Loading...
HomeMy WebLinkAboutResolutions - 2015.12.09 - 22111Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item Qty Ratel Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 124.0000 24.859 0.000 FTE 3,082.00 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 5.740 3082.000 177.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials 6 Travel 7 Communication Telephone Communications 0.0000 0.000 0.000 6,731.00 8 County-City Central Services 9 Space Costs Building Space 0.0000 0.000 0.000 23,923.00 10 All Others (ADP, Con. Employees, Misc.) IT Operations 0.0000 0.000 0.000 660.00 Total Program Expenses 34,573.00 TOTAL DIRECT EXPENSES 34,573.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 3082.000 427.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 3,142.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,076.00 Total for Other Costs Distributions 4,218.00 Total Indirect Costs 4,645.00 TOTAL INDIRECT EXPENSES 4,645.00 TOTAL EXPENDITURES 39,218.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 91 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161102-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Immunization Action Plan (IAP) DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/112015 To :913012016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Fi Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 240,358.00 240,358.00 2 Fringe Benefits 176,350.00 176,350.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual — 0.00 0.00 5 Supplies and Materials 24,834.00 24,834.00 6 Travel 9,594.00 9,594.00 7 Communication 4,632.00 4,632.00 8 County-City Central Services 0.00 0.00 9 Space Costs 11,781.00 11,781.00 10 All Others (ADP, Con. Employees, Misc.) 65,996.00 65,996.00 Total Program Expenses 533,545.00 533,545,00 TOTAL DIRECT EXPENSES 533,545.00 533,545.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 33,290.00 33,290.00 2 Other Costs Distributions 33,314.00 33,314.00 Total Indirect Costs 66,604.00 66,604.00 TOTAL INDIRECT EXPENSES 66,604.00 66,604.00 TOTAL EXPENDITURES 600,149.00 600,149.00 Date: 11106/2015 Contratt # 20161702-00, Oakland County Department of Health and Human Services/ Page: 92 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 531,835.00 0.00 0.00 531,835.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 68,314.00 0.00 68,314.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 531,835.00 68,314.00 0,00 600,149.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 93 of 167 Health Division, Comprehensive Agreement - 2010 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail , Line item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses Salary & Wages Coordinator 2080.0000 33.493 0.000 FTE 69,665.00 Public Health Nurse 2080.0000 31.763 0.000 FTE 66,066.00 Assistant 2080.0000 18.840 0.000 FTE 39,188.00 Clerk 1280.0000 19.838 0.000 FTE 26,393.00 Assistant 2080.0000 17.964 0.000 FTE 37,365.00 Overtime 125.0000 21.445 0.000 FTE 2,681.00 Total for Salary & Wages 240,358.00 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 73.370 240358.000 176,350.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 2,500.00 Postage 0.0000 0.000 0.000 16,834.00 Printing 0.0000 0.000 0.000 3,000.00 Educational Supplies 0.0000 0.000 0.000 2,500.00 Total for Supplies and Materials 24,834.00 6 Travel Mileage Notes : 6250 miles @ .575 0.0000 0.000 0.000 3,594.00 Conferences 0.0000 0.000 0.000 6,000.00 Total for Travel 9,594.00 7 Communication Telephone I 0.00001 0.000 0.000 4,632.00 County-City Central Services Date; 11/0612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 94 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11106/2015 Line Item I Qtyl Rate Units UOM Total 9 Space Costs Building Space Rental 0.0000 0.000 0.000 11,781.00 10 All Others (ADP, Con. Employees, Misc.) Equipment Repair 0.0000 0.000 0.000 200.00 Convenience Copier Notes : copier 0.0000 0.000 0.000 2,400.00 IT Operation & Development Notes : printing 0.0000 0.000 0.000 53,047.00 Insurance 0.0000 0.000 0.000 1,200.00 Advertising 0.0000 0.000 0.000 9,149.00 Total for All Others (ADP, Con. Employee 65,996.00 Total Program Expenses 533,545.00 TOTAL DIRECT EXPENSES 633,545.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 240358.000 33,290.00 2 Other Costs Distributions Other Cost Distributions-Nurse TrainNFC 0.0000 0.000 0.000 -35,000.00 Health Adrn Distribution 0.0000 0.000 0.000 50,880.00 Nursing Adm Distribution 0.0000 0.000 0.000 17,434.00 Total for Other Costs Distributions 33,314.00 Total Indirect Costs 66,604.00 TOTAL INDIRECT EXPENSES 66,604.00 TOTAL EXPENDITURES 600,149.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 95 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Immunization ELPHS DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Deparlrnent of Health and Human Services/ Health Division BUDGET PERIOD From : 101112015 To: 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r,-..-: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml _ ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 5,935,902.00 5,935,902.00 Total Indirect Costs 5,935,902.00 5,935,902.00 TOTAL INDIRECT EXPENSES 5,935,902.00 5,935,902.00 TOTAL EXPENDITURES 5,935,902.00 5,935,902.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 96 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11106/2015 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 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-ELP HS 0.00 0.00 0.00 0.00 Other Non-ELP HS 0.00 0.00 OM 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 884,466.00 0.00 0.00 884,466.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type III Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,734,024.00 0.00 2,734,024.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 884,466.00 5,051,436.00 0.00 5,935,902.00 Dale: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 97 of 167 Health Division, ComprehensIve Agreement -2010 Contract #20161702-00 Date: 11/0812015 3 Program Budget - Cost Detail Line Item Qty Ratel UnitslUOM 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 Other Cost Distributions-Clinic 0,0000 0.000 0.000 3,618,490.00 Federally Provided Vaccines Notes : Used 2014-15 budgetary figure/current not available yet. 0.0000 0.000 0.000 2,317,412.00 Total for Other Costs Distributions 5,935,902.00 Total Indirect Costs 5,935,902.00 TOTAL INDIRECT EXPENSES 5,935,902.00 TOTAL EXPENDITURES 5,935,902.00 Date: 11/0612015 Contract #20161702-00, Oakland County Department of Health and Human Services,' Page: 98 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 1110612015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Infant Safe Sleep DATE PREPARED 11/612015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT WI Original 1-- Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 4,156.00 4,156.00 2 Fringe Benefits 2,902.00 2,902.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 9,242.00 9,242.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 1D All Others (ADP, Con. Employees, Misc.) 5,624.00 5,624.00 Total Program Expenses 21,924.00 21,924.00 TOTAL DIRECT EXPENSES 21,924.00 21,924.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 576.00 576.00 Other Costs Distributions 2,712.00 2,712.00 Total Indirect Costs 3,288.00 3,288,00 TOTAL INDIRECT EXPENSES 3,288.00 3,288.00 TOTAL EXPENDITURES 25,212.00 25,212.00 Date: 11106/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 99 of 167 Health Divlsion, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind 1 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-ELP HS 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 22,600.00 0.00 0.00 22,500.00 ELPHS - MDHHS Hearing 0.00 0.00 0,00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0,00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,712.00 0.00 2,712.00 inkind Match 0,00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 22,500.00 2,712.00 0.00 25,212.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 100 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 1Line Item L Oty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Health Educator 125.0000 25.250 0.000 FTE 3,156.00 Chief Nursing 25.0000 39.986 0.000 FTE 1,000.00 Total for Salary & Wages 4,156.00 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 69.830 4156.000 2,902.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials Printing 0.0000 0.000 0.000 4,717.00 Educational Supplies 0.0000 _ 0.000 0.000 1,150.00 Client Support Materials 0.0000 _ 0.000 0.000 3,375.00 Total for Supplies and Materials 9,242.00 Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Advertising 0.0000 0.000 0.000 5,624.00 Total Program Expenses 21,924.00 TOTAL DIRECT EXPENSES 21,924.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.00001 13.850 4156.000 576.00 2 Other Costs Distributions Date: 11/0612015 Contract #20I61702-00, Oakland County Department of Health and Human Services/ Page: 101 of 167 Health Division, Comprehensive Agreement 2016 Contract # 20161702-00 Date: 11/06/2015 Line Item Qty Rate Units UOM Total Health Adm Distribution 0.0000 0.000 0.000 2,020.00 Nursing Adm Distribution 0.0000 0.000 0.000 692.00 Total for Other Costs Distributions 2,712.00 Total Indirect Costs 3,288.00 TOTAL INDIRECT EXPENSES 3,288.00 TOTAL EXPENDITURES 25,212.00 Date: 1110612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 102 of 167 Health Division, Comprehensive Agreement - 2010 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 20161 Laboratory Services Bio DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/3012016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r7, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 I Category 1 Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 25,014.00 25,014.00 2 Fringe Benefits 1,438.00 1,438.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 84.00 84.00 Total Program Expenses 26,536.00 26,536.00 TOTAL DIRECT EXPENSES 26,536.00 26,536.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 3,464.00 3,464.00 2 Other Costs Distributions 2,693.00 2,893.00 Total Indirect Costs 6,157.00 6,157.00 TOTAL INDIRECT EXPENSES 6,157.00 6,157.00 TOTAL EXPENDITURES 32,693.00 32,693.00 Date: 1110612015 Contract #20I61702-O0, Oakland County Department of Health and Human Services/ Page: 103 of 167 Health DivisIon, Comprehensive Agreement -2016 Contract #20161702-00 Data: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 30,000.00 0.00 0.00 30,000.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0,00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 2,693.00 0.00 2,693.00 Inkind Match 0.00 0.00 0.00 0.00 MDFIHS Fixed Unit Rate Totals 30,000.00 2,693.00 0.00 32,693.00 Date: 't 1106/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 104 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 'Line Item Qty Rate' UnitsIUOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages -. Technician Notes : Medical Technologist 952.0000 26.275 0.000 FTE 25,014.00 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 5.750 25014.000 1,438.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0,000 0.000 84.00 Total Program Expenses 26,536.00 TOTAL DIRECT EXPENSES 26,536.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.00001 13.850 25014.0001 3,464.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 2,693.00 Total Indirect Costs 6,157.00 TOTAL INDIRECT EXPENSES 6,157.00 TOTAL EXPENDITURES 32,693.00 Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health arid Homan Services/ Page: 105 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11106/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Nurse Family Partnership -MCH DATE PREPARED 11/612015 CONTRACTOR NAME Oakland County Department of Health and Human Serv ices/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 1.7 Original 17 Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 69,665.00 69,665.00 2 Fringe Benefits 46,139.00 46,139.00 3 Cap. Exp. for Equip & rec. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 300,00 300.00 7 Communication 1,032.00 1,032.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0,00 10 All Others (ADP, Con. Employees, Misc.) 2,720.00 2,720.00 Total Program Expenses 119,856.00 119,856.00 TOTAL DIRECT EXPENSES 119,856.00 119,856.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 9,649.00 9,649.00 2 Other Costs Distributions 14,671.00 14,671.00 Total Indirect Costs 24,320,00 24,320.00 TOTAL INDIRECT EXPENSES 24,320.00 24,320.00 TOTAL EXPENDITURES 144,176.00 144,176.00 Date: 11106/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 106 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0,00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 129,505.00 0.00 0.00 129,505.00 Local Funds - Other 0.00 14,671.00 0.00 14,671.00 Inkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 129,505.00 14,671.00 0.00 144,176.00 Date: 11106/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 107 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item QtYl Rate Units I UOM 1 Total DIRECT EXPENSES Program Expenses Salary & Wages Coordinator 1.0000 69665.000 0.000IFTE 69,665.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 66.230 69665.000 46,139.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Supplies and Materials 6 Travel Mileage Notes : 522 MILES @ .575 0.0000 0.000 0.000 300.00 7 Communication TELEPHONE 0.000D 0.000 0.000 1,032.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) IT IOPERATIONS 0.0000 0.000 0.000 2,720.00 Total Program Expenses 119,856.00 TOTAL DIRECT EXPENSES 119,856.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs Cost Allocation Plan 0.0000 13.850 69665.000 9,649.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 11,049.00 Nursing Adm Distribution 0.0000 0.000 0.000 3,622.00 Total for Other Costs Distributions 14,671,00 Total Indirect Costs 24,320.00 TOTAL INDIRECT EXPENSES 24,320.00 Date: 1110612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 108 of 167 Health Division, Comprehensive Agreement - 2018 Contract #20161702-00 Date: 11106/2015 Line Item 1 Qty Rate Units UOM Total TOTAL EXPENDITURES 144,176.00 Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Service-s/ Page: 109 of 167 Health Division, Comprehensive Agreement -2016 Contract 20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016! Nurse Family Partnership Services DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2015 To : 913012016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT Pc Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 409,873.00 409,873.00 2 Fringe Benefits 266,281.00 266,281.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 10,005.00 10,005.00 5 Supplies and Materials 13,126.00 13,126.00 6 Travel 8,766.00 8,766.00 7 Communication 4,532.00 4,532.00 8 County-City Central Services 0.00 0.00 Space Costs 4,343.00 4,343.00 10 All Others (ADP, Con. Employees, Misc.) 23,970.00 23,970.00 Total Program Expenses 740,896.00 740,896.00 TOTAL DIRECT EXPENSES 740,896.00 740,896.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 9,649.00 9,649.00 2 Other Costs Distributions 85,026.00 85,026.00 Total Indirect Costs 94,675.00 94,675.00 TOTAL INDIRECT EXPENSES 94,675.00 94,675.00 TOTAL EXPENDITURES 835,571.00 835,571.00 Date: 11106/2015 Contract If 20161702-00, Oakland County Department of Health and Human Services/ Page: 110 of 167 Health Division, Comprehensive Agreement- 2016 Contract #20161702-00 Date: 1110612015 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-ELP HS 0.00 0.00 0.00 0.00 Local Non-ELP HS 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 621,040,00 0.00 0.00 621,040.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private! Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 214,531.00 0.00 214,531.00 lnkind Match 0.00 0.00 0.00 0.00 MDHI-IS Fixed Unit Rate Totals 621,040.00 214,531.00 0.00 835,571.00 Date: 11106/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 111 of 167 Health Division, Comprehensive Agreement -2015 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item Qty Ratej Units UOM 1 Total DIRECT EXPENSES Program Expenses I Salary & Wages Public Health Nurse Notes : Public Health Nurse III 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse ILL 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse III 1.0000 52735.000 0.000 FTE 52,735.00 Public Health Nurse Notes : Public Health Nurse ill 1.0000 66066.000 0.000 FTE 66,066.00 Public Health Nurse Notes : Public Health Nurse II 1.0000 55749.000 0.000 FTE 55,749.00 Assistant Notes : Office Assistant II 0.4808 39184.000 0.000 FTE 18,840.00 Assistant Notes : Office Assistant 0.4808 27409.000 0.000 FIE 13,178.00 Coordinator Notes : Program Coordinator 1.0000 69665.000 0.000 FTE 69,665.00 Overtime Notes : Overtime (PHNs) 0.0240 62820.000 0.000 FTE 1,508.00 Total for Salary & Wages 409,873.00 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 64.967 409873.000 266,281.00 3 Cap. Exp. for Equip & Fac. 4 Contractual NFP National Office Program Suppo 0.0000 0.000 0.000 7,620.00 NFP Consultation 0.0000 0.000 0.000 1,826.00 NFP materials 0.0000 0.000 0.000 559.00 Total for Contractual 10,005.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 112 of 167 Health Division, Comprehensive Agreement - 2016 pressure readings, total cholesterol, HDL cholesterol, and glucose or A1C), and delivery of risk reduction counseling. All Direct Service claims must be billed to the MDHHS 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 MDHHS Cancer Prevention and Control Section. This includes follow-up fasting lipid panel, fasting glucose, Al c, and one diagnostic exam. No Direct Services expenses will be reimbursed through the Comprehensive Agreement. The Coordination and Screening amount is $145 per woman based on a target caseload established by MDHHS. 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 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 MDHHS 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 W1SEWOMAN Program issued in August of each fiscal year. The above referenced documents are available at www.michigan.govicancer. 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. I. 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. 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. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 23 of 46 6/29/2015 Contract #20161702-00 Date: 11/06/2015 Line Item I Qty Rate I Units UOM Total 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 3,000.00 Postage 0.0000 0.000 0.000 350.00 Printing 0.0000 0.000 0.000 4,000.00 Client Support Materials 0.0000 0.000 0.000 5,000.00 Educational Supplies 0.0000 0.000 _ 0.000 776.00 Total for Supplies and Materials 13,126.00 6 Travel Client Transportation 0.0000 0.000 0.000 384.00 Mileage Notes : 14,578 miles @ .575 0.0000 _ 0.000 0.000 8,382.00 Total for Travel 8,766.00 7 Communication Telephone Communications 0.0000 0.0001 0.000 4,532.00 8 County-City Central Services 9 Space Costs Building Space Rental 0.0000 0.000 0.000 4,343.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 1,350.00 Info Tech Operations 0.0000 0.000 0.000 15,720.00 Translation & Interpretation 0.0000 0.000 0.000 500.00 Staff Training 0.0000 0.000 0.000 6,400.00 Total for All Others (ADP, Con. Employee 23,970.00 Total Program Expenses 740,896.00 TOTAL DIRECT EXPENSES 740,896.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 69665.000 9,649.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 64,036.00 Nursing Adm Distribution 0.0000 0.000 0.000 20,990.00 Total for Other Costs Distributions 85,026.00 Total Indirect Costs 94,675.00 TOTAL INDIRECT EXPENSES 94,675.00 TOTAL EXPENDITURES 835,571.00 Date: 11/06/2015 Contract #20161702-00. Oakland County Department of Health and Human Services/ Page: 113 of 167 Health Division, Comprehensive Agreement -2010 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016/ Medicaid Outreach DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To: 913012016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT f7,7, Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 233,669.00 233,669.00 2 Fringe Benefits 151,186.00 151,186.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 Space Costs 12,335.00 12,335.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 Total Program Expenses 397,190.00 397,190.00 TOTAL DIRECT EXPENSES 397,190.00 397,190.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 32,363.00 32,363.00 Other Costs Distributions 38,558.00 38,558.00 Total Indirect Costs 70,921.00 70,921.00 TOTAL INDIRECT EXPENSES 70,921.00 70,921.00 TOTAL EXPENDITURES 468,111.00 468,111.00 Date: 11106/2015 Contract # 20161702,-00, Oakland County Department of Health and Human Services/ Page: 114 of 167 Health Division, Comprehensive Agreement - 2016 Contract tt 20161702-00 Date: 11/06/2015 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) OM 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 214,777.00 0.00 0.00 214,777.00 Required Match - Local 0.00 214,776.00 0.00 214,776.00 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 38,558.00 0.00 38,558.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 214,777.00 253,334.00 0.00 468,111.00 Dale: 11106/2015 Contract # 20161702-00, Oakland County Deparlment of Health and Human Services/ Page: 115 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 1Line Item Qty Ratel Units UOIVI Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Multiple positons Notes : Amount determined based on time studies. 1.0000 233669.000 0.000 FIE 233,669.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 64.701 233669.000 151,186.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Travel 7 Communication 8 County-City Central Services 9 Space Costs Office Space Rental I 0.0000 0.000 0.000 12,335,00 10 All Others (ADP, Con. Employees, Misc.) Total Program Expenses 397,190.00 TOTAL DIRECT EXPENSES 397,190.00 INDIRECT EXPENSES Indirect Costs Indirect Costs Cost Allocation Plan 0.0000 13.850 233669.000 32,363.00 2 Other Costs Distributions Health Adm Distribution 0.0000, 0.000 0.000 38,558.00 Total ndirect Costs 70,921.00 TOTAL INDIRECT EXPENSES 70,921.00 TOTAL EXPENDITURES 468,111.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 116 of 167 Health Division, Comprehensive Agreement - 2016 Contract t/ 20161702-00 Date: 11106/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Public Hlth Functions & lnfratruct - MCH DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :10/1/2015 To: 9130/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT p-. Original F. Amendment AMENDMENT # o CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses Salary & Wages 22,234.00 22,234.00 2 Fringe Benefits 1,278.00 1,278,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 5,869,00 5,869.00 6 Travel 2,054.00 2,054.00 7 Communication 336.00 336.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 7,074.00 7,074.00 Total Program Expenses 38,845.00 38,845.00 TOTAL DIRECT EXPENSES 38,845.00 38,845.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,079.00 3,079.00 2 Other Costs Distributions 3,801,413.00 3,801,413.00 Total Indirect Costs 3,804,492.00 3,804,492.00 TOTAL INDIRECT EXPENSES 3,804,492.00 3,804,492,00 TOTAL EXPENDITURES 3,843,337.00 3,843,337.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 117 of 167 Health DIvision, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 41,924.00 0.00 0.00 41,924.00 Local Funds - Other 0.00 3,801,413.00 0.00 3,801,413.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 1 41,924.00 3,801,413.00 0.00 3,843,337.00 Date: 11/06/2016 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 118 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 'Line Item I Qty Rate' Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Public Health Nurse 0.0962 66040.000 0.000 FTE 6,353.00 Public Health Nurse 0.2404 66066.000 0.000 FTE 15,881.00 Total for Salary & Wages 22,234.00 2 Fringe Benefits All Composite Rate Notes : FICA, LIFE INS, DENTAL, UNEMPLOYMENT, VISION, WORK COMP, RETIREMENT, HOSPITALIZATION, SHORT/LONG TERM DISABILITY 0.0000 5.750 22234.000 1,278.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Printing 0.0000 0.000 0.000 2,700.00 Educational Supplies 0.0000 0.000 0.000 3,169.00 Total for Supplies and Materials 5,869.00 6 Travel Mileage Notes : 1833 miles @ .575 0.0000 0.000 0.000 1,054.00 Client Transportation 0.0000 0.000 0.000 500.00 Conferences 0.0000 0.000 0.000 500.00 Total for Travel 2,054.00 7 Communication Telephone 0.00001 0.000 0.000 336.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Info Tech Operations 0.0000 0.000 0.000 2,800.00 Insurance 0.0000 0.000 0.000 789.00 Translation & Interpretation 0.0000 0.000 0.000 3,235.00 Periodicals Boods Publ Sub 0.0000 0.000 0.000 250.00 Total for All Others (ADP, Con. Employee 7,074.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 119 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11106/2015 Line Item QtYI Rate Units UOM Total Total Program Expenses 38,845.00 TOTAL DIRECT EXPENSES 38,845.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13,850 22234.000 3,079.00 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 3,577.00 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 0.000 3,757,863.00 Nursing Adm Distribution 0.0000 0.000 0.000 1,172.00 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 % back to MCH for Education is 2.855%. Health is in the process of updating their time study to "random moment in time" for FY 2014-15 0.0000 0.040 0.000 _ 38,801.00 Total for Other Costs Distributions 3,801,413.00 Total Indirect Costs 3,804,492.00 TOTAL INDIRECT EXPENSES 3,804,492.00 TOTAL EXPENDITURES 3,843,337.00 Date: 11/0612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 120 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 20161 Public Health Emergency Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To :9/30/2016 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 Category Amount Total DIRECT EXPENSES Program Expenses Salary & Wages 26,234.00 26,234.00 2 Fringe Benefits 15,379.00 15,379.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 27,258.00 27,258.00 6 Travel 0.00 0.00 7 Communication 456.00 456.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 22,800.00 22,800.00 Total Program Expenses 92,127.00 92,127.00 TOTAL DIRECT EXPENSES 92,127.00 92,127.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,633.00 3,633.00 2 Other Costs Distributions 8,596.00 8,596.00 Total Indirect Costs 12,229.00 12,229.00 TOTAL INDIRECT EXPENSES 12,229.00 12,229.00 TOTAL EXPENDITURES 104,356.00 104,356.00 Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 121 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 95,760.00 0.00 0.00 95,760.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 8,596.00 0.00 8,596.00 Inkind Match 0,00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 95,760.00 8,596.00 0.00 104,356.00 Date: 1110612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 122 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item Qty Rater Units1110M Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Epidemiologist 100.0000 35.896 0.000 FTE 3,590.00 Epidemiologist 100.0000 32.484 0.000 FTE 3,248.00 Health Educator 1000.0000 19.396 0.000 FTE 19,396.00 Total for Salary & Wages 26,234.00 2 Fringe Benefits All Composite Rate Notes : FICA UNEMPLOY RETIREMENT HOSPITAL LIFE INSURANCE VISION DENTAL WORKERS COMP SHORT/LONG TERM DISABILITY 0.0000 58.621 26234.000 15,379.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 148.00 Disaster Supplies 0.0000 0.000 0.000 17,110.00 Printing 0.0000 0.000 0.000 10,000.00 Total for Supplies and Materials 27,258.00 6 Travel 7 Communication Telephone 0.0000 0.000 0.000 456.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Staff Training Notes : professional services will be to hire someone to train our staff (and maybe some outside agency people like EMTs) in Donning and Doffing of PPE 0.0000 0.000 0.000 20,000.00 IT Operations 0.0000 0.000 0.000 2,800.00 Date: 11106/2015 Contract #20151702-00, Oakland County Department of Health and Human Services/ Page: 123 of 167 Health Division, Comprehensive Agreement - 2015 Contract # 20161702-00 Date: 11/06/2015 Line Item I Qty Ratel Units ,UOM Total Total for All Others (ADP, Con. Employee 22,800.00 Total Program Expenses 92,127.00 TOTAL DIRECT EXPENSES 92,127.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan I 0.0000 13.850 26234.000 3,633.00 2 Other Costs Distributions Health Adrn Distribution 0.0000 0.000 0.000 8,596.00 Total Indirect Costs 12,229.00 TOTAL INDIRECT EXPENSES 12,229.00 TOTAL EXPENDITURES 104,356.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 124 of 167 Health Division, Comprehensive Agreement -2010 Contract #20161732-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / MDEQ On-site Wastewater Treatment DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10)1/2015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 NJ. 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 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0,00 2 Fringe Benefits 0.00 0.00 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Other Costs Distributions 927,491.00 927,491.00 Total Indirect Costs 927,491.00 927,491.00 TOTAL INDIRECT EXPENSES 927,491.00 927,491.00 TOTAL EXPENDITURES 927,491,00 927,491.00 Date: 11/06/2015 Contract # 20161702-00, Oakland county Department of Health and Human Services/ Page: 125 of 167 Health Division, Comprehenstve Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount -r Cash Inkind Total "I Source of Funds Pees 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0,00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private! Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 372,426,00 0.00 0.00 372,426.00 MCH Funding 0.00 0.00 0.00 , 0.00 Local Funds - Other 0.00 555,065.00 0,00 555,065.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 372,426.00 555,065.00 0.00 927,491.00 Date: 1f06/205 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 126 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-DO Date: 1110612015 3 Program Budget - Cost Detail Line Item Qty I Ratel Units UOM 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 Hith Adm Distribution 0.0000 0.000 0.000 927,491.00 Total Indirect Costs 927,491.00 TOTAL INDIRECT EXPENSES 927,491.00 TOTAL EXPENDITURES 927,491.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 127 of 167 Health Division, Comprehensive Agreement -2016 Contract 4 20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016/ SIDS DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2015 To: 9130/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT F. Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount [ Total DIRECT EXPENSES Program Expenses Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs , 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 2,000.00 2,000.00 Total Indirect Costs 2,000.00 2,000.00 TOTAL ENDIRECT EXPENSES 2,000.00 2,000.00 TOTAL EXPENDITURES 2,000.00 2,000.00 Date: 11/06/2016 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 128 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 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 1VIDHHS 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: 11/06/2015 Contract #20161702-02, Oakland County Department of Health and Human Services/ Page: 129 of 167 Health Division, Comprehenstve Agreement - 2010 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item I Qty Ratel Units UOM 1 Total DIRECT EXPENSES Program Expenses 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 2 Other Costs Distributions Health Adm Distribution Notes : Cost Distributions for SIDS Fees from Health Adminstration 0.0000 0.000 0.000 2,000.00 Total Indirect Costs 2,000.00 TOTAL INDIRECT EXPENSES 2,000.00 TOTAL EXPENDITURES 2,000.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 130 of 167 Health Div/sloe, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Sexually Transmitted Disease (STD) Control DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From :1011/2015 To: 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT rwil Original rr Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE ,48341-0432 FEDERAL ID NUMBER 38-6004876 Category 1 Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 47,696.00 47,696.00 Fringe Benefits 34,897.00 34,897.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 57.00 57.00 Total Program Expenses 82,650.00 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 82,650.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Other Costs Distributions 7,419.00 7,419.00 Total Indirect Costs 7,419.00 7,419.00 TOTAL INDIRECT EXPENSES 7,419.00 7,419.00 TOTAL EXPENDITURES 90,069.00 90,069.00 Dale: 11/06/2015 Contract #20161702-00, Oakland County Depattment of Health and Human Services/ Page: 131 of 167 Health Division, Comprehensive Agreement 2016 Contract #20161702-00 Date: 11106/2015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash 1 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 82,650.00 0.00 0.00 82,650.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 7,419.00 0.00 7,419.00 lnkind Match 0.00 0.00 0.00 0.00 MDFINS Fixed Unit Rate Totals 82,650.00 7,419.00 0.00 90,069.00 Date: 1110612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 132 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2016 3 Program Budget - Cost Detail Line Item Qty Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Medical Technologist 1563.0000 30.515 0.000 FTE 47,696.00 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 73.166 47696.000 34,897.00 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.) Insurance 0.0000 0.000 0.000 57.00 Total Program Expenses 82,650.00 TOTAL DIRECT EXPENSES 82,650.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 7,419.00 Total Indirect Costs 7,419.00 TOTAL INDIRECT EXPENSES 7,419.00 TOTAL EXPENDITURES 90,069.00 Date: 1110612015 Contract #20161702-00, Oakland County Departmental Health and Human Services/ Page: 133 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-30 Date: 11/0612015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016/ Sexually Transmitted Disease (STD-ELPHS) DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17: Original r Amendment AMENDMENT # 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0,00 8 County-City Central Services 0.00 0.00 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 1,642,727.00 1,642,727.00 Total Indirect Costs 1,642,727.00 1,642,727.00 TOTAL INDIRECT EXPENSES 1,642,727.00 1,642,727.00 TOTAL EXPENDITURES 1,642,727.00 1,642,727.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 134 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 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 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 400,764.00 0.00 0.00 400,764.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 1,241,963.00 0.00 1,241,963.00 lnkind Match 0.00 0.00 0.00 0.00 PADHHS Fixed Unit Rate Totals I 400,764.00 1,241,963.00 0.00 1,642,727.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 135 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item I Qty Rate' UnitslUOM 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 Nursing Adm Distribution 0.0000 0.000 0.000 18,727.00 Other Cost Distributions-Clinic & Lab di 0.0000 0.000 0.000 1,624,000.00 Total for Other Costs Distributions 1,642,727.00 Total Indirect Costs 1,642,727.00 TOTAL INDIRECT EXPENSES 1,642,727.00 TOTAL EXPENDITURES 1,642,727.00 Date: 1110612015 Contract # 20161702-00, Oakland County Department of Health and Human Service& Page: 136 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/0612015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / TB Control DATE PREPARED 1116/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 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 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 12,185.00 12,185.00 2 Fringe Benefits 701.00 701.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 44,104.00 44,104.00 6 Travel 13,700.00 13,700.00 7 Communication 718.00 718.00 8 County-Uty Central Services 0.00 0.00 9 Space Costs 2,100,00 2,100.00 10 All Others (ADP, Con. Employees, Misc.) 51,831.00 51,831.00 Total Program Expenses 125,339.00 125,339.00 TOTAL DIRECT EXPENSES 125,339.00 125,339.00 INDIRECT EXPENSES Indirect Costs 1 indirect Costs 1,688.00 1,688.00 2 Other Costs Distributions 291,079,00 291,079.00 Total Indirect Costs 292,767.00 292,767.00 TOTAL INDIRECT EXPENSES 292,767.00 292,767.00 TOTAL EXPENDITURES 418,106.00 418,106.00 Date: 11106/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 137 of 167 Health Division, comprehensive Agreement .2016 Contract #20161702-00 Date: 11/0612015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 48,678.00 0.00 0.00 48,678.00 ELPHS - MDHHS Healing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0,00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 369,428.00 0.00 369,428.00 lnkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 48,678.00 369,428.00 0.00 418,106.00 Date: 11/060016 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 138 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item QtyL Rate UnitslUOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Outreach Worker Notes : Auxiliary Health Worker 800.0000 15.232 0.000 FTE 12,185.00 2 Fringe Benefits All Composite Rate Notes : Social Security Unemployment Ins Retirement Hospital Ins Life Ins Vision Ins Dental Ins Work Comp 0.0000 5.750 12185.000 701.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Medical Supplies 0.0000 0.000 0.000 1,000.00 Postage 0.0000 0.000 0.000 200.00 Client Support Materials 0.0000 0.000 0.000 750.00 County TB medical,office,drugs, et 0,0000 0.000 0.000 41,954.00 Office Supplies 0.0000 0.000 0.000 200.00 Total for Supplies and Materials 44,104.00 6 Travel Mileage Notes : 17,095 miles @ .575 0.0000 0.000 0.000 9,200.00 Conferences 0.0000 0.000 0.000 4,000.00 Client Transporation 0.0000 0.000 0.000 500.00 Total for Travel 13,700.00 Communication Communication 718.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0,000 — 0.000 2,100.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 180.00 Date: 11/06/2015 Contract #20161702-00, Oakland Coun y Department of Health and Human Services/ Page: 139 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2016 Line Item Qty Rate Units UOM Total Lab Fees 0.0000 0.000 0.000 15,304.00 Professional Svcs, Translation/It 0.0000 0.000 0.000 1,920.00 Equipment Repair 0.0000 0.000 0.000 250.00 County TB, prof svcs, interpretati 0.0000 0.000 0.000 34,177.00 Total for All Others (ADP, Con. Employee 51,831.00 Total Program Expenses 125,339.00 TOTAL DIRECT EXPENSES 125,339.00 INDIRECT EXPENSES Indirect Costs I Indirect Costs Cost Allocation Plan 0.0000 13.850 12185.000 1,688.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 11,402.00 Other Cost Distributions-Field Nursing d 0.0000 0.000 0.000 25,490.00 Nursing Adm Distribution 0.0000 0.000 0.000 5,751.00 Other Cost Distributions-Misc 0.0000 0.000 0.000 248,436.00 Total for Other Costs Distributions 291,079.00 Total Indirect Costs 292,767.00 TOTAL INDIRECT EXPENSES 292,767.00 TOTAL EXPENDITURES 418,106.00 Date: 1110612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 140 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Immunization Fixed Fees DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 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 Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0,00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 0.00 0.00 2 Other Costs Distributions 35,000.00 35,000.00 Total Indirect Costs 35,000.00 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 35,000.00 TOTAL EXPENDITURES 35,000.00 35,000.00 Date: 1110612016 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 141 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11106/2015 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 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private ) Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 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 WIDHHS Fixed Unit Rate IMM: 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: 11/06/2015 Contract it 20101702-00, Oakland County Department of Health and Homan Services! Page: 142 of 167 Health Division, Comprehensive Agreement -2016 Contract ti 20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 1Line Item Qty.' Rate UnitslUOM 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 IAP 0.0000 0.000 0.000 35,000.00 Total Indirect Costs 35,000.00 TOTAL INDIRECT EXPENSES 35,000.00 TOTAL EXPENDITURES 35,000.00 Date: 1110612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 143 of 167 Health Division, Comprehensive Agreement - 2016 Contract 4 20161702-00 Date: 11106/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Vision ELPHS DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1011/2015 To : 9/30/2016 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 Category Amount , Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 292,428.00 292,428.00 Fringe Benefits 95,029.00 95,029.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 3,444.00 3,444.00 Travel 5,693.00 5,693.00 7 Communication 622.00 622.00 8 County-City Central Services 0.00 0.00 9 Space Costs 11,719.00 11,719.00 10 All Others (ADP, Con. Employees, Misc.) 4,033.00 4,033.00 Total Program Expenses 412,968.00 412,968.00 TOTAL DIRECT EXPENSES 412,968.00 412,968.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 40,501.00 40,501.00 2 Other Costs Distributions 105,003.00 105,003.00 Total Indirect Costs 145,504.00 145,504.00 TOTAL INDIRECT EXPENSES 145,504.00 145,504.00 TOTAL EXPENDITURES 558,472.00 558,472.00 Date: 11/06/2015 Contract if 20161702-00, Oakland County Department of Health and Human Services/ Page: 144 of 167 Health DIvIsion, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/0612015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash Inkind Total Source of Funds Fees and Collections - 1st and 2nd Party 1100 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 IVIDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 225,683.00 0.00 0.00 225,683.00 ELPHS - MDHHS Other 0.00 0.00 0,00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0,00 0.00 0.00 Local Funds - Other 0.00 332,789.00 0.00 332,789.00 lnkind Match 0.00 0.00 0.00 0.00 IVIDHHS Fixed Unit Rate Totals 225,683.00 332,789.00 0.00 558,472.00 Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 145 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line item Qty , Rate ., Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Supervisor 2080.0000 18.157 0.000 FIE 37,767.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1248.0000 19.838 0.000 FTE 24,757.00 Technician 1000.0000 17.995 0.000 FTE 17,995.00 Technician 2000.0000 15.232 0.000 FTE 30,463.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1248.0000 19.838 0.000 FTE 24,757.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1000.0000 15.232 0.000 FTE 15,232.00 Technician 1000.0000 15.232 0.000 ETE 15,232.00 Coordinator 1040.0000 33.493 0.000 FTE 34,833.00 Total for Salary & Wages 292,428.00 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 32.497 292428.000 95,029.00 3 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials Office/Medical Supplies & Printing 0.0000 0.000 0.000 3,444.00 6 Travel Travel-terms not specified 0.0000 0.000 0.000 5,693.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Homati Services/ Page: 146 of 167 Health Division, Comprehensive Agreement -2016 Contract 4 20161702-00 Date: 11/06/2015 Line Item 1 Qty Rate' Units UOM Total 7 Communication Telephone 0.0000 0.000 0.000 622.00 8 County-City Central Services 9 Space Costs Bldg Space Costs 0.0000 0.000 0.0001 11,719.00 10 All Others (ADP, Con. Employees, Misc.) Equip Maint, Copier, Training 0.0000 0.000 0.000 4,033.00 Total Program Expenses 412,968.00 TOTAL DIRECT EXPENSES 412,968.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan 0.0000 13.850 292428.000 40,501.00 2 Other Costs Distributions Other Cost Distributions-Misc Distributi 0.0000 0.000 0.000 59,059.00 Health Adm Distribution 0.0000 0.000 0.000 45,944.00 Total for Other Costs Distributions 105,003.00 Total Indirect Costs 145,504.00 TOTAL INDIRECT EXPENSES 146,504.00 TOTAL EXPENDITURES 558,472.00 Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 147 of 167 Health Division, Comprehensive Agreement 2016 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM 1 PROJECT Comprehensive Agreement - 2016/ Immunization Vaccine Quality Assurance DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 1D1112015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 17 Original r Amendment AMENDMENT if 0 CITY Pontiac STATE Ml ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 1,975,152.00 1,975,152.00 2 Fringe Benefits 1,230,744.00 1,230,744.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 Supplies and Materials 948,782.00 948,782.00 6 Travel 7,565.00 7,565.00 7 Communication 34,395.00 34,395.00 County-City Central Services 0.00 0.00 9 Space Costs 111,312.00 111,312.00 10 All Others (ADP, Con. Employees, Misc.) 276,789.00 276,789.00 Total Program Expenses 4,584,739.00 4,584,739.00 TOTAL DIRECT EXPENSES 4,584,739.00 4,584,739.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 273,559.00 273,559.00 2 Other Costs Distributions -3,664,544.00 -3,664,544.00 Total Indirect Costs -3,390,985.00 -3,390,985.00 TOTAL INDIRECT EXPENSES -3,390,985.00 -3,390,985.00 TOTAL EXPENDITURES 1,193,754.00 1,193,754.00 Date: 1110612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 148 of 167 Health Division, Comprehensive Agreement -2016 Contract # 20161702-00 Date: 11106/2015 2 Program Budget - Source of Funds SOURCE OF FUNDS Category Amount Cash I inkind Total 1 Source of Funds Fees and Collections - 1st and 2nd Party 0.00 839,513.00 0.00 839,513.00 Fees and Collections - 3rd Party 0.00 241,000.00 0.00 241,000.00 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 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-ELP HS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 113,241.00 0.00 0.00 113,241.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 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 MDHHS Fixed Unit Rate Totals 113,241.00 1,080,513,00 0.00 1,193,754.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 149 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 'Line Item I QtYI Rate[ UnitslUOM Total DIRECT EXPENSES Program Expenses I Salary & Wages Clerk Notes : Vaccine Supply Clerk 2080.0000 17.074 0.000 FTE 35,514.00 Clerk Notes : Vaccine Supply Clerk 800.0000 19.838 0.000 FTE 15,870.00 Overtime Notes : Various Clinic Public Health Nurses 270.0000 18.455 0.000 FTE 4,983.00 County PH Clinic Nurses-various 1.0000 1918785.000 0.000 FTE 1,918,785.00 Total for Salary & Wages 1,975,152.00 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 75.844 56367.000 42,751.00 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 1187993.00 0 1,187,993.00 Total for Fringe Benefits 1,230,744.00 Cap. Exp. for Equip & Fac. 4 Contractual 5 Supplies and Materials County Med, Office, Educ, Postage, Notes : Clinic 0.0000 0.000 0.000 944,360.00 Date: 11106/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 150 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2016 Line Item Qty Rate Units UOM Total Office Supplies Notes : VQA 0.0000 0.000 0.000 300.00 Materials & Supplies Notes : VQA 0.4000 0.000 0.000 4,122.00 Total for Supplies and Materials 948,782.00 6 Travel Mileage Notes :1511 miles @ .575 VQA 0.0000 0.000 0.000 869.00 Mileage Notes : 11,645.2 miles @ .675 Clinic 0.0000 0.000 0.000 6,696.00 Total for Travel 7,565.00 7 Communication Telephone 0.0000 0.000 0.000 34,395.00 B County-City Central Services 9 Space Costs Bldg Space Cost 0.0000 0.000 0.000 111,312.00 10 All Others (ADP, Con. Employees, IVIisc.) Laundry, IT Oper, Memberships, Pro Notes : Clinic 0.0000 0.000 0.000 275,764.00 Insurance Notes : VQA 0.0000 0.000 0.000 325.00 Prof Svcs - Smart Temps 0.0000 0.000 0.000 700.00 Total for All Others (ADP, Con. Employee 276,789.00 Total Program Expenses 4,584,739.00 TOTAL DIRECT EXPENSES 4,584,739.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs Cost Allocation Plan Notes : VQA 0.0000 13.850 56367.000 7,807.00 Cost Allocation Plan Notes : CLINIC 0.0000 13.850 1918785.00 0 265,752.00 Total for Indirect Costs 273,659.00 2 Other Costs Distributions Health /Om Distribution 0.0000 0.000 0.000 1,978,768.00 Nursing Adm Distribution 0.0000 0.000 0.000 192,962.00 Date: 11106/2015 Contract # 20161702-00, Oakland County Department of Health arid Human Services/ Page: 151 of 167 Health Division, Comprehensive Agreement 2016 Contract 420161702-00 Date: 11/06/2015 Line Item Qty Rate Units UOM Total Other Cost Distributions-misc 0.0000 0.000 0.000 -5,836,274.00 Total for Other Costs Distributions -3,664,544.00 Total Indirect Costs -3,390,985.00 TOTAL INDIRECT EXPENSES -3,390,985.00 TOTAL EXPENDITURES 1,193,754.00 Date: 11/06/2015 Contract # 20161702-00, OaWand County Department of Health and Human Services/ Page: 152 of 167 Health Division, Comprehensive Agreement 2016 Contract #20161702-00 Date: 11/06/2015 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 /WIC Breastfeeding DATE PREPARED 1116/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To: 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT 171 Original IT Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount 1 Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 27,851.00 27,851.00 2 Fringe Benefits 34,644.00 34,644.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 73,397.00 73,397.00 5 Supplies and Materials 1,317.00 1,317.00 6 Travel 1,538.00 1,538.00 7 Communication 408.00 408.00 8 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0,00 10 All Others (ADP, Con. Employees, Misc.) 385.00 385.00 Total Program Expenses 139,540.00 139,540.00 TOTAL DIRECT EXPENSES 139,540.00 139,540.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 3,857.00 3,857.00 2 Other Costs Distributions 12,620.00 12,620.00 Total Indirect Costs 16,477.00 16,477.00 TOTAL INDIRECT EXPENSES 16,477.00 16,477.00 TOTAL EXPENDITURES 156,017.00 156,017.00 Date: 11106/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 153 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 143,397.00 0,00 0.00 143,397.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds-Other 0.00 12,620.00 0.00 12,620.00 lnkind Match 0.00 0.00 _ 0.00 0.00 NID1-11-IS Fixed Unit Rate Totals 143,397.00 12,620.00 . 0.00 156,017.00 Date; 11106/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 154 of 167 Health Division, Comprehensive Agreement 2016 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail Line Item Qty Rate] Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Lactation Specialist 2080.0000 13.390 0.000 FTE 27,851.00 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 124.390 27851.000 34,644.00 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA 0.0000 0.000 0.000 73,397.00 Supplies and Materials Office Supplies 0.0000 0.000 0.000 186.40 Printing 0.0000 0.000 0.000 1,131.00 Total for Supplies and Materials 1,317.00 6 Travel Mileage Notes : 500 miles @ .575 0.0000 0.000 0.000 288.00 Conferences 0.0000 0.000 0.000 1,250.00 Total for Travel 1,538.00 7 Communication Telephone Communications 0.0000 0.000 0.000 408.00 8 County-City Central Services 9 Space Costs 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 385.00 Total Program Expenses 139,540.00 TOTAL DIRECT EXPENSES 139,540.00 INDIRECT EXPENSES Indirect Costs Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 155 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 Line Item 1 Qty Rate' UnitslUOM Total Indirect Costs Cost Allocation Plan 0.0000 13.850 27851.000 3,857.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 12,620.00 Total Indirect Costs 16,477.00 TOTAL INDIRECT EXPENSES 16,477.00 TOTAL EXPENDITURES 156,017.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 156 of 167 Health Division, Comprehensive Agreement - 2010 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / WIC Resident Services DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To; 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Ea Telegraph Rd. 34 st BUDGET AGREEMENT 17 Original 1---. Amendment AMENDMENT # 0 CITY Pontiac STATE M1 ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 980,534.00 980,534.00 2 Fringe Benefits 685,099.00 685,099.00 Cap. Exp. for Equip & Fac. 0.00 0.00 Contractual 431,550.00 431,550.00 5 Supplies and Materials 45,990.00 45,990.00 6 Travel 5,800.00 5,800.00 7 Communication 16,110.00 16,110.00 8 County-City Central Services 0.00 0.00 9 Space Costs 75,652.00 75,652.00 10 All Others (ADP, Con. Employees, Misc.) 99,700.00 99,700.00 Total Program Expenses 2,340,435.00 2,340,435.00 TOTAL DIRECT EXPENSES 2,340,435.00 2,340,435.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 135,804.00 135,804.00 2 Other Costs Distributions 261,233.00 261,233.00 Total Indirect Costs 397,037.00 397,037.00 TOTAL INDIRECT EXPENSES 397,037.00 397,037.00 TOTAL EXPENDITURES 2,737,472.00 2,737,472.00 Date: 11/0612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 157 of 167 Health DINAsion, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2016 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 0.0D 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-ELP HS 0.00 0.00 0.00 0.00 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 2,476,239.00 0.00 0.00 2,476,239.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0.00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 0.00 0.00 0.00 0.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 261,233.00 0.00 261,233.00 Inkind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 2,476,239.00 261,233.00 0.00 2,737,472.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 158 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11106/2015 3 Program Budget - Cost Detail Line Item I Qtyl Rate Units UOM Total DIRECT EXPENSES Program Expenses 1 Salary & Wages Coordinator 2080.0000 30.779 0.000 FTE 64,021.00 Supervisor 2080.0000 22.966 0.000 FTE 47,769.00 Supervisor 2080.0000 23.899 0.000 FTE 49,710.00 Assistant Notes : Dietetic Tech 750.0000 13.992 0.000 FTE 10,494.00 Outreach Worker Notes : WIC Supervisor 2080.0000 17.074 0.000 FTE 35,514.00 Outreach Worker Notes : Office Supervisor 1 2080.0000 17.995 0.000 FTE 37,429,00 Outreach Worker Notes : Office Supervisor 2 2080.0000 19.838 0.000 FTE 41,263.00 Outreach Worker Notes : PH Nutritionist 2 3.0000 31682.000 0.000 FTE 95,046.00 Technician 2080.0000 20.895 0.000 FTE 43,461.00 Technician 2080.0000 16.044 0.000 FTE 33,372.00 Technician 2080.0000 20.895 0.000 FTE 43,461.00 Technician 2.0000 42774.000 0.000 FTE 85,548.00 Technician 2080.0000 22.611 0.000 FTE 47,031.00 Nutritionist/Dietician 2080.0000 27.758 0.000 FTE 57,736.00 Nutritionist/Dietician 2080,0000 30.533 0.000 FTE 63,509.00 Nutritionist/Dietician 2080.0000 27.758 0.000 FTE 57,736.00 Nutritionist/Dietician 2080.0000 30.515 0.000 FTE 63,472.00 OVERTIME 550.0000 20.239 0.000 FTE 11,132.00 Assistant 15.3380 2080.000 0.000 FTE 31,903.00 Outreach Worker 15.2317 4000.000 0.000 FTE 60,927.00 Total for Salary & Wages 980,534.00 2 Fringe Benefits All Composite Rate Notes : FICA Unemployment Ins, Retirement Hospital Ins. Life Ins. Vision Ins. Hearing Ins, 0.0000 69.870 980535.000 685,099.00 Date: 11/06/2015 Contract # 20151702-00, Oakland Coon y Department of Health and Human Services/ Page: 159 of 167 Health Division, Comprehensive Agreement - 2010 Contract #20161702-00 Date: 11106/2015 Line Item Qty Rate Units UOM Total Dental Ins. Work Comp Short/Long Term Disability 3 Cap. Exp. for Equip & Fac. 4 Contractual Subcontracting Agency-OLSHA- WIC svcs in 0.0000 0.000 0.000 i 431,550.00 5 Supplies and Materials Office Supplies 0.0000 0.000 0.000 9,750.00 Medical Supplies 0.0000 0.000 0.000 13,000.00 Educational Supplies 0.0000 0.000 0.000 9,450.00 computer supplies 0.0000 0.000 0.000 100.00 Postage 0.0000 0.000 0.000 1,700.00 Printing 0.0000 0.000 0.000 7,948.00 Materials & Supplies 0.0000 0.000 0.000 4,042.00 Total for Supplies and Materials 45,990.00 6 Travel Mileage Notes : 6,750 miles @ .575 0.0000 0.000 0.000 3,800.00 Conferences 0.0000 0.000 0.000 2,000.00 Total for Travel 5,800.00 7 Communication Telephone 0.00001 0.000 0.000 16,110.00 8 County-City Central Services 9 Space Costs Space/Rental Costs 0.0000 0.000 0.000 75,652.00 10 All Others (ADP, Con. Employees, Misc.) Insurance 0.0000 0.000 0.000 6,690.00 Equipment Repair 0.0000 0.000 0.000 1,500.00 Convenience Copier 0.0000 0.000 0.000 4,500.00 IT Operatons 0.0000 0.000 0.000 57,210.00 Advertising 0.0000 0.000 0.000 21,750.00 Staff Training 0.0000 0.000 0.000 1,750.00 Prof svcs, interpretation, laundry 0.0000 0.000 0.000 6,300.00 Total for All Others (ADP, Con. Employee 99,700.00 Total Program Expenses 2,340,435.00 TOTAL DIRECT EXPENSES 2,340,435.00 Date; 1006/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 160 of 167 Health Division, Comprehensve Agreement -2016 Contract #20161702-00 Date: 11/06/2015 !Line Item Qty [ Rate Units UOM Total INDIRECT EXPENSES Indirect Costs I Indirect Costs Cost Allocation Plan 0.0000 13.850 980535.000 135,804.00 2 Other Costs Distributions Health Adm Distribution 0.0000 0.000 0.000 222,273.00 Other Cost Distributions-Health Educatio 0.0000 0.000 0.000 38,960.00 Total for Other Costs Distributions 261,233.00 Total Indirect Costs 397,037.00 TOTAL INDIRECT EXPENSES 397,037.00 TOTAL EXPENDITURES 2,737,472.00 Date: 11/06/2015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 161 of 167 Health Division, Comprehensive Agreement -2016 Contract #20161702-00 Date: 11/06/2015 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / MDEQ Private and Type Ill Water Supply DATE PREPARED 111612015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/30/2016 MAILING ADDRESS (Number and Street) 1200 N. Telegraph Rd. 34 East BUDGET AGREEMENT r7 Original r Amendment AMENDMENT # 0 CITY Pontiac STATE MI ZIP CODE 48341-0432 FEDERAL ID NUMBER 38-6004876 Category I Amount I Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 0.00 0.00 2 Fringe Benefits 0.00 0.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 0.00 0.00 5 Supplies and Materials 0.00 0.00 6 Travel 0.00 0.00 7 Communication 0.00 0.00 County-City Central Services 0.00 0.00 9 Space Costs 0.00 0.00 10 All Others (ADP, Con. Employees, Misc.) 0.00 0.00 INDIRECT EXPENSES Indirect Costs Indirect Costs 0.00 0.00 2 Other Costs Distributions 1,015,467.00 1,015,467.00 Total Indirect Costs 1,015,467.00 1,015,467.00 TOTAL INDIRECT EXPENSES 1,015,467.00 1,015,467.00 TOTAL EXPENDITURES 1,015,467.00 1,015,467.00 Date: 11/06/2015 Contract #20161702.00, Oakland County Department of Health and Human Services/ Page: 162 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 MDHHS Comprehensive 0.00 0.00 0.00 0.00 ELPHS - MDHHS Hearing 0.00 0.00 0.00 0.00 ELPHS - MDHHS Vision 0.00 0.00 0,00 0.00 ELPHS - MDHHS Other 0.00 0.00 0.00 0.00 ELPHS - Food 0.00 0.00 0.00 0.00 ELPHS - Private / Type Ill Water Supply 514,301.00 0.00 0.00 514,301.00 ELPHS - On-Site Wastewater Treatment 0.00 0.00 0.00 0.00 MCH Funding 0.00 0.00 0.00 0.00 Local Funds - Other 0.00 501,166.00 0.00 501,166.00 In kind Match 0.00 0.00 0.00 0.00 MDHHS Fixed Unit Rate Totals 514,301.00 501,166.00 0.00 1,015,467.00 Date: 11106/2015 Contract it 20161702-00, Oakland County Department of Health and Human Services/ Page: 163 of 167 Health Division, Comprehensive Agreement - 2010 Contract #20161702-00 Date: 11/06/2015 3 Program Budget - Cost Detail 1Line Item Qtyl Rate Units UOIVI 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 1 Indirect Costs 2 Other Costs Distributions Environmental Hlth Adm Distribution 0.0000 0.000 0.000 882,229.00 Other Cost Distributions-Misc. Distribut 0.0000 0.000 0.000 133,238.00 Total for Other Costs Distributions 1,015,467.00 Total Indirect Costs 1,015,467.00 TOTAL INDIRECT EXPENSES 1,015,467.00 TOTAL EXPENDITURES 1,015,467.00 Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human Services/ Page: 164 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/06/2015 Summary of Budget PROGRAM / PROJECT Comprehensive Agreement - 2016 / Comprehensive Agreement - 2016 DATE PREPARED 11/6/2015 CONTRACTOR NAME Oakland County Department of Health and Human Services/ Health Division BUDGET PERIOD From : 10/1/2015 To : 9/3012016 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 Category Amount Total DIRECT EXPENSES Program Expenses 1 Salary & Wages 14,001,562.00 14,001,562.00 2 Fringe Benefits 8,876,295.00 8,876,295.00 3 Cap. Exp. for Equip & Fac. 0.00 0.00 4 Contractual 657,336.00 657,336.00 5 Supplies and Materials 1,601,933.00 1,601,933.00 6 Travel 381,169.00 381,169.00 7 Communication 240,921.00 240,921.00 8 Space Costs 1,078,870.00 1,078,870.00 9 All Others (ADP, Con. Employees, Misc.) 2,079,703.00 2,079,703.00 Total Program Expenses 28,917,789.00 28,917,789.00 TOTAL DIRECT EXPENSES 28,917,789.00 28,917,789.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs 1,868,474.00 1,868,474.00 2 Other Costs Distributions 8,063,288.00 8,063,288.00 Total Indirect Costs 9,931,762.00 9,931,762.00 TOTAL INDIRECT EXPENSES 9,931,762.00 9,931,762.00 TOTAL EXPENDITURES 38,849,551.00 38,849,551.00 SOURCE OF FUNDS Date: 11/0612015 Contract # 20161702-00, Oakland County Department of Health and Human ServIces/ Page: 165 of 167 Health Division, Comprehensive Agreement - 2016 Contract #20161702-00 Date: 11/0612015 Category Amount Cash Inkind Total 1 Fees and Collections- 1st and 2nd Party 0.00 3,271,613.00 0.00 3,271,613.00 2 Fees and Collections - 3rd Party 0.00 241,000.00 0.00 241,000.00 Federal or State (Non MDCH) 0.00 0.00 0.00 0.00 4 Federal or State (Non MDCH) 0.00 1,946,956.00 0.00 1,946,956.00 5 Federal Cost Based Reimbursement 0.00 0.00 0.00 0.00 6 Federally Provided Vaccines 0.00 2,317,412.00 0.00 2,317,412.00 7 Federal Medicaid Outreach 318,623.00 0.00 0.00 318,623.00 Required Match - Local 0.00 318,622.00 0.00 318,622.00 9 Local Non-ELPHS 0.00 0.00 0.00 0.00 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 MDHHS Non Comprehensive 0.00 0.00 0.00 0.00 14 MDHHS Comprehensive 5,464,407.0 0 0.00 0.00 5,464,407.00 15 ELPHS - MDHHS Hearing 225,684.00 0.00 0.00 225,684.00 16 ELPHS - MDHHS Vision 225,683.00 0.00 0.00 225,683.00 17 ELPHS - MDHHS Other 2,251,290.0 0 0.00 0.00 2,251,290.00 18 ELPHS - Food 859,213.00 0.00 0.00 859,213.00 19 ELPHS - Private/Type Ill Water Supply 514,301.00 0.00 0.00 514,301.00 20 ELPHS - On-Site Wastewater Treatment 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 19,873,394.0 0 0.00 19,873,394.0 0 23 lnkind Match 0.00 0.00 38,615.00 38,615.00 24 MDHHS Fixed Unit Rate 288,855.00 0.00 0.00 288,855.00 Date: 1110612015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 166 of 167 Health Division, Comprehensive Agreement - 2016 Contract # 20161702-00 Date: 11/06/2015 TOTAL 10,841,939. 00 27,968,997.0 0 38,615.00 38,849,551.0 0 Source of Funds Date: 11/06/2015 Contract #20161702-00, Oakland County Department of Health and Human Services/ Page: 167 of 167 Health Division, Comprehensive Agreement - 2016 Version: Comprehensive MICHIGAN DEPARTMENT OF HEALTH AND HUMAN SERVICES FY 15116 AGREEMENT ADDENDUM A 1. This addendum adds the following section to Part I and Renumbers existing 11 Special Certification to 12 and existing 12 Signature Section to 13: Part I 11. Agreement Exceptions and Limitations Notwithstanding any other term or condition in this Agreement including, but not limited to, any provisions related to any services as described in the Annual Action Plan, any Contractor (Oakland County) services provided pursuant to this Agreement, or any limitations upon any Department funding obligations herein, the Parties specifically intend and agree that the Contractor may discontinue, without any penalty or liability whatsoever, any Contractor services or performance obligations under this Agreement when and if it becomes apparent that State or Department funds for any such services will be no longer available. Notwithstanding any other term or condition in this Agreement, the Parties specifically understand and agree that no provision in this Agreement shall operate as a waiver, bar or limitation of any kind, on any legal claim or right the Contractor may have at any time under any Michigan constitutional provision or other legal basis (e.g., any Headlee Amendment limitations) to challenge any State or Department program funding obligations; and, the parties further agree that no term or condition in this Agreement is intended and no such provision shall be argued to state or imply that the Contractor voluntarily assumed or undertook to provide any services as described in the Annual Action Plan, and thereby, waived any rights the Contractor may have had under any legal theory, in law or equity, without regard to whether or not the Contractor continued to perform any services herein after any State or Department funding ends. 2. This addendum modifies the following sections of Part II, General Provisions: Part II I. Responsibilities-Contractor J. Software Compliance. This section will be deleted in its entirety and replaced with the following language: 1 Version: Comprehensive The Michigan Department of Health and Human Services 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. 1. 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 ATTACHMENT I MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES FY 15/16 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 MDHHS/G&PD FY 15/16 ATTACHMENT I Page 1 of 46 6/29/2015 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. II. MINIMUM BUDGETING REQUIREMENTS A. Cost Principles - Types or items of cost which will be considered for reimbursement are generally consistent with definitions contained in Title 2 Code of Federal Regulations CFR, Part 200 Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards. 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). MDHHS/G&PD FY 15/16 ATTACHMENT I Page 2 of 46 6/29/2015 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) listed or a locally defined program which is defined in the LMCH Community Plan. The Local MCH projects need to be budgeted separately instead of being distributed in projects: 1. Childrens Special Hlth 5. Enabling Services 9. Immunization-Women- Care Svc-MCH Women -MCH MCH 2. Direct Services Children- 6. Family Planning- 10. Maternal Infant Health MCH Adolescents-MCH Program (MIHP)- Children-MCH 3. Direct Services Women- 7. Family Planning-Women- 11. Maternal Infant Health MCH MCH Program (MI HP)-Women- MCH 4. Enabling Services 8. Immunization-Children- 12. Public Health Functions Children -MCH MCH & lnfrastructure-MCH 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 MDHHS 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. MDFIHS/G&PD FY 15/16 ATTACHMENT I Page 3 of 46 6/29/2015 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. 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 Contractor Designation The Subrecipient or Contractor Designation column identifies the type of relationship that exists between the Department and grantee on a program-by-program basis. Federal awards expended as a subrecipient are subject to audit or other requirements of OMB Circular A-133 and Title 2 Code of Federal Regulations (CFR). Payments made to or received as a Contractor are not considered Federal awards and are, therefore, not subject to such requirements. 1. Su brecioient 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. Therefore, a pass-through entity must make case-by-case determinations whether each agreement it makes for the disbursement of Federal program funds casts the party receiving the funds in the role of a subrecipient or a contractor. 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 were met; C. Has responsibility for programmatic decision making; d. Is responsibility for adherence to applicable Federal program requirements specified in the Federal award; and MDFIHS/G&PD FY 15/16 A11ACHMENTL Page 4 of 46 6/29/2015 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. Contractor A Contractor 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. Contractor 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. In determining whether an agreement between a pass-through entity and another non- Federal entity casts the latter as a subrecipient or a contractor, the substance of the relationship is more important than the form of the agreement. All of the characteristics listed above may not be present in all cases, and the pass-through entity must use judgment in classifying each agreement as a subaward or a procurement contract. 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 Title 2 CFR, Section 200.87, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Research and development (R&D) means all research activities, both basic and applied, and all development activities that are performed by non-Federal entities. 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/ Contractor designations, as in prior years: MDHHS/G&PD FY 15/16 ATTACHMENT I Page 5 of 46 6/29/2015 REIMBURSEMENT CHART Program Element/ Funding Source°) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Contractor Designation Adolescent STD Screening Staffing (6) N/A Subrecipient Body Art Fixed Unit(2) N/A Contractor Breast & Cervical Cancer Control Coordination Performance) 95% # Women Screened for Breast & Cervical Cancer Subrecipient Building Health Communities Staffing (6) N/A Subrecipient Centralized Access Home Visiting Hub Staffing{6) N/A Subrecipient Childhood Lead Poisoning Education & Outreach Staffing(6) N/A Subrecipient Childhood Lead Poisoning Intervention Staffing(6) N/A Subrecipient Childhood Lead Poisoning Prevention Staffing Subrecipient CSHCS — Case Management/Care Coordination Fixed Unit Rate) N/A Contractor CSHCS Medicaid Outreach Staffing(6) NA Subrecipient CSHCS - Outreach & Advocacy Staffing(6) N/A Sub recipient Comprehensive Cancer Control (CCC) Community Implementation Project Staffing(6) N/A Subrecipient County Health Rankings & Roadmaps Staffing(6) N/A Subrecipient Subrecipient Eat Safe Fish Staffing MDHHS/G&PD FY 15/16 ATTACHMENT I Page 6 of 46 6/29/2015 ELPHS MDHHS Staffingn N/A Contractor MDA Performance 75% % of Food Contractor Service Licensees received required inspections MDEQ Staffing(6) N/A Contractor Hearing Program Staffing(6) N/A Subrecipient Vision Program Staffingn N/A Subrecipient Family Planning Services General Services Performance(6)(8) (13) 95% # Unduplicated Clinic Users Served Subrecipient Fetal Alcohol Spectrum Disorder Projects Staffing (6) N/A Subreciplent Fetal Infant Mortality Review (FIMR) Case Abstractions Staffing(6) N/A Contractor Gonococcal Isolate Surveillance Project Staffing(6 N/A Subrecipient Highly Targeted Community Based HIV Prevention Services Staffing(6) N/A Subrecipient HIV/AIDS Linkage to Care Staffing n N/A Subrecipient HIV Prevention Services Categorical Non-Categorical Staffingn Fixed Unit Rate V) (12) N/A N/A Subrecipient Contractor HIV Ryan White Part B Staffingn N/A Subrecipient HIV/STD Partner Services Staffing(6) N/A Subrecipient HIV Surveillance Support Staffing(6) N/A Subrecipient HOPWA Staffingn N/A Subrecipient MDHHS/G&PD FY 15/16 ATTACHMENT Page 7 of 46 6/29/2015 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method (2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Contractor Designation Immunization AFIX Follow-up Site Visit Fixed Unit Rate(7) N/A Contractor Immunization Billing Staffing (6) N/A Subrecipient Practice Infrastructure Enhancement Field Service Reps Staffine N/A Subrecipient Immunization Action Plan Staffing(6) N/A Subrecipient (6) Michigan Care Staffing N/A Subrecipient Improvement Registry Nurse Education Fixed Unit N/A Contractor Rate(2X7) Vaccine Quality Assurance Staffing(6) N/A Contractor Program VFC/AFIX Site Visit Fixed Unit N/A Contractor Rate(2X7) Infant Safe Sleep Staffing (6 N/A Subrecipient Informed Consent Fixed Unit Rate(2)(7) N/A Contractor Laboratory Services Staffing(6) N/A Subrecipient Local Maternal Child Health (MCH) Block Grant Staffine N/A Subrecipient Local Tobacco Reduction Staffing(6) N/A Subrecipient MDHHSIG&PD FY 15/16 ATTACHMENT I Page 8 of 46 6/29/2015 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method(2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Contractor Designation 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 Medicaid Outreach Staffing(6) N/A Subrecipient Michigan Abstinence Program Performance)(18) 90% Number of unduplicated youth to be served Subrecipient Michigan Adolescent Pregnancy & Parenting Program Staffing(6) N/A Subrecipient Michigan Colorectal Cancer Screening Program Performance) 90% Number of women and men that complete a screening test. Subrecipient Michigan Home Visiting Initiative Rural Expansion Grant Staffing (6) N/A Subrecipient Million Hearts Michigan Learning Collaborative Staffing(6) N/A Subrecipient Nurse Family Partnership Services (NFP) Staffing(6) N/A Subrecipient Nurse Family Partnership (NFP) Medicaid Outreach Staffing(6) N/A Subrecipient Nutrition and Physical Activity Self-Assessment for Child Care Staffing{6) N/A Subrecipient Obesity Prevention Active Living Grant Staffing (6) N/A Subrecipient MDHHS/G&PD FY 15/16 ATTACHMENT I Page 9 of 46 6/29/2015 REIMBURSEMENT CHART Program Element/ Funding Source ) Reimbursement Method (2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Contractor Designation Public Health Emergency Preparedness (PHEP) Public Health Emergency Staffin g (6) (14)(18) N/A Subrecipient Preparedness (PHEP) 10/1/2015-6/30/2016 Public Health Emergency Staffin g(6) (14) (18) N/A Subrecipient Preparedness (PHEP) Cities of Readiness Initiative (CRI) 10/112015- 6/30/2016 Public Health Emergency Staffing(6) N/A Subrecipient Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II 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 Contractor SEAL! Michigan Dental Sealant Program Staffing(6) N/A Subrecipient Taking Pride in Prevention Performance(818) 90% Number of unduplicated youth who complete at least 75% of program intervention Subrecipient Tobacco Use Reduction in People with HIV/AIDS Staffing(6) N/A Subrecipient TB Control Directly Observed Therapy (DOT) Staffing (6) N/A Contractor MDHHS/G&PD FY 15116 ATTACHMENT I Page 10 of 46 6/29/2015 REIMBURSEMENT CHART Program Element/ Funding Source) Reimbursement Method (2) Performance Level If Applicable) Performance Target Output Measure Subrecipient or Contractor Designation WIC - Resident Performance 97% #Average Monthly Participation Subrecipient WIC - Breastfeeding Staffing (6) N/A Subrecipient WIC - Migrant Staffing Subrecipient WISEWOMAN Project Coordination Performance )°) 95% # Women Screened for Cardiovascular Disease Risk Factors Subrecipient MDHHS/G&PD FY 15/16 ATTACHMENT I Page 11 of 46 6/29/2015 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. Allocation to be reflected in individual programs during budgeting process. Not Applicable. Subject to statewide maintenance of effort requirement for Title X. State funding is first source (after fees and other earmarked sources). Fixed unit rate subject to actual costs. The performance reimbursement target will be the base target caseload established by MDHHS. Subject to a match requirement (hard or in-kind) of $1 for each $3 of MDHHS agreement funding for coordination. Fixed rate limited to contract amount. Up to 6 visits per family. 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 Title 2 CFR Section 200.87. (17) Not Applicable. (18) Subject to match requirement as specified in Attachment III — Program Assurances and Specific Requirements. (3) (4) (5) (6) (7) (a) (9) (10) (11) (12) MDHHS/G&PD FY 15/16 ATTACHMENT I Page 12 of 46 6/29/2016 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 Title 2 CFR, Part 200 Appendix V State/Local Government and Indian Tribe- Wide Central Service Cost Allocation Plans and the brouchure published by the Department of Health and Human Services entitled "A Guide for State, Local and Indian Tribal Governments: Cost Principles and Procedures for Developing Cost Allocation Plans and Indirect Cost Rates for Agreements with the Federal Government. 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 MDHHS/G&PD FY 15116 ATTACHMENT I Page 13 of 46 6/29/2015 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. 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 Title 2 CFR, part 200. I. 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. Indirect Cost — These cost categories are used to distribute costs of general administrative operations that have not been directly charged to individual subrecipient programs. The Indirect Cost expenditures distribute administrative overhead costs to each program element, project or service grouping. Two separate local rates may apply to the agreement period (i.e., one for each local fiscal year). Use Calendar Rate 1 to reflect the rate applicable to the first part of the agreement period and Calendar Rate 2 for the rate applicable to the latter part. Indirect costs are not allowed on programs elements designated as vendor relationship An indirect rate proposal and related supporting documentation must be retained for audit in accordance with records retention requirements. In addition, these documents are reviewed as part of the Single Audit, subrecipient monitoring visit, or other State of Michigan reviews. Following is further clarification regarding indirect rate and/or cost allocation approval requirements to distribute administrative overhead costs, in accordance with Title 2 CFR Part 200 (formerly Circular A- 87 2 CFR Part 225, Appendix E), for Local Health Departments budgeting indirect costs: 1. Local Health Departments receiving more than $35 million in direct Federal awards are required to have an approved indirect cost rate from a Federal Cognizant Agency. If your Local Health Department has received an approved indirect rate from a Federal Cognizant agency, attach the Federal approval letter to your MI E-Grants Grantee Profile. M CHFIS/G&PD FY 15/16 ATTACHMENT I Page 14 of 46 6/29/2015 2. Local Health Departments receiving $35 million or less in direct Federal awards are required to prepare indirect cost rate proposals in accordance with Title 2 CFR and maintain the documentation on file subject to review. 3. Local Health Departments that received approved indirect cost rates from another State of Michigan Department should attach their State approval letter to their MI E-Grants Grantee Profile. 4. Local Health Departments with cost allocation plans should reflect these allocations in the Other Cost Distributions budget category. See Section M. Other Cost Distribution for budgeting guidance. 5. As a Subrecipient of federal funds from MDHHS, a Local Health Department that has never received a negotiated indirect cost rate, your Local Health Department may elect to charge a de minimis rate of 10% of modified total direct costs (MTDC) based on Title 2 CFR part 200 requirements. MTDC includes all direct salaries and wages, fringe benefits, supplies and materials, travel, services, and contractual expenses up to the first $25,000 of each contract. MTDC excludes all equipment, capital expenditures, charges for patient care, rental costs, tuition remission, scholarships and fellowships, participant support costs, and portions subcontractual/subaward expenses in excess of $25,000 per contract. Attach a current copy of the letter stating the applicable indirect costs rate or calculation information justifying the de minimis rate calculation to you MI E-Grants Grantee profile. Detail on how the indirect costs was calculated must be shown on the Budget Detail Schedule. The amount of Indirect Cost should be allocated to all appropriate program elements with the total equivalent amount reflected as a credit or minus in the Administration projects. 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 element and the offsetting credit reflected in the program element being distributed. There must be a documented, well-defined rationale and audit trail for any cost distribution or allocation based upon Title 2 CFR, Part 200 Cost Principles Local Health Departments using the cost distribution or cost allocation must develop the plan in accordance with the requirements described in Title 2 CFR, Part 200. Local Health Departments should maintain supporting documentation for audit in accordance with record retention requirements. The plan should include a Certification of Cost Allocation plan in accordance with Title 2 CFR, Part 200 Appendix V. The cost allocation plan documentation is not required to be submitted unless specifically requested. Cost associated with the Essential Local Public Health Services (ELPHS), Maternal and Child Health (MCH) Block Grant and Fixed Fee may be budgeted in the associated program element and distributed to the associated projects. Federal Provided Vaccine Value should be reported on a separate line and clearly identified. N. Total Direct & Admim Expenditures — The MI E-Grants System sums the indirect expenditures program element and records in the Total Indirect Expenditure line of the Budget Summary. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 15 of 46 6/2912015 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: A. Fees & Collections - Fees 1St & 2nd party_ st party funds projected to be received from private payers, including patients, source users 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 [EPSDT1 Screening, Family Planning.) C. Federal/State Funding (Non-MDHHS) - Funds received directly from the federal government and from any state Contractor other than MDHHS, 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 Medicaid Outreach 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 Medicaid Outreach, 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 riot 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 MDHHS/G&PD FY 15/16 ATTACHMENT I Page 16 of 46 6/29/2015 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 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. MDHHS - NON-COMPREHENSIVE - Funds budgeted for services provided under separate MDHHS agreements. Examples include: funding provided directly by the Community Services for Substance Abuse for community grants, etc. K. MDHHS - 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 - MDHHS Hearing - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Hearing program and has to equal the MDHHS ELPHS Hearing allocation. Additional ELPHS to be budgeted for the Hearing Program must be entered into ELPHS - MDHHS Other. Hearing allocations may only be spent on the Hearing Program. M. ELPHS - MDHHS Vision - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Vision program and has to equal the ELPHS MDHHS Vision allocation. Additional ELPHS to be budgeted for the Vision Program must be entered into ELPHS - MDHHS Other. Vision allocations may only be spent on the Vision Program. N. ELPHS - MDHHS Other - This section includes all funding projected to be due under Comprehensive Agreement specific to the ELPHS MDHHS Other program for eligible program elements. Please note: The MI E-Grants System validates the ELPHS MDHHS Other budgeted funds across the applicable program elements to assure the agreement does exceed the ELPHS - MDHHS 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 MDFIHS/G&PD FY 15/16 ATTACHMENT I Page 17 of 46 6/29/2015 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. MDHHS Fixed Unit Rate — Select the type of fee-for-services from the lookup to correspond with the program element. MDHHS/G&PD FY 15116 ATTACHMENT I Page 18 of 46 6/29/2015 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 Fundino 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 Health & Human Services 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 15/16 allocation of the CDC Public Health Emergency Preparedness (PH EP) funds in nine equal prepayments for the period October 1, 2015 through June 30, 2016. LHDs must submit a nine-month budget and a quarterly Financial Status Report (FSR) for each of the following COMPREHENSIVE program elements: 1. Public Health Emergency Preparedness (PHEP) (October 1, 2015 — June 30, 2016) 2. Public Health Emergency Preparedness (PHEP)— Cities of Readiness (October 1, 2015—June 30, 2016) 3. Laboratory Services - Bioterrorism (October 1, 2015 — September 30, 2016) B. W1C 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 MOHHS/G&PD FY 16/16 ATTACHMENT I Page 19 of 46 6/29/2015 these forms are contained at the end of this section. Agencies receiving WIC-USDA Infrastructure grants must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. Agencies receiving WIC-USDA Breastfeeding Peer Counselor funds must budget these funds as a separate element. Agencies must track and report expenditures separately on the FSR. And comply with special reporting requirements. 2. Costs Allowable Only With Prior Approval -The following costs are allowable only with prior review/approval of the Michigan Department of Health & Human Services 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 MDHHS or subsequently in a written request approved in writing by MDHHS. 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 Title 2 CFR, Part 200 and 7 CFR Part 3015. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 20 of 46 6/29/2015 C. Family Planning Special Budget Requirements 1. Cost/Funding Categories - The following local budget breakdowns are required to fulfill Family Planning grant application budget requirements each fiscal year: Salaries & Wages Fringe Benefits Travel Equipment Supplies Contractual Construction All Other Direct Costs Indirect Costs All Funding Sources By Type The Family Planning cost/funding categories and supporting budget detail requirements are 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 MDHHS. Prior approval is accomplished by providing appropriate detail in the budget request approved by MDHHS or subsequently in a written request approved in writing by MDHHS. A. Alterations and Renovations - to change the interior arrangements or other physical characteristics of existing facilities or installed equipment, to the extent that such changes cost more than $1,000 each. B. Audiovisual Materials and Activities - acquired, produced, presented, or disseminated to the general public. C. Consultant Contracts for General Support Services - including equipment and supplies, that will cost in excess of $25,000 or 10% of the total direct cost budget (whichever is greater). D. Equipment - including general purpose and special equipment (e.g., air conditioning) costing $5,000 or more per unit. E. Insurance - contributions to a reserve for a self-insurance program. F. Public Information Service Costs — for the cost of providing public information services. G. Publication and Printing Costs - for the cost of publications. H. Capital Expenditures - for land or buildings. I. Indemnification Against Third Parties Costs - insurance against potential liabilities. J. Mass Severance Pay - involving grant-supported personnel. K. Organization/Reorganization Costs - allocable to the program. L. Overtime Premium - involving grant-supported personnel. M. Patient Care Costs - rebudgeting out of or reduction in patient care costs (considered a change in scope). N. Professional Services - in connection with Patent/Copyright Infringement Litigation. MDHHS/G&PD FY 15116 ATTACHMENT I Page 21 of 46 6/29/2015 0. Trailers or Modular Units — for costs of trailers and modular units. P. Transfers Between Construction and Nonconstruction - for approved construction funds. Q. Transfers Between Indirect and Direct Costs - for amounts awarded for indirect costs to absorb increases in direct costs. R. Transfers for Substantive Programmatic Work - to a third party, by contracting, or any other means used for the actual performance of substantive programmatic work. All charges to Family Planning must be necessary, reasonable, allowable, and allocable, for the proper and efficient administration of the program. Further information and cost standards are provided in federal instructions including 2 CFR, Part 225 (OMB Circular A-87), A-102 Common Rule and 2 CFR, Part 215 (OMB Circular A-110) D. Breast and Cervical Cancer Control Coordination Program Special Budget Requirements 1. The Breast and Cervical Cancer Control Coordination Program (BCCCP) budget is to be developed in the following way: 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 Navigation Services, must be billed to the MDHHS 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 MDHHS Cancer Prevention and Control Section. No Direct Services or Navigation Service expenses will be reimbursed through the Comprehensive Agreement. The Coordination amount $175 per woman based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 95% performance requirement for this program. There is no longer a match requirement. Match is recorded by the program and reported to MDHHS. 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 BCCCNP issued in August of each fiscal year. The above referenced documents are available at www.michigancancer.orq/BCCCNP. 2. 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 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 MDIIHS/G&PD FY 15/16 ATTACHMENT I Page 22 of 46 6/29/2015 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. 11. 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. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 24 of 46 6/29/2015 1 Miscellaneous I Wes ! I Budget I Is Show Tree pF [51:41 copy 1 1 ey gt- I I I " X Close I 0 0 I If3l Ve tide to I Attachment 1 BI Attachment 131-Program Budget Summary rfilenigan.gOU 412, Ow Canal State IIIt of Shawn Wehana 491- EGrAMS Application Budget Category Application 0 0 riDenct, ARC Health Department Application: Family PlannIng Son:Ices SAMPLE Program: Comprehensive Agreement-Pt 20)0( Show Documents Budget Summary Oecnplion DIRECT EXPENSES Program Expenses Salary & Wages Fringe Benefits Cap, Exp. for Equip & FaC, Contractual Supplies and Materials Travel Communication County-City Cenhal Services Space Costs All Others (ADP. Con. Employees, Misc.) Total Program Expenses TOTAL DIRECT EXPENSES INDIRECT EXPENSES Indirect Coals indirect Costs Other Costs Distributions Total Indirect Costa TOTAL INDIRECT EXPENSES TOTAL EXPEriorruRE 5 haro r 03,09.001 I 83.419.00i I om, p 34,iiiii] I 34 202.00l 1 OMO 1 i L- -1 E T 1 23,275.001 1 23,275.001 E , 0.0 E 3,340.001 r 3,340.001 L_ 0.001 I 7,262.00 I 7,262.cT3 C. r- 1 F 1 F------1 ID; EIIioi [III EIIIPL000 J.,804.001 L. 3,1304.00 I D.DD r 165,523.00 135,523101 f_ 0.0D LI165,523,001 165,523101 I L 29,406.00-11 9,405.00 (1.1 L 11 46.0 121 1,685.061 r 11 0.001 [.. 31,000.401 31,00000 IIT'1...i11I.i I1 17 0.014 1 31M9D 0 0011 . 31,090,00 I.. 0:0 r .001' . ..... ._ ..... .._........_, ..... .... .. _. . . r-----66-,Fii-7-061 I6,613.611 I 904 .1..__...... 944 r; ATTACHMENT I Page 25 of 46 MDHHS/G&PD FY 15/16 6/29/2015 Program : ComprehensiVe Agreement - FY20/IX Conlin:aeons I Fscesheet Fh shod Tree I Eurct,,1 I kr copy 1 PDF I tg1 Vehdate 1 losare*1 I 115ave I Agency ABC Health Department Application : Family Planning Seivicea SAMPLE 11 Budget ) Miscellaneous I Index Show Documents I c lose I 0 0 106,813.0011 L 9.001 0.00 TOTAL EXPENDITURES 108,613,001 Source ot Funds Fees and Coiled! Bug -lot and 2nd Party Fees and Collections - 3rd Party Federal or Slate Non MDCH) X Federal Cost Based Reimbursement Federally Prodded Vaccines Federal Medicaid Outreach Required Match - Local Local Nori-ELPHS Li 0.00i o[ 0.-oot loocaoa] 0.00] _op* o,00l orooi 0,001 0.00! 0.001 0001 0.001 o.00 0.00 „ 0.00; 00,000.00 a,00 10,00000I 0.00; 0.00! 0.00 0.031 fl 0.01:4 6661 0-01)1 Del. Description 12111211 1±1811 Source of Funds EGrAMS Application The Dificol State i"nI Michroan We'ante_ Dole : Mar-20-13 Timeout : 20 mine Source or Funds Local llon-ELPHS Other Non-ELPHS LOCH Non Comprehensive or MOCH Comprehensive ELPHS –MOCH Hearing ELPHS–MDCH Vision ELPHS– MDCH Other ELPHS – Food ELPHS — Drinking Water ELPHS — On-Slte Sewage MCH Funding X Local Funds- Other InlOnd Match IALICH Reed Unit Rare 0,00 0.00! 0.001 66113001 0.001 r ii — o.00l 0.00, 1 0.00 1 0 00 0.00 1 0.0011 0.00 0,001 1 44,000.00 0.001 0.00 000: 133 0.00 0.00 E3 0.00, El Goo El o o o El _ _ o.00 El . 0.001 El 44.800.001 ES • 0.00. El o,00l El wool o.o6f, o.o0 1106" -WOO; cool o401 1100 CI 00 0.00 0.00 0:00 0.00' 0,00 0_00 0.00 ATTACHMENT I Page 26 of 46 MCHHS/G&PD FY 15/16 6/29/2015 B2 Attachment B2-Program Budget Cost Detail EGrAMS Application Budget Category Application Program Comprehensive Agreement - FY 20>0< Agency ABC Health Department Application : Family Planning Services sAupLE Budget . . . Miscellaneous Index I Facesheet Certifications Save I • Save, l [ID Error, I la Validate 41 POP lb Copy j Tirneout 1 20 mins 00 I h Show Troll lYlichigan.gou 112, lhe Chien State PP of Michigan Webehe Onto: Mar-25-13 Snow Documentsi i I X Close I jnseactiens : .......... ........___........ . . .. ..... [ Egiripment b defined aa the coat of a innate tern valued 01 05,000 or Mere and web a useful efe of more Man one year, Costs should Include the tam and any applicable expenses such as Insielleirn coats, mainienance leek etc. lame costing leas than 55,000 sesuld be entered Inlo he supplies and malaria's hie. instructions Select the Menthe description. Identity One quantity as FTEs. Ideality the rate,, average cast per FIE. 11111 1=1:11Z o i4 9,000.000iFTE 181 , .1Ojl 17,20 n 0. . 0 o 1,17, , 290.00j o.oc 04311 349324ErE 1:7600i 100000 t 0.00. t nTa000018L 20,925.00,1 20,925.001 PAL COO 11 1,09! 26725240 FIE 20.135 00i 2P13540. COO t 215n11M01311E 181 IX nor .1 IA copy J I g Show Tree I 113 save "155avael I El Validate I tA Ersnr,t I E. Descrptioo 0 x iNurse Preolttioner 0 X [lUletileil-lealtli NUTge: 0 X rCoortilnator ... ... X [Clerk Budget Detail Categery: ,Program Expenses -Cap, Exp. for Egulp &Fee. _ Itpe I Expenditure Classificatiot —11 - 00 I h Show Tree I 1 Narrative: 0 Budget Detail Category: lPrograniVxpenses - Contiactual Classification Seq. : _ Type: dhlire Sub Type : !Sired E Valida te lit cony I I RI annul I g Fr rOrt: I OSevcrej inlet 11.611111 11 'Br 11— I f it 0 I 15 Save" I Sieve al I lig Validate I g r.,i01, IP PDF I Rs corny I h Show Tree Bildtlet Detail Category; iProgram ExpenseS - Salary &Wages Dee : ilapendlture Clasaincation Sen.: Sub Type : ;Direct Narrative Ingirrodlonit: 77. Contractual refers to secondary recIpW9 organtudions only. Please enter the cooled information. Ca n e silents and appointing service subcontracts shauld be budgeted under the airier taper ue Budget Delia Category : Progirt..ExpenseB -Supplies and Materials Type : Expenditure Classlifcailon Seci. ; 11 j Level: 0 Lino tern °Category Sub Type: rDirect _ _ Inefiudlone • Narrative: 121 0 X iPrinling J01 100.00 ibII o.00:. o.00l DEMME 11D1 700.001--7665:611 0.011; 6.60. tn MIMS _ ......... UMW= MDHHS/G&PD FY 15/16 ATTACHMENT I Page 27 of 46 6/29/2015 I h Show Tree 00 I • save +I Validate I u ,:r on, I lib Copy I . ,.. Category: 'Program EXpenS,es -Travel ' 1 Type: 'Expenditure Classification Sag.: 11 , Lest: 0 Une Item °Category SubType : !Direct i Narrative: [3 instructions : III Description Total ArrnlInt Cahli 1 n 74 'mileage . . ... .. jp : 3,00009 3,090,9ol, _ 000 0.001 _______ .. .. . ....... _... ... _ ..... .. .. . _ __ . . . El 7, [conferences 1(11: 34e09 r----i40.0q 5051 0.00i e...) [101Save I I II Save o I I Fil Validate II Ei Cr sor - I ISP PDF 1 I PE!) Cnpy Sinnoi Tr--.7 1, 0 0 Budget Detail Category: 'Classification see : program Exoenses Comment alien - lope: lenanntiure I ... i 1 .; Level: 0 Line Item °Category sup Type : 'Direct _ i _Narrative : CI __ .. ......____. ... . ._. __.. ..,. ..... _._.......... __ _ .. . ..........____ .. ...,____....... .. ......_...._ _ _. ......_.... ,. ....._ _ _ . . . . InStructIons : A nescuprnn It 0 X IDMer Total Amount loktwl Mal 1131 7-,202.001 7,282.661' 0.00 . 0.00, t [phones mad IT liners 1 Le save I. la Validate 11321121 47 PDF 14 Copy 1.1=313 0 0 Budget Detail Category : classification Seq. ' iProgram Expenses - County.City Central Services I Type : :Expenditure 11 ; Level: 0 Line item 0 category sug Type: .Direct t Narrative: In instriCilone ; Fraai Ars .citt Cash Mind Hole, 10 1 ........... . . . . _.. . ..._ 10 ._ . [ • save i • Sere 4- 7i Va li da te I rt ' n ,rnL • I Ni 11_LD.FLI Lit±Col_ h Show Tres (x) (t..) Budget Detail Category ' 1-Program EVenses -Space Coals i Type : !Expenditure _ . i Classification Seg.: It 1 Level: 0 line Item ()Category silo Type : I Cited Narrative : l2l Instructions : L _ ._ _ ,O,„,- 011'.1,11, I ,i`,11 1111011K1 Nolo, --PI 0 X 'Rent 9.023.00t DOW 0.06 e5 ....6,923.79031 El x [other ._._ JO 1 iiiiii10,1_ 2:66.07-- (lop': 6.0 b 'owes i imam Eizew ist Validate 131=1 El PDF 03:311 11111=10231 it n ) BUdget Detail Category,: ir'regram Expenses -All Oilier. a (ADP, Con. Employees, Mtn Type: 'Expenditure .. Classification gee. : It_ ._. I Level : 0 Line Mint 0 Category SuOType 1 I Direct ' mamma ; CI ___.. . _ .. Instructrens : i zwimmimmimimmimi____mil=t_ O )'. 91.1PPorlIn5 Services IS I . 2,279:00 I z 279 DOI 0 00 0.00 e,21 . ....... ._... o x 16-1;-ree. ip 306001 300.05;1 00 000 -- n x Ihihp'r —..... 171 Inn nn Inn rmll n nn non; ftt ....._ MDHHS/G&PD FY 15116 6/29/2015 ATTACHMENT I Page 28 of 46 •5oj I flSnar j ILi V&IdtIIf:.7L,1: Iga PDF I I litt Copy I I h Shaw Treo I () (1) Budget MOM Category: :Indirect cests=i&irect costs Dtpe : tExpendtlure , SUPType : , Indirect Narrative: MI ciessiocation Seq.. 3 Instructions : — _ Deacription Mt, Total Ward hole, ....... - xi 1,0 : 25.0-0-41):P , g21 29,405.00 I 20,40g00; 0 00 0.001 D FIscal Year Rate 0 .' : IEI I. _11 __J 4_ . ____; __ ___ 1 t ._ ... ... . _ 1 .. Save I • Save a j la validate II in i , ,,,,.. i 0 poF 1 lib copy I [ b Show Tree! 0 0 Budget Retell Category : , Ind! re ct Costs - Other Costs Dist0bution s DP e : LF-Iii-F6*-011.1..... 11. _ _ __ CI ass Incabon See.; 3 Sub Type : 'indirect arratote El _ Instrudtons : PeSCrIptiOti T1,11 Arnold Plki114.1 .. I - 1 085.001- 10 0 00 0 OD5.01 t —71 117 ;_ 'F.I '1 tn _. _ ._ _ . _____ ._ , IVIDHHS/G&PD FY 15/16 ATTACHMENT I Page 29 of 46 6129/2015 F. 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 MDHHS in accordance with the instructions listed below. Medicaid Outreach Activities funding is a subrecipient relationship. I. Budget Preparation A. Medicaid Outreach Activities 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 05-29. Complete the MI E-Grants application and budget forms for this program. 1. Expenditure Category Tab Enter the expenditures budgeted for the fiscal year: 10/01/xx-09/30/xx. Expenses budgeted for each of the listed expenditure categories are allowable and must be specific to the Medicaid program as described in MSA Bulletin 05-29 s. Outreach activities must not be part of direct service. Expenditures must be reflected in the cost allocation plan. 2. 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 must match. 3. 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. Nurse-Family Partnership Outreach (applicable only for Berrien, Calhoun, Ingham, Kalamazoo, Kent, Oakland , and Saginaw) Complete the MI E-Grants application and budget forms for the application titled Nurse- Family Partnership Medicaid Outreach for the timeframe: 10/01/xx-09/30/xx. Complete the MI E-Grants application and budget forms for this program, Expenditures related to Nurse-Family Partnership Medicaid Outreach should be reflected under one program element and adhere to Section VIII, Special Budget Instructions section found in the Comprehensive Budget Instructions - Attachment I. The budget should reflect the entire fiscal year period: 10/1/xx-091301xx. MCHHS/G&PD FY 15116 ATTACHMENT I Page 30 of 46 6/29/2015 1. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LH D 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) 2. 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 ehe414 must 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. 3. 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. C. CSHCS Medicaid Outreach Complete the MI E-Grants application and budget forms for the application titled CSHCS Medicaid Outreach for the timeframe: 10/01W-09/30/xx. 1. Expenditures related to CSHCS Medicaid 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:1011 /xx-09130/xx. a. Federal Medicaid Outreach Fifty percent (50%) of local funds after the percentage of Medicaid clients enrolled in the LHD CSHCS program has been applied. A table containing each health jurisdiction Medicaid Participation Rate is located in the MI E-Grants site. The formula for calculating the federal funding is as follows: Federal funding = (Local funds x % of Medicaid Participation Rate) x 50% Federal Administrative Match rate) b. Required Match - Local Represents the 50% match of local contributions. Budget the local match contribution. Federal Medicaid Outreach and Required Match — Local must equal each other. Additional local contribution that is not eligible for the 50% federal match should be reported on the Local Funds — Other line.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. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 31 o146 6/29/2015 1. Comprehensive CSHCS Outreach and Advocacy and Case Manaqement/Care Coordination Funds Should be reported in a separate program element. 2. 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. 3. Cost Allocation Certification This certification remains on file with the Department until no longer valid (see Sample 2). Any changes in the Cost Allocation Plan (See Sample 3) requires the Cost Allocation certification to be updated. 4. Cost Allocation Plan for Medicaid Outreach Activities A cost allocation plan is a way to identify costs associated with providing Medicaid Outreach. The plan includes both direct and indirect costs. The plan should describe how costs are determined and allocated or distributed to assure the costs are being assigned to the correct program. The cost allocation plan should also identify any non-reimbursable costs. Cost allocation plans are a requirement for receiving federal awards. The agency must retain a copy on file and make available for review upon request. (Sample 2) For FY 2016, LHDs must submit a copy of their cost allocation plan with the budget request. The allocation plan is to be attached to an expenditure line on the Medicaid Outreach budget. H. 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 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 05-29 and not part of a direct service. Expenses should be supported by an approved methodology. 1 Federal Medicaid Outreach Should be used to request the 50% federal administrative match for Medicaid Outreach. 2. Required Match - Local Should be used to report the remaining portion of the local contribution of the Medicaid Outreach Match. Both amounts should equal. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate MDHHS/G&PD FY 15/16 ATTACHMENT I Page 32 of 46 6/29/2015 line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non-ELPHS or Local Funds — Other), Total Source of Funds must equal Total Expenditures. B. Nurse-Family Partnership Medicaid Outreach — Quarterly and Final FSRs 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 MSA Bulletin 05-29 and not part of a direct service. Expenses should be supported by a time study or other federally approved methodology. 1. 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. 2. Required Match - Local Should be used to report the remaining portion of the local contribution for the Medicaid Outreach Match. Both lines should equal. Additional local contribution related to service provision for non-Medicaid eligible participants which are not eligible for the 50% federal match should be reported in Local Funds - Other. 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I (e.g., Local non-ELPHS or Local Funds — Other). C. CSHCS Medicaid Outreach — Final FSR CSHCS Medicaid Outreach billing should occur on the final FSR through the MI E-Grants system after Comprehensive Agreement CSHCS Outreach and Advocacy funds have been expended. 1. 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. 2. 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. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 33 of 46 6/29/2015 3. Source of Funds Category Other source of funds that are non-reimbursable for Medicaid Outreach (i.e., other federal grants, other MDHHS grants, etc.) should be reported on the appropriate line has indicated in the Comprehensive Budget Instructions - Attachment I. 4. Comprehensive CSHCS Outreach and Advocacy and Care Coordination Should be billed as separate program element. III. Comprehensive Agreement Obligation Report — filed in September 20xx. The Obligation report is used to estimate the payable amount due to Local Health Departments from MDHHS 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. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 34 of 46 6/29/2015 Example Medicaid Outreach Cost Allocation Plan Orange County Health Department Cost Allocation Methodology For Medicaid Outreach Activities Orange County Health Department allocated costs for Medicaid Outreach as follows: Salaries & Fringes: Distributed based on the actual,ainount of time each'employee spends in each program for which they work. Vacation/sick/holiday pay is allocated in the same manner. Supplies and Materials: Directly expensed 'to the speCificpi'ogram(S)\identified by the employee as needed. Costs that benefit all programs will be allocated based On'percentage'staff in each program. \ Travel: All travel costs are charged direUly;,tolhe \proiram for ,which the travel was incurred. , Communications: Distributed based\ on. the percentage of time staff worked in each program. Space Costs: DistribLited based \on the square footage used by the FTE and the percentage of time they worked in each prograM. C \crnMen area' sqUare footage is allocated based on percentage staff in each \ All Others: (Translation service's, nhiscellaneous services, insurances, dues, etc...) Costs are charged directly to the program for which the s,'er\iice occurred. Indirect costs: distributed across all programs based on the salaries and fringes of staff in each program. program. MDHHS/G&PD FY 15/16 ATTACHMENT I Page 35 of 46 6/29/2015 Example 2 Orange County Health Department Medicaid Outreach Cost Allocation Methodology Certification This is to certify that I have reviewed the cost allocation plan and to the best of my knowledge and belief that: 1. All costs contained in this proposal to establish cost allocations or billings for Medicaid Outreach Activities are allowable in accordance with the requirements of Title 2 CFR Part 200, "Uniform Administrative Requirements, Cost Principles and Audit Requirements for Federal Awards," and the federal and state awardS to which they apply. Unallowable costs have been adjusted for in allocating costs as indic*d in the Cost allocation plan. 2. All costs included in this proposal are prop4.011Ocable td ,the'Medic‘aid Outreach Activities Administration award on a OsiS`,of-a ben6ficial 'causal relationship between the expenses incurred and the Medicaid Otritiaah`Adminitratibri award to which they are allocated in _- accordance wjth'appliCahl,,(00*-ftents,( Further, the same costs that have been treated as indirect costs have,no4e0.Clainnad aS\clirect costs. Similar types of costs have been accounted fOr cOnSistantly, , „ N. , n ,-, 3. This certificatinn, will be resubmitted if a significant change occurs that impacts the Medicaid (D(.1treach'iactiVities or upon a Department review that results in a finding of non- i compliance. If neither of these conditions exists, the certification remains valid in subsequent fiscal years. I declare that the foregoing is true and correct: Health Department: Signature: Name of Official: Title: Date: An authorized official of the organization must certify that the plan has been prepared in accordance with authorizing legislation and regulations, and state or other applicable requirements. Every cost allocation plan must include a certification. MDHHS/G&PD FY 15/16 ATTACHMENT! Page 36 of 46 6/29/2015 SAMPLE 3 ORANGE COUNTY HEALTH DEPARTMENT Budgeted Costs for Medicaid Outreach Activities 1 Program Budget Summary PROGRAM / PROJECT Comprehensive Agreement - 2016 / Medicaid Outreach DATE PREPARED 08/17/2015 CONTRACTOR NAME Orange County Health Department BUDGET PERIOD From :10/112015 To : 913012016 7AMENDMENT # 0 MAILING ADDRESS (Number and Street) 123 Acme Rd. BUDGET AGREEMENT Original Amendinent CITY Orangegrove STATE MI ZIP CODE 49555 FEDERAL ID NUMBER 38-5555555 1 . Total Category Amount Cash ' I InRincl DIRECT EXPENSES Program Expenses 1 Salary & Wages '53,556,00 ' 0.00 0.00 153,556.00 _ Fringe Benefits 7 1,204.00 0.00 0.00 71,204.00 3 Cap. Exp. for Equip & Fac. 0.03 0.00 0.00 0.00 4 Contractual . -. 0.0b 0.00 0.00 0.00 5 Supplies ane Materials 2,500_00 0.00 0.00 2,500.00 6 Travel 500.00 0.00 0.00 500.00 7 Communication 5,000.00 0.00 0.00 5,000.00 8 County-City Central Services 0.00 0.0(1 0.00 0.00 9 Space Costs 8,000_00 0.00 0.00 8,000.00 10 Al! Others (ADP, Con. Employees, Misc.) 4,500.00 0.00 0.00 4,500.00 Total Program Expenses 245,260.00 0.00 0.00 245.260.00 TOTAL DIRECT EXPENSES 245,260.00 0.00 0.00 245.260.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Coats 37,220.00 0.00 0.00 27,610.00 2 Other Costs Distributions 35,000.00 0.00 0.00 35,000.00 Total Indirect Costs 72,220.00 0.00 0.00 72,220.00 TOTAL INDIRECT EXPENSES 72,220,00 0.00 0,00 72,220.00 TOTAL EXPENDITURES 317,480,00 0.00 0.00 317,480.00 MDHHS/G&PD FY 15116 ATTACHMENT I Page 37 of 46 6/29/2015 2 Program Budget- Source of Funds Source of Funds Category Amount Cash Inkind Total 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 158,740_00 0.00 0.00 158,740.00 Required Match - Local 0.00 108,740.00 0.00 15E1,740.00 Local Non-ELPHS C 00 0.00 0.00 0.00 Local Non-ELPHS 0.0C 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 Com•rehensiva, 0.00 • 0.00 0,00 0.00 ELPHS - MDCH Hearing 0.00 0.00 0.00 0.00 ELPHS - MOCI1 Visinn 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 158,740.00 153740.00 0.00 317,480.00 MDHHS/G&PD FY 15/16 ATTACHMENT I Page 38 of 46 6/29/2015 3 Program Budger- Cost Derail! Line Item Qty Rate UOM Amount Cash InkInd Total DIRECT EXPENSES Program Expenses 1 !Salary & Wages Public Health Nurse 1.0370 54,545.00 FTE 58,563.17 0.00 0.00 56,583 Social Worker 0.2800 51,876.00 FTE 14,525.26 • 0.00 0.00 14,525 Technician 0.5850 40 650.00 FTE 23,7420.25 0.00 0.00 23,780 Health Educator 0.5550 50 955.00 FTF. 28,280.01 0.00 0.00 28,280 Clerical 0.4850 34,071.00 FTE 16,624.44 0.00 0.00 18,524 Supervisor 0.2200 63,102.00 FTE 13,802.44 0.00 0.00 13,682 Total for Salary & Wages 153,555.R0 0710 0.00 153,556 2 Fringe Benefits 0.0000 45.370 All Composite Rata Notes : FICA, FUTA, LIFE, , HEALTFI, DENTAL/VISION,' PENSION, UNEMPLOYMENT, WORKMANS COMP. 71,203.73 0,00 0.00 71204 Cap, Exp. for Equip & Fac 4 Contractual Supplies and Materials Printing 750.00 0,00 0.00 750.00 Office Supplies 1,250.00 0.00 0.00 1,250.00 Postage 500.00 0.00 0.00 500.00 Travel Mileage 500.00 0.00 0.00 500.00 Communication Telephone, Cell 5,000.00 0.00 0.00 5,000.00 County-City Central Services Space Costs 'pace Coots 13,000.00 0.00 0.001 8,000.00 10 All Others (ADP, Con. Employees, Misc.) Translation Services 4,000.00 0.00 0.00 4,000,00 Miscellaneous 500.00 0.00 0.00 500,00 Total Program Expenses 245 260.00 0.00 0.00 245,260.00 TOTAL DIRECT EXPENSES 245,260.00 0.00 0.00 245,260.00 INDIRECT EXPENSES Indirect Costs 1 Indirect Costs - , 37,220.1r- 0.00 0.00 37,220 - Fiscal Year Rate 0.0000 16.560 Other Costs Distributions Nursing Adman Distribution --1_ OAMI 0.00 35,000 00 0.00 0.00 35,000 Total Indirect Costs , 72,220.15 0.00 0.0D 72,220 TOTAL INDIRECT EXPENSES 72,220.15 0.00 0.00 - 72,220 TOTAL EXPENDITURES 317,480.15 0.00 0.00 $317,480 MDHHSIG&PD FY 15/16 ATTACHMENT I Page 39 of 46 6/29/2015 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. 1. All direct service claims must be billed through the MDHHS Cancer Prevention and Control Section. The LH D and/or direct service providers with contracts or letters of agreement with the LHD will be responsible for billing. 2. The staffing, coordination and direct service total amount is $105 per woman or man based on a target caseload established by MDHHS. Performance reimbursement will be based upon the understanding that a certain level of performance (measured by outputs) must be met. There is a 90% performance requirement for this program. The performance target output measure is the number of women and men that complete a screening test for colorectal cancer. 3. For specific program requirements, including current direct service reimbursement rates and other documentation refer to the most current MCRCEDP manual. MDHHS/G&PD FY 15/16 ATTACHMENT i Page 40 of 46 6/29/2015 Allowable Uses of 317 and VFC FA Operations Funds IlNAHOVIIV (.1 POB developed the followingr table to a.ssist awardees in preparing budgets that are in compliance -with federal gran policies and CDC award requirements. The table was developed using a combirarion, of 0MI1 Circular A-87, PHS Grants Policy S-4tement 9505, and POB-identified arograrn priorities. Object Class Category/Expenses Allowable with 317 operations IMINEMININIIIIIIIIM =111111111111121111111 Allowable Allowable with VEC with WC operations ordering funds funds funds .iillowable with VECAFIX fonds Allowable ' with Pan no fonds Allowable with VPC Distribution funds (where appricaIde) Pers nnel Salary/ways Frinoe Conwensatio fri e benefi Travel StateRocalaeleonai conference travel expenses Local meetings/conferences (Ad hoc) (excluding meals) .,-------- in-state travel costs if Sf Nt of state mr,:rel costs (e„g, NIC, Hep B Coordinators Meeting., ProgrArn ManagersallA Meeting, ACT maefings, AMC aud VFC tainings, Program Managers Orientaiion, and other CDC-sponsored matunivitionprogram aim-lugs)* ve" .,/ • (ieTc-rei,4 ..(,./ VFC-mlared) Cprepamigal,. reared) Please refer to Operations funding Categories., ,10 – 11 for additional infortna.tion. VFC-ord site sisits Aft-only site visits 7/17/2014 Secdot) I—The Basics p.20 'ROM 201$ IINARHOV_UM Object Class Category ?Tenses Allowable with 317 operations funds Allowable with ITC operations funds Allowable with VIC ordering fonds Allowable with VFC/AFIX Nuts Allowable with, 1:Fau. Mu fluids Allowable with \PC Distribuilion fonds i:where applicable) 1 Combbled (AFIX & VFC site visits) Perinatal ho k tal record reviews IIIIIIIIIIMIIMIMI IIIIIIIIIIIIMIIIIIIIIMI Eon! Vaccine storage equipment for VFC vaccine IBMMEMBIMMTM11111112==.111MMIIMIIIIIIIIIIIIIIIM V ror4:a7the'lidem aziffpo ',....._nua .chiri:_e_s_ I I 1 *Equtprnent: an article of tangible nonexperuiable personai property hca-ing usefid life of more than one year and 44 aCeprisifiOn , . LE:51-1_0.111,Mar.....17110 unit IMplies I Vaccineadrrdn' istration supplies (including, "but jnot limited to, nasal pharyngeal swabs, syriniTe,s , for ernereemy va.ccination clinics) ir i. office supplies-oomputers, general office (pens, paper. paper clips. etc.), ink caraidges. catc-ulators I i I ... V' 1 i Personal computers i EsLT_Lii Tablets Pink Books. Red Books, Yellow Books i Printers t Laboratory supplies (influenza cultures and PeRs, cultures and molecular, lab media 5t.0 0 a 0 rf) if 11111 1111111111.11111111.111 Digital data logger with valid certificate of I calibrationlval it:la/ion/testing I Vaccine shipping supplies (storage containers, ice packs, bubble wrap, etc.) 9H0 Z'17 Obed 711712014 Sectionl—The Basics p21 IPONT 2015 11NEWHOVIIV Object Class Category/Expenses Allowable with 317 operations fonds Allowable with VFC operations funds Allowable with VFC ordering funds Allowable with 1TFUAFIX fonds Allowable with Pan Flu foods Allowable with VFC Mtribudion fonds (Aare e3pplicable) Contractual Stneaocal conferences expenses (conference , site, materials printing, hotel accommodations 1 ex . enses, s.:,-; . 44 fees) Food is nor allowable. .7 .../ ./ R – "onalfi_pcal meetiovs General contractaal services (e.g., IAPs., local health denarnme.nts, nonmetal sta advisory committee media, prorader tainings) -i- , V- ,/ l , GSA Contractual services 1 Other US contraonal ageements (support:, enhancement, upgrades) .V. FA : Non-CDC Contract vaccines I Indirect Incline. costs IIIIIIIIIIIIIIIIIIMI .1.12.1.1.111=1=0111110111111111111111MMIIMI IINIMIIIMIIIMIIIIIIMIIMMIMIIIMIIMIIIIIIIMMIIIIII 21,1iscellaneous 1111 ACCOuntal' F- senices 1. Advertising (resticted to recruitment of staff or I trainees, proem-et-nett of goods and services: i -,.,,- di • /sni` of .:,/, / Or 0117LS rnat4feals) 1 Att 't Fees BRFSS Sum Committee meet:rip <mom rental, equipment rental, etc. i .7 i Communication (dm:route/commit= 1 ' 7/171.1034 Section 1—The Basics p22 MOM 2015 I IN8INHOVI1V Object Oass Category/Expenses Allowab.k with 317 operations fun& Allowable wilh WC operations fonds miimuncu Allow2ible with VFC ordering Allowable Allowable Allowable with with with pan STC Distribraion WC/FIX na funds funds funds pAmmimi 1.1whaxv appiic b EtanSMittaL messenger, postage, local and long distpl-rce mleohone) v Consumer information aCtiV nes Consul-nor'-provider board participation (travel reimbursemen t I I V Laboratory senices (rests nthicted for irannini -on . ! . s) =111111011111111.1M Local. serviot delivery activities - i.u.we. 4.r.1.4.1.torm...of k.4 Mal notice insurance for volunteers Membershinsisobscriptie. s NIS Oversampling V Pagers/cell phones V Printino of vaccine accountability forms Professional serme costs din2ctly related to irriounizprion activities (limited tenn staff), Attorney General Office servies V Public relations V Publication/painting costs (all can r v v i V ' invourlization related publication and printing nses) Rent 0'6:piles explanation of why these costs are not included in the indirect cost rate a.-. .- ment or cost allocation 'Ian v (for vacci4e distribution -.iizciliryJ Shipping (other than vaccine. Shipping (vaccine) Software licensziRenew s (ORACL •etc. •Stipend Rehnhursments 7117/2014 Section I-211e Basics p.23 T03.12015 4., 0 Object Class Category/Experses Allowable with 317 operations funds Allowable with VIC operations funds Allowable with VC ordering funds Allowable with VFC/AFIX funds Allowable with Pan Fla funds Allowable with VFC Distribution funds (whem applicable) - Toll-fret • lone lines for vaccine orderincr ,./ I' IIIIIIMMMIMIIIIIMIIII Trai.nin costs— Statewide, 5taff, mviders V V Translaiions (tran.slaiing materials) I Vehicle lease (restricte4 w. aw4rd.f4S with policies that prohibit local travel 111111 re'imbursencten) vrc ero1mentmtrials V 111.2111111111111111.11 VFC rovider feedback sur,,evs I i IIIIIIMIIIIMIIIM VIS come-la-mad , co ies I 7/17/2014 Scion I—The Basics p:24 IPOM 2-0I5 I .LNDV 1-10V1J_V Non-Allowable Expenses with Federal Immunization Funds Expenge NOT allowable whit federal hill miminition hinds 1 Honemiiii V Advertising costs (04.f„ corliv.inqoar, displays, itsigN'is, lektearags, . ilvavrtoraidi la, 4 1-, S .1Vellii".q. V Alcoholic- beverages. V Building purchases, construction, capital improvements. . I...and purchases Legislative/lohbying activities Boadinl De reciat ion on use charges . Research V Ftmdraising V Interest on loans for the ttC,CILIdAtiOii andlor modernization of an existin huildin • Clinical core Pomi-iumneihrtations-crigee..e) Entertainment i In mont of hnd debt V ..DS,X4e'"!!ir.,1&,, . 'vehicle I'arehase Promotional Malerirds (A.g., plirwey, efoifteng (ad .iterna .m..c,?, as 134.ns, nuA.'eups, foldersOlios tan rd. eiln renere ba s Purchase of food (unless pan' qf required rain/1.t.er diem cavt,$) Other remrictions which nuist be taken into account while writing the budgev Funds may be spent only for activitio,q and personnel costs that are directly minted to the Immunizafion and Weenies for Children Cooperative Agreem.ent, Funding requests not directly related u3 immunization activities are, outside the scope of this cooperative agrmnont program and will not be funded, Pre-.award costs will not. heroin-Alarm:A. 7/17/2014 Section I—The Basics p,25 1POM 2015 IVICHHS/G&PD FY 16/16 ATTACHMENT I Page 46 of 46 612g/2015 ATTACHMENT III MICHIGAN DEPARTMENT OF HEALTH & HUMAN SERVICES FY 15/16 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. 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. Breast and Cervical Cancer Control B. Clinical Laboratory C. Family Planning D. Food Service Sanitation E. General Communicable Disease Control F. Healthy Homes and Lead Poisoning G. Hearing H. HIV/STD Prevention & Treatment I. Immunization (Essential Local Public Health Services & Categorical) J. LHD/CSHCS K. Michigan Care Improvement Registry L. On-Site Wastewater Treatment Management M. Private and Type ill Water Supply N. Vision 0. WIC Page 1 of 96 MDHHS/G&PD FY 15/16 ATTACHMENT III 6/29/15 For FY 15/16, special requirements are applicable for the remaining program elements listed in the attached pages. Adolescent Sexually Transmitted Disease (STD) Screening Body Art Facility Licensing Breast and Cervical Cancer Control Navigation Program (BCCCNP) Childhood Lead Poisoning Education & Outreach Childhood Lead Poisoning Intervention Childhood Lead Poisoning Prevention (CLPPP) Children's Special Health Care Services (CSHCS) Comprehensive Cancer Control (CCC) Community Implementation Project County Health Rankings & Roadmaps Eat Safe Fish Essential Local Public Health Services (ELPHS) Family Planning-Pregnancy Prevention Fetal Alcohol Spectrum Disorder (FASD) Projects Fetal Infant Mortality Review (FIMR) Case Abstractions Gonococcal Isolate Surveillance Project (GISP) HIV/STD Partner Services HIV Prevention Services HIV/AIDS Linkage to Care HIV Ryan White Part B HIV Ryan White Part B — Coordinated State Planning HIV Surveillance Support Housing Opportunities for Persons Living with HIV/AIDS ( HOPWA ) Immunization Action Plan Immunization Assessment Feedback Incentive Exchange (AFIX) Follow-up Site Visit Immunization Billing Practice Infrastructure Enhancement Immunization - Field Service Representatives Immunizations Michigan Care Improvement Registry ( MCIR ) Regional Immunization - Nurse Education Reimbursement Immunization - Vaccine Quality Assurance Program Immunization - VFC/AFIX Site Visit Infant Safe Sleep Informed Consent Laboratory Services LHD Service Sharing Support Local Maternal and Child Health (MCH) Local Tobacco Reduction Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Local Home Visiting Leadership Group Maternal Infant Early Childhood Home Visiting Initiative (MIECHV) Rural Local Home Visiting Leadership Group Maternal Infant Early Childhood Home Visiting Pgm. (MIECHVP) Healthy Fam. America Expansion MI Home Visiting Initiative Rural Expansion Grant Michigan Abstinence Program (MAP) Michigan Adolescent Pregnancy & Parenting Program (MI-APPP) Page 2 of 96 MDHHS/G&PD FY 15/16 ATTACHMENT III 4/10/15 Michigan Care Improvement Registry Michigan Colorectal Cancer Early Detection Program Million Hearts Michigan Learning Collaborative Nurse Family Partnership (NFP) Services Public Health Emergency Preparedness (PHEP) Base/CRI (Now includes EPI support) Public Health Emergency Preparedness (PHEP) Ebola Virus Disease (EVD) Phase II SEAL! Michigan Dental Sealant Program Sexual Violence Prevention Sexually Transmitted Disease (STD) Control Sudden Unexplained Infant Death (SUID) and Other Fetal Infant Death Taking Pride in Prevention (TP1P) Tobacco Reduction in People with HIV/AIDS Tuberculosis (TB) Control 340B Tuberculosis (TB) Control and Elimination WIC WIC Breastfeeding Peer Counseling Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) WISEWOMAN Community Navigation Pilot WISEWOMAN Entrepreneurial Gardening Project WISEWOMAN Systems and Environmental Change Project Page 3 of 96 MDHI-15/G&PD FY 15/16 ATTACHMENT III 4/10/15