rapid test technologies has completed, successfully, rapid test counselor certification course (if applicable), test device training, and proficiency testing. f. Ensure that site supervisors have completed, successfully, appropriate laboratory quality assurance training, blood borne pathogens training and rapid test device training. g. Develop, implement and monitor protocol and procedures to ensure that patients receive confirmatory test results. 3. The Grantee and its subcontractors are required to use the HIV Evaluation System (HES) to enter client and service data into the centrally managed database on a secure server. The collection of all required data variables and the clean-up of any th missing data or service activities should be completed in HES no later than the 15 day after the end of each calendar quarter. Department Requirements 1. Provide training and technical assistance in the use of rapid HIV tests. Page 41 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 2. Provide training on HES, CLAS, the MI E-Grants system and other issues related to Prevention services. HIV RYAN WHITE PART B SPECIAL REQUIREMENTS (CENTRAL MICHIGAN DISTRICT HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT) Granjee Specific Requirementi. 1. Adhere to all federal and Michigan laws pertaining to HIV/AIDS treatment, disability accommodations, non-discrimination and confidentiality. 2. Adhere to all federal and the Department issued guidance and policy for services provided. http://www.hrsa.qov/orants/hhsorantsoolicv.pdf http://www.hab.hrsa.dov/manadevourqrant/policiesletters.html, http://hab.hrsa.govimanaqeyourgrantifiles/fiscalmonitorinopartb.pdf, http://www.hab.hrsa.dov/managevourorant/files/programmonitoringpartb.pdf, and http://www.hab.hrsa.dov/manadeyourprant/files/universalmonitoringpartab.pdf 3. Adhere to the Department Culturally and Linguistically Appropriate Service (CLAS) Standards. Specifically, Standards and Practices must address sexual minorities. htto://www.michician.dov/documents/mdch/Standards - CLAS Final 225817 7.odf http://www.michidan.dov/mdch/0,4612,7-132-2940 2955 2982 46000 46001— 00.html 4. Develop, in consultation with the Department staff, and implement an annual work plan that describes the objectives, activities and measures for work to be performed under this contract. The work plan will include measurable outcomes, and anticipated numbers of clients and services provided for each funded service. 5. Develop a Quality Management plan and submit to the Department's 1111/ Care Section Grants and Contracts Administrator no later than March 31. 6. Participate in monitoring site visits including review of fiscal and programmatic compliance with federal and the Department policies and contract requirements. 7. Ensure that records are available for review by the Department auditors, staff and federal government agencies, if applicable, to monitor performance. Maintain and provide access to primary source documentation. 8. Grantees may enter into subcontracts or vendor agreements to fulfill the service delivery expectations of this agreement. a. All subcontracts issued under this funding agreement are subject to the same requirements as outlined in this agreement and subject to prior approval by the Department. b. The Grantee will monitor subcontractors annually to assess compliance with the subcontract; take primary responsibility to monitor follow-up and remediate in cases where the subcontracted entity is not in compliance with the contract; Page 42 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 and report the results of all contract monitoring activities to the Department Grants and Contracts Administrator. c. Provide one copy of all fully signed subcontracts, memorandums of understanding (MOUs) or letters of agreement related to the services in this agreement to the Department Grants and Contracts Administrator by the start of the contract year or within 30 days of execution. 9. Provide immediate notification to the Department Grants and Contracts Administrator, in writing, in the event of any of the following: a. Any formal grievance initiated by a service recipient and subsequent resolution of that grievance. b. Any event occurring, or notice received by the grantee or subcontractor that reasonably suggests that the grantee or subcontractor may be the subject of, or a defendant in, legal action related to services covered by this contract or administrative and/or financial practices of the grantee. This includes, but is not limited to, events or notices related to grievances by service recipients or grantee or subcontractor employees. c. Ryan White-funded staff vacancies that exceed 30 days. 10. Establish evaluation methods to assess client satisfaction to improve service delivery using any of the following methods: Consumer Advisory Board, client satisfaction survey, suggestion box or other client input mechanisms, focus groups, and/or public meetings. 11. When issuing statements, press releases, requests for proposals, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal money, all grantees receiving Federal funds, including but not limited to State and local governments and recipients of Federal research grants, shall clearly state (1) the percentage of the total costs of the program or project which will be financed with Federal money, (2) The dollar amount of Federal funds for the project or program, and (3) percentage and dollar amount of the total costs of the project or program that will be financed by non-governmental sources. 12. Maintain relationships with entities in the area that constitute key points of access to the health care system for individuals with HIV. Key points of access to health care system that link and retain clients in care which leads to healthy outcomes and viral suppression. Examples include, but are not limited to, medical providers, emergency rooms, substance abuse treatment programs, STD clinics, HIV counseling and testing sites, mental health programs, homeless shelters, community health centers, and FQHCs. 13. Participate in the Department needs assessment activities. 14. Maintain, for a minimum of three (3) years, program and fiscal records and files including documentation to support program activities and expenditures, under the terms of this agreement. Page 43 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 15. The Ryan White legislation imposes a cap on Grantee administration. The legislative intent is to fund services and keep administrative costs to a minimum. Grantees must keep administrative costs to 10% of the total Ryan White budget unless the Department provides the grantee with a written exception to the 10% cap. Refer to MDCH Ryan White Guidance 14-02. 16. HRSA funds and Ryan White funds identify specific items for which Ryan White funds may not be used. For a detailed description of all unallowable costs, refer to HRSA and Ryan White documents to view a detailed description of all unallowable costs (http://www.hhs.gov/asfr/ogapa/aboutoq/hhsqbs107.0df , pages 11-30 -11-34 and http://www.hab.hrsa.qov/manageyourqrant/pinspals/eliqible1002.html ). 17, Client Eligibility: Refer to MDCH Ryan White Guidance 14-01. 18. In order to ensure that Ryan White funds are payer of last resort, clients must be screened to determine eligibility to receive services through other programs (e.g., Medicaid; Medicaid Expansion; Medicare; VA benefits; private health insurance through the Marketplace Exchange, family, employer or direct purchase). This screening must also take place every six months and documentation must be included in the client files. Policies and procedures must be in place addressing these screening requirements. 19. Policies and procedures must be established to implement a schedule of charges for all services provided with Ryan White funds and an annual cap on charges to implement with each individual client. Refer to MDCH Ryan White Guidance 14-04. 20. Each employee funded in whole or part with federal funds must record time and effort spent on the project(s) funded. Policies and procedures must be in place to ensure this occurs. The staff member must clearly identify the percentage of time devoted to contract activities in accordance with the approved budget. The percent of effort devoted to the project may vary from month to month. The percent of effort recorded for Ryan White funds must match the percentage being claimed on the Ryan White voucher for the same period. In cases where the percentage of effort of contract staff changes during the contract period, sub-recipients must submit a budget modification request to the Department. 21. The grantee and its subcontractors are required to use the HRSA-supported software CAREWare to enter client and service data into the centrally managed database on a secure server. Data must include all clients who receive any Part B eligible service (regardless of the source of funding for the services) and all Part B eligible services delivered to HIV-infected or affected clients. All data should be entered into CAREWare monthly. The collection of all required data variables and the clean-up of any missing data or service activities should be completed in CAREWare each month. Grantee Reporting Requirements 1. To complete the RSR, a HRSA required annual data report, all CAREWare data must be complete, cleaned and entered into an online form via the HRSA Electronic Handbook between March 10 and 20, 2015. The report will be closed for any Page 44 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 further data entry at end of business on March 20, 2015. 2. Bi-Annual and Annual Progress Reports will be required. Submit to the Department HIV Care Section Grants and Contracts Administrator in accordance with the following dates: Period Covered Due Date October 1 — March 31 April 30 April 1 — September 30 October 30 These reports will include: a. Progress made to date on work plan objectives and activities. b. Other measurable outcomes negotiated between the Grantee and the Department. c. Complete Attachment F. 3. Allocations reports are required three times each year to identify expenses by Ryan White Service Category. These must be submitted according to the following schedule: Report How to Submit Due Date Planned Allocation by Service Category of FY15 Budget To MDCH HIV Care Section Grants and Contracts Administrator October 31, 2014 Allocation of Actual Six Month FY15 Expenditures by Service Category Attached to FSR April 30, 2015 Allocation of Actual FY15 Year End Expenditures by Service Category Attached to FSR October 30, 2015 4. Administrative Costs and Program Income must be reported quarterly, attached to the FSR. Department Requirements 1. The Department will provide technical assistance, as requested, on the development and/or implementation of the Quality Management Plan. 2. The Department will provide technical assistance and training, as requested, on CAREWare, CLAS, and other issues related to Ryan White services. Page 45 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 3. The Department will conduct a site visit, including both fiscal and programmatic review, at least annually. The Department will provide 30 days written notice of the site visit, Including an agenda and the assessment tool to be used. The Department will provide a written report post-site visit within 45 days. If a plan of correction is necessary as a result of the site visit, a timeframe will be provided in the report. 4. The Department will review bi-annual and annual reports. Questions or clarifications, if any, will be requested within 45 calendar days of submission due date. HEALTH DISPARITIES BUILDING ORGANIZATIONAL CAPACITY TO ADOPT CULTURALLY AND LINGUISTICALLY (CLAS) APPROPRIATE STANDARDS SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT AND WASHTENAW COUNTY PUBLIC HEALTH DEPARTMENT) Objective The Grantees will implement activities to support racial/ethnic health and healthcare disparities through activities aimed to increase the number of Michigan organizations that adopt and/or implement the National Enhanced Culturally and Linguistically Appropriate Standards (CLAS). Grantee Requirements 1. Ensure that activities implemented under this grant award are in accordance with established Health Disparities Reduction Minority Health Section (HDRMHS) program standards, as well as State and Federal policy and statutes including HIPPA. 2. Participate in technical assistance, training, and/or skills enhancement opportunities offered by the Department /HDRMHS. Including monthly conference calls focused on reporting program implementation progress. 3. Adhere to timelines and work plans, budgets, and staffing plans submitted and approved by the Department /HDRMHS. Deviations from approved timelines, work plans, budgets and staffing plans must receive advance authorization from the Department /HDRMHS. Failure to make reasonable progress in program development may result in revocation or reduction of the grant award. 4. Collaborate HDRMHS staff, cross-site evaluator, and the local evaluator identified by the Grantee during all phases of grant award including, application submission process, Implementation, development of tools related to data collection, program evaluation that identifies the process and outcome indicators of the project. The Grantee must adhere to the Department policies and standards related to Institutional Review Board. 5. Ensure that services and materials are culturally and linguistically appropriate to meet the needs of the respective client populations to which include; African American, Arab Page 46 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 American/ Chaldean, Asian American/Pacific Islander, Hispanic/Latino, and Native American/ American Indian and multi-cultural populations. HDRMHS Requirements 1. Provide technical assistance, training, and/or skills enhancement opportunities to Grantees. 2. Collaborate with cross-site evaluation consultant, Grantees, and local evaluators in the development of tools related to data collection; community needs assessments, and program evaluation that identifies the process and outcome indicators of the project. 3. Review program narrative progress and evaluation reports and financial status reports and provide feedback. 4. Ensure that Grantees awarded under the program implement activities in accordance with established program standards, as well as State and Federal policy and statutes including HIPPA. 5. Provide technical assistance related to cultural and linguistically appropriate services. Performance / Progress Report Requirements The Grantee shall submit the following reports on the following dates: 1. Quarterly Reporting Requirements — Grantees are required to submit a quarterly narrative progress and evaluation report that adhere to the format and guidelines established by HDRMHS. OMH supplemental reports should be submitted in accordance to the following timelines Quarter OHM Reporting Time Period Due Date October 1 — November 30 December 15 2rid December 1— February 28 March 16 3rd March 1 — May 30 June 15 4th June 1 August 30 September 21 FINAL September 1 — September 31 November 2 Completed Narrative Progress & Evaluation report templates should be submitted via email to the Shronda Grigsby at driqsbvsl Rmichigan.crov and copied to Joann Mawasha at joann.mawashawright.edu . Material that cannot be e-mailed should be sent to: Shronda Grigsby, Program Coordinator Michigan Department of Community Health Health Policy and Innovation Health Disparities Reduction and Minority Health Section 201 Townsend Street, 7th Floor Lansing, Michigan 48913 Page 47 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ili 07/03/14 2. Quarterly Financial Status Reports (FSR) Grantee FSR submission shall be prepared in accordance with the Department quarterly reporting instructions and submitted utilizing MI E-Grants no later than thirty (30) days after the close of each reporting period. FSRs must reflect actual program expenditures, regardless the source of funds. 3. Quarterly Progress reports and quarterly Financial Status Reports shall be evaluated by for their completeness and adherence to reporting requirements. 4. The Grantees shall permit the HDRMHS staff or its designee to visit and to evaluate the project, as determined by the Contract Manager. HOUSING OPPORTUNITIES FOR PERSONS LIVING WITH HIV/AIDS (HOPWA) SPECIAL REQUIREMENTS (MARQUETTE COUNTY HEALTH DEPARTMENT) Special Note: The annual FY HOPWA Formula Operating Instructions have yet to be issued. If or when they are issued, it may be necessary to amend these Program Specific Assurances and Agreements 1. Budaet and Agreement Requirements HOPWA PROGRAM OVERVIEW The Housing Opportunities for Persons with AIDS.(HOPWA) program provides housing assistance and related supportive services for low-income persons living with HIV/AIDS and their families. The HOPWA program helps eligible clients improve their health by providing stable housing as a basis for increased participation in the coordinated delivery of supportive services. These services may involve support with their daily living activities; case management; substance abuse treatment and counseling; and other services, to help beneficiaries maintain appropriate housing and access other needed support. HOPWA clients very often use a range of health and supportive services funded by HHS through the Ryan White Care Act and other public or private support, which will improve their ability to participate in health care and access other supportive services. A. HOPWA Eligibility An eligible person means a person with acquired immunodeficiency syndrome or related diseases who is below 80% median income. A family member regardless of income is eligible to receive housing information services. Any person living in proximity to a community residence is eligible to participate in that residence's community outreach and educational activities regarding AIDS or related diseases. Within the population eligible for this program, nondiscrimination and equal opportunity regulations must be followed, including fair housing and affirmative outreach. A project sponsor and all Grantees and subcontractors must adopt procedures to ensure that all Page 48 of 121 MDCH/G&PD FY 14/15 ATTACHMENT HI 07/03/14 persons who qualify for the assistance, regardless of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the availability of the HOPWA program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of the procedures. HIV Status Determination HIV status must be documented for each client, subject to confidentiality procedures. Acceptable forms of documentation include the following: • Documentation from a health professional qualified to make such a determination. • Documentation from an HIV test conducted by a physician, community health center or HIV counseling center. Income Determination Household Income must be determined and verified prior to housing assistance being provided and annually thereafter. Income determination includes all members of the household. Nondiscrimination and equal opportunitx Within the population eligible for this program, the nondiscrimination and equal opportunity requirements apply including Fair Housing and Affirmative Outreach. Affirmative outreach requires that a project sponsor must adopt procedures to ensure that all persons who qualify for the assistance, regardless of their race, color, religion, sex, age, national origin, familial status, or handicap, know of the availability of the HOPWA program, including facilities and services accessible to persons with a handicap, and maintain evidence of implementation of the procedures. B. Allowable Use of Funds Funds may be used to assist all forms of housing designed to prevent homelessness. This includes emergency housing, shared housing arrangements, apartments, single room occupancy (SRO) dwellings, and community residences. It includes assistance to remain in current homes, whether owned or rented, and assistance in relocating to another home if needed. In the Department's HOPWA program, housing options have been limited by excluding the construction, purchase or renovation of a structure by HOPWA Sponsors or to establish a Facility-based housing option. The following activities may be carried out with HOPWA funds: a. HOUSING SUBSIDY ASSISTANCE i. Tenant Based Rental Assistance (TBRA): Subsidy for use on the open rental market. Tenant holds lease to unit rented at or under Fair Market rent (FMR), is documented to be Rent Reasonable, and meets Housing Quality Standards (HQS) or HOPWA Habitability Standards. Calculation of utility allowances as needed. Page 49 of 121 MDCH/G&PD FY 14/15 ATTACHMENT HI 07/03/14 ii. Short-Term Rent, Mortgage and Utility (STRMU) payments: Subsidy to prevent homelessness of mortgagors or renters in their current place of residence. Persons cannot be homeless and the subsidy is limited to 21- weeks in any 52-week period. iii. Permanent Housing Placement: Expenditures that help establish a household in a housing unit. May include application fees, related credit check fees, reasonable security deposits (limited to amount equal to two months rent), and one-time utility connection fees. Provide counseling in understanding a residential lease and its obligations, and mediation of disputes. b. SUPPORT SERVICES. I. Housing Case management: The goal is to establish stable permanent housing and prevent homelessness. It is expected that many of the services needed by the client will be provided by other staff or assistance agencies via referral from the Housing Case Manager. Housing Case management may include directly or through other agencies: client advocacy; assistance with access to local, State, and Federal government benefits(SSI/SSDI application using the SOAR model); assistance completing the housing application and assessment form; assistance with developing a budget; assuring that all required forms and documents are completed fully and in a timely manner; Fair housing counseling for eligible persons who may encounter discrimination on the basis of race, color, religion, sex, age, national origin, familial status, or handicap. ii. Other Support Services: Assistance obtaining other support services needed. HOPWA funded Support Services are limited to categories in the CAPER: Adult Day Care & personal assistance; Alcohol and Drug abuse services outreach, Child Care and other child services; Education; life skills management; education; Legal services; Transportation; Mental Health services; Meals and nutritional services; Health/medical/intensive care services if approved by DCH/HUD (conform with 24CFR 574.310) and health services may only be provided to individuals with acquired immunodeficiency syndrome or related diseases and not to family members of these individuals. HOPWA cannot fund services already available through other agencies or funding sources, c. HOUSING INFORMATION SERVICES i. Housing Information Services: Information and referral services to assist eligible persons and their families with locating, acquiring, financing and maintaining housing. Activities may include housing counseling, housing advocacy, housing search assistance, etc. Page 50 of 121 MDCH/G&PD FY 14/15 ATTACHMENT fl 07/03/14 d. GRANT ADMINISTRATION AND OTHER ACTIVITIES i. Resource Identification: Activities to establish, develop, and coordinate housing assistance resources. This can include attending Continuum of Care meetings, meeting with landlord associations, etc. Does not include any client contact activities ii. Administration: General management, oversight, coordination, evaluation, and reporting on eligible activities. Such costs do not include costs directly related to carrying out eligible activities, since those costs are eligible as part of the activity delivery costs of such activities. C. DCH will determine the total budget for HOPWA. Sponsors, in consultation with the HOPWA Specialist will determine the estimated funding amounts for each activity (See Operating Year Budget and Plan below), Deviations in funded amounts of activity categories are allowed as long as the total contract amount is not exceeded and the DCH HOPWA Specialist is notified. Deviations over 5% of the Activity budget must be approved by the DCH HOPWA Specialist. Expenditures for Administration cannot exceed 7% of the total budget as it is fixed at 7% by law. A formal amendment is required to request an increase in the total contractual amount. 2. Grantee Reauirements A. The HOPWA OPERATING YEAR PLAN and OPERATING YEAR BUDGET. The HOPWA Operating Year is July 1st through June 30th. This coincides with the Reporting Year for HOP WA. The annual report, the Consolidated Annual Performance and Evaluation Report (CAPER), must report on the funds expended, household demographics, and answers to narrative questions concerning the households assisted during this Operating / Reporting Year. DCH is reimbursed by HUD according to the Operating Year and Budget. HUD notifies the HOPWA Consolidated Plan Lead Agency Michigan State Housing Development Authority (MSHDA for the Michigan HOPWA program of the total HOPWA grant amount available. This notification usually occurs between February and the end of March (although at times it has been later). DCH administrative staff will review the grant funds available and the DCH HOPWA Specialist will notify each sponsor of the planned amount of funding for the HOPWA Operating year for each sponsor. The HOPWA Specialist will send each Sponsor instructions for completing the Operating Year Narrative Plan and Operating Year Budget. In consultation with and assistance from the HOPWA Specialist, the Sponsor will determine the estimated Operating year budget amounts for each allowed HOPWA Activity and complete the narrative Page 51 of 121 MDCH/G&PD FY 14/15 ATTACHMENT HI 07/03/14 Operating Year Plan covering July 1, through June 30. This Operating year Budget and Plan is to be submitted to DCH by with the Fiscal Year contract. NOTE: The 1st quarter of the HOPWA Operating year (July 1 to September 30) will be the amount of funds remaining from the previous fiscal year contract with DCH. The amount for the balance of the Operating Year Budget (October 1 to June 30) will generally be calculated as 3 quarters of the new Fiscal Year (October 1 to September 30) budget. This plan, along with an annual report (the CAPER), data from ongoing HMIS (or other) data collection systems and the Grantees FSR Supplemental Forms, will provide the Department with information to satisfy most federal reporting requirements, carry out monitoring activities, and assure that departmental goals for this program can be met. See Operational Plan Details below. The Operating Year Plan and Budget are to be returned to DCH with the new Fiscal Year contract — generally in August. An electronic copy of the Operating Year Budget in Excel format must be submitted electronically to: ebys@michigan.gov B. Fiscal Year Contract and Budget The Department's Fiscal Year runs from October 1 through September 30. The Fiscal Year contract from DCH is sent to Health Department Sponsors via the MI E-Grants system in early July. The contract in the MI E-Grants system needs to be completed and returned to DCH within 2 weeks of receipt of the MI E-Grants system contract. Billing for HOPWA reimbursement will involve completing a DCH FSR form and attaching the HOPWA FSR Supplemental form (attached). The FSR for HOPWA will not be reimbursed without the FSR Supplemental form. The pages of the FSR-Supplemental form must be attached in the M1 E-Grants system in an Excel format. C. GRANTEE SERVICE REQUIREMENTS Project Sponsors must assure access to HOPWA assistance in their assigned service area. Qualified households from outside the Sponsor's assigned service area but seeking assistance from your service area are to be assisted. (See attached Service Areas' page). The Grantee must assure that all persons living with HIV/AIDS (PLWH/A) and seeking housing assistance must be provided Housing Information Services. To the extent that HOPWA funds are available, persons seeking housing assistance are to be provided: a. DIRECT HOUSING ASS1TANCE: Tenant Based Rental Assistance (TBRA), Short-Term Rent, Mortgage and Utility (STRMU), and Permanent Housing Placement Services. See descriptions above. b. SUPPORT SERVICES: Housing Case Management and Other Support Services. See descriptions above. Page 52 of 121 MDCH/G&PD FY 14/15 ATTACHMENT UI 07/03/14 c. HOUSING INFORMATION SERVICES: Housing Information Services. See description above. d. GRANT ADMINISTRATION AND OTHER ACTIVITIES: Resource Identification. See description above. D. Reporting and Data Collection Submission of the FSR and the FSR Supplemental Forms for reimbursement per the billing instructions, the collection of data used for the annual HOPWA report, the CAPER, and collection of data required by standards regarding eligibility, HIV status, and documentation of provision of required/needed services. In order to submit the Michigan CAPER report, HOPWA Sponsors are required to obtain a DUNS (Data Universal Numbering System) number and) obtain an account with the System for Award Management (SAM) https://)Aww.sam.govhDortal/public/SAM/ The SAM Service Desk is at URL: htlpiAivww.FSD.gov. If you had an active record in CCR, you have an active record in SAM. You do not need to do anything in SAM at this time, unless a change in your business circumstances requires updates to your Entity record(s) in order for you to be paid or to receive an award or you need to renew your Entity(s) prior to its expiration. SAM will send notifications to the registered user via email 60, 30, and 15 days prior to expiration of the Entity. To update or renew your Entity records(s) in SAM you will need to create a SAM User Account and link it to your migrated Entity records. You do not need a user account to search for registered entities in SAM by typing the DUNS number or business name into the search box. References: Section 872 of the National Defense Authorization Act, the American Recovery and Reinvestment Act (ARRA) and the Federal Funding Accountability and Transparency Act (FFATA). a. Sponsors must fully implement HUD's Measurement of Performance Outcomes Reporting Requirements. Data collected must include all data required for the HOPWA Consolidated Annual Performance and Evaluation Report (CAPER) Exp. Currently the plan is that the demographic will be collected in the HMIS System and use of HMIS must continue until another DCH approved data collection system is approved . Data not collected in HMIS must be collected and reported by the Sponsor to the HOPWA Specialist.. Data must be internally consistent and complete per Data Quality checks and consistent with data obtained via FSRs, FSR Supplemental forms and any monitoring of records. Data not obtainable from HMIS (Financial data) must be provided directly from Sponsor records to the DCH HOPWA Specialist. Data and answers to Page 53 of 121 mDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Narrative questions will be combined and summarized by the HOPWA Specialist for the Michigan CAPER. Separate CAPER reports for each Sponsor will be created by the Integrated Disbursement and Information System (IDIS), therefore all narrative questions applicable to the Sponsor must be complete. b. Staff are required to attend offered HMIS training to increase skills and use of HMIS or another approved data collection system that DCH is using. Staff assigned to complete data entry into HMIS and/or run HMIS reports are to attend the HOPWA HMIS Webinars. c. The project sponsor agrees, to Staff assigned to complete data entry into HMIS and/or run HMIS reports are to attend the HOPWA HMIS Webinars of the HOP WA Financial Management Online Training http://www.hudhre.info/index.cfm?do=viewHopwaFinancialTraining, or to demonstrate financial management capacity by the use of other credentials related to Federal requirements at 24 C.F.R. 85.20, as specified in a HUD- approved plan. If the HOPWA Financial Management trained staff leaves the Sponsor's employment, another staff must complete the HOPWA Financial Management training within 90 days. d.. Sponsors and staff will work cooperatively with DCH and provide staff time to develop HUD required Policies and Procedures to be used by all sponsors and to develop and/or revise required HOPWA forms. The current mandatory forms in use include but which may be modified during the operating year include: LII Conflict of Interest Assurances — included with the contract. Must be signed and returned each year. El Housing Application & Assessment El Client File Documentation-STRMU assistance CI Client Budget Worksheet LII DCH HOPWA Habitability Standards inspection form (TBRA) with Lead based paint Acknowledgement form when required El Zero Income Affidavit El Client File Contents Checklist — TBRA El Client File Contents Checklist — STRMU Additional forms and documents that must be used and filed in the client record include those that are needed to verify: o HIV Status o Status of Disability o Releases of Information completed o Household Income and HOPWA financial eligibility (Pay stubs, Benefit letters or copies of checks, copy of checking and Page 54 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 savings account statements, Median Income documents; etc.) o Home ownership or lease responsibility o Expenditures claimed. For Example: lease/house payment; taxes; payments for home/apartment/vehicle/life insurance; vehicle debt & payments; credit card debt & payments; phone, cable, TV expenses; utilities that are not part of the Tease; other personal debts owed & the payments; etc. o Estimates of Other expenditures. For example: food, out of pocket medical expenses, gas & vehicle repairs, bus or other transportation costs, Household supplies, cigarette & entertainment expenses, etc. o Calculation and determination of Household Median Income with published current HUD/MSHDA Median Incomes for the county of residence. o Calculation of adjusted income o Shared Housing Rent Calculation o Income and Rent Calculation including current Utility Allowance calculation with Utility Allowance documents for the county of residence. o Domestic Partnership Declaration o Client Housing Plan that includes: Need(s) identified the reason(s) this household needs HOPWA housing assistance at this time, what precipitated the current situation; eligibility status; current type of housing, make-up of Household; analysis of income, expenditures; a monthly budget; specific goals with measureable short term tasks to meet the goal(s); responsibility for completing tasks. Must be regular updates on the Plan (can be a call to check on status of the completion of a task, questions about any household changes, etc. The Plan should address immediate needs first then move on to longer term goals of increasing income, benefits, skills, job training, education, etc. Also address ways to decrease expenses and/or reduce barriers to housing stability. All households should be required to apply for all other supported housing options. o Current Fair Market rent (FMR) form for county of residence o Verification of Rent Reasonableness o Receipt of Grievance policy form and a Client Termination of Services policy that includes the involvement of DCH as needed. A copy must be kept in the client record. Page 55 of 121 ATTACHMENT III Current Documents and Forms are subject to review and modification with DCH approval. HOPWA Client forms and documents must be collected/filed so that they are easily assessable (table of contents, location of document in file — use of tabs) legible and signed and dated as needed, and renewed annually as specified in policies and procedures. Documents may be kept electronically with DCH approval. Grantee must have a plan to meet concerns for security, confidentiality, ease of use for monitoring, and data back-up as needed. Sponsors must have a backup of HMIS client access codes. e. All forms, policies and procedures are subject to review by the HUD Field Office. Grantee Reauirements - Standards 1. All Project sponsors using grant funds to provide housing must adhere to the following standards: A. Ensure that qualified available, mainstream service providers in the area make available appropriate supportive services to the individuals assisted with housing assistance through HOPWA. If services are denied or unavailable, notify the Grantee in writing specifying denials or unavailability of the support services. Monthly summary reports are adequate. If available, qualified Sponsor staff may provide these needed support services as a last resort. B. For any individual with acquired immunodeficiency syndrome or a related disease who requires more intensive care than can be provided in housing assisted under HOPWA, the project sponsor shall provide assistance in locating a care provider who can appropriately care for the individual and for referring the individual to the care provider. C. Ensure that grant funds will not be used to make payments for health services for any item or service to the extent that payment has been made, or can reasonably be expected to be made, with respect to that item or service: under any State compensation program, under an insurance policy; under any Federal or State health benefits program; or by an entity that provides health services. D. Operate the program in accordance with the provision of 24 CFR 574 and other applicable HUD regulations. Prior to dispensing HOPWA direct housing assistance and at least annually thereafter, document the eligibility of each person receiving HOPWA benefits: To include documentation of HIV status of the eligible individual and verification of income of all members of the household (household income to be less than 80% of area Median income). Page 56 of 121 MDCH/GOD FY 14/15 ATTACHMENT III 07/03/14 E. Keep records and reports which are consistent with the information required by the current Consolidated Annual Performance and Evaluation Report (CAPER) as requested by the Department through the operating year Annual reports for HOPWA. Implement the Uniform Reporting System which includes data regarding HOP WA eligible persons and information needed for the CAPER. Submit needed financial data for the CAPER and have HMIS data fully available in HMIS for the operating year July 1 through June 30. F. Participate with the Department in facilitating and conducting site visits. Comply with on-site and/or remote monitoring of their program. Monitoring may include but not limited to reviews of: Housing Applications and Assessment forms; documentation of eligibility — documentation of household income, number of persons in the household, HIV status; housing habitability inspection reports; tracking of TBRA & STRMU expenditures and the 21 week limit for STRMU; current conflict of interest statement; use of DCH specified mandatory forms; documentation relating to the annual report data; tracking of program income (tenant co- pay for TBRA; returned security deposits); adequate documentation of expenditures, etc. G. Provide services in accordance with an approved housing plan and comply with reporting requirements as specified by law, HUD and/or the Department. H. Retain documentation of the rental subsidy payment calculations, Habitability inspections, and for repayment of security deposits and other HOPWA records for a period of 4 years. Disposal of confidential records must assure confidentiality. Keep a record of their destruction, The Department of Housing and Urban Development has insisted that all employee costs that are to be billed to the HOPWA grant be documented through the use of a time sheet. All time/costs billed to the HOPWA grant must be documented and readily available to HUD and the Department staff. This includes calculations of salaries, fringe benefits, and in-direct costs as allowed. Rather than specify a particular format, the Department requires only that the tracking document conform to general accounting principles in the applicable OMB circulars, in acknowledgment of sponsor accounting system variations. J. Oversee process and performance of subcontractors for the provision of HIV related HOPWA services. Ensure a contractual requirement to adhere to all applicable state and federal laws and regulations for all subcontractors. K. Conduct an ongoing assessment of the housing assistance and supportive services required by participants as identified in Individual Housing and Service Plans, including an annual assessment of their housing situation, a reevaluation of the appropriateness of rental subsidies or other support, and a report on annual results of program activities under the HOPWA client outcome goals for achieving stable housing, reducing risks of homelessness and improving access to healthcare and other support. Specifically complete Page 57 of 121 MDCH/G&PD FY 14/15 ATTACHMENT441 07/03/14 and report the results of the Housing component of the Acuity Scale. Prepare a summary report annually and keep original assessments on file. L. Assist the Grantee in completing elements of the Consolidated Plan per 24 CFR part 91. The HOPWA Consolidated Plan should incorporate the following elements: a. Consult with other public and private agencies that provide assisted housing, health services, and social services for persons with H1V/AIDS and their families; b. Consider any comments or views expressed on HIV/AIDS housing and service needs by citizens under their citizen participation plan; c. Estimate the number and type of family members in need of housing assistance for persons with HIV/AIDS and their families under the housing and homeless needs assessment (including needs in their HOPWA service area, i.e. the size and characteristics of the population with HIV/AIDS in the entire eligible metropolitan statistical area (EMSA) for a city grantee, or, for a state grantee, the areas of the state that are outside of any EMSA); in addition to homeless needs, the plan's assessment of "other special needs" should include the number of persons with HIV/AIDS; d. Individuals and their families who are not homeless but require supportive housing; e. In providing a housing market analysis, including the supply, demand, condition and cost of housing and the housing stock available to serve persons with HIV/AIDS and their families; f. Address other special needs with components relative to persons with HIV/AIDS and their families who are not homeless but require supportive housing that: i. Indicate general priorities for allocating HOPWA program funds geographically within the eligible metropolitan statistical area and among priority needs; ii. Describe the basis for assigning the priority given to each category of priority needs; iii. Identify any obstacles to meeting underserved needs; iv. Summarize the priorities and specific objectives, describing how funds made available will be used to address identified needs; and v. For each specific objective, identify proposed accomplishments the jurisdiction hopes to achieve in quantitative terms over a specific time period (e.g. over two-five years), or in other measurable terms as identified and defined by the jurisdiction. g. Provide outcome measures for activities in the action plan consistent with the HOPWA reporting format; Page 58 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 h. Provide specific one-year goals for the number of households to be provided housing through the use of HOPWA activities for STRMU assistance payments to prevent homelessness, as well as TBRA assistance and units provided in housing facilities that are developed and/or operated with HOPWA funds; Identify the method of selecting project sponsors, including providing full access of HOPWA funds to grassroots, faith-based, and other community organizations; and In annual reporting compare proposed to actual outcomes for measures in their plan; explain, if applicable, why progress was not made toward meeting goals and objectives. Obtaining Certification of Consistency with the Consolidated Plans in your service area is not required for existing DCH HOPWA programs. They are only required when a new Sponsor is awarded a HOPWA contract. They would also be required for establishing a community residence or housing facility which DCH HOPWA does not do. That said, contact with the agencies or units of local government that complete Consolidated Plans is encouraged. These are the grantees that would establish low income housing and for them to be aware of the need of low income HIV positive persons could be beneficial to people needing affordable housing. N. Defaults and Remedies. A default shall occur when the Sponsor materially fails to comply with program requirements. A default may consist of using Grant Funds other than as authorized by this Agreement, noncompliance with statutory, regulatory, or other requirements applicable to this HOPWA award, any other material breach of this Agreement, or any material misrepresentation, which, if known to the Grantee, would have resulted in the Grant Funds not being provided. If the Sponsor fails to comply with any term of this award, including the prompt submission of data for reporting, keeping HMIS data up- to-date, fully completing needed documents and forms, serving only qualified individuals and families, or other Sponsor requirements, the Grantee may: a. Temporarily withhold further payments pending corrective action by the Project Sponsor; b. Disallow all or part of the cost of an activity or action not in compliance; c. Wholly or partly suspend or terminate the current award for the Sponsor's program; d. Withhold further awards for the HOPWA program; e. Reduce or recapture Grant Funds; f. Require the Sponsor to reimburse program accounts with non-Federal funds for the amount of ineligible costs; or Page 59 of 121 mDcH/G&pb ry 14/15 ATTACHMENT !I I 07/03/14 g. Take other appropriate action, including, but not limited to, any remedial action legally available, such as affirmative litigation seeking declaratory judgment, specific performance, damages, temporary or permanent injunctions and any other available remedies. Nothing in this paragraph shall limit any remedies otherwise available to the Grantee in the case of a default by the Sponsor. No delay or omissions by the Grantee in exercising any right or remedy available to it under this Agreement shall impair any such right or remedy or constitute a waiver or acquiescence in any Sponsor default. The Grant may be terminated for convenience when both parties agree that the continuation of the award would not produce beneficial results. Email a copy of all HOPWA required documents to: ebvs(a.michician.qov With approval, mail a copy to: Division of Community Living Michigan Department of Community Health Lewis Cass Building, 5th Floor North, 320 S. Walnut Lansing, Michigan 48913 Attention: HOPWA Program Grantee Requirements A. Assure that Grantees and subcontractors have developed and make available to service recipients both grievance and appeals processes (Termination of Services Policy). B. Determine/document the unit cost per service for each funded service. Retain data supporting the per-unit cost and how it was determined. C. Assure the confidentiality of the name of any individual assisted and any other information regarding individuals receiving assistance per HIPAA standards that apply. The grantee shall agree, and shall ensure that each project sponsor agrees, to ensure the confidentiality of the name of any individual assisted under this part and any other information regarding individuals receiving assistance D. Assure that no fee, except tenant portion of rent, shall be charged to an eligible person for housing or services. E. Assure that Grantees and subcontractors have the capacity to effectively carry out the activity and that they agree to maintain and make available to HUD for inspection financial records sufficient to ensure proper accounting and disbursing of amounts received. F. Ensure that issue statements, press releases, RFP, bid solicitations and other documents describing projects or programs funded in whole or in part with Federal funds, clearly state 1) the percentage or total cost of the program or project which will be funded with Federal funds; 2) the amount of Federal funds for the project or program; and 3) percentage and dollar amount of the total Page 60 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 costs of the project or program that will be financed by non- governmental resources. Releases by the Sponsor need to include copies sent to DCH of statements and press releases issued by the Grantee. Retain copies of same on file for two (2) years. G. Ensure all services are available in the entire Grantee catchment's area. If persons from outside a catchment's area are assisted, communicate with the Sponsor for that catchment's area to verify that assistance is not duplicated and that STRMU funds do not exceed the 21 week limit. H. Ensure that all activities funded under the program will meet urgent needs that are not being met by available public and private sources. Provide ongoing monitoring and on-site monitoring as required of all HOPWA Sponsors. Provide technical assistance where required or seek it through the HUD Field Office. Provide Policy and procedures governing HOPWA Operations and supply all Sponsors with needed forms and HOPWA related information provided by HOPWA/HUD offices. Grantees ReportaOsecial Requirements Sponsors must fully implement HUD's Measurement of Performance Outcomes reporting requirements. See the HOPWA Consolidated Annual Performance and Evaluation Report (CAPER) HUD-40110-D (Expires 10/31/2014). Obtain at hftp://www.hudhre.info/index.cfm?do=viewResource&ResourcelD=383 . As such demographic data should be collected from HMIS as possible. Some demographic data, most financial data and all narrative responses will need to be reported separately to DCH from Sponsor records. 1 Copies of all HOPWA required documentation, a copy of the FSR and FSR Supplemental HOPWA forms and the CAPER Financial Data must be emailed to Sue Eby at ebysOmichiaan.aox Materials that cannot be emailed, should be sent to: HOPWA Program Division of Community Living Michigan Department of Community Health Lewis Cass Building, 5 th Floor North 320 S. Walnut Lansing, Ml 48913 2. Reimbursement: Financial Status Reports (FSRs) shall be prepared and submitted to the Department via the MI E-Grants system. The FSR Supplemental (FSR-S) pages must be included as an attachment. Follow the instructions provided for use of this automated system including completing a Fiscal Year (October 1 to September 30) Budget. A copy should be with the documents in the MI E-Grants system. Page 61 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 Reimbursement for Administration is limited to the 7% of your contract as allowed by law (3% for agencies providing fiduciary services only). Total expenditures for other Activity categories can vary from the ones proposed in your budget by 5% with notification of the HOPWA Specialist, but total expenditures cannot exceed the total amount of the contract. Contact the HOPWA Program manager prior to changes exceeding 5% of the Activity amount. An Excel formatted copy of the FSR Supplemental (FSR-S) form has been emailed to all Sponsors. Additional copies can be obtained from Housing Services staff. ebvsmichician.gov. 3. Sponsor will participate in the training for and the continued implementation of the Homeless Management Information System (HMIS). It is expected that all persons who are recipients of HOPWA services will be entered into the HMIS system during the current contract year. At the end of the operating year (June 30) it is expected that service data extracted from the HMIS system will be consistent with the data submitted in the FSR & FSR Supplemental forms and internally consistent. Continue to work with DCH staff to develop a means to collect data on qualified people that cannot obtain housing assistance — Unmet Need. This would include people, who are turned away for any reason including a decision that sufficient funds are not available, or the person's financial needs are too great to be assisted at this time, or there are persons with a higher priority. Or other reasons that you may be aware of. OPERATING YEAR NARRATIVE PLAN AND OPERATING YEAR BUDGET - COMPONENTS The HOPWA Specialist will email you the amount of your budget by May 30. An Excel formatted version will be emailed to sponsors or you can contact the HOPWA Specialist for a copy. It is recommended that you enter a minimum amount in every activity, even if it is just $50. That $50 can always be transferred to another Activity at the end of the year. However, if you do not have any funds entered into an Activity at the beginning of the year, you cannot bill from that activity without completing an amendment which is a lengthy process. The HOPWA Specialist will contact each Sponsor to review this budgeting process. This operating year budget will serve as the basis for reporting financial information for the CAPER. As mentioned in Grantee Requirements 2A, the completed Operating Year Budget will be used to complete the Fiscal Year Budget quickly but with forethought. The Operating Year Plan is a narrative summary of the past Operating Year (July 1 through June 30) and a narrative of your plans for the upcoming Operating Year (July 1 through June 30). Page 62 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 The summary of the past year will be questions that need to be answered on the upcoming CAPER. Page references below are to the corrected CAPER. Send a Word document to the attention of the HOPWA Specialist that contains the following information plus the plan budget: Begin by reviewing the CAPER (sent to you electronically) to make sure the data for your agency is correct for Item 2 Project Sponsor Information (pages 3-12). Send corrections if needed. (A). Grantee and Community Overview. Provide information about your organization, area of service and an overview of the type of housing provided. See the CAPER. Please add a description of where clients assisted were/are located (city/county). Note that this section is to be 1-3 pages and DCH has to combine/summarize 7 sponsor's information for the Michigan Caper, however individual sponsor CAPWERs will also be completed so provide all relevant information. (B). Annual Performance under the action Plan. Questions 1 & 2 it will be difficult to answer the numeric questions until the 2012 CAPER is compiled in July or August. However you can provide information from question 2 to describe other steps you want to take with your program. (B). Annual Performance under the action Plan. Question 3 Coordination, needs to be addressed by your agency as to coordination with other mainstream housing and supportive services resources - be sure to name them. (B). Annual Performance under the action Plan. Question 4 Technical Assistance. Provide your input as to training that would benefit your agency and the clients assisted. Please specify by subject: training on utility allowances, developing a Housing Plan, identifying housing plan tasks, etc. Or you can broaden your scope to a training session between various community agencies so that you can work more cooperatively. (C) Barriers and Trends overview Questions 1 through 3. When describing (1) Barriers, note those barriers that clients face and those barriers that your agency faces (lack of funds, hard to keep staff, cost of implementing a new accounting system, lack of agency cooperation, whatever is hampering you and ultimately impacting service to your clients. What is particularly difficult in your area? High rent in Kalamazoo due to the college? Has SOAR training been helpful? Check applicable boxes. For (2) Trends I think we need some mention of people living longer, being older and having health problems, needing longer term assistance, harder to find jobs, etc. Trends Page 63 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ili 07/03/14 can be local, state or national. Are fewer people qualifying as disabled? Has bus service been cut? Inability to get mental health diagnosis (use numbers of people) For (3) Evaluations, please include a summary of the housing evaluation that is to be done yearly (See Grantee Requirements — Standards (K) above), plus any satisfaction surveys or maybe a review of the Acuity scale scores from July 1 until May or June 1. It does not have to be a HOPWA initiated evaluation. Provide references where possible. The Plan Narrative and Plan Budget should be emailed to ebvsmichigan.gov when the Fiscal Year contract and budgets are completed.. References See: 24 CFR574; 24 CRF 5.611; 24 CFR 5.601; 24 CFR 5.609; 24 CFR 21; 24 CFR 35; 24,CFR 87; 24 CFR 100; 24 CFR 107; and 24 CFR 82.306(d); CPD Notices 01-01; 02-09; 03-09; 04-10; 06-06; 06-07; 07-06; 07-07; 08- 05; and 94-05; FAQ STRMU updated 8/3/06; OMB Circulars A-110, A-122 and A-133; CPD Monitoring Handbook Chapter 10; HOPWA Grantee Oversight Resource Guide; CAPER form HUD-40110-D, HOPWA Financial Management online training guide. HIV SURVEILLANCE SUPPORT PROGRAM SPECIAL REQUIREMENTS (OAKLAND COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION) Grantee Requirements: Provide the resources necessary to house the Department's HIV Surveillance Staff at the South Oakland Health Center, 27725 Greenfield Road, Southfield, MI 48076. Support includes overhead costs for the office space and includes costs and technical support for phone and technology lines. Department Requirements: Reimburse the Grantee for costs associated with the location of the State HIV Office in the South Oakland Health Center as reflected in the attachment to the Comprehensive Agreement. IMMUNIZATION ACTION PLAN SPECIAL REQUIREMENTS Grantee Requirements 1. Service Delivery: Offer immunization services to the public. Page 64 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 A. Collaborate with public and private sector organizations to promote childhood, adolescent and adult immunization activities in the county including but not limited to recall activities. B. Educate providers about vaccines covered by Medicare and Medicaid. C. Provide and implement strategies for addressing the immunization rates of special populations (i.e., college students, educators, health care workers, detention centers, homeless, tribal and migrant and child care employees). D. Develop mechanisms to improve jurisdictional and LHD immunization rates for children, adolescents and adults. E. Ensure clinic hours are convenient and accessible to the community, operating both walk-in and scheduled appointment hours. F. Coordinate immunization services, including WIC, Family Planning, and STD, developing plans or memorandums of understanding. G. Collaboratively work with regional MCIR staff to ensure providers are using MCIR appropriately. H. Develop strategies to identify and target local pocket of need areas. 2. Adhere to federal and state appropriation laws pertaining to use of programmatic funds. See Immunization Allowable Expenditures in Attachment 1 for appropriate use of Federal Funds. 3. Adhere to requirements set forth in the Omnibus Budget Reconciliation Act of 1993, section 1928 Part IV — Immunizations and the most current CDC Vaccines for Children Operations Manual, Michigan Resource Book for VFC Providers, and documents that are updated throughout the year pertaining to the Vaccines For Children (VFC) Program. 4. Ensure that federally procured vaccine is administered to eligible children only and is properly documented per VFC guidelines. A. The VFC Program provides VFC vaccine to only eligible children who meet the following criteria: are Medicaid eligible, have no health insurance, are American Indian or Alaskan Native, are served at a Federally Qualified Health Center (FQHC), a Rural Health Center (RHC) or a public health clinic affiliated with a FQHC and are also under-insured. B. Ensure state-supplied vaccines provided in the jurisdiction are administered only to eligible clients as determined by the state. This program allows for the immunization of select populations who are underinsured and not served at a FQHC, RHC, or a public health immunization clinic affiliated with a FQHC as defined by current state program requirements. C. Ensure that all providers receiving vaccine from the state screen children for VFC eligibility for children D. Fraud or abuse of federally procured vaccine should be monitored and reported. Page 65 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 5. Adhere to all Federal and Michigan Laws pertaining to immunization administration and reporting including reporting to the MCIR, VAERS and schools and daycare reporting 6. Coordinate the submission of immunization data from schools and child care centers in your jurisdiction and follow-up with programs providing incomplete or inaccurate data. Assure compliance levels are adequate to protect the public. 7. Monitor any provider receiving federally procured vaccine including but not limited to VFC/AFIX site visit. 8. Ensure on-site attendance of at least 1 LHD immunization program staff to two (2) Immunization Action Plan (IAP) meetings each year. 9. Submit original FSR's to the Department on a quarterly basis. 10. IAP Reports are submitted electronically in accordance with due dates set by the Department. 11. IAP Plan will be submitted electronically using a template provided by the Department, in accordance with due dates set by the Department. 12. By April 1, of each year provide one copy of the provider enrollment form which includes a profile for each provider who receives vaccine from the state. These documents must be postmarked or filed electronically no later than April 1. 13. Implements Perinatal Hepatitis B program activities to prevent the spread of Hepatitis B Virus (HBV) from mother to newborn. A. Verify pregnancy status on all hepatitis B surface antigen (HBsAg) positive pregnant women of childbearing years (10-60 years of age.) B. Ensure HBsAg positive pregnant women are reported to the Perinatal Hepatitis B case manager and according to the Public Health Code. C. Coordinate Perinatal Hepatitis B case management activities between local health department, provider, and Perinatal Hepatitis B Case Manager to: 1. Ensure that all infants, born to women who are HBsAg positive receive hepatitis B vaccine and hepatitis B immune globulin (HBIG) within 12 hours of life, a complete hepatitis B vaccine series with post vaccination serology testing and program support services,. 2. Ensure that all susceptible household and sexual contacts associated with HBsAg positive women receive appropriate testing, vaccination, and support services. D. Ensure birthing hospitals are able to offer hepatitis B vaccine to all newborns prior to hospital discharge by enrolling them in the Universal Hepatitis B Vaccination Program for Newborns. 14. Surveillance of vaccine preventable disease (VPD) activities: A. Ensure that all reportable diseases are reported to the Department in the time specified in the public health code and appropriate case investigation is completed. B. Conduct active surveillance when indicated (i.e. during an outbreak) and contact hospitals, laboratories, and/or other providers on a regular basis. Page 66 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ili 07/03/14 C. Utilize VAERS to report all adverse vaccine reactions. Department Requirements 1. The department will develop templates for submission of IAP reports and the annual IAP plan, and provide feedback to the local health departments. 2. Provide technical assistance in establishing and operating immunization action plans. 3. Provide technical assistance in MCIR activities through regional coordinators. 4. Provide supportive services and resource identification when needed. 5. Provide financial support for LHD and Community / Migrant Health Centers for Immunization in pocket of need (PON) areas. 6. Each LHD will have an annual VFC site visit by the Department. 7. Develop pre-formatted tools including training for new initiatives and IAP reports / plan. IMMUNIZATION ASSESSMENT FEEDBACK INCENTIVE EXCHANGE (AFIX1 FOLLOW-UP SITE VISIT SPECIAL REQUIREMENTS Budget and Agreement Requirements The rate of reimbursement per AFIX follow-up visit is $100 for an on-site personal visit to the provider office or $50 for a follow-up phone call (with information mailed afterward) to the provider office. Grantee Requirements 1. Conduct AFIX follow-up with all providers with identified follow-up issues/activities. Department Requirements 1. The Department will provide payment quarterly based on the fixed unit rate reimbursement mechanism upon completion and timely submission of the required documents mentioned above. 2. The Department will develop pre-formatted tools. The Department will provide support to the Grantees. 3. The Department will provide AFIX training module upon request by the LHD and will also provide guidance at IAP meetings and through the Department Immunization field representatives. 4. The Department will provide written guidance to agencies on annual requirements to complete AFIX site visits. Page 67 of 121 MDCH/G&PD FY 14/15 ATTACHMENT 111 07/03/14 IMMUNIZATION — FIELD SERVICE REPRESENTATIVES SPECIAL REQUIREMENTS (DISTRICT HEALTH DEPARTMENT #10, KENT COUNTY HEALTH DEPARTMENT, LIVINGSTON COUNTY HEALTH DEPARTMENT, MARQUETTE COUNTY HEALTH DEPARTMENT, MONROE COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT) Grantee Re w_ir _n _it§.1_D_i Counties . Employ and oversee a full-time Immunization Field Representative for the Immunization Program who shall be acceptable to the Department and who shall be supported by this agreement, understanding that their full time is to be devoted for regional immunization related activities. 2. Provide the Immunization Field Representative with permanent office space and supplies, including, but not limited to: a telephone, general office supplies, a computer with high speed Internet capabilities, a printer, a cellular telephone and a use of vehicle or reimbursement mechanism for transportation unless otherwise arranged. 3. Ensure the Immunization Field Representative will be available to all local health departments in the assigned regions to provide immunization Program activities equitable and at the direction of the Department. Refer to field representative responsibilities as defined by the Department and distributed to the Grantee. 4. Provide for reimbursement for reasonable telephone charges incurred in the conduct of business by the Immunization Field Representative unless otherwise arranged. 5. Provide reasonable reimbursement for any travel and subsistence expenses incurred by the Immunization Field Representative necessary to the conduct of the Immunization Program. Travel could include the annual National Immunization Conference or other professional immunization related conferences, attendance at the Department Immunization staff meetings and trainings, and accreditation visits made in other areas of the state. Grantee Regmirements — Kent. Livingston and Monroe Counties 1. Provide adequate office space, telephone connections, and high-speed internet access. Also provide access to fax and photocopiers. 2. Provide feedback to Division Director as needed, on employee work related conduct. Field Representative Roles and Responsibilities- District #10. Marquette. and St. Clair Counties This position serves as a liaison, resource person and as a regional expert for local health jurisdictions regarding all the Department immunization programs and initiatives. Page 68 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 I PROGRAM SUPPORT: A. Assist with the regional MC1R activities and act as a regional resource on MC1R processes and assessment protocols. B. Assist with the local implementation and monitoring of all state programs at the regional level- including IAP implementation, VFC, AFIX, Accreditation, Perinatal Hepatitis B, School / Childcare reporting, special projects and the INE program. C. Participate in planning for regional conferences, 1AP Coordinator meetings, and other the Department programs and initiatives as needed. D. Assist state, regional and local epidemiologists and communicable disease staff as needed with VPD surveillance and outbreak control. 2. PROGRAM QUALITY ASSURANCE: A. Assist in the orientation of new 1AP Coordinators. B. Work with local health departments to assess and increase immunization levels for all age groups, especially identifying and targeting pockets of need. C. Identify evidence-based strategies that support improved coverage levels in the region, including use of recall, coordination of LHD services, and provider and LHD staff education. D. Consult with the local health department on the immunization component of the accreditation process, including preparation for reviews and conducting a walk through or mock accreditation review. E. Consult with local coalitions and private stakeholders to promote immunizations and ensure consistent messages are relayed to the public. F. Consult with local health departments on the school and day care assessment process. G. Encourage or provide educational updates and interventions on all immunization issues with staff at local health departments, healthcare providers, school and childcare staff and other stakeholders. 3. PROGRAM COMPLIANCE: A. Monitor compliance with policies/legislation at national/state and local levels such as: I. VFC program requirements and vaccine distribution 2. VAERS program 3. Public Health Code 4. Administrative Rules a. School and childcare legislation and reporting requirements b. MC1R legislation and rules c. Communicable Disease Rules 4. PROGRAM OVERSIGHT and PROGRAM REVIEW: A. Perform oversight of the following programs with assigned local health departments. MDCH/G&PD FY 14/15 ATTACHMENT III Page 69 of 121 07/03/14 B. Accreditation-Conduct reviews, and monitor corrective actions. C. VFC including orientation to annual VFC site visit process, monitoring of VFC vaccine losses, submission of mandatory reports, annual LHD VFC site visits and quality assurance review of all provider public vaccine orders. D. AFIX—including assuring local feedback with providers, and follow up on recommendations. E. Perinatal Hepatitis B-regional birth dose levels and universal vaccine program. F. Review and summarize LHD 1AP Annual Plans and Biannual IAP Reports. G. Monitor LHD compliance with Comprehensive agreements and special requirements relating to the Immunization program. H. Subrecipient monitoring of funds. Department Requirements 1. As financially feasible, provide necessary adjunct clerical services to the Immunization Field Representatives for the duplicating/printing of materials and the packaging and distribution of these materials. 2. Provide program direction, responsibilities and definition of Immunization Field Service Representative responsibilities. 3. Support or solicit the Immunization Field Service Representative input into policy- making decisions. IMMUNIZATION MICHIGAN CARE IMPROVEMENT REGISTRY (MCIR) REGIONAL SPECIAL REQUIREMENTS (DISTRICT HEALTH DEPARTMENT #10, GENESEE COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH & COMMUNITY SERVICES, MID-MICHIGAN DISTRICT HEALTH DEPARTMENT, PUBLIC HEALTH, DELTA AND MENOMINEE COUNTIES) Grantee Requirements - All Other Departments The Grantee shall ensure the performance of the following activities on behalf of the Department to support the MCIR: 1. Promote and train providers and Health Care Organizations (HC0s) on all features of the MCIR Web application. 2. Support regional MC1R users by operating the regional help desk in accordance with Department approved procedures. 3. Monitor and develop strategies to increase private provider and HCO enrollment and participation in the MC1R which includes development of strategies to encourage all providers to fully participate with the MCIR, (such as sites of excellence awards). Page 70 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 4. Process all user/usage agreements, according to the Department's approved procedures, to create user accounts. 5. Implement and update marketing plans in support of increased provider and parent acceptance and use of the MCIR. 6. Keep regional users updated on MCIR status and system changes. 7. Conduct ad hoc reporting and querying on behalf of MCIR users. 8. Work with local health departments to establish a mechanism and internal process to assure persons who have died within their county are appropriately flagged in the MC1R. 9. Maintain a listing of HCO private and public immunization providers. This listing should be as comprehensive as possible and should include all providers in the region. 10. Conduct regular de-duplication activities to assure that duplicate records are removed from the MC1R as quickly as possible. 11. Process user petitions to change MC1R data according to Department approved procedures. 12. Monitor ongoing immunization data submission for all local health departments and private providers. 13. Conduct training functions as needed to assure that local health department staff can train and educate providers on how to access and submit data into MC1R. 14. Maintain a policy/procedure manual, approved by the Department. 15. Process and file all "opt out" forms according to the Department approved procedures. 16. Attend regular MCIR regional Grantee/coordinator meeting. 17. Perform quality assurance checks on the MC1R data for the region as prescribed by the Department. A. Assist local health departments and private providers with methodologies to "clean up" their data. B. Provide assistance to the Department on User Acceptance Testing (UAT) when required to verify MC1R system releases of bug fixes and enhancements. C. Attend all UAT training sessions as required by the Department. 18. The Grantee shall provide to the MC1R Regional Coordinator: a) permanent office space; b) general office supplies; c) a land based telephone; d) a computer with high speed internet capabilities; e) a printer; f) a cellular telephone; and g) use of a vehicle or in the alternative reimbursement mechanism for transportation unless otherwise arranged. 19. When sufficient funding is available, provide to the MCIR Regional Coordinator reimbursement for travel to attend the National Registry related meetings if approved by the Department. This includes travel related expenses concerning air fare, lodging, baggage processing, taxi services, etc. 20. Consult with the Department on any personnel or performance issues that could affect the above mentioned contract requirements. Page 71 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 21. Facilitate the Department's attendance in the interview process for hiring of a MC1R Regional Coordinator / MCIR staff. This process includes consultation with the Department regarding selection of interview candidates as well as participation in the hiring determination. Grantee Performance/Progress Report Reauirements 1. Ensure the quarterly submission of status reports on work plan progress. Reports are due within 30 days of the end of each quarter. (January 31, April 30, July 31, October 31 ). 2. Final quarterly report shall be an annual report. The annual report will be distributed to the Department and shall include: A. Summary of provider enrollment (breakdown by role); B. The amount of data submitted to the region during the fiscal year; C. Summary of staff resources; D. Sites of excellence award recipients. 3. Any other information as specified in the special requirements shall be developed and submitted by the Grantee as required by the Department. Reports and information should be submitted to; Bea Salads, MCIR Coordinator Michigan Department of Community Health Immunization Division P.O. Box 30195 Lansing, MI 48909 Phone: (517) 335-9340 The Grantee shall permit the Department or its designee to visit and to evaluate on an as- needed basis. Department Requirements 1. Provide support and technical assistance to Regional staff. 2. Provide initial training and support to a MC1R Regional Coordinator 3. The Department shall evaluate submitted reports as described above for their completeness and adequacy. IMMUNIZATION — NURSE EDUCATION REIMBURSEMENT SPECIAL REQUIREMENTS Budget and Aareement Reauirements The rate of reimbursement is $200 per eligible educational session for all modules except Vaccines Across the Lifespan, which is to be reimbursed at $250 per eligible educational session to the Grantee, upon completion and submission of NE Provider Contact and Report Forms. Reimbursement will be based on a first come-first served basis and also Page 72 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 based on most current INE Program Guidelines. . All requests for reimbursement should be submitted on the quarterly Financial Status Report (FSR) and should include all sessions conducted during that quarter. The submission should include, as an attachment to the FSR, detail of the sessions during that quarter using the spreadsheet information provided by the Department. Grantee Reauirements 1. Ensure that all Immunization Nurse Educators are trained as required by the Department. 2. Ensure that the INE Provider Contact and Report Form is complete and submitted to the Department/Immunization Program within 5 days after the presentation. Department Reauirements 1 The Department will provide payment based upon the fixed unit rate reimbursement mechanism upon completion and submission of the INE Provider Contact and Report Forms for eligible sessions. Payment will be based on submission of the quarterly FSR that should include all sessions conducted during that quarter with detail of the sessions documented on the spreadsheet that is provided by the Department. 2. The Department will provide two (2) sessions per calendar year for Grantee Immunization Nurse Educators. IMMUNIZATION — VACCINE QUALITY ASSURANCE PROGRAM SPECIAL REQUIREMENTS Grantee Requirements 1. Follow-up on vaccine losses and replacement for compromised vaccines for immunization providers within the jurisdiction, 2. Monitor and approve all temperature logs, doses administered reports, and ending inventory reports received from participating VFC providers within the jurisdiction, 3. Monitor and approve vaccine orders for participating VFC providers within the jurisdiction 4. Act as the Primary Point of Contact (PPOC) for VFC providers within the jurisdiction. 5. Provide education and intervention on inappropriate use of publicly purchased vaccine. 6. Follow-up on VFC site visit non-compliance issues. 7. Assist VFC providers within the jurisdiction on issues related to balancing vaccine inventories. 8. Assist with the redistribution of short dated vaccine for providers within the jurisdiction. 9. Assist with the equitable allocation of vaccines to providers in the jurisdiction during a vaccine shortage. Page 73 of 121 MDCH/G&PD FY 14/15 ATTACHMENT IN 07/03/14 Department Requirements 1. Monitor and approve all temperature logs, doses administered reports and ending inventory reports received from Local Health Departments. 2. Monitor and approve vaccine orders for Local Health Departments. 3. Consult with Local Health Departments on vaccine losses and assist as needed. 4. Act as the PPOC to Local Health Departments. 5. Assist Grantees on education and intervention on the inappropriate use of publicly purchased vaccine. 6. Assist Local Health Departments on issues related to MC1R functionality and operation. 7. Assist Grantees with the redistribution of short dated vaccine. IMMUNIZATION VFC/AFIX SITE VISIT SPECIAL REQUIREMENTS Budget and Agreement Reauirements The rate of reimbursement is $150 for a VFC Enrollment or VFC only visit, or $350 for a combined VFC/AF1X or birthing hospital visit. 1. The rate of reimbursement is $150 for a VFC Enrollment or a VFC Only visit, $300 for a combined VFC/AFIX or birthing hospital visit. An enrollment visit is required for all new VFC enrolled provider sites. All LHD staff involved with any AFIX site visits must complete the Department AFIX training module, presented by the Department AFIX Coordinator, prior to conducting any AFIX visits. Annual VFC/AFIX visit guidance and review will be provided to each LHD at the IAP Meetings and consult will be conducted by the Department Immunization Field Representative for each Grantee. 2. Jurisdictions must visit at least 50 percent of their sites every year. The requirement is that all enrolled and active VFC providers receive a VFC site visit at least every other year. This means that one half are visited one year and the other half are visited the following year. Detroit Department of Health and Wellness Promotion Immunization Program is required to complete visits annually to 100% of the VFC providers in accordance with the SEMHA Quality Assurance Specialist (QAS) contractual obligations. Combined VFC/AFIX site visits will be conducted using registry based AFIX reports and AFIX tools developed by the Department. 3. All reimbursement requests should be submitted on the quarterly Comprehensive Financial Status Report (FSR). The submission should include, as an attachment, detail all of the visits during the quarter using the spreadsheet information provided by the Department. Page 74 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 The format of the site visit will be based on the complete site visit questionnaire reviewed at the most recent Fall IAP meeting and the site visit guidance documents (VFC and AF1X) provided by the department and the CDC. Site visit information shall be entered into the appropriate database as required by CDCwithin 10 days of the site visit. 4. Data from the Department's/Immunization Program regarding the number of site visits will be used to reconcile the request for reimbursement. For additional detail on the program requirements, refer to the Resource Book for Vaccine for Children Providers and the AFIX site visit guidance documents, as well as other guidance provided by the Department /Immunization Program in correspondence to Immunization Action Plan (IAP), Immunization Coordinators, or through health officers. Department Requirements 1. The Department will provide payment quarterly based upon the fixed unit rate reimbursement mechanism upon completion and submission of the questionnaires. 2. The Department will develop pre-formatted tools. 3. The Department will provide support to the Grantees. 4. The Department will provide training at 1AP meetings, vaccine management calls, and through field representatives. INFANT SAFE SLEEP SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MACOMB COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DEPARTMENT, SAGINAW COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT,C1TY OF DETROIT HEALTH AND WELLNESS, KALAMAZOO COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT) Objective: Provide funding to select local health departments (LHD) to support promotion and awareness of infant safe sleep best practices in their communities. Funding must be expended by September 30. Grantee Requirements 1. LHD personnel will provide educational activities, conduct community outreach efforts and/or expand community awareness of infant safe sleep. These efforts must adhere to the guidelines for infant safe sleep safety and SIDS risk reduction issued by the Page 75 of 121 MDCH/G&PD FY 14/15 ATTACHMENT Ill 07/03/14 American Academy of Pediatrics in 2011. Activities are to be culturally relevant to at- risk, high-risk families in the community and reflect diversity in terms of race, ethnicity, language, and socioeconomic status. 2. LHD will convene and facilitate a local advisory team that focuses on infant safe sleep, a public/private partnership that coordinates local efforts to promote infant safe sleep and reduce infant deaths related to unsafe sleep environments. If a similar community based group or team addressing infant safe sleep already exists, it is not necessary to create a new one. 3. Funds may be used for the purchase of demonstration and/or educational items. Additionally, a maximum of 15% of the funding may be used for giveaway items that are directly related to infant safe sleep such as cribs, pack- and-plays, and/or sleep sacks.. A maximum of 25% of the funding may be used for advertising, including billboards, bus signage and the purchase of radio, tv and/or print media. Department Requirements 1. Provide technical assistance for infant safe sleep through Infant Safe Sleep Program Coordinator. Reporting Requirements 1. Prior to the submission of the proposed FY15 workplan, LHD will participate in a group conference call with all mini-grantees facilitated by the Infant Safe Sleep Program Coordinator to review current data, discuss infant safe sleep best practices and answer any questions related to mini grant requirements. 2. LHD will submit a written summary to date on all activities using the template provided in the mini grant guidance. This summary will be due to the Infant Safe Sleep Program Coordinator 15 days after the end of the 2nd quarter (April 15). 3. LHD will participate in a TA call with the Infant Safe Sleep Program Coordinator by April 30 to review progress to date. 4. LHD will submit a final report on all activities, using the template provided in the mini grant guidance, by October 30 via email to Patti Kelly, MDCH Infant Safe Sleep Program Coordinator, at kellyp2@michigan.gov. INFORMED CONSENT SPECIAL REQUIREMENTS Grantee Requirements The following requirements apply to all Grantees, whether the Grantee operates a Family Planning Clinic or not: Page 76 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 1. When a woman states that she is seeking an abortion and is requesting services for that purpose the Grantee will provide: A pregnancy test with a determination of the probable gestational stage of a confirmed pregnancy. Note: The Grantee must destroy the individual "informed consent" files containing identifying information (Name, Address, etc.) after 30 days. 2. When a woman seeks a pregnancy test and does not explicitly state that she is doing so for the purpose of obtaining an abortion, she should be directed to a family planning clinic or to her primary care provider for a pregnancy test. Services to comply with PA 345 of 2000 should not be provided to a woman in a Title X funded family planning clinic. Department Requirements The Department will provide funding, at the fixed rate of $50 per woman served, for each woman that expressly states that she is seeking a pregnancy test or confirmation of a pregnancy for the purpose of obtaining an abortion and is provided the services noted in item 1 above. The number of services, rate per service and total amount due must be noted as a funding source, under the element where the staff providing the services are funded, on the Comprehensive FSR through the MI E-Grants system. 1NTERCONCEPTION CARE PROGRAM EVALUATION SPECIAL REQUIREMENTS (KENT COUNTY HEALTH DEPARTMENT) Objective: The Kent County Health Department will collaborate with the Department of Community Health to develop and implement an evaluation of the Kent County Infant Health initiative - Interconception Care Program. The purpose of the project is to improve data collection, monitoring and evaluation of the Kent County Interconception Care Program. The project will conduct quality improvement of surveillance data to monitor interconception health indicators, to evaluate program outcomes, and to conduct quality improvement for the Interconception Care Program services and interventions. To better understand how to effectively address the pre-pregnancy health needs of women who experience late fetal loss, funds may also be used to support a pilot project and evaluation of interconception care services for women who have experienced fetal loss. No funds can be used to support care services, except for women who experience fetal loss Page 77 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 where there are no other sources to support the limited intervention services offered by the lnterconception Care Program. Grantee Requirements: 1. Comply with the approved project plan and budget submitted to Barbara Derman, Program Consultant, dermanbRmichiqan.gov 2. Collaborate with Dr. Patricia McKane, MCH Epidemiologist mckanepRmichion.00v in the design of project data, indicators and analysis. 3. Share monitoring and evaluation results with the Division of Family and Community Health, Michigan Department of Community Health. 4. Produce quarterly project status reports for submission to the Division of Family and Community Health, MDCH. Reporting Requirements: 1. Submit quarterly project status reports including monitoring and evaluation of results for women traditionally served in the program and results for women who have experienced fetal loss served in the pilot project. Due Dates: January 10 April 10 July 10 October 10 2. Any such other information as specified in the Statement of Work, Attachment A shall be developed and submitted by the Grantee as required by the Contract Manager. 3. Submit quarterly project status reports to: Barbara Derman, Program Consultant at: dermanbmichion.qov or Michigan Department of Community Health Division of Family and Community Health P030195 Lansing, MI 48909 Phone: (517) 335-8696 4. The Contract Manager shall evaluate the reports submitted for their completeness and adequacy. 5. The Grantee shall permit the Department or its designee to visit and make an evaluation of the projects as determined by the Contract Manager. Page 78 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 LABORATORY SERVICES SPECIAL REQUIREMENTS (KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES, KENT COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY HEALTH DIVISION, SAGINAW COUNTY HEALTH DEPARTMENT) Grantee Requirements 1. Grantee Specific Requirements - All Grantees A. Meet established standards of performance and objectives in the following areas: a. Bioterrorism: i. Make one FTE available to participate in training and exercises associated with Bioterrorism (BT). Train additional staff to perform Laboratory Response Network (LRN) Sentinel and Reference level laboratory procedures. Secure and maintain Select Agent Registration. iv. Maintain competency and proficiency for testing procedures described in the LRN protocols including result entry into LRN Results Messenger. v. Participate in the Department sponsored proficiency testing (PT) program consisting of two PT shipments per year and with CDC provided LRN PT. Continued funding is based on successful participation with a minimum passing grade of 80%. vi. Temporarily assign one FTE to the Department or another LRN Reference level laboratory as surge capacity for emergency situations if needed. vii. Develop a plan to provide laboratory services 24 hours a day, 7 days a week for a BT event. viii. Provide secure facilities to store reagents, quality control organisms and patient isolates. ix. Provide 24/7 contact information. x. Initiate BT testing within 4 hours of sample receipt in Grantee lab. b. Maintain Clinical Laboratory Improvement Amendments (CLIA) of 1988 certification for high complexity testing. c. Establish submission procedures for designated agencies/physicians for the timely transport of appropriate specimens to the laboratory. d. Renew yearly a Memorandum of Understanding (MOU) with the Department BOL for Laboratory Response Network (LRN) testing. B. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not specifically supplied by the Department in this agreement. Page 79 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 C. Provide the Bureau of Epidemiology, and Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Grantee for the Department all specimen submission data and reporting data will be entered and reported using Bureau of Laboratories (BOL) Laboratory Information Management Systems (LIMS) software. The Grantee will designate one staff member as a liaison to the Bureau of Laboratories. Each Grantee must designate appropriate staff to take part in LIMS training activities. D. Provide information on specimen submission to local health jurisdictions to assure that specimens are submitted to LRN regional laboratory, or nearest appropriate LRN laboratory as determined by the Department. Department Requirements 1. Department Requirements (for All Grantees): A. The Department will provide notifications and explicit instruction for stop and start days to Grantee laboratory regarding this contractual arrangement prior to its implementation. B. The Department will provide access to LIMS, support for LIMS hardware and software, user training for LIMS utilized for testing performed under contract, advanced training for LIMS liaisons for test master and Grantee specific data. The Department will maintain the sole contract with LIMS vendor. Backups and maintenance of all module(s)/customization(s) will be performed by the Department staff. C. Analyze data from reports submitted from Grantee. Supply timely feedback of statistical analysis and other data related to ongoing program activities. D. Assist in technical training of testing personnel and computer software utilization. E. Supply Grantee with a copy of the contracts associated with this program. F. Renew yearly a Memorandum of Understanding (MOU) with Grantees for Laboratory Response Network (LRN) testing. G. The Department will provide training at the Department for up to two individuals in Laboratory Response Network (LRN) Sentinel and Reference level laboratory procedures as needed. H. The Department will provide proficiency testing materials on a semi-annual basis and funding, as available, for materials and supplies necessary to perform designated LRN Reference Level lab protocols. 2. Department Requirements (for Kalamazoo County Health & Community Services, Kent County Health Department and Saginaw County Department of Public Health Only) Page 80 of 121. MDCH/G&PD ry 14/15 ATTACHMENT Ill 07/03/14 A. The Department: a. Designate and assign personnel who meet the qualifications required as a high complexity laboratory director in CUA 1988. b. Laboratory Directors will: I. Sign the appropriate CMS paperwork for CUA certification for their region as needed. ii. Perform annual site visit of the Grantee high complexity laboratory and assist in CLIA surveys. iii. Be available for consultation to the Grantee laboratory by telephone, email, and other communication methods. iv. Provide technical consultation for laboratory guidelines, testing procedures, quality control methods or quality assurance in accordance with CLIA requirements. v. Review Quality Assurance program with attention to effective quality control activity and corrective action. vi. Review and sign training records and competency evaluations. vii. Review and sign external proficiency testing results in a timely manner. viii. Review and sign procedure manual(s) annually, and any new procedure prior to its implementation. Grantee Specific Requirements 1. Saginaw County Department of Public Health A. Perform pre-paid tests for Gonorrhea and Chlamydia by nucleic acid amplification. A list of assigned submitters will be provided by the Department. The Saginaw County Department of Public Health will meet established standards of performance and objectives in the following areas: a. Perform testing using the Gen Probe APTIMA Tigris system. b. Maintain CUA certification. c. Subscribe to and successfully participate in proficiency testing for CT/GC. d. Enter all specimens and report results in StarLIMS. Data entry should include all fields associated with race, ethnicity, date of collection, gender, specimen type, provider type, reason for test and all other fields required for regulatory compliance. e. Initiate testing on the day the specimen is received by the laboratory and no later than one calendar day after the specimen is received. Page 81 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 MDCH/G&PD FY 14/15 07/03/14 f. Perform testing Monday — Friday, except for the following holidays: New Year's Eve, New Year's Day, Martin Luther King Day, Presidents day, Good Friday, Memorial Day, July 4 th , Labor Day, Veteran's Day, Thanksgiving Day, day after Thanksgiving, Christmas Eve, and Christmas Day. g. Participate in quarterly Michigan Infertility Prevention Program Alliance (MIPP) meetings held in Lansing. h. Provide a quarterly report that include test volumes, turn around times, and a summary of any quality assurance issues encountered and action taken to resolve them. Average turn around times shall not exceed 4 days, including weekends. Work with the Department staff to resolve data integrity issues that are found when quarterly IPP reports are prepared for the Centers for Disease Control and Prevention (CDC). j. Maintain an adequate inventory of reagents and disposables to insure no interruptions in testing. k. Attempt to establish reimbursement agreements with relevant Medicaid Managed Care Provider Networks to secure third party reimbursement for non- voucher tests submitted for eligible Medicaid patients. The laboratory will test appropriately collected specimens from Medicaid Provider Networks even in the absence of a reimbursement agreement with that provider. The STD, Family Planning, or Adolescent Health Programs will reimburse the testing laboratory the comprehensive agreement cost per voucher test for rejected charges as funding permits. m. Follow a quality system plan equivalent to the Department's plan including but not limited to quality control intervals, occurrence management, personnel assessment (education, training, and competency). n. Package and ship collections kits for all voucher and non-voucher tests for all submitters assigned to their laboratory. o. Develop a continuity of operations with the Department to assure uninterrupted testing. p. Test 15,000 CT/GC voucher tests and 2,930 CT only voucher tests. The department will reimburse the Saginaw County Department of Public Health$12.72 for each voucher GC/CT test reported in StarLIMS and $11.33 for each voucher CT only test reported in StarLIMS. A test is considered a voucher test if it is received on a voucher requisition showing a valid control number. Page 82 of 121 ATTACHMENT III LABORATORY SERVICES ELC SPECIAL REQUIREMENTS (KALAMAZOO COUNTY HEALTH AND COMMUNITY SERVICES DEPARTMENT) Grantee Specific Reauirements— Kalamazoo County Department of Public Health 1. Provide laboratory support to investigate all suspect Norovirus outbreaks that occur in Kalamazoo County. 2. Act as a surge capacity laboratory for the Department to perform Norovirus testing when the Department has reached maximum testing capacity or if the Department laboratory resources are required for another purpose. Activation of the Kalamazoo County laboratory for this purpose will be made by the Bureau of Laboratories (BOL) Infectious Diseases Division Director. The Department -BOL shall provide $5,000 initially to Kalamazoo County. Kalamazoo will bill the Department -BOL for $100.00 per test that is not covered in the initial amount. 3. Purchase and maintain adequate inventories of any supplies needed for testing and reporting, not specifically supplied by the Department in this agreement. 4. Provide the Bureau of Epidemiology, arid Bureau of Laboratories records and reports as required. For all testing services performed under contract by the Grantee for the Department all specimen submission data and reporting data will be entered and reported using Bureau of Laboratories (BOL) Laboratory Information Management Systems (LIMS) software. The Grantee will designate one staff member as a liaison to the Bureau of Laboratories. Each Grantee must designate appropriate staff to take part in LIMS training activities. 5. Meet established standards of performance and objectives in the following areas: A. Participate in an the Department sponsored proficiency testing program consisting of two proficiency events per year. Continued funding is based on successful participation with a minimum passing grade of 80%. B. Provide Laboratory support for examination of up to 100 stool specimens associated with suspect Norovirus disease outbreaks. Specimens are to be processed within 2 business days of receipt. C. Utilize standardized testing procedures, standards of quality assurance and quality control approved by the Department laboratory director. Assist the Department in Quality Assurance Assessment semi-annually or as determined by the Department. D. Establish and maintain a personnel training and competency assessment program. Maintain documentation of training of all testing personnel. E. Maintain Clinical Laboratory Improvement Amendments (CLIA) of 1988 certification for high complexity testing. Page 83 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 LOCAL HEALTH DEPARTMENT SNAP-ED SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, DICKINSON-IRON DISTRICT HEALTH DEPARTMENT, DISTRICT HEALTH DEPARTMENT #10„ MARQUETTE COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY DEPARTMENT OF HEALTH AND HUMAN SERVICES/HEALTH DIVISION, OTTAWA COUNTY HEALTH DEPARTMENT, WASHTENAW COUNTY HEALTH DEPARTMENT, WESTERN UPPER PENINSULA DISTRICT HEALTH DEPARTMENT) The Local Health Department will: implement the Local Health Department SNAP-Ed Project in local communities in its jurisdiction, delivering programming with a primary focus on nutrition education according to the approved Supplemental Nutrition Assistance Plan- Education (SNAP-Ed) plan of work between October 1 through September 30; assure that efforts are made to target Supplemental Nutrition Assistance Program (SNAP) participants and eligible populations, especially adults and families; use appropriate allowable educational strategies and implementation methods to reach potentially SNAP eligible individuals/families; collect and report data regarding participation in SNAP-Ed and characteristics of those served. Grantee Requirements 1. The Grantee's program plan will be on file with the department. 2. Participate in an evaluation process for the project in collaboration with the Department staff. 3. Assist the Department staff and its partners with Local Health Department SNAP-Ed regional train ings. 4. Attend required meetings and trainings as identified by the Department. 5. The Grantee shall collaborate with their program consultant to schedule site visits. 6. Implement programming with a primary focus on nutrition education according to the approved SNAP-Ed plan; assuring that efforts have been made to target SNAP-Ed participants; using appropriate educational strategies and implementation methods that are in compliance with Federal and State SNAP-Ed policies and procedures; collect and report data regarding participation in SNAP-Ed, and characteristics of those served and outcomes of educational programming. 7. Ensure cash or in-kind donations from other non-federal sources to SNAP-Ed have not been claimed or used as match or reimbursement under any other Federal program. 8. Upload a total of four progress reports into the MI E-Grants system using the reporting formats as required and made available by the Cardiovascular Section of the Department. Page 84 of 121 MDCH/G&PD FY 14/15 ATTACHMENT II 07/03/14 a) Submit two quarterly progress reports as an attachment to your January and May FSRs, in the same document as the Local Health Department SNAP- Ed Work Plan. Reporting Period Report Due Dates October 1 — January 31 February 15 (attach to Jan FSR) February 1 — May 31 June 15 (attach to May FSR) b) Submit two Michigan Nutrition Network bi-annual progress reports as an attachment to your March and September FSRs, and all requested deliverable materials, using the reporting format as required and made available by the Department. Reporting Period Report Due Dates October 1 - March 30 April 15 (attach to March FSR) April 1 - September 30 October 15 (attach to Sept FSR) 9. Each Health Department has a 35% required match amount. Local Health Departments match spending must be allowable under SNAP-Ed guidelines and be accurately reported each month on the monthly Financial Status Reports (FSR). Supporting documentation for allowable monthly match spending must be kept on file at the Local Health Department and made available for review on request or during site visits. 10. Health Departments will be paid monthly based on actual expenditures reported on their monthly Financial Status Reports (FSR), which are due by the 15 th of every month, using the reporting format as required by the Department through the MI E-Grants system. 11. Documentation of local costs, payments, procedures, inventory, and itemized receipts for non- personnel expenses, in addition to original timesheets and personnel activity reports for billed hours must be maintained by the Grantee and will be available for the Department, the Michigan Nutrition Network, the Michigan Department of Human Services and/or the USDA to review and audit. 12. All materials developed or printed with SNAP-Ed funds MUST include the appropriate USDA nondiscrimination statement, credit to SNAP-ED, the Michigan Nutrition Network or the Department as a funding source, and a brief message about how the SNAP can help provide a healthy diet and how to apply for benefits. Materials that cannot be e-mailed should be mailed/faxed to: Michigan Department of Community Health 109 W. Michigan Ave., 6th Floor Lansing, MI 48913 ATTN: Katherine Nault Fax: 517-335-9056 13. Messages of nutrition education must be consistent with the Dietary Guidelines for Americans and stress the importance of variety, balance, and moderation, and do not disparage any specific food, beverage, or commodity. Page 85 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 14. Failure to comply with contract requirements may result in consequences including but not limited to denial of reimbursement for activities that were not performed, documented or were unallowable denial of future funding, and/or others as appropriate. LOCAL MATERNAL AND CHILD HEALTH IMCH1 PROGRAM SPECIAL REQUIREMENTS General Performance Requirements 1. LOCAL MATERNAL AND CHILD HEALTH A. Local MCH funds are intended to be flexible and available to Grantees to address locally identified needs related to the health of women and children in their jurisdictions. It is expected that each local health department will use a defined needs assessment process to determine and identify its MCH needs. B. Grantees are asked to examine, (to the extent data is available) their status on each of 28 MCH National and State Performance Measures. Eighteen of these indicators have been established by the MCH Bureau (MCHB) of the federal Department of Health and Human Services (DHHS) as mandated reporting requirements for all states. An additional ten measures have been selected as State measures by the Department for annual monitoring and reporting to DHHS in accordance with Title V MCH Block Grant requirements. It is important that local jurisdictions review these performance measures and identify any efforts to address these measures using their Local MCH allocation. It is left to local health departments to determine how Local MCH funds are to be used to address MCH needs. Grantee Reauirements 1. Submit a Local Maternal and Child Health Community Plan for use of the funds allocated for Local MCH Programs and report on the previous year's activity. The department will develop the format for the plan and the previous year's activity report. The plan due date is September 1, The previous year's activity report will be due at the time of the final FSR submission. 2. Local MCH funds are to be budgeted as a funding source under any appropriate program element(s) (i.e., Children's Special Health Care Services (CSHCS) MCH, Child Health, Family Planning, Immunization, Maternal Infant Health Program, or Other Local MCH (locally defined program as described in the Local MCH Community Plan). This funding source cannot be used under the WIC element Page 86 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 except in extreme circumstances where a waiver is requested in advance of the expenditures and evidence is provided that the expenditures satisfy all funding requirements. 3. Local MCH funds may not be used to supplant available/billable program income such as Medicaid or Healthy Michigan Plan fees or additional funding under the Medicaid Cost-Based Reimbursement process. 4. Local effort for program elements supported by Local MCH funds must not be reduced in instances in which added Medicaid has been generated through enhanced collection of Medicaid fees and/or funding under the Medicaid Cost-Based Reimbursement process. LOCAL TOBACCO REDUCTION SPECIAL REQUIREMENTS (BARRY EATON DISTRICT HEALTH DEPARTMENT, BRANCH/HILLDSDALE/ST. JOSEPH HEALTH AGENCY, CHIPPEWA COUNTY HEALTH DEPARTMENT, DICKINSON-IRON DISTRICT HEALTH DEPARTMENT, GENESEE COUNTY HEALTH DEPARTMENT, HEALTH DEPARTMENT OF NORTHWEST MICHIGAN, INGHAM COUNTY HEALTH DEPARTMENT, JACKSON COUNTY HEALTH DEPARTMENT, PUBLIC HEALTH DEPARTMENT DELTA & MENOMINEE COUNTIES, WASHTENAW COUNTY HEALTH, WESTERN UPPER PENINSULA HEALTH DEPARTMENT) Budget and Agreement Reauirements No funds may be expended for lobbying as defined in Act No. 472 of the Public Acts of 1978, being sections 4.411 to 4.431 of the Michigan Compiled Laws. Grantee Reqpirements Complete requirements and update information in attached reports: 1 st tri-annual report October 1—January 31 — due February 16 2nd tri-annual report— February 1—May 31 — due June 15 3rd tri- annual report June 1—September 30— due November 2 Page 87 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 MATERNAL INFANT EARLY CHILDHOOD HOME VISITING INITIATIVE (MIECHV) COMPETITIVE EXPANSION GRANT SEED FUNDING SPECIAL REQUIREMENTS (BERRIEN COUNTY HEALTH DEPARTMENT, CALHOUN COUNTY HEALTH DEPARTMENT, GENESEE COUNTY HEALTH DEPARTMENT, INGHAM COUNTY HEALTH DEPARTMENT, KALAMAZOO COUNTY HEALTH & COMMUNITY SERVICES DEPARTMENT, KENT COUNTY HEALTH DEPARTMENT, MUSKEGON COUNTY HEALTH DEPARTMENT, OAKLAND COUNTY DEPARTMENT OF HEALTH & HUMAN SERVICES/HEALTH DIVISION, SAGINAW COUNTY HEALTH DEPARTMENT, ST. CLAIR COUNTY HEALTH DEPARTMENT, WAYNE COUNTY HEALTH DEPARTMENT.) Purpose: To provide 'exploration' funding to eleven counties/communities for initial work related to the Michigan Maternal, Infant and Early Childhood Home Visiting Initiative Competitive Expansion Grant. The funding will allow each community's local home visiting leadership group to collaborate to complete/update an Exploration and Planning Tool that reflects the current needs and gaps in their community and to explore the possibility of, and options for, (additional) expansion of evidence-based home visiting programs in these high-risk communities. Funding Requirements: The local health department for each of the communities listed above will receive $8,000 in 'exploration' funding to help support the analysis work of their local home visiting leadership group. 1. This funding MUST be used to support the completion of an Exploration and Planning Tool that will contribute to the Department funding decisions regarding whether or not evidence-based home visiting services will be expanded in the each of the respective high-risk communities. 2. The Tool must be completed collaboratively. The local home visiting leadership group that completes this Tool MUST include Public Health, Mental Health/Substance Abuse, DHS/CAN Council, and Head Start. Other representatives strongly encouraged, but not limited to, are: parents of children who are or have received prevention-focused home visiting, Education, local Home Visiting Programs, and from your Great Start Collaborative/Great Start Parent Coalitions. We also recommend that the local groups include members of Tribal Nations whose service areas overlap the county/community, and members of community services agencies that represent populations that frequently experience health disparities. 3. More specifically, this funding can be used to: A. Purchase/offset the cost of the time for staff to help gather and submit data needed for the Exploration and Planning Tool. B. Support activities to develop an inventory of locally available data that can be used for the data analysis. Page 88 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 C. Purchase/offset the cost of the time of an Epidemiologist (or equivalent) to help conduct the data analysis. D. Financially support families representing the identified service population to be authentically involved as members of the local home visiting leadership group. E. Purchase/offset the cost of the time of someone to help gather and submit additional data needed for the state home visiting program database. The funds can be expended between October 1 and September 30. The Department staff will work with each site to develop an alternate spending plan in the event that this funding cannot be fully expended on the activities listed above. Reporting Requirements: 1. A budget must be submitted via the Department's electronic MI E-Grants system. 2. Financial Status Reports (FSR's) will need to be submitted quarterly, through the Michigan E-Grants system. All FSR's must report total actual expenditures, regardless of the source of funds and must be submitted within 30 days of the required time period outlined in the contract. 3. The Exploration and Planning Tool must be submitted to Penny Eisfelder via e-mail or fax by 5:00 p.m. on December 13. Penny Eisfelder, Program Analyst Division of Family & Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, MI 48909 Phone: 517-241-6841 Fax: 517-335-8697 eisfelderpmichigan.clov MICHIGAN MATERNAL, INFANT AND EARLY CHILDHOOD HOME VISITING INITIATIVE LOCAL HOME VISITING LEADERSHIP GROUP FUNDING SPECIAL REQUIREMENTS (GENESEE COUNTY HEALTH DEPARTMENT) Purpose: To provide funding to support the convening of the Local Home Visiting Leadership (LLG) group in the Grantee's respective county. Funding Requirements: 1. The local health department, listed above, will receive $50,000 in funding to help support the operations of the LLG in their respective county. 2. The LLG will work with the Department Grantee, Early Childhood Investment Corporation (ECIC), who will provide technical assistance to the LLG as they seek to carry out the MIECHV activities related to carrying out local HV system CQ1, developing a continuum of models and sustainability planning. Page 89 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 More specifically, this funding can be used to: • Enable the LLG to pay for staff support. • Financially support parent leaders to be a part of the LLG. • Carry out the MIECHV activities, as specified in this agreement. 3. The LLG must include Public Health, Mental Health/Substance Abuse, DHS/CAN Council, and Head Start. Other representatives strongly encouraged, but not limited to, are: parents of children who are or have received prevention-focused home visiting, Education, local Home Visiting Programs, and from your Great Start Collaborative/Great Start Parent Coalitions. We also recommend that the local groups include members of Tribal Nations whose service areas overlap the community, and members of community services agencies that represent populations that frequently experience health disparities. For the current year the Grantee will work with ECIC to: • Continue to implement the plan that incorporates required partners, including parent representatives. • Continue home visiting system level Continuous Quality Improvement (CQI) efforts. • Develop and implementa plan for the development of a continuum of home visiting programs within the community. The Department staff will work with each site to develop an alternate spending plan in the event that this funding cannot be fully expended on the activities listed above. Reporting Requirements: 1. A budget must be submitted via the Department's electronic MI E-Grants system. 2. Financial Status Reports (FSR's) will need to be submitted quarterly, through the Michigan E-Grants system. All FSR's must report total actual expenditures, regardless of the source of funds and must be submitted within 30 days of the required time period outlined in the contract. 3. A work plan must be submitted to Penny Eisfelder via e-mail or fax by 3:00 p.m. on October 15, 2014: Penny Eisfelder, Program Analyst Division of Family & Community Health Michigan Department of Community Health P.O. Box 30195 Lansing, MI 48909 Phone: 517-241-6841 Fax: 517-335-8697 eisfelderomichigan.qov 4. Quarterly work plan reports must be submitted to Penny Eisfelder (contact information above) within 30 days of the end of each quarter; the format for the quarterly reports will be provided by the Department. Page 90 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14 MATERNAL INFANT EARLY CHILDHOOD HOME VISITING PROGRAM (MIECHVP) HEALTHY FAMILIES AMERICA EXPANSION SPECIAL REQUIREMENTS (WAYNE COUNTY HEALTH DEPARTMENT) Funding Requirements: All Maternal, Infant and Early Childhood Home Visiting Initiative (MIECHV) subcontracting agencies must follow the program assurances and requirements, as prescribed below. Program Specific Assurances and Requirements: 1. Each subcontracting Grantee must serve the target population identified in their community's Needs Assessment, which was approved by the Michigan Department of Community Health. The target populations for each community are as follows: The Wayne County Babies Healthy Families America Programs will serve an additional 37 families, who are African American teens living in Highland Park, Hamtramck, Redford, and Inkster Michigan. 2. Each subcontracting Grantee will be required to adhere to Michigan's MIECHV Program Requirements (PRs), as outlined in the chart below. The PRs are written based on the Federal MIECHV Program Grant Application submitted to the Health Resources and Services Administration (HRSA). Minimum Program Requirements: Activity(ies) Responsible Individual Timeline Deliverable(s) Objective: Deliver home visiting services with model fidelity. Expand home visiting services in the respective community, as outlined above. Program Director Oct. 1- Sept. 30 • Hire/maintain appropriate staff relative to the MIECHV expansion. • Charge appropriate staff time to grant. • Initiate/amend any necessary subcontracts. • Obtain necessary training, curriculum and supplies for new and/or existing staff. Page 91 of 121 MDCH/G&PD FY 14/15 ATTACHMENT III 07/03/14